Tim Pawlenty's Courage to Stand 6: Public Sector Unions and Health Care

I have two items from my latest reading of Tim Pawlenty's Courage to Stand.

1.  Pawlenty talks about his conflict with the bus drivers union.  I talked some about this in my last post on this book, for I quoted Pawlenty's lament that there were people who had worked only fifteen years as public bus drivers yet were receiving a lifetime of health insurance on account of that job, thereby costing the state of Minnesota a lot of money.  In my latest reading, Pawlenty discusses the union's strike that took place when Pawlenty was challenging that particular policy.  Fortunately, Pawlenty and the union reached an agreement: lifetime health insurance would not be granted to newly-hired bus drivers.

How did Pawlenty and the union get to the bargaining table?  You'd think that the union would have all the power, since a necessary service was going on strike, and it could stay on strike unless the union's demands were met.  But that's not exactly what happened.  Why not, according to Pawlenty?  First of all, people in the Twin Cities found creative ways to work around the problem of an absent bus service so they could get to work, and that eased the union's stranglehold.  Second, when Pawlenty told voters in Minnesota that people were getting lifetime health insurance after only working for fifteen years, many voters thought that was outrageous and thus sided with Pawlenty.  Third, Pawlenty states that bus drivers were eager to get back to work after a month of not working, and so they were pressuring union leaders to settle.

I am against depriving public-sector unions of all of their power to bargain collectively.  At the same time, I'm against unions strangling a location until all of its demands are met, especially if those demands cost the taxpayers a lot of money.  I hope there's a way for negotiations with public-sector unions to be true negotiations----with give-and-take.

2.  I did not care for something that Pawlenty said about health care.  On page 177, Pawlenty says that the third-payer system makes the health care system like an open bar, and that people "consume goods and services without knowing or caring about price or quality", since somebody else is paying the bill.  But many people are not getting their health care cheaply or for free, for they have to pay high premiums, or high copays or deductibles.  Then there are cases in which health insurance companies choose not to cover certain operations.  People who receive Medicaid may get health care for free, but this is because they cannot afford health insurance.  I wish that Pawlenty were more sensitive to these issues.

Pawlenty does talk about his state's successful attempts to keep premium increases "relatively small or flat for five years" for state employees.  Essentially, they are given a choice: they pay less if they go with a "higher-quality, more efficient provider", and more if they choose a "costly alternative".  I'm interested in learning about what this entails, for why would anyone choose a costly health insurance package over one that is high-quality and more efficient?  My hunch is that she'd do so because the costlier package covers more, whereas the "higher-quality, more efficient provider" is more stingy.  That's just my hunch, though.