Friday, September 11, 2009

Why healthcare reform is essential, especially for women

(The following is an expanded version of an earlier post.)

The advocacy group makes some interesting points about why health care reform is especially important for women:

1) Because employed women often work less than full-time hours, they aren't eligible for employer-sponsored health insurance.

2) Women are more than twice as likely as men to get employer-sponsored coverage through their spouses. But many employers are reducing health care coverage for dependents, which leaves millions of women and children at risk.

I have health insurance now, through my husband's corporate job. (Knock on wood, fingers crossed that the job and the benefits continue.) However, even with employer-sponsored coverage, we pay several hundred dollars a month out-of-pocket toward the coverage premiums, and of course for the deductibles, co-pays, etc.

Although my family is currently blessed with decent employer-sponsored health coverage, I am a strong believer in health care/health insurance reform. Experience tells me that good fortune doesn't always last.

As a child in the mid-1970s, my father and stepfather were both unemployed at the same time due to corporate layoffs. Although my mother and my dad's wife worked, neither had jobs with health coverage. I remember being very sick (with some strange allergy that left me puffed up and covered in hives) and not being able to see a doctor due to our lack of health insurance, and money.

Several times during our careers, my husband and I have been self-employed due to a job layoff or working for an employer who skirted employment laws by not putting hires on staff.

We've twice paid the full cost of employer coverage via COBRA, the federal law that allows workers to keep their employer-sponsored health benefits for 18 months after a job loss by paying the full cost of the premiums. (In response to the bad economy and the escalating cost of insurance premiums, President Obama signed legislation earlier this year enabling laid off employees to pay just 35 percent of the cost of coverage. While $350 a month in premiums sure is better than, say, $1,000, it's still a big bill to foot when you're unemployed. Not only that, the coverage expires.)

When a magazine I worked for folded in 1990, I spent $400 a month for medical and dental coverage premiums as a single person.

In 2001, when my husband lost his Wall Street-area, Internet-industry job due to layoffs and accepted a hard-to-turn-down consulting position in Maryland, I left my corporate career in New York. Although I redirected my work efforts toward freelance assignments and caring for our toddler son, because my spouse received no employee benefits (remember, he was a consultant), I sought out a family-flexible retail job that paid just $10 an hour but provided health insurance for a 30 hour week. (These days, with employers, and especially retail employers, slashing hours and benefits, such a work-for-the-insurance option might be nearly impossible to find.)

Soon after, I became pregnant with twins. I quickly became too sick to work and was put on bed rest. I had to quit the job. (I hadn’t been there long enough to qualify for disability leave.) We wound up paying nearly $1,000 a month for family coverage premiums through COBRA. We were lucky to be able to keep (and afford) the employer-contracted group coverage. If we'd been forced to shop for private insurance on the open market, the cost would have likely been higher, and my pregnancy would almost certainly have been deemed a pre-existing condition and excluded from coverage.

Why reform is needed for everyone:

1) The current system is modeled on a work environment that is disappearing. In the past, people often spent their entire careers working for one company, which provided insurance, a pension, and all sorts of other benefits. Nowadays, people switch jobs (due to layoffs, relocations, the need for better opportunities) and employers frequently choose not to pay, or can't afford, the full costs of hiring a staff employee. Even when an employer offers a health plan, it's not uncommon for employees not to join due to the cost. (Some employers pay a portion of the premiums, some don't.)
While small businesses often can't afford the costs, many huge corporations simply choose not to take on the expenses of staff. I was a "permalance" (permanent freelance) employee for a few years before achieving full "citizenship" (my term) on staff at Time-Warner.

In April, while presenting at a book festival (as the author of The Stay-at-Home Survival Guide), I had a conversation with a permalancing New York Times writer. While this writer works more than full-time for the paper, he receives no benefits (no insurance, no paid vacation, no 401k), and he can't apply for unemployment insurance if the job ends. On the plus side, he was actually feeling a bit lucky in this economy, since businesses now fire staffers and keep freelancers.

Fortuitously, our casual chat took place in the presence of a member of Congress. U.S. Rep. Pete Stark (D-CA) happened to be seated with us in the author’s lounge. (He was there waiting for a family member.) The Times writer and I pointed out that, courtesy of taxpayers like us, his salary, expenses, pension and insurance (for himself and his family) are fully financed. Congressman Stark was fortunately sympathetic to our plights, and he is supportive of the larger cause.

2) The current system fosters dependency. Coverage comes through marriage, which can be both a good and a bad thing. It's good if you have a good marriage (to someone who has a job with benefits); bad if you have a bad marriage or, as is the case for committed same-sex couples, aren't allowed to marry. Because people are fearful of losing their insurance, the system also fosters a dependency by workers upon those employers who do provide coverage.

3) Health insurance should be "person-based" not employment-based. Ideally, I think, health insurance needs to be provided to—and hence travel with—people on an individual basis, rather than on the basis of their job or relationship with someone who has a job that happens to provide coverage. Saying as much is not an endorsement of people living off the public dime. Instead, it’s an acknowledgement that health insurance benefits are burdensome for employers, and not everyone can participate in the paid workforce, or find a job with coverage. After all, children don't work, and many mothers (and some dads) aren't in the workforce due to child care responsibilities. New graduates frequently can't find jobs with benefits (and they're too old to be on their parents' policies). Of the non-workers and workers who can't afford or qualify for their own insurance, only those "fortunate" enough to be dependent upon a covered worker, very poor (i.e. Medicaid-eligible) or very old (i.e. Medicare-age) have access to affordable health care coverage. That's illogical.

4) Health care reform won’t bring "socialized medicine." That's not what President Obama is proposing. There is a middle ground between what we have now (inefficient, profit-motivated health care that's controlled by insurance companies) and what many scream against (the government financing and rationing of health care and/or controlling all access to it). What is being proposed is within that middle ground. Relatedly, President Obama is not a socialist. Democrats are not socialists. The United States is a mix of many "isms," and we can, should and do pull from many governing systems (capitalism, democracy, socialism, etc).

5) Health care is being rationed … for profit. While we don't want government rationing our care, or intruding upon our health care access and choices, neither should we want insurance companies to ration and intrude upon our health care access and choices. But that's exactly the system we have now. The way insurance companies make money for their executives and stockholders is by restricting care, reimbursement and coverage. Perhaps health care is something that shouldn’t be for profit. Perhaps health insurers should operate like private colleges do, in which a not-for-profit institution provides a service, while also covering its real costs and saving and investing for its future.

A friend challenged my views by asking, “Why should health care be a right?” I responded that instead of arguing over whether health care is a “right,” we need to accept that it’s a reality. The reality is that all people need health care, and dealing with that reality is a collective responsibility—unless we want to be a nation in which only those with enough money and luck thrive and survive. (In others words, “break a leg” that you don’t actually break a leg.)

Americans need affordable, comprehensive, permanent health insurance. How that coverage should be provided (be it through the private or public sector, or some combination thereof) requires rational thought and discussion, not crazed distortions and shouting. Ensuring that all Americans have access to affordable medical care, especially to preventive health care, is good for our economy and collective quality of life. To have a society of health care haves and haves nots—consisting of "haves" who, with one injury or medical situation, can overnight become "have nots"—is immoral and unsustainable. While individuals suffer directly, our nation suffers as a whole.


Teresa T. said...

Yes, yes, yes. My husband is self-employed, I'm a SAHM, we pay a lot for a very minimal policy and live in fear of each year's renewals. (Will they renew us? How much will the rate increase be?) I want a public option, either so we can buy into it, or so that the private insurers will have some competition. Right now, they're the only game in town, and they don't want individual policy holders like us. I laughed at your comment about Medicare and Social Security. My not well off but retired parents hate President Obama and talk all that government takeover stuff, but oh do they love having Medicare and their Social Security checks. (As I point out, they are taken care of in old age because of Democratic presidents--FDR and LBJ--but they've always voted Republican.)

Anonymous said...

With the recent news of hospitals pledging $155 billion, where are the costs going to be shifted? Doesn't anyone get it? It is going to be shifted somewhere. In Utah, studies conducted by revealed that cost shifting already exists in ER. Why do you think aspirins cost $10? Someone is going to pay whether it be a reduction in quality service or higher charges for those with insurance policies. Someone gets dropped off at the ER doorstops full of bullet holes with no insurance….next person that comes in with a insurance cared has costs shifted to them. I see it daily when advising hospitals through billing issues with which is our state’s steps towards health care reform. Sure, the government is proposing subsidy…so how much will that affect the tax payer? Again, why are we not talking about TORT REFORM to push liability insurance premiums down that absorb as much as 15% in expenses with medical providers?? Take 15% off total medical expenditures in US and you will see savings in the trillions.

Teresa T said...

Tort reform alone will not solve the problem of people not having access to affordable healthcare. If everyone is insured, there won't be a need for pass along billing.

Carolyn said...

I'm totally what you describe. I work full-time, but I can't afford to pay the premiums of my employer-sponsored healthcare. (I was told by the business manager here that employers only have to pay 10% of the cost of the premiums and can make employees pay the 90% that remains if they want to buy into the plan.) My kids fortunately have insurance through my ex husband. My parents recently turned 65 so they now get medicare. I'm a full-time working person who is no longer related to someone who can provide me insurance. Friends joke I should find an insured guy to marry. I bet people wind up doing things like that.

Nicole said...

I'm new to your blog -- I found it through the MomsRising event info for tomorrow's meeting. I've enjoyed reading your post and look forward to reading more of what you have to say.

Chrysula Winegar said...

It has always been deeply troubling to me that in the "land of the free, home of the brave", the very country that prides itself on independence, individualism and personal freedom, that the vast majority of people are too frightened to live their dreams because if they leave their job they cannot afford to go to the doctor.

I have lived in countries all my life where private AND public health insurance systems co-exist and function together. Not always perfectly of course. But when I have needed it, I have always had the best of care, without having to think about declaring bankruptcy.

As for the taxpayer cost argument, do you honestly think you are not already paying this price? It will only get worse. Yes tort reform. But it's a tiny piece.

We want health insurance and we want it now. Portable, equitable and accessible. For all. It IS a right. It might not be spelled out in our Constitution, but neither is education or so many other precious services we regard as rights.

Melissa - THANK YOU. A well reasoned, clear and simple summary of the issues. Thank you too, for commenting on my post for Whitney Johnson on daretodream. I am delighted to have found your site and to "meet" you.

Kaylie said...

I totally agree with your comments. NPR recently rebroadcast their interview with TR Reid, who visited many different countries and observed how their health care systems work. You might like this.
There are lots of ways we could improve our health care system. Why not look at other countries to see how they did it and learn from them?

Melissa said...

Chrysula and Kaylie: Thanks for visiting, and for your supportive comments. I had heard bits of that NPR broadcast but would like to listen to the entire thing. I love that Chrysula shared her experiences from living abroad. I've lived abroad for a bit, too, and traveled. I think that Americans are often loathe to admit that sometimes we're not the "best," and sometimes we make mistakes, and that we can and should learn from other people and nations. The American-might-is-right mindset seems to be especially prevalent among people who've never lived abroad, or traveled abroad (other than on a cruise ship or to a confined resort). So much of what's fueling the opposition and rancor to health care reform among regular people (ie: not the paid corporate lobbies) seems to be ignorance, fear, mis-directed frustration and, terrifyingly, hate.


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