© copyright 2007 Betsy L. Angert
On September 14, 2006, the Commonwealth Fund revealed the results of a recent study on Health Insurance. The news was disheartening though not surprising to me. Nearly nine out of ten workers seeking Individual Health Care coverage do not find a plan that they can afford. Ultimately, these persons decide to forfeit medical protection. They hope and pray that they will stay healthy. Such is the state of the union in the United States of America; it has been my state of affairs more often than not.
Currently, in 2006, sixty-one  percent of American firms offer health care benefits. Only a year ago sixty-nine  percent offered such prized perks. However, as health care costs increase employers forego providing this “luxury.” Since 2000, premiums have increased eighty-seven percent; wages twenty percent. Employers are only willing or able to extend themselves so far. Corporate executives say something has to give; they have concluded it can no longer be them. Thus, more and more individual citizens are seeking health care coverage and finding they cannot afford it.
In America, we are experiencing a health care crisis. It is not exclusively, nor is it predominately a poor persons problem. Eight of ten of the uninsured are working families. 60.4 percent of the uninsured are full-year, full time working families. Well over twenty-two percent are working slightly less than full time. Just over seventeen percent of the American population fit the poverty profile typically attributed to the uninsured.
I know this personally for I live it and have for years. One incident alone illustrates my reality. I was fully employed, though technically by the standards of some considered less than. It mattered not that my most every waking hour was consumed with work, planning curriculums, reading reports and journals, researching, offering comments and concepts to my students, officially I was not working full-time. Supervisors acknowledged my commitment, as did administrators, still there are strict guidelines that must be adhered to. I understand. I do as I do because I care, regardless of the less than thoughtful structure of the system.
One day I awoke with excruciating pain. I felt as though I needed to urinate; yet, I could not fully. I felt hot, white-hot. I took off all my clothes. Later, I felt icy cold. I cuddled up in a down comforter. I could not get comfortable. I was paralyzed in a fetal position. Though I have an extremely high tolerance for pain, I relented. I moaned, I groaned; periodically I even cried.
After eight hours of agonizing, burning, aching everything I telephoned my doctor and asked for his advice. He strongly suggested I needed to go to the Emergency Room. He said, “Call the paramedics and go.” I calmly declared I could not do as he thought best. Urgent medical services are costly and I do not have health insurance. I endured for an hour more. As I fell in and out of consciousness, I realized a need to retract my earlier statement. I called for assistance. After, indeed, the bills came pouring in.
Upon making the call for help I knew that I would experience a newer, more novel suffering, one our compassionately conservative President has yet to address. George W. Bush and Congresspersons, people in the upper echelon choose not to imagine what is a daily truth for many of America’s citizens. They prefer not to know the sense of futility and helplessness that huge medical bills can and do bring. They revel in their blissful ignorance. Instead of addressing profound issues of the day numerous people in power profess, “All is well,” for it is for them and their kind.
According to this Administration and those economically at the top of the power pyramid, all is well. The Administration and elite entrepreneurs avow our economy is strong; job creation continues. I ask; has Mr. Bush ever gone out looking for a job, particularly in times such as these? Have those amongst the “Corporate Clan” born with silver spoons in their mouths and more than pennies in their pockets ever pounded the pavements? I have.
I experience the sense of desperation economists, experts, and even some corporate executives now reluctantly state. Employers and employees find themselves strapped. One need only look at the automobile industry for evidence of the health care crunch. General Motors and Ford are both laying off workers in an attempt to lower health care costs. These companies are not alone. They are only more prominent.
To assuage the pain of paying for health insurance, many companies are asking their employees to cover all or part of the expense. Workers are concluding they cannot afford the coverage.
Millions of employed Americans who are offered health insurance through their jobs are turning down the benefit because of high costs. This has been a tragic fact for many years, but the situation is only getting worse.
According to a recent, report from the Robert Wood Johnson Foundation, the number of workers who declined to accept health insurance when it was offered by their employer increased by three million between 1998 and 2003. All told, some 12 million workers eligible for work-based health insurance turned it down in 2003.
Then there are those full-time workers that do not have access to employer-paid health care. There numbers are growing. In a country where careers no longer last a lifetime, businesses are no longer loyal to their workforce and personal recognizes there is no permanency. Job security is thing of the past. Thriving in a stable career is rarely possible; survival may be the only satisfaction a worker receives in 2006.
A wide variety of occupations now involve large numbers of people with no choice but to be self-employed consultants or to obtain work through temp agencies or contract houses. At least 20 million workers — one-seventh of the American workforce — are self-employed or working on contract. More and more firms are relying on these non-permanent but often long-term relationships with workers to get specific tasks done. A major reason is to avoid paying for health insurance and other benefits.
In my own life I worked as a Faculty Lecturer at a prominent University. Three quarters of the teaching staff were not permanent employees, though their contracts were renewed year after year. By maintaining a workforce that does not receive benefits, operational costs are lowered and after all, operational costs are a greater concern than people. People, personnel, come and go; institutions prosper on into infinity, or rather, more accurately infamy.
Belatedly I discovered that some of the part-time Faculty does qualify for benefits; however there is no effort to inform them of this. If they do not ask, they are not told. The eligibility does not automatically generate a provision. When the union informs the employee, it is through a flyer or an email. These often go unread and thus, the process is overlooked. In most cases, the requirement for benefits is not met. Professional people are left scrambling for security.
This increasing reliance on non-permanent employees permeates a wide array of occupations for which college is a prerequisite. They include software engineers, accountants, human resource professionals, producers in advertising and broadcasting, writers and editors, even teachers and college professors. Many people in these occupations earn middle-class incomes over a year, but they must constantly hustle to get the next contract to maintain them. Most do not belong to an employer-group that gives them access to low-cost health plans. This puts them at a tremendous disadvantage for obtaining, much less affording, health insurance.
In my own life, I have worked full-time without benefits for many years and in many situations. Technically, I am a “trained professional.” However, I have often felt as though I am a peon or less. I am poorly paid and compassionate compensations are not offered. I experience, in many industries, employers do not provide life-sustaining benefits.
I did take a job in a mailroom for a time. I thought it would be a summer respite. This employer did offer benefits. After years without medical options, I needed these. There was dental work to be done and physical examination that were past due. While I thought and hoped that all would be taken care of in the warmer months of the year, sadly, this was not true.
After taking this position, I felt like I was loosing my mind. I thought my brain was turning to mush. The work I was doing was mindless; a machine could have done such tasks. While it is pleasant for those in power to have a person to relate to when doing their mailing transactions, for the mail clerk, the exchanges are too often unreal. The pressure not to be the thinking, creative, productive person I am was taxing.
I developed physical problems; the demands of being a peon in the eyes of authority are enormous. My mind and body felt imprisoned. The politics involved in being a subservient and silent servant felt overwhelming. The stress of this occupation took its toll. I began to grind my teeth in my sleep. I became disillusioned with people. When you are merely a paid slave, you see people at their worst. When I was away from work, I did not wish to engage with others as I had. I was mentally and physically drained. I was tired! I felt locked into the world of nothingness. I could not afford health care without this employment; nor could I afford to be without the coverage. Ultimately, I left this position or condition. I could no longer sacrifice my soul.
Private insurance is costly. I could not pay the premiums. I, and millions of others decided to forego the coverage.
The percentage of Americans with private health insurance declined to 67.7 percent in 2005, marking a pattern of erosion for the past several years. A new research study by Jack Hadley, a health economist at the Urban Institute, found that the main reason that adults’ private insurance coverage has faded in recent years is that the costs of insurance premiums have climbed, making coverage less affordable for employers and employees alike. Hadley also found that rising private insurance premiums have led to higher Medicaid enrollment of adults, as low-income workers are squeezed out of private coverage and into Medicaid. Data from the Kaiser Family Foundation show that, on average, employers are requiring employees to contribute more in cost-sharing (i.e., premiums, deductibles, and/or co-payments) for their health insurance and that fewer small businesses are offering health coverage.
As conditions prevail, the number of underinsured Americans increases.
People nationwide are assessing their options. For the most part, there are three.
In Massachusetts; they can purchase a policy in the health insurance market for individuals, where policies typically cost $300 a month without prescription drug coverage and more than $400 a month with it. The third choice is to become uninsured.
However, even if insurance can be secured there are other considerations. For years, I had a pre-existing condition, bulimia. It was my burden and my truth. It was a costly proposition. Bulimia can be costly. There is food to buy, consume, and then purge. However, that is only part of the equation. The price tag for purging is greater than what is easily evident. There are hidden charges, the fee for this “infirmity” is ineligibility.
Insurers in the individual and small-group markets are wary of their own potential customers. Because we do not require people to purchase health insurance, insurers suspect that those who apply for coverage are more likely to have high medical expenses. So they charge individuals and small groups higher premiums.
Thus, those that need insurance walk away from the prospect or more accurately, are forced to flee the market. Health care in this nation heals only the few and forgets the rest. The classes are ensured quality care. The masses for the most part must care for their own. However, rarely is that possible. Eventually, the poor or less powerful must turn towards medical professionals. They too must ultimately pay the exorbitant prices.
There are discussions of Universal Health Care; however, these go nowhere. We accept what we know and what has always been. Most of us suffer silently.
From 2004 to 2005, the number of US Americans without health insurance climbed from 45.3 to 46.6 million. One of every six US Americans faces the most expensive health care system in the world (both per capita and as a percentage of GDP) without the safety net of insurance. A shamefully low 60% of US workers receive coverage from their employers. Lamentably, over 11% of children in the United States have no health insurance.
To add some perspective, the 46.6 million uninsured are or represent:
- Over 12 times the number of millionaires (3.8 million) in the United States.
- Almost equal to all Americans age 65 and older (35.9 million)
- 12 million more than the population of Canada (32.2 million)
- Nearly 7,500 uninsured Americans for each hospital in America
- Over 84,000 uninsured Americans for each Member of Congress
(Thanks to the Center for American Progress for the above information)
Though the numbers speak volumes, as they did during the Clinton era, when experts wrote,
The population of full-time workers and their families without employer benefits is a generally healthy-and insurable-group that has health care expenditures similar to those of all insured workers. They are working to support themselves and their families, and they have earnings that could be used toward health insurance premiums, if only coverage were available at reasonable rates. An increasing number of American workers find themselves uninsured. The numbers of uninsured have risen from 25 million in the mid-1970sto 42 million in 1996, primarily due to erosion of employer group coverage. Today, full-time workers and their family members are 60% of the uninsured. Neither tax policies nor market reforms have yet given them the same kinds of financial assistance and well-functioning markets as better-organized worker and business groups.
These problems affect more than workers and dependents in the individual coverage market at this time. A worker with group coverage today can lose coverage in the future, e.g., the worker may decide to switch jobs, his or her company may go out of business, or the employee may be “downsized,” “out-sourced,” or laid off. Potentially, many more individuals are at risk of having to seek health insurance in the individual coverage market.
. . . little has changed for the better. Health Care in the United States worsens, as does the health of our citizenry. The millions of uninsured stay silent. These individuals and families are as a heart attack waiting to happen, quiet killers.
There are millions in America’s mainstream suffer needlessly. Yet, these individuals do not speak of their pain; nor do they tell their stories. Personal sagas are rarely stated aloud. On occasion, we may read an anecdote such as this.
A little over five years ago, I was diagnosed with testicular cancer. Even with my insurance, it still took me years to pay off the thousands of dollars of out-of-pocket costs.
After three years of follow-up visits, my insurance company told me that they no longer considered my hospital a provider for their plans. I had developed a relationship with the doctors, nurses, and staff at the hospital. They had been there during some of the toughest times of my life.
When it comes to a person’s well being there isn’t much of a choice. Who chooses not to seek treatment for cancer? When the doctor tells you to do something or you will die, who says, “Gee, that’s a little more than I was hoping to spend today”? It isn’t like choosing between Coke or Pepsi.
However, few of us can place a face with a telling.
Until this moment, I was among those that could not think of a scenario that a friend or family had shared. Then, my telephone rang. A close friend and co-worker wanted me to know of a colleague that I admire. She was in a serious motorcycle accident. She broke her hip and arm. She is in the hospital and her wellness is in question. She can be healed, physically. Yet, the financial strain is in question. Melinda has not worked for the company long enough to receive her health care benefits. She is not covered. Though she is a professional, pursuing a career track, in this moment she is among the uninsured!
Melinda’s life hangs by a thread. She will survive; thriving with such, a potentially debilitating debt will be a struggle. Melinda’s current experience, among millions, and my own reality forces me to ask, what will we as a society do?
Will we claim to be strong as we watch people suffer. Will we care for the masses as we do for the classes? Will we accept what does not affect us personally, though has a profound impact on our image and our communal health. Will we as a nation stand by knowing that eighteen thousand Americans die annually because they do not have health insurance.
You decide; then act on your decision. Choose to continue being silent, sullen, sorrowful, and, or avoidant, or choose differently. You have the power for you are among the people that make this country robust or not. We can accept our station while ignoring that of others or we can be compassionate, conservatives and progressives alike.
Resources that will Not Pay Medical Bills . . .
- Nearly Nine of Ten Who Seek Individual Market Health Insurance Never Buy a Plan, Contact Mary Mahon, Bethanne Fox, Jacki Flowers. The Commonwealth Fund. September 14, 2006
- Squeezed: Why Rising Exposure to Health Care Costs Threatens the Health and Financial Well-Being of American Families. S. R. Collins, J. L. Kriss, K. Davis, M. M. Doty, and A. L. Holmgren. The Commonwealth Fund, September 2006
- Health Insurance Is Twice Inflation Rate, By Kevin Freking. Associated Press. CBS News. September 26, 2006
- Health Care and the Uninsured Middle Class, By Ed Gordon. News & Notes. National Public Radio. May 5, 2005
- For Insurance, Adult Children Ride Piggyback, Jennifer 8. Lee. New York Times. September 17, 2006
- August 31, 2004, Number of Uninsured Americans Rises. U.S. Chamber of Commerce.
- The Number of Uninsured Is At An All Time High. Center on Budget and Policy Priorities. August 29, 2006
- President Bush: High Tech Improving Economy, Health Care, Education. Office of the Press Secretary. June 24, 2004
- Job Creation Continues: More than 5.7 Million Jobs Created Since August 2003. Office of the Press Secretary. Monday, September 25, 2006
- New job, new life, no insurance, By Katherine Swartz. The Boston Globe. September 12, 2006
- PDF New job, new life, no insurance, By Katherine Swartz. The Boston Globe. September 12, 2006
- Health Care on a Wing and a Prayer, By Jonathan Teller-Elsberg. Center for Popular Economics. August 9, 2006
- It’s Time to Cure Health Care, By Chris Farrell. Sound Money. BusinessWeek. January 23, 2006
- If America’s So Great, Where’s Our Health Care? By Sarah Ruth van Gelder and Doug Pibel, YES! Magazine. AlterNet September 23, 2006.
- Health Care: It’s What Ails Us, By Doug Pibel and Sarah van Gelder. YES! Magazine. Fall 2006
- Speaking of Health Care, Personal stories from patients, doctors, and activists. By Daina Saib. YES! Magazine. Fall 2006
- Workers Without Health Insurance: Who Are They and How Can Policy Reach Them? Bowen Garrett, Len M. Nichols, Emily K. Greenman. Urban Institute.2001
- The Number of Uninsured Americans is at an All Time High, Center on Budget and Policy Priorities. August 29, 2006
- Health Insurance Reform Project, George Washington University. February 1998