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Where's my second case of Lacroix?
I must have looked baffled as I delivered $246 worth of
groceries to an office manager on Market Street in San Francisco.
I was fully out of breath.
I just climbed up five flights of stairs,
carrying a good 40 pounds of groceries and
what I get is not a thank you, but an accusation.
Where's my damn Lacroix?
What she didn't know was that as I was biking over to her office,
I almost got into a car accident.
The mercedes adjacent to me swerved into my lane and to dodge him,
I had to hit the curb.
I was ultimately okay.
But the unfortunate victim of that journey was that second case of Lacroix.
Had I been seriously injured, I would have been compensated, nothing.
Isn't it so funny in America if you are an employee,
you fully expect your employers to compensate you in two parts, wages and
benefits of which one of the largest parts of that is health care.
But if you are a contractor, like I was at that moment,
everything goes out the window.
My name is Josue, and
I've dedicated my career to building gig platforms at Uber and DoorDash.
In fact, I lead the driver pricing team at Uber.
So how much workers are compensated is bread and butter to my every day.
And yet, I hear so many stories filled with anguish and
frustration from gig workers every day.
So to understand this you better, I signed up to be a Instacart shopper.
I traded my laptop for a shopping cart and a bike.
You can check out my cool setup right here.
And in this role I realized just how hard the job was, I wasn't paid nearly
enough to live in a tier one city like San Francisco, I was on the hook for
all performance related expenses, and no surprise, I had zero benefits.
And this isn't just a problem for an Instacart shopper, or a DoorDash driver,
20% of our economy, our gig workers, that's 57 million Americans.
Tech giants like Google have more contractors on their payroll than full
time employees.
Universities are increasingly hiring more adjunct professors where they're not
on tenure track and therefore don't actually get more benefits.
In California, we have argued back and
forth on whether contractors are employees and vice versa.
And I say, prop 22, 85, all of these bills are a red herring.
Let's solve the real problem here.
Let's decouple health care benefits from employers.
Let me say this again, let's decouple health care benefits from employers.
>> [APPLAUSE] >> Right now the way our system is,
is a historical accident.
Wine company, Kaiser steel was astute enough to realize after World War II when
the government put in place wage ceilings because we had an excess of jobs and
a shortage of workers, that if they allowed the use of the onsite clinic as
a benefit that was considered non inflationary.
They double check with the IRS, and the IRS said, yeah, yes, that makes sense.
And so they did that, and it was a really effective recruiting tool.
And so other employers followed, and that's why employers pay for
our health care.
And look, this makes sense in 1940s,
when an American stayed in one job their whole lives.
But we're now in the next century, where a worker changes
jobs more than five times before they even turned 30,
this system no longer makes sense.
Why should switching jobs from driving a GM as
a factory worker tester to driving for
Uber have anything to do with your health insurance?
Let me confess, I'm Canadian.
>> [APPLAUSE] >> [LAUGH] So growing up,
I never thought much about healthcare.
I never had surprise bills, a ride to the ambulance didn't cost
me my month's rent, and everything I needed from medication,
to surgeries to services, were all covered.
And when you have chronic illnesses like diabetes, life sustaining drugs,
like insulin costs less than $12 a pop versus north of $100 here,
all the while, infant mortality rates are lower and health expectancy is higher.
Just look at how much more the US spends on health care,
double, double that of Canada's.
This past month, lawmakers in California had the rare opportunity to
overhaul the California healthcare system by providing medical coverage for
every single resident.
That bill was killed before it even made it onto the floor
because critics said that it was too crazy and too expensive.
Well, you want to talk expensive,
let's talk about the current US healthcare system.
Every single year, employers pay $690 billion to pay for
employees' health insurance,
while employees still have to pay out of pocket for co-pays and deductibles.
And if you're not in this employer-employee binary, so if you're
self-employed, if you're a contractor, if you're in between jobs, you have to buy
from a separate exchange, usually at higher rates because it's assumed you have
more health defects when you don't just because your pool is smaller.
And on top of all of this, the government subsidizes, so you as the taxpayers also
pay into the current high cost low performing US healthcare system.
It's scattershot, it's wasteful, and some would even say, it's crazy.
The center for medicaid and medicare found that we could
reduce health care costs by 13% or $600 billion a year
if we decouple health care from employers, why is that?
Number one, it reduces the number of middlemen and
brokers in this process all making a margin.
Number two, we reduce the amount of administrative costs, of which right now
the US pays four times that of Canada and other wealthy countries.
So what do we do?
Well, there's a lot of really smart people thinking about this problem, so
I don't want to be too prescriptive, but I'll leave you with two models.
The first one is the gay model we've talked about, it's a single payer
universal health care system that a lot of progressives in the US are buying for.
But similarly,
conservatives also want to decouple the health care system from employers.
They just want to create one large health care exchange.
Labor laws would say that if your employer no longer had to pay for
your benefits, they need to increase your wages to stay competitive.
And in that world, what happens?
Everyone buys from one system.
It's transparent, it's open,
and it doesn't matter what your worker classification is.
And that's how the Netherlands does health care.
And it's actually how we as Americans think about car insurance.
You are all future leaders.
In fact, some of you are running companies right now.
You want to do right by your workers, but you also want to maximize your profit.
It's a conflict that anyone operating a business that uses contractors
will have to face until we decouple healthcare from employers.
Because doing so will not only increase job mobility and
reduce the burden on businesses and think about this,
but ultimately, it'll spur innovation in America.
Right now, if you have a really great idea, the reason you're not pursuing it
should not be because you're afraid you're going to lose your health insurance.
The current system is creating friction to entrepreneurship.
We're always afraid of the next bubble.
We had the internet bubble in the 2000s, the housing and
credit crisis in 2008, we're currently in a student debt crisis,
but what happens when a fifth of the US economy has a rainy day and
no safety net to fall back on?
Imagine yourself, or your friends, or your family, biking your delivering groceries
and then out of nowhere a car beat lines you to the curb.
One medical bill,
one emergency room visit will push you to the brink of financial ruin.
This is the reality for 57 million Americans and
that number is only increasing while health outcomes are decreasing.
Decoupling healthcare from employers is not crazy, it's common sense.
Thank you.
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