The Other 20%

Unless you're one of the lucky few who's always had "Cadillac" health insurance through your employer you know how much impact it has on your life. Heck, even if you've always had "Cadillac" health insurance you've probably thought about how much impact it has because you've likely said something like this to yourself: "Man this job is an endless procession of soul-sucking days with absolutely no redeeming value. I'd quit, but damn those health benefits are great." *

Since our mid-20s my wife and I have always been highly attuned to the cost of health insurance because we've always either been self-employed or worked for companies that couldn't afford great benefits. With the exception of the jobs we had when we first got married in '92 we've always had to pay a huge chunk of our health insurance premiums which has translated into a monthly expense ranging between roughly $500 and $1000, and quite frankly we've known plenty of folks who have had it worse. Still we've always managed to keep our insurance, although it often required some sacrifice. Keep in mind, that's just the premiums. To paraphrase former US Senator Dirksen, add your $35 office visit co-pay here, your $20 prescription co-pay there, and pretty soon you're talking about real money.

But what about those people who just can't swing the health insurance? The level of angst they experience over the health care/insurance issue is on a whole other level and is nicely captured in this blog post written by a Scientific American writer living in Cateret County, NC. His son contracted pneumonia, but because they had no health insurance they didn't take him to the doctor immediately because they thought it was the flu and tried to treat it with over-the-counter medication. Eventually they made their way to urgent care, and then the hospital, and thankfully his son is recovering. Still it really is a must-read because he does a great job of providing insight into the reasons behind being uninsured, some common misperceptions about the uninsured, and Catch-22 the uninsured find themselves in. Here's a sample:

But recently my mindset has become affected by our position. I tell my kids not to do things that I certainly enjoyed doing as a kid, like don’t climb high on trees, run a little slower on the trail, watch out for roots and stones! It’s not just the usual parental concern either. I’m consciously thinking “oh my god, I cannot afford to fix them if they get broke!”.

This is the luxury gap between the between the 20% of nonelderly americans who are uninsured and the rest. The luxury is, of course, being able to just walk into a doctor’s office and see them at the appropriate times. It is easy to discount this minority since most are at or near the poverty line. But many of the uninsured are like myself and just can’t seem to make the numbers work for a family of four each month by adding on private individual (i.e. non-group discounted) health insurance. Especially when you factor in the myriad other insurances we already pay: renter’s or home, wind and hail, flood, car, life, etc. It’s not that we are irresponsible, but the numbers. just. don’t. work…

Most of the uninsured in this country aren’t lazy, freeloading hobos who don’t wanna work. They span a wide variety of demographics. As a 30 something, white male with advanced college degree who works full time as a self-employed consultant and writer are you surprised that I cannot afford health insurance for my family? In fact, the majority of uninsured are in my age range and are full or part time workers earning incomes above 100% the federal poverty level. The fact of the matter for many of the uninsured is that employment-sponsored coverage has been in decline due to the escalating costs of health care. Employers can’t remain competitive and pay double the costs they were paying a decade ago for insuring their workers. An October 2011 report from the Kaiser Commission on Medicaid and the Uninsured found that

“Job-based coverage has been gradually declining since 2000, even during years when the economy was stronger and growth in health insurance premiums was slowing.  From 2007 to 2010, the percentage of the nonelderly population with employer-sponsored coverage declined by approximately 5%.[…] Even when workers can afford coverage for themselves, the cost of health insurance for their families is often prohibitive. Employees in firms with many low-wage workers are typically asked to contribute a larger share of the insurance premium than employees of firms with fewer low-wage workers (38% vs. 27% of the premium costs for family coverage). Declines in dependent coverage accounted for more than half of the recent decline in employer-sponsored insurance.”

Uninsured people look just like everyone else. They might look like they can easily afford the premiums and in fact might earn salaries similar to yours. But every family’s situations and employment-based coverage options are unique and this goes far beyond stereotypes of the “working poor”. My son could have suffocated from his pneumonia had we not sucked it up and rushed him to the hospital on Tuesday morning. If we were able to see a doctor a day earlier, he perhaps could have been treated at home as an outpatient with antibiotics. I don’t know what our final bill will be when we leave tomorrow morning, right now I don’t care. All I know is my son got better under the supervision of a wonderful team of nurses and pediatricians. My community has income-based charity care which will hopefully reduce our bill to a much more manageable sum. All minor details when the stakes are as high as your children’s lives. Plus, we can sleep in beds without motors.

*I firmly believe that if you took concerns about health coverage off of the table you'd see an explosion in entrepreneurialism. Soooo many people who hate their jobs/companies would strike out on their own to create something they've dreamed about, or they'd jump ship to someone else's enterpreneurial firm. Sure I could be wrong, but how many people do you know who've stuck with a job simply to keep their benefits? See what I mean? 

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