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 MomsRising.org 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.

Thursday, September 10, 2009

Caring for ourselves, our families, and one another

I found the following portion of President Obama's address to Congress last night very moving. I'm often stunned by the many people who rail against government providing people with services and safety nets, yet cash their Social Security checks and use their Medicare insurance and wouldn't give up either benefit. It's important to think about what our country would be like, and what our personal lives would be like, if as a society we didn't collectively care for one another in these ways. For instance, how many of us could truly afford to care for and fully finance our aging parents? (Especially while we're doing the same for young children.)

"... concern and regard for the plight of others ... is not a partisan feeling. It's not a Republican or a Democratic feeling. It, too, is part of the American character—our ability to stand in other people's shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.
This has always been the history of our progress. In 1935, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism, but the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress—Democrats and Republicans—did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter—that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves."

The full text of the speech is available at www.thewhitehouse.gov

Wednesday, September 9, 2009

Mothers are Talking—and Speaking Up


Fyi: MomsRising.org has published links to dozens of blogs in which women write about healthcare reform and the impact of healthcare on families. (Click here.) My post, Why heathcare reform is essential, especially for women, makes an appearance—as the first link listed! I'm honored.

In more blogging mom news, join me at TheMotherhood.com on Thursday, October 1, 1 p.m. EST for an online chat about the Mothering Challenges We Can All Relate To—whether you're employed, at home caring for kids, or some combination thereof. (All mothers are working mothers!) Here's a link to the article that inspired the discussion.

Emily and Cooper, the founders of TheMotherhood.com, are sponsoring 100 Conversations in 100 days. I appreciate that they've asked me to host a day. Click here to access TheMotherhood.com chat page. You can sign-up now!


 

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