Chaka Chatsopano chimabweretsa malonjezo kwa ife tokha: kulowa nawo masewera olimbitsa thupi, kusiya kusuta, kubwereranso pa ngolo ya zakudya. Olemba ntchito ambiri tsopano ali ndi mapulogalamu azaumoyo kuti atithandize.
Koma chodabwitsa nโchakuti: Mapologalamu a umoyo wa olemba ntchito ndi okhudza zimene ogwira ntchito ayenera kuchita pa nthawi yawo, osati zimene oyangโanira angachite kuti asiye kudwala kuntchito. Olemba ntchito omwe amayendetsa antchito akuvutika ndi kupsinjika maganizo, kuthamanga, ndi nthawi yowonjezera yokakamiza mwadzidzidzi amafuna kuwalimbikitsa kuti "akhale bwino."
"Sikuti aliyense amakhulupirira zimenezo," akutero Dan Campbell, yemwe adakambirana za pulogalamu yaumoyo ya ogwira ntchito mumzinda m'tawuni ina ya Wisconsin. โNdipo moyenerera. Mwadzidzidzi mabwana amangonena kuti, โIzi ndi zimene zili zabwino kwa inu ndi zabwino kwa ife,โ ndipo anthu amati, โtinazimvapo kale.โโ
Mapulogalamu a zaumoyo adapangidwa kuti achepetse ndalama za inshuwaransi yaumoyo wa olemba ntchito popewa matenda. Ena amapereka umembala wa masewera olimbitsa thupi kapena mapulogalamu osiya kusuta. Ena amafuna kuti ogwira ntchito azilipira ndalama zambiri za inshuwaransi yawo ngati sanawonedwe zina. Mapulogalamu okakamiza kwambiri amafuna kuti ogwira ntchito akwaniritse zolinga zaumoyo kapena kulipira chilango.
Ngati olemba anzawo ntchito akuda nkhawa, bwanji osangoyamba ndi zomwe angakwanitse komanso kuti azikhala ndi malo ogwirira ntchito otetezeka komanso athanzi?" akufunsa Nancy Lessin, katswiri wa zaumoyo ndi chitetezo ku Steelworkers. "Monga akuyenera kuchita mwalamulo."
Ogwirizana ndi mabungwe ena amanena kuti mabungwe ayenera kulimbikitsa thanzi labwino, monga phindu kwa mamembala komanso kuchepetsa ndalama zothandizira zaumoyo. Kukwera kwamitengo ya inshuwaransi, ndikomwe kwachititsa kuti malipiro achepe pazaka khumi zapitazi.
Teamsters Local 1149 ku Syracuse, New York, ikulimbana ndi ndondomeko ya zaumoyo ya Pepsi yomwe imalipira antchito $ 50 pamwezi ngati amasuta kapena ali ndi vuto lachipatala lomwe lingayambitse kulemera. Koma Mlembi wa Msungichuma Steve Richmond akufotokoza kuti, โMonga trustee wa thumba la zaumoyo ndi chisamaliro, powona matenda okhudzana ndi kusuta ndi zodandaula zomwe timalipira m'malo mwa mamembala athu - osati olemba ntchito okha omwe akufuna kusunga ndalama. Nthaลตi zonse tikakhala patebulo, nkhani zimasanduka chisamaliro chaumoyo.โ
Ena amachita mantha kwambiri ndi kuwukira kwachinsinsi komanso kuwongolera kwa olemba ntchito miyoyo ya mamembala. John Borsos, mlembi-msungichuma wa National Union of Healthcare Workers ku California anati:
Gene Elk amakambirana ndi General Electric kwa United Electrical Workers (UE). Akuti osuta ku GE amalipira ndalama zambiri pa inshuwalansi yawo ndipo amatsutsa zomwe amazitcha "kuimba mlandu wozunzidwa".
Elk (yemwe kale anali munthu wonyamula mapaketi atatu kapena asanu patsiku) akuti, โIwo amafuna kuimbidwa mlandu anthu amene akopeka ndi kusatsa malonda kwa Big Fodya. Sindimawaona akugwetsa Fodya Wachikulu mโmabungwe ndi kuwakana.โ Elk amalosera kuti GE idzaika "msonkho" pa body mass index (BMI) kenako.
ZOFUNIKA ZOKHUDZA
Ogwira ntchito m'boma la Connecticut apangana ndi Health Enhancement Program yokhala ndi zofunikira za mamembala. Pafupifupi antchito 200,000, odalira, ndi opuma pantchito ndi gawo la ndondomekoyi.
Sal Luciano, mkulu wa bungwe la AFSCME Council 4, akuti HEP idagwirizana mu 2011 pamene bwanamkubwa ankafuna kuti antchito a boma alandire malipiro chifukwa cha kuchepa kwa bajeti. "Titha kupita njira ziwiri," adatero Luciano: "kukankhira antchito ndalama zambiri kapena kuyang'ana zomwe zikupangitsa kuti mitengo yazithandizo ziwonjezeke."
Robert Krzys wakhala woimira Service Employees '(SEIU) pa komiti yosungira ndalama zothandizira zaumoyo ku Connecticut kwa zaka 25. Pokankhira HEP, akuti, mgwirizanowu udatchula mamembala 880 omwe amathandizidwa ndi khansa ya m'matumbo mchaka chimodzi, pamtengo wa $ 15,000 pamwezi aliyense. Zaka zinayi pambuyo pake theka linafa. Ndipo khansa ya m'matumbo imatha kupewedwa ndi colonoscopy yokhazikika.
Ogwira ntchito m'boma la Connecticut osakwana zaka 40 tsopano ayenera kutenga ndalama zaulere zaka zitatu zilizonse kapena kulipira $100 yochulukirapo pamwezi pa inshuwaransi yawo, kuphatikiza $350 yochotsedwa. Oposa 50 amatenga thupi chaka chilichonse.
ZOFUNIKA KUCHITA
Koma pali zinanso. Ogwira ntchito akuyeneranso kupeza zoyezetsa zaulere zomwe madokotala amapangira pazaka zawo: katemera, kuyezetsa maso, colonoscopies, mammograms, Pap smears. Ayenera kutsukidwa mano kawiri pachaka.
Amene ali ndi vuto lililonse mwa zisanu (asthma), matenda a mtima, kuthamanga kwa magazi, cholesterol yambiri, shuga) ayenera kulankhula ndi phungu miyezi isanu ndi umodzi iliyonse ndi kutenga mankhwala aliwonse omwe apatsidwa popanda mtengo uliwonse. โSitingakukakamizeni kuwatenga,โ akutero Luciano.
Mabungwewo ankaganiza kuti ndalama zidzakwera m'chaka choyamba, chifukwa anthu ambiri adzakhala akulandira chithandizo chamankhwala. Koma izi sizinachitike, chifukwa maulendo opita kuchipinda chodzidzimutsa adagwa.
Mabungwewo adaneneratu za 50 peresenti ya otenga nawo mbali - koma, kaya karoti kapena ndodo ipeza ngongole, ikuwona oposa 99 peresenti, ndi 178 okha mwa antchito 45,000 osatenga nawo mbali.
Luciano akuti zinsinsi zimatetezedwa chifukwa gulu lachitatu limayang'anira pulogalamuyi, mgwirizano ndi owalemba ntchito amalandira ziwerengero wamba.
Lessin akuti nzeru zolandilidwa pakuwunika zimasintha mobwerezabwereza ndipo nthawi zambiri palibe mgwirizano pakati pa akatswiri. Ofufuza asintha upangiri wawo pa ma frequency a mammogram kangapo. Mayeso a kansa ya prostate tsopano akukayikiridwa kuti angayambitse opaleshoni yosafunikira, kusadziletsa, ndi kusowa mphamvu.
"Zisankho zosagwirizana ndi zomwe zili zabwino kwa inu - pomwe bwana amalowa mu izi kuti apulumutse ndalama, zitha kubwereranso," adatero Lessin.
OBAMACARE
The Affordable Care Act imakankhira mapulogalamuwa. Omwe ali ngati Connecticut akugwirizana ndi malangizo a ACA, komanso mapulogalamu omwe amafuna kuti mamembala apeze kapena kukhala ndi zotsatira za thanzi labwino (monga kukhala wosasuta, kupeza zotsatira zodziwika bwino poyesa biometric, kapena kuchita masewera olimbitsa thupi), zomwe boma limayitana. "Mapulogalamu okhudzana ndi thanzi labwino."
Bhonasi yololedwa ndi ACA kapena chilango kwa iwo omwe sagwirizana ndi malangizo angakhale 20 peresenti ya mtengo wa ogwira ntchito okha-ndipo ndalamazo zidzakwera kufika 30 peresenti mu 2014.
Chitetezero chokha pa kusankhana nโchakuti โmuyezo wina woyenereraโ uyenera kuperekedwa kwa anthu amene โkuli kovutirapo mopanda nzeru chifukwa cha matenda kuti akwaniritse miyezo yoyambirira.โ
Sizikudziwika kuti malamulowa adzatanthauziridwa bwanji. Kodi nโkupanda nzeru kuyembekezera wantchito amene bwana wake amamukalipira tsiku lonse kuti asiye kusuta pasanathe masiku 90? Kodi bwana wokalipira ndi matenda?
Mabungwe ambiri akukambirana za mapulogalamu omwe amalipira kuti atenge nawo mbali (kapena kulanga chifukwa chosatenga nawo mbali) m'malo mofuna zotsatira. Ku Oregon, ogwira ntchito m'boma ku SEIU Local 503 poyambirira amayenera kulipira $17.50 pa nthawi yolipira ngati sanalembetse "Health Engagement Model" ndikuchita nawo zochitika ziwiri, monga makalasi, pachaka. Ndodo yasinthidwa kukhala karoti: tsopano apeza $17.50 kuti atenge nawo mbali.
Mamembala omwe amaphunzira m'kalasi pazakudya, mwachitsanzo, samayesedwa kuti achepetse thupi. "Sindikuganiza kuti mamembala athu angavomereze kuyang'aniridwa," adatero Keary Debeck wa gulu lokambirana za mgwirizano.
Ku Chicago, aphunzitsi adalimbana ndi dongosolo lazaumoyo lomwe linakankhidwa ndi Meya Rahm Emanuel mu kampeni yawo ya mgwirizano ndikumenyera chaka chatha koma pamapeto pake adavomereza kuti asinthe mitengo ya inshuwaransi yozizira.
Pansi pa pulogalamuyi, kuti iyambe mu Januwale, mamembala ndi okwatirana ayenera kuyesa mayeso asanu aulere a biometric: cholesterol, shuga, kuthamanga kwa magazi, kulemera, ndi BMI. Kutengera zotsatira zawo, alumikizidwa ndi mphunzitsi.
Mamembala ayeneranso kupeza mfundo mwezi uliwonse polowa patsamba lazaumoyo kuti awerenge zolemba kapena kuwonera makanema. Amapatsidwa chindapusa cha $50 ngati satero, koma salipidwa chifukwa cholephera kukwaniritsa zolinga zomwe mphunzitsi wawo wakhazikitsa.
Mamembala atha kutuluka mu pulogalamuyi polipira $600 kutsogolo. โSitikulimbikitsa zimenezo,โ anatero Annette Rizzo, woyangโanira zaumoyo wa mโderalo.
'THONYO YONSE'
Koma mapulogalamu ena amapita patsogolo. John Borsos wa National Union of Healthcare Workers akuwona zovuta mu pulogalamu yodziwika bwino yotchedwa "Total Health" yomwe idakambidwa ndi bungwe lopikisana la SEIU la United Healthcare Workers West (UHW) ku Kaiser Permanente ku California. Ogwira ntchito akuyenera kulandira bonasi yophatikiza ngati akweza mawerengero awo a biometric (kulemera, kusuta, kuthamanga kwa magazi, ndi cholesterol) komanso ngati kusinthako kumabweretsa ndalama.
Izi zimapanga chilimbikitso kwa ogwira nawo ntchito kukhala apolisi aumoyo. Ndichitsanzo chofanana ndi mapulogalamu achitetezo omwe amalipira bonasi kumagulu omwe ali ndi masiku ambiri ogwirira ntchito popanda kuvulala komwe adanenedwa. Onsewa akuyenera kupangitsa kukakamizidwa kwa anzawo, koma m'mapulogalamu otetezera, zimangopangitsa kuti musanene za ngozi. Ndi "Thanzi Lathunthu," ndizotheka kuwonjezera kupsinjika pamene ogwira nawo ntchito amayang'anizana kuti awone ngati awonda.
Kafukufuku wa Total Health omwe amagwiritsidwa ntchito ku Kaiser akuphatikiza mafunso monga "M'miyezi inayi yapitayi, kodi matenda anu adakhudza bwanji zokolola zanu?" ndi "Kodi munayamba mwamwapo mankhwala ochulukirapo kuposa omwe adakulamulani?" Management ikufuna kudziwa, "M'sabata yapitayi. . . Ndinasungulumwa (inde kapena ayi).โ
Kumalo ena antchito a SEIU, Alta Bates Summit Medical Center ku Bay Area, ogwira ntchito omwe satenga nawo gawo pazaumoyo ayenera kulipira 20 peresenti ya ndalama zomwe amalipira pamwezi. Palibe amene sangakwanitse kutenga nawo mbali, akutero wotumiza mayendedwe Keesha Johnson, ngakhale akuganiza kuti "ndizochulukirapo."
Ogwira ntchito akuyenera kulembetsa pulogalamu yotsogozedwa ndi makochi kapena yotsogozedwa ndi dokotala, ndipo amalandila mfundo zochitira zinthu monga mawonetsero a kuthamanga kwa magazi, adatero.
โChodabwitsa,โ anatero Johnson, โnโchakuti kupsinjika kwanga kochuluka kumachititsidwa ndi abwana anga.โ Kulemba ntchito kwasungidwa kwa zaka zopitirira ziwiri, adatero, ngakhale chiwerengero cha odwala chikachuluka.
โNdine wonenepa pangโono. Ndili ndi mwana," adatero Johnson. "Koma ndi ntchito yomwe imandipangitsa kuchita chilichonse chomwe chimandipangitsa kuti ndikhale ndi nkhawa."
Ndodo ZOchuluka
Robert Krzys akunena kuti ku Connecticut, okambitsirana โanakangana za kaloti zonse,โ koma pulogalamuyo imaphatikizapo ndodo yandalama ya $1,200-$1,500 pachaka. Ndi pulogalamu yanji yomwe oyang'anira adzakhazikitsa m'malo ogwirira ntchito omwe si a mgwirizano? โNdodo zambiri,โ anatero Krzys.
Mapulogalamu a zaumoyo angathandizedi. Wogwira ntchito amene akufuna kusiya kusuta, mwachitsanzo, angayamikire mwayi wopeza pulogalamu yaulere. Koma kwa bwana wodera nkhaลตadi za thanzi, osati kungosunga ndalama, mamenejala angayangโane pagalasi kuti awone mmene zochita zawozo zikudwalitsira antchito awo. Adzalingalira za kuchuluka kwa nkhawa zomwe akuwonjezera pamiyoyo ya ogwira ntchito mwa kuwopseza zochulukirapo kapena ndalama zambiri.
M'mawu a mafunso a Kaiser Permanente's Total Health, "M'mwezi watha, kodi mwakwiya kangati chifukwa cha zinthu zomwe simunazilamulire?"
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