Vox clamantis in deserto
Stony show in Barre
“Ancient Deity,’’ by the late John A. Matusz, in the group show “Rock Solid,’’ at Studio Place Arts, Barre, Vt., through Oct. 24.
Studio Place Arts explains:
“This annual stone sculpture exhibit since 2000 showcases stone sculptures and assemblages by area artists. This year the show includes a group of sculptures by the late John A. Matusz, who was involved in the show for 14 years.
“View granite sculptures around downtown, historic Barre by means of the Art Stroll, a self-guided tour. Maps are available at the SPA website and in the gallery.’’
Elisabeth Rosenthal: How patients get financially hammered by ‘vertical integration,’ private equity
Though the U.S. health-care system tends to produce more innovation, it has a lower level of regulation, and almost every form of its health care costs more than in other high-income countries.
From Kaiser Family Foundation Health News (KFF Health News) (not including image above)
“Antitrust laws aren’t fit for purpose at this point, and the agencies that enforce them are under-resourced.’’
— Zack Cooper, an associate professor of public health and economics at Yale University
After a failed round of in-vitro fertilization this year, Anne Hug’s fertility doctor said she had a single polyp in her uterus that should be removed to improve the chance of pregnancy. Hug, a professor of radiology, learned that the American College of Obstetricians and Gynecologists says the procedure can be done in a doctor’s office with local numbing.
Her doctor referred her to a physician at the same hospital, which is part of a large Ohio health system. That doctor’s plan was to do the procedure in a hospital operating room, with anesthesia administered by an anesthesiologist.
Hug balked at the $18,000 estimate.
So she found an obstetrician who said he would do it in the doctor’s office. And she took the required two-week course of a hormone in preparation.
But the day before the polyp removal, the doctor’s office called to say, sorry, but he had to do it in a freestanding surgery center owned by the same system. The health system had bought the OB-GYN practice in 2025, so it called the shots. The next day, Hug recalled, “I’m in a venue I didn’t need or use, with surgical techs and OR nurses running around.”
Though she was scheduled for anesthesia or sedation, she wanted none of it. The doctor numbed the cervix and removed the polyp in a few minutes, with “a few seconds of cramping,” she said. Hug remembers watching pictures of the polyp removal and “talking to the OR crew about snorkeling.”
The estimate for the in-office procedure was around $3,000. The bill when she was forced at the last minute to switch to the surgery center was around $6,000. She now wonders, “How is it legal for these hospitals to force patients to have procedures done in a hospital when professional organizations recommend differently?”
Hug’s experience is a classic example of the predicted outcome of “vertical integration” in the health-care system, when one company owns or controls multiple parts of a supply chain and can therefore direct patients to more expensive treatment options.
KFF Health News agreed not to publish some identifying details about Hug and her health-care providers, to protect her patient privacy and ongoing relationship with the hospital system.
In any case, such health-care integration is occurring at a breakneck pace all across the nation, with endless permutations: Hospitals are buying doctors’ practices and surgery and imaging centers. Insurers are buying doctors’ practices and specialty pharmacies and sometimes merging with pharmacy chains. Hospitals are buying or creating insurers. Private-equity firms are behind many of the deals, buying practices, reorganizing operations, paring costs, then selling at a profit in a few years to a hospital or insurer higher up the health-care food chain.
And while the stated purpose is generally greater efficiency, studies have shown that for patients the net result has been higher prices and no benefit, or worse health outcomes. That’s in part because the purchases have been driven by financial efficiency, not more seamless and attentive care, said Soroush Saghafian, an associate professor at Harvard University’s Belfer Center for Science and International Affairs. What’s more, these transactions occur in a gray zone of competition law, and regulators’ tools to examine or stop them are plodding and not up to the task.
“Antitrust laws aren’t fit for purpose at this point, and the agencies that enforce them are under-resourced,” said Zack Cooper, an associate professor of public health and economics at Yale University who has sounded the alarm about the trend. The tools at the agencies’ disposal are limited — warning letters, lawsuits, and consent decrees modifying the terms of a merger to restore competition — and often slow to get results. Meanwhile, the dealmaking is galloping ahead.
Patients like Hug are often directed to a higher-priced location for procedures. They are effectively required to buy from their insurers’ specialty or retail pharmacy, which may not stock the drug the doctor prescribes or provide it at the lowest price.
The Federal Trade Commission and the Justice Department together police mergers in healthcare to protect competition and patient choice. Generally, the FTC oversees hospitals and doctors, while the Justice Department scrutinizes insurers, though their territories overlap and there are gaps. Middlemen like pharmacy benefit managers fall somewhere in between, though in recent years the FTC has taken the lead in this arena. But federal regulators are playing a tough game of catch-up.
Over the past decade, the number of doctors working for hospitals rather than in private practice has more than doubled. Today 82% of physicians are employed by hospitals, other corporate entities (like insurers), or private equity firms. For example, UnitedHealth Group’s then-CEO said in 2024 that it employed around 10,000 primary care physicians. That did not include UnitedHealth’s 80,000 “affiliated” physicians.
Many of these vertical transactions are too small for the regulatory agencies to spot. Under the 1976 Hart-Scott-Rodino Act, mergers valued over a certain dollar threshold set annually — this year it’s $133.9 million — must be reported for antitrust scrutiny. Many hospital mergers or insurer mergers exceed the threshold. But mergers involving doctors’ practices often do not, leading to consolidation and monopoly by slow accretion.
Cooper and his group, the Health Care Affordability Lab, studied hospital acquisitions of physician practices and found that over 99% of the more than 275 deals examined fell below the reporting threshold. “I’m really struggling with this,” Cooper said. “What you’re talking about is sort of like death by a thousand paper cuts.”
The FTC has brought eight actions or suits against health-care mergers and acquisitions in President \Trump’s second term. “The FTC has made health-care competition one of our top priorities,” said Daniel Guarnera, director of the FTC’s Bureau of Competition. Nonetheless, he said the agency relied on complaints and news reports to learn about smaller mergers.
The Justice Department has brought only two cases, both challenging hospital-insurer contracts rather than mergers. It has also settled a suit brought by the Biden administration that sought to block UnitedHealth’s $3.3 billion acquisition of Amedisys, a home health-care agency. The 2025 settlement required the divestiture of 164 home health and hospice locations across 19 states.
After KFF Health News requested an interview, the department’s press office replied in an unsigned email: “You’ve emailed the Department of Justice. Please reach out to FTC’s media team to set up an interview.” Further requests went unanswered.
Guarnera, at the FTC, noted that the agencies’ task is to enforce regulations, limiting the challenges they can bring.
“Some of the market distortion is caused by regulations that have anticompetitive effects,” he said.
For example, countless health-policy experts have proposed regulations mandating “site-neutral payment,” a system in which providers would get the same amount for a procedure no matter where it was performed. That would prevent predicaments like Hug’s, in which a vertically integrated system effectively backs doctors into directing patients to a more expensive venue for treatment.
Within the government, the FTC has advocated for new pro-competitive regulations, suggestions that are now under review by the White House’s Office of Management and Budget. They are not public, and Guarnera wouldn’t say whether site-neutral payment is included. Meanwhile, the Trump administration in July proposed instituting site-neutral payments for some services for Medicare beneficiaries.
The economic theory adjudicating the pros and cons of vertical integration is “nuanced,” Cooper said.
It is far easier to assess the effects of horizontal integration — when a hospital merges with a hospital or an insurer with an insurer — on patient care and cost. If two hospitals merge and become the only care provider in town, that leaves patients with less choice and can make it easier for the new monopoly to skimp on care and raise prices. There is no way “to walk with your feet” to another hospital system for care, Cooper said.
But with vertical integration, for example, a hospital merger with an insurer and doctors’ practices could in theory diminish friction, compared with a disaggregated system in which every bill is haggled over by different sectors trying to maximize their piece of the pie. Some successful and popular hospital-insurer combinations, such as Kaiser Permanente, are vertically integrated. So merely taking a “sledgehammer” to such mergers could backfire, Cooper said.
But with money on the table and business interests governing healthcare, studies have shown that cons of vertical integration — opportunities for gaming away those beneficial arrangements and raising revenue — prevail.
When Harvard researchers sought to assess the effect of hospital purchases of gastroenterology physician groups on colonoscopy care, the negative impact was clear. “It changed the way they did business,” said Saghafian, the paper’s main author.
All told, quality went down and prices as well as complication rates rose. “What improves is ‘operational throughput,’” or the efficiency with which the system could move patients through colonoscopies fastest with the least staff involvement, Saghafian said. “That’s a financial metric.”
‘It Feels Like Double-Dipping’
While health economists are studying the impacts to help regulators figure out when to act, the horse is out of the barn. All the biggest health insurers have already merged with pharmacy benefit managers, specialty and commercial pharmacies, as well as new lines of businesses that insurers require members to use to manage copay assistance from pharmaceutical companies. For example:
CVS acquired Aetna in 2018, meaning Aetna subscribers are directed to the CVS Specialty pharmacy through Caremark, its pharmacy benefit manager.
Cigna owns Accredo (a specialty pharmacy), Express Scripts (a pharmacy benefit manager), and EviCore (which does preauthorization for prescription requests).
UnitedHealth includes Optum Rx (a pharmacy benefit manager), Optum Specialty Pharmacy, and Optum Infusion Pharmacy.
So when patients change insurers, their steady access to longtime drugs at a predictable price can go out the door.
In Florida, Ari H.’s family uses three high-priced specialty drugs for chronic conditions. All three had long been subsidized by patient assistance programs from their manufacturers. KFF Health News agreed to only partially identify him, because he works for a government contractor where policy has become political and he fears retaliation.
Signing up for a $3,000-deductible plan with a new insurer, Aetna, put a new strain on his family’s finances. On his new plan, he was signed up for all Aetna’s pharmacy-related products, too. He could not choose to order elsewhere. Most importantly, his old insurance counted the copay assistance money toward his deductible, but his new insurer did not, scooping up his patient assistance money from pharmaceutical firms.
“I pay substantial premiums, and I pay my deductible and my out-of-pocket maximum — that’s all paid by me,” Ari H. said. “But now all the copay assistance goes back to them. It feels like double-dipping.”
Ethan Slavin, an Aetna spokesperson, said the company “is committed to helping members choose and use health plans that best meet their health, financial, and lifestyle needs.” He added that the insurer offers “supports that may lower out-of-pocket expenses.”
Ari H. is right, said Mark Cuban, the billionaire investor who in 2022 launched the Cost Plus Drugs site, which sells mostly generic drugs to cash-paying patients at a discount — often for less than what they would pay using insurance. “It’s crazy stuff,” he said of vertical integration. “The right pocket gives to the left pocket.”
In July the FTC reached a settlement in a suit against Caremark, requiring it to be more transparent and give patients and pharmacies more choice. It had previously reached such an agreement with Express Scripts and is working on one with Optum.
Academics like Cooper are trying to help clarify “which of these vertical deals are bad.” A clearer economic theory, he said, might help regulators make the patient experience just “a little less worse.”
Elisabeth Rosenthal (erosenthal@kff.org) is a KFF Health News reporter.
First gradually, then suddenly
“Touch of Autumn” (encaustic on panel), by Dale O. Roberts, at Portland Art Gallery.
He can’t fake it in Vt.
Strafford, Vt., Meeting House, built in 1799
“Even when I play shows, I'm more nervous to play a show in Vermont or New Hampshire than I am to play a song about New England in Missouri because they assume that I've captured the experience, whereas in Vermont, they know what this place is like.’’
— Noah Kahan (born 1997), American singer-songwriter. He was born in Strafford, Vt.
Soporific in the sun
“Bathers on Rocks” (watercolor and pencil on paper), by Herbert Mayer (1882-1960), at the University of Vermont’s Fleming Museum of Art, Burlington.
Making one’s way in society
“Mariages d’aventure’’ (pieces of old book jacket, endpapers and encaustic paint), by Nancy Whitcomb, a Providence-based writer.
And they didn’t have Labor Day
The Cordwainer statute in the City of London.
In 1860, an uprising by shoemakers across New England became the largest labor strike in the United States before the Civil War. The walkout spread to more than two dozen towns, including Natick, Mass., and involved about 20,000 workers. Although the strike lasted only six weeks, it captured national attention and signaled the growing power of organized labor.
In Natick, shoemaking began as a “putting out” or “cottage industry” in the early 19th Century. Cordwainers (shoe artisans) made shoes by hand in their homes and in “ten-footer” workshops all over town. They sent the finished shoes to Boston on wagons. However, after the Boston & Worcester Railroad arrived in Natick in 1834, the shoe industry boomed. By the mid-19th Century, 1,050 Natick men and women—almost 20 percent of the population and about 75 percent of the workforce—were employed in the shoe industry.
Most of the shoes produced in Natick were heavy work shoes, including the “brogan,” which was first designed by Asa Felch in 1827. Southern planters purchased brogans in large quantities for enslaved people. In 1858, a shoe sewing machine was patented, and the shoemaking business model changed drastically. Machine stitching greatly enhanced production capability, but it minimized the function and cut the pay of the shoe workers in their homes. In some cases, every family member was employed in making shoes, and pay cuts made their situation bleak.
The 1857 nationwide financial panic hurt commerce everywhere, and Natick shoe factories were hit hard. Many workers lost their jobs and borrowed money to pay their bills. When the economy grew stronger again, they were rehired, but with more extended workdays and reduced pay. For 16-hour days, men earned $3 a week, and women were paid only $1. It wasn’t enough to support a family.
In February 1860, crowds of more than 500 Natick workers met several times in the Universalist Church. They formally resolved “that in our opinion the late reduction in the prices for bottoming shoes was uncalled for, oppressive, and unjust, therefore believing that no first quality shoe can be made for less than [20 cents] without injuring the laborer, and the best interests of the community.”
Across Massachusetts and New Hampshire, strike committees formed rapidly. By March 10, with long-distance support from Republican presidential candidate Abraham Lincoln, 517 Natick shoemakers joined workers in other towns to go on strike. Although some manufacturers were ready to boost wages, most stonewalled the strikers. By mid-April, workers returned to factories. Though they succeeded in getting national attention, the strikers did not win concessions to their demands. A letter published in the Natick Observer on May 9, 1860, claimed, “The shoe business of our village is once more in full blast. Some firms are doing more business than ever before and will soon bridge the gap caused by the recent strike.” The following spring, everyone’s attention turned to the new Civil War.
‘A tree becomes a gesture’
From the late Wolf Kahn’s (1927-2020) “Pastels” show at Morrison Gallery, Kent, Conn., Sept. 12-Oct. 25.
The gallery says of the artist’s work:
“These works are less concerned with describing a particular place than with capturing the experience of seeing it. A landscape can feel quiet and familiar in one moment, then strange, luminous, or almost dreamlike in the next. Kahn finds that shift through color, reducing the landscape to its essential elements while leaving room for something more intuitive to emerge.
“Wolf Kahn ‘Pastels’ invites a closer look at the space between representation and abstraction, where a field becomes a field of color, a tree becomes a gesture, and the familiar begins to feel newly seen.’’
‘Poor race in a land of dollars’
W.E.B. DuBois in 1918
The title page of Du Bois's Harvard dissertation.
“To be a poor man is hard, but to be a poor race in a land of dollars is the very bottom of hardships.’’
— W.E.B. Du Bois (1868-1963), in his 1903 collection of essays, The Souls of Black Folk
The African-American sociologist, writer, historian, and Pan-Africanist civil-rights activist was born and raised in Great Barrington, Mass., in The Berkshires, a relatively tolerant and integrated community, compared to much of the United States at the time.
Weaving complexity
Work by Jeffrey Nowlin in his show at Boston Sculptors Gallery, through Sept. 27.
He says:
“My recent work imagines the complexities of human experience through weaving and embroidery. I am making connections between traumatic experiences such as illness and addiction, and the psychological and somatic responses engendered by these experiences. These works incorporate conscripted objects---wooden frames, bottle caps, vessels and ephemera---which I combine with various forms of weaving, sewing and quilting. These identifiable objects imbue my work with a sense of the common and the particular, a means of intersecting and highlighting what everyday events prove to be---highly regular but unique to the individual. In this process, I render the experience through a visual format, unifying the perceptual fragmentation which occurs into coherent art objects.’’
Chris Powell: State’s concern about social-media harm to kids is laughably hypocritical
MANCHESTER, Conn.
Every individual and business in news and entertainment media tries to entice an audience to return -- to addict it, more or less. Meta Platforms, operator of the Facebook and Instagram social-media outlets, has agreed to pay nearly $17 billion to settle multi-state federal lawsuits charging that the company has been too successful enticing young people, addicting them and causing a national epidemic of mental illness.
Since they are by nature self-absorbed, insecure, and neurotic, young people surely would do better to be less involved with social media. But almost any product can be abused, and blaming social-media companies for the abuse of their products is a stretch that disregards First Amendment rights even as the best solution is close to home.
After all, social-media companies don't give mobile telephones, computers, and Internet connections to minors and then fail to monitor what they make of them. Their parents do. The settlement with Meta Platforms is essentially a substitute for parenting.
The likely disposition of the $265 million Connecticut is expected to receive from the settlement suggests as much. Gov. Ned Lamont says the money will be spent on "mental-health and crisis intervention, after-school and summer school programming, and implementation of phone-free school zones."
There is much mental distress among young people in Connecticut, but with about a third of the state's children living in single-parent households -- in the cities the figure is 60 percent or more -- little of that distress begins with social media. Rather, youthful obsession with social media may be more a consequence of that distress, a consequence of parental neglect.
In any case state government's concern about social-media addiction is laughably hypocritical.
Connecticut has legislated some restrictions on how social-media companies engage with minors but they will have little effect if parents fail to monitor their children's activity on social media and internet. The restrictions that Connecticut has enacted are just substitutes for parenting.
Meanwhile, state government itself has thrown itself into the addiction business -- first with casino gambling and Internet gambling, from which it collects tens of millions of dollars each year through tribute from Connecticut's two Indian tribal casinos, and second through licensing retailers of marijuana products and taxing their sales.
Gambling addiction has devastated thousands of lives in the state and has caused much embezzlement and theft.
Frequent use of marijuana is addictive and often leads to addiction to more dangerous drugs.
But now that state government itself is in the gambling and drug businesses, the only addiction about which the governor, Atty. Gen. William Tong, and state legislators get indignant is addiction to social media. With the settlement of the Meta lawsuit, state government soon will be making money off social media addiction as well.
The most timely and compelling question in American society may be: Where are all the disturbed kids coming from? Some of Connecticut's windfall from the Meta lawsuit settlement could be used to investigate that issue -- or maybe to hire some parents for the many kids who lack them.
ELICKER's COWARDICE: Another New Haven police officer accused of misconduct and hastily fired for his role in the Randy Cox case four years ago, Luis Rivera, has been reinstated by the state Board of Mediation and Arbitration, which found that the officer was not to blame for Cox's crippling injury. The board already had reinstated Officer Oscar Diaz for the same reason. The appeal of a third fired officer is pending while the firing of a fourth has been upheld.
The board found that Cox's injury almost certainly had nothing to do with how he was handled by police after his arrest but was entirely a matter of the lack of seatbelts in the police van in which he was being transported when it stopped abruptly to avoid a crash.
Cox is Black and there were false shrieks of racism when he was injured, and Mayor Elicker lacked the courage to stand up to them and insist on due process.
Chris Powell has written about Connecticut government and politics for many years (CPowell@cox.net).
Turning green landscapes into feed lots
“Mato Grosso (Brasil)’’ (detail), (Epson Ultrachrome K3 pigment print on Hahnemuhle William Turner paper), by Daniel Beltrá, at the Hood Museum of Art, Hanover, N.H., in the “New Amazon Landscape” series.
Charles Ponzi: A temporary financial giant
The dapper Charles Ponzi, circa 1920
— Digital Commonwealth photo
And see photo below
A Boston Guardian article by Mannie Lewis, slightly edited here
(Robert Whitcomb, New England Diary’s editor, is chairman of The Boston Guardian’s board.)
BOSTON
One hundred three years ago, Downtown Boston was the epicenter of one of history’s most infamous financial crimes.
Charles Ponzi (1882-1949) launched the fraud that would make his name synonymous with white-collar malfeasance in January 1920 from his office on School Street, above what is now a Starbucks next to Old City Hall.
Ponzi bilked victims in Boston and beyond out of what today would be hundreds of millions of dollars before his exposure and eventual prosecution. Yet a century later, the details of the original Ponzi scheme and its impact on Bostonians have largely been forgotten.
By the time that he settled in Boston, in 1917, the Italian-born Ponzi was already an established con man who had served prison time in both Atlanta and Montreal. He came to Boston ostensibly for a fresh start, marrying the daughter of a local produce distributor and eventually taking over his business. But the company failed within a year, leaving Ponzi penniless and in debt. It didn’t take long for the former scammer to turn to less legitimate sources of income.
Ponzi’s scheme centered around an obscure U.S. Postal Service voucher called an “international reply coupon (IRC),” which could be redeemed for a postage stamp in both the U.S. and throughout Europe. He told investors he would purchase IRC’s in Italy, where postal rates were much lower, then resell them in the US for a 50 percent profit.
There is little evidence that Ponzi ever purchased a single IRC.
Charming and manipulative, he pitched his bogus investment opportunity throughout Boston’s Italian community, using money from new investors to pay out fraudulent dividends to existing clients.
Word spread quickly about the financial wizard providing 50 percent returns, and soon Bostonians of all stripes were clamoring to give Ponzi their money. By March, he was bringing in nearly a million dollars a month.
“The cash is coming in so fast that they have bags in the office that they are filling up with cash,” Suffolk University history professor and Ponzi expert Robert Allison told the Smithsonian Institution in 2016. “The police had to hire special details to keep track of what’s happening on School Street because you have these crowds of people coming in either to invest with Ponzi or get paid by Ponzi.”
Not everyone was fooled. Financial journalist Clarence Barron identified Ponzi as a fraud, but his exposé was so steeped in xenophobic language that it actually promoted further investment throughout Boston’s immigrant communities.
“[Barron] sees through it almost immediately, but then he says, ‘Well of course you couldn’t expect someone like Ponzi to understand banking because he’s an uneducated Italian,’” Allison told the Smithsonian. “If you’re an uneducated Italian, you now know you have to show your solidarity by investing with Ponzi to show this Barron guy.”
Others soon caught on. An article in The Boston Post proved that there were not enough IRCs in the world to generate the amount of income Ponzi claimed to generate. Just six months after Ponzi lured his first customers, his scheme crumbled. He would spend years in a Massachusetts jail before being deported, dying impoverished in Brazil.
In those six short months, Ponzi created a trail of financial ruin that sent shockwaves through the city. Six banks shuttered in the wake the scheme’s collapse, and hundreds of Bostonians, from recent immigrants to Brahmins, faced financial ruin. Seventy percent of the Boston police force was estimated to have lost money in the scam.
A century after he enticed his first victims, Ponzi’s name lives on in infamy, even if his connection to Downtown has largely faded from memory.
Even before his trial, Ponzi's name had begun to pass into the language as a fraudster. This is a Sept. 25, 1920 ad.
In the fourth dimension
“Harborside” (mixed media on gallery-wrapped canvas), by Sue Charles, at Alpers Fine Art, Rockport, Mass.
She says:
“Long lines of landscape space, curious shapes, the interconnectedness of light, air and every thing...the mute profundity of nature. A painting exists in many dimensions. It is an object crafted of wood, cloth and paint and it represents three dimensions on two. It holds the fourth dimension of time in its marks and it expresses metaphysical ideas of memory, spirit, experience and emotion. A painting is thought made visible. The best ones stay with you like a hummable melody. I aim for that.’’
Paul Osterman: Not so happy Labor Day
From The Conversation (except for image above)
When I leave my Boston condo every day, I say good morning to the concierge, who works for a contracting company providing staff to residential buildings. When I conduct an interview in a nearby building, the people who clean that office at night are contractors. The person who serves me my lunch sandwich is a part-timer with no career prospects in that job.
When my best intentions to eat well are for naught and I gorge on Doritos, I remember that the tasters PepsiCo hires to test the chips’ addictiveness are contractors.
These are all examples of what I call “disposable jobs.” People who have them work at an employer’s site, but their employer makes no commitment to them regarding career prospects or job security. My research shows that employers treat more than 1 in 3 U.S. workers as disposable. That comes to just under 57 million full- or part-time workers out of the nation’s workforce of 162 million.
I am a labor economist. In my new book, “Disposable Workers: The Transformation of Employment,” I explain why this is happening, what forms it takes, how common it is, what the consequences are for people and for society, and what can be done about it.
3 different varieties
To learn more, I commissioned a nationally representative survey of over 6,000 people in late 2022. I also interviewed nearly 100 workers, employers and policymakers.
I found that there are three categories of disposable workers.
1. Contractors who are employed by a staffing firm but work at a client’s site. Examples include temporary office workers, building cleaners and security guards. Many of these people are poorly paid, but some, such as travel nurses, are highly compensated. My survey shows that these contractors account for 13% of the workforce.
2. Freelancers who work for companies, organizations or agencies without being employees. Examples include Uber and Lyft drivers, food delivery drivers, computer programmers and freelance journalists. In my survey, organizational freelancers represent 5% of the workforce. I don’t include in this category freelancers who work for individual people, such as most dog-walkers and handymen, because my focus is on how employers treat their employees.
3. Marginal workers who are employed by companies, organizations or agencies. They lack career opportunities, and their jobs have high turnover built in. Marginal workers account for 17% of the workforce in my survey.
Marginal work is important due to its magnitude and because although those jobs look standard, they are designed to be disposable.
Sometimes there’s no way to progress in your job. bpawesome/iStock via Getty Images Plus
Who are marginal workers?
Staff attorneys are quintessential marginal employees. They’re hired by law firms as employees, but the central feature of their jobs is that they are not on the promotion ladder to partner. Unlike their career-track counterparts, they have no job security. They are often hired to do the grunt work on a specific case, with the understanding that there is no commitment to keep them on if business lags or the project ends.
Adjunct professors are another good example. This group includes part-timers who teach a small number of courses and full-time contract faculty, but in both cases they lack job security and aren’t on track to obtain permanent, tenured, academic jobs.
In 1970 people with tenure or tenure-track jobs constituted 73% of those teaching at colleges and universities. By 2021 only 32% had that status, and the rest were adjunct instructors or contract faculty.
Part-time marginal workers
Another example of marginal work is part-timers.
Employing part-time workers costs less than having full-timers on the payroll. Part-time jobs pay an hourly wage that is nearly 20% below what workers with full-time jobs earn after age, education, occupation and industry are taken into account. When benefits are considered, the gap rises by another 5%.
A second advantage of part-timers from the employer’s perspective is higher turnover, which provides an easy path to be able to adjust the size of the workforce and which enables them to avoid investing in career development.
When a team of researchers led by professor Susan Lambert interviewed 88 employers that pay low wages, they found that many use part-time work to make their workforces more “flexible.” One manager explained that high churn of part-timers gave the company so much flexibility that they didn’t need temp workers.
“Temp workers: We don’t need them,” he said. “Wait a day for turnover.”
(Paul Osterman’s book, Disposable Workers, explains how ties between employers and their employees are fraying. Harvard University Press)
Evidence that employers try to maximize the number of people working for them part time instead of full time and with benefits arose after the Affordable Care Act fully took effect in 2014.
The ACA requires that employers with 50 or more employees either provide them with health insurance or pay for them to buy it, but only for people who work 30 or more hours a week. Otherwise they pay, as of 2026, a penalty of US$3,340 per uninsured employee.
Another team of researchers compared trends in part-time work in three low-wage industries – retail, hotels and restaurants, before and after the ACA rolled out. They found that the use of part-timers increased by 500,000 in the years after the Affordable Care Act was implemented. This suggests that companies add to their part-time ranks to save on the health insurance costs of standard employment.
Forces behind this trend
Why do employers want many of their workers to be disposable?
A primary motive is to save money. Employing freelancers and contractors means they can avoid mandatory benefits such as Social Security contributions and, for larger employers, contributing to the cost of health insurance.
Marginal workers, to be sure, do receive these benefits. But the high turnover built into their jobs means that their employers can invest less in their training and avoid the management costs otherwise associated with layoff severance and fair treatment on the job.
An additional motive for many employers is a lack of respect for what front-line employees can contribute. A 2023 report from the McKinsey consulting firm illustrated this tendency when it asserted that 5% of employees deliver 95% of “an organization’s value.”
This claim, which I believe is inaccurate, still speaks volumes about the attitude of McKinsey and the firms they interviewed regarding the other 95% of workers. They see those employees as disposable.
Outsourcing cleaning services might seem like a good way to cut costs, but in hospitals it can undercut safety. Jupiterimages/BananaStock via Getty Images Plus
Less pay and job satisfaction
My survey showed that contractors, freelancers who work for employers and marginal employees all earn less than regular workers do.
In addition, the survey found that contractors and marginal workers are notably less satisfied with their jobs compared with regular workers, whereas freelancers, due to their ability to choose where and when to work, are more satisfied.
The public also pays a price for the use of disposable workers. As examples, researchers have found that hospital infection rates rise when cleaners are contract workers and that the use of contractors leads to a higher rate of industrial accidents.
Paul Osterman is a professor emeritus of human Resources and management at the Sloan (Business) School at the Massachusetts Institute of Technology.
He received funding from the Russell Sage Foundation and the Lumina Foundation for research described in this article.
Evidence of absence
“Evidence of Absence”(woodcut Japanese technique), by Kevin Frances, in the group show “Home Sweet, Somewhere,’’ at Phillips Exeter Academy’s Lamont Gallery, Exeter, N.H., through Nov. 21.
The gallery explains:
“Kevin Frances’s story {is} about the lives of the people who live in them; the human presence is evident, but the people are absent. In ‘Home Sweet, Somewhere,’ Frances expands his ‘Superposition’ body of work, which is set in the home of a fictional couple. The artist begins by creating a scaled model of an imagined home. He then takes photographs of the hand-built miniature, which then become the inspiration for his woodblock prints. While the artist says the series, ‘is first and foremost about a relationship,’ the process blurs our understanding of reality, perception, and what is really there.
UMaine to promote 3-D homes using state’s wood products
House created through 3-D printing.,
— University of Maine photo
From The New England Council
The University of Maine has received $4 million in congressionally directed spending to support the construction of nine 3-D printed homes for people experiencing homelessness in the Greater Bangor area. The university’s Advanced Structures and Composites Center (ASCC) will use its BioHome3D technology to design and construct the homes.
The University of Maine first showcased its BioHome3D technology in 2022 by printing a 600-square-foot prototype home; each home built with the new funding will be similarly sized and made to withstand Maine’s climate. Since then, the ASCC continued developing large-scale 3D printing technology, including unveiling the world’s largest polymer 3D printer in 2024.
The project could provide a new way to support those experiencing homelessness while making use of materials from Maine’s forestry industry and reducing reliance on traditional construction methods. “By using waste wood from the sawmills, we drive costs down. And by using automated manufacturing, we address the labor issues, the shortage issues that we have in Maine,” said Dr. Habib Dagher, executive director of the Advanced Structures and Composites Center at UMaine.
Too hot to cool off
“Bacchanal with Picnic” (oil and collage on canvas), by Patty Adams, in her show “Bathers and Bacchanals, at Bromfield Gallery, Boston, Sept. 30-Nov. 1
She says:
“There are bodies and there is nature. They are profoundly connected.
““In this work I have drawn on the art historical imagery of the nude figure in nature both as bathers and revelers. I have tried to capture their joy and pleasure of being alive in the natural world.
“I was inspired by discovering Grace Hartigan and how she used Henri Matisse’s ‘Bathers by a River’ as an inspiration for her own ‘River Bathers.’ Her painting was strangely like and yet unlike Matisse’s. I wanted to have a similar experience.
“The above painting is based on a similar but more general inspiration from Rubens and Poussin and their paintings of orgiastic dancers and satyrs worshipping Venus and Pan. This painting is oil on canvas but its surface has been enlivened by collaged elements of paper and theatrical gels.’’