Using a database (or any product) very effectively often has little or not translation into working on the guts of the product.
However, knowing how to use a product effectively is one of the keys to writing useful documentation.
If he is stuck in a part time position then he is probably does not show any initiative. Showing some initiative should be the first step and trying to pursue full time status.
Is it just me or doesn't going through all the hassle of trying to unionize his store show some serious initiative?
Not saying he's a model employee, but there aren't too many people who try to organize unions because it's easy.
You say there's no optimal command style solution to health care...
The trouble with applying market economics to health care like this is that markets achieve maximum efficiency through consumers acting as -rational- actors seeking to maximize value. When it comes to health care, people are not terribly rational and not terribly good as assigning value.
Sometimes, it's a matter of information. (Turns out, there might be something in that decade of schooling for doctors.) Sometimes, it's a matter of emotion... I mean, what wouldn't you pay to save your life? What about your arm? Or your vision? (I'd pay damn near anything... I'm just glad I live somewhere where I won't be paying personally.)
Brain off-line, please wait.