Monthly Archives: August 2009

Why we should pay for health care but it shouldn’t be about business

(Click here to read about my personal health struggle and why I care so much about health care reform.)

All the talk about health care in the U.S. and how to pay for it had me thinking: What did people do before health insurance anyway?

I found many dates and theories by doing a Google search for “history of health insurance.”  (Listen to a brief history here, or read a detailed presentation here.)  But I wanted a more human, first-hand account, so I asked my mom, a member of the baby boomer generation.

Health insurance existed in the 1950s, but my mom doesn’t remember having it.  She said, “People didn’t go to the doctor for every little headache.  We took Bayer aspirin, Dristan for allergies,” doctors made house calls, there were nurses in schools and a mobile clinic visited neighborhoods.  Families depended on home remedies, like Vick’s vapor rub and a hot towel, a spoonfull of castor oil and on the Watkin man, who delivered both the world’s best vanilla extract and the world’s strongest cough syrup door to door from a truck.

From a historical perspective I have to remember, blacks weren’t always admitted to hospitals, even for the things we now take for granted as essential, like childbirth.  My mom was born in a house.  People knew then, but we’re even more certain now that giving birth is complicated and risky; hundreds of things could go wrong, and it’s best that a mother be surrounded by professionals who know how to handle the what-ifs.

And that’s what we’re paying for.  Advancements in medicine, research and technology cost money.  (That’s why I’m walking to raise money for lupus research on September 19.  Click here for more info.)  State of the art machines and facilities save lives and give comfort, and they don’t just build themselves.  If they did, every country would have them, and they don’t.  Medical treatment in the United States trumps that of almost every other country.

When you can afford to get treated.

There’s something inherently wrong about health care being a business.  It’s different from wellness, from doing basic things to prevent disease.  It’s hard to quit smoking, but no one is forced to start.  Clean water and soap are fully accessible in the U.S.  It’s free to walk outside for 30 minutes a few times a week, and even people in the smog-filled City of Angels do that on days when Santa Ana winds carry ashes from wildfires into their lungs.  Louisville’s own urban center is a food desert, but most people have easy access to fresh fruit and vegetables.  Beyond that, if you want the Bath & Body Works anti-bacterial collection instead of Softsoap on sale for a dollar, for example, or if you want to join a gym or buy exclusively organic, it’s your choice.  Having lupus or breast cancer or a broken leg or a debilitating personality disorder is not.  And to me, it feels wrong that diseases that cost you so much could also cost you hundreds of thousands of dollars to treat.  And never cure.

It doesn’t feel wrong because I don’t think doctors, nurses, aides, and medical technicians should be paid.  Quite the contrary; we pay everyone else for their skills, and if the technicians who run the machines and the doctors who diagnose us based on the machines’ results had to pay to learn how to accurately operate the machines and diagnose us, they deserve to get paid well for their skills.

It feels wrong because someone who is not in the business of saving lives can refuse to help you pay your highly-skilled doctors when you do get sick, even after you’ve paid him for months or years to pay those doctors when that happens.

It feels wrong because I have friends who are doctors, who took an oath to “apply, for the benefit of the sick, all (emphasis mine) measures [that] are required,” but who can’t fulfill the oath because their patients don’t want all measures because they can’t afford them.

It feels wrong because some of those same doctor friends participate in medical mission trips and use their own money to give all available care to people who have no concept of a statement of benefits or of a claim stamped “DENIED,” but in their own country, they’re limited by what’s covered by their health insurance.

It feels wrong to let people die for the sake of profit.

The next post is about my personal health struggle and why I care so much about this topic.  Click here to read it.

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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Let’s talk about health care – Part Two: More concerns, especially for the ladies, working or living life laid off

By Mariam Williams

“If a man will not work, he shall not have adequate health care.”  2 Thessalonians 3:10, NOECV (New Ongoing Economic Crisis Version)

I’m concerned about our attachment to employer-sponsored health care and the resulting fears and bad habits.  The above verse really says, “If a man will not work, he shall not eat,” but we behave as if health insurance as a standard benefit of regular, full-time employment were mandated by God.  We can’t imagine it being any other way, unless we are extremely poor or extremely old, in which case we already live with state and/or federally funded alternatives.

Yet, we don’t see how it traps us.  I know a brilliant entrepreneur who has often chosen to be someone else’s employee while running his own businesses just for the benefit of group insurance. I applaud a recent post on “Please Feed the Animals” for asking just how many other would-be entrepreneurs exist who desperately want to boost our economy and enjoy more time with their families but are afraid of losing their health insurance?

It’s a perk that I kind of miss for reasons you’ll see later, but the dependence on employer-sponsored health care coverage might be one reason the health of so many people in our nation is so bad.  It hit me just recently that employer-sponsored health insurance removes some of the individual responsibility to take care of yourself.  Do you smoke?  Are you overweight or obese?  A binge drinker?  Do you just like to see doctors a lot?  Are you into bungee jumping or sky diving?  Searching for health insurance on your own, every factor that you can control matters, as do many that you can’t control.  Smokers, the obese and the adventure-seekers pay more for individual health insurance.  If an employer handles it, the employer’s co-sponsorship portion goes up, but unless the company is forced to drastically cut costs, the employees never see the effects of their own behavior.  You can do as much damage as you please while someone else fits the bill, never fully understanding how much you’re costing everyone.

I discovered this about one month before I was laid off, when every employee at my former place of employment was required to re-enroll in or reject the company group insurance plan.  The plan had increased about $30 a month over the previous year.  I wasn’t happy about the cost increase, so I shopped around for alternatives.  A former health insurance agent advised me to go ask the human resources department just how much the company’s portion of the monthly premium is and to then compare the plan they offered to an individual plan with similar coverage.  He said I might be surprised at just how much the company was paying for each of us.  He went on to explain that along with all those factors we can control, participants in a group coverage plan also pay for other factors, like every coworker over the age of 45, every one with a pre-existing condition, all female coworkers still in their child-bearing years and all coworkers with children under 23.  The insurance company calculates the risk and, in my former employer’s case, a separate benefits company then negotiated a rate the employer felt was fair.

The HR manager wouldn’t tell me what that rate was, but I found out about a month and a half later when my COBRA letter arrived, informing me that I could keep the same coverage I was unhappy with for the low monthly premium of nearly $400.

You see, with COBRA, you continue with the group insurance plan.  You get your low deductible (although this particular plan’s out-of-pocket limit was still well into the thousands), $35 co-pays for office visits, free labs and your $15 prescription drug benefit. Your pre-existing conditions are covered.  You don’t have to get a physical.  You don’t have to sit on the phone for an hour with an underwriter who grills you about the medical records he has open right in front of him.  You don’t have to sign anything giving that underwriter permission to contact your doctors and find out if you left out anything.  If you’re pregnant, you’re still covered.  And for those conveniences, you pay what you didn’t know your employer was paying every month.

I, a healthy woman in her late twenties, had the option of paying a premium of $400 a month. And if I had had a serious pre-existing condition or if I had been pregnant, there wouldn’t have been many other options for me.  There’s just something wrong with that.

Even when the HR manager declined to reveal how much the company was paying, I had a feeling it was something ridiculous like that, and I started to get pissed off about it.  I was angry that I was in my late twenties, exercised daily, was petite, childless, ate right, rarely watched television, had never ever smoked anything, did nothing adventurous, and I was paying for everyone who wasn’t any of those things.  I think there’s something wrong with that too, and I’m concerned that a nation that doesn’t know about this stuff will continue to contribute to the astronomical cost of health care with its bad habits.

As a country, we have another bad habit that shows up more quietly in our health care system than it does in our economy, but affects health care just the same: we spend a lot of money on things we don’t need.  How much would each household save if they only bought the health coverage they really needed?  In my research on the group plan, I found the only prescription drug I used at the time for $9 at one pharmacy, and a prescription drug I had used in the past for $4 at another.  I didn’t need a prescription drug benefit.  I’ve shared my thoughts on children on this blog before; I obviously wasn’t trying to have any, so I saw the prenatal care and maternity coverage as being only for a shocking and nearly impossible accident.  I had no reason to see a doctor or a specialist several times a year, so although I appreciated the idea of a low co-pay just in case there came a time when I did need to see a doctor often, it frustrated me then.  I only opted in to the group health plan because the premium was pre-tax, and I would actually take home more money with the coverage.  The unemployed don’t have the pre-tax option.

As I end this venting session, I leave you with one more concern: adequate and equal health care for women.  When I met with the former insurance agent, I learned that my gender would complicate my search for individual coverage.  Did you know health insurance companies charge women more money just because we go to the doctor more instead of waiting until we’re near death like men do?  Did you know that birth control is never covered under an individual health care plan because (as an underwriter once explained to me) it’s seen as something for a lifestyle choice, not for a medical condition?  Did you know that’s bull, because some birth control does treat certain medical conditions?  Did you know that Viagra is covered under individual health insurance plans?  Do you know how difficult it is to find an individual plan that will cover prenatal care, labor, and the first seven days of an infant’s life?  Do you know of an individual plan that will pay for an abortion?

Did you know that the bill going through the House right now mandates that women can’t be charged more for their health insurance than men?

Do you trust the very insurance companies that treat women unfairly to be honest without a public option, or without any reform at all?

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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Let’s talk about health care – Part One: Why health insurance sucks when you’re living life laid off

By Mariam Williams

I was taught in a personal finance class in my senior year of college that most Americans use health insurance the wrong way.  I learned in the class that it should be for truly catastrophic events, not for covering the basics.  Seeing a doctor for your annual physical is health care, but health insurance is for the medical equivalent of a tornado turning your home into a pile of matchsticks.

The former you should be able to pay for out of your liquidity fund (six months of income saved up) or out of a health savings account, something you get with a high-deductible health insurance plan.  The latter you can’t pay for no matter how much you make or how much you save.  But because you have an emergency fund and an HSA, you should be able to pay a deductible of up to about $3000 to $5000 dollars with the latter option. So you get a high-deductible plan with a low monthly premium, pay your basic costs out of pocket, and use your insurance for a true emergency.

For instance, an annual pap smear and the lab fees for the results might cost a woman about $75 and $300, respectively, out of pocket with such a plan.  That seems crazy compared to the $35 office visit and zero-dollar lab fee in the insurance plans most Americans choose, but reasonable when you consider a woman would have paid about $600 total in premiums over 12 months verses $1200 to $1500 in premiums over the same amount of time with a more traditional insurance plan.  If the results of the pap are normal, she may not have to spend another dime the rest of the year.  If they reveal she has cervical cancer, she pays her monthly premium and a $4000 deductible, much of it from the money she has in savings, while her insurance company pays the remaining hundreds of thousands of dollars for her treatment.  (Assuming they don’t drop her when she gets sick.)

You save a lot of money each month, but there are two main problems with these plans: 1. They don’t cover pre-existing conditions, not before you meet the deductible, not after.  2. When you don’t have any savings or liquidity—like when you’re unemployed for example—these types of plans can keep you from seeking out the preventive care that may save you money in the long run and save your life.

I bring this up because it’s the kind of plan I’m on right now, and because it’s the kind of plan I’ve been kind of hoping a public option in health care reform would allow me to dismiss some time in the next five years.

I’ve stayed away from this debate for a long time, feeling like there was enough confusion out there without me adding my two cents to the milieu and feeling like I’m just complaining without offering any real solutions.  Now that the White House is backing off of its endorsement of a public option, and my congressman (hooray John Yarmuth!)  has pledged not to sign a bill that doesn’t have the public option, it feels more appropriate to voice my concerns, to say what I would like to see, even if I still don’t have any real solutions.

Am I concerned that the government might not be able to run its own major health insurance system efficiently?  Absolutely.  I’m currently in a government system that assists millions of people.  I’m on emergency unemployment compensation, and I’ve been frustrated with the errors, the long appeals process, the need to have special inside connections to reach someone over the phone, the length of time I have to wait at the unemployment office to get my questions answered when the special connection is out of the office, and with the fact that an unemployment insurance appeals court decided the state does indeed owe me money from October and November 2008 that I still haven’t seen. Employees in the unemployment office have told me they run into new situations they have no clue how to handle every single day.  And yet, if I didn’t have EUC, I wouldn’t have anything at all.  No way to pay rent and keep the lights on.  No way to buy food.  No way to pay my monthly health insurance premium.

One other benefit: all the flaws in EUC motivate me to keep job hunting and find something better, just as private health insurance companies – big, bureaucratic systems with long phone hold times, long appeals processes, and at least as many claim denials as state unemployment offices – will theoretically be motivated to be better if competing with a public option.

To read the remaining concerns, click here.

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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More black college grads are living life laid off

By Mariam Williams

About one week after I published my last post debating the merits of a four-year degree in today’s economy, CNN’s “Black in America 2” debuted.  The program featured a story on The Capital Preparatory Magnet School in Hartford, Conn.  Although most of the students are black or Hispanic and come from disadvantaged homes, they defy statistics: every single student graduating from the school goes on to college.

The following day I saw this recap of the segment, written by Javacia Harris Bowser for the blog Georgia Mae:

“During the program the principal of the school said “education is the great equalizer” and this is a statement in which I truly believe. Most of the life experiences and opportunities I have had and the self-confidence I hold are all results of my education. …

But one of my buddies brought up a very valid point — today many college graduates are drowning in debt and unemployed thanks to our country’s economic downturn. So is education really the great equalizer or just a waste of money?”

I answered:

“I think my thoughts on the value/futility of education are well known, but I must add a couple of caveats to my usual rants: 1) … The current economic climate is a pretty unusual circumstance. 2) There is absolutely nothing else you can encourage children in poor or otherwise disadvantaged backgrounds to do to emerge from poverty other than to get an education …” (read my full comment here)

A few days later, I opened my July 2009 issue of Black Enterprise (I know I was late) and found this statistic: the jobless rate for African Americans with four-year degrees was 7.2% in March 2009, up 4.5 percentage points since March 2007, before the recession hit.  (My, that seems so long ago!)  Compare that to a jobless rate of 3.8% in March 2009 and 1.6% in March 2007 for white Americans with four-year degrees, and you have to ask (again), is education really the great equalizer or just a waste of money?

As we can see through the above statistics, it’s neither, at least not in this economy.  The jobless rates in March 2009, without regard to educational attainment, were 7.9% for whites and 13.3% for blacks.  (In March 2007, the numbers were 3.8% and 8.4%, respectively.  Jump to the table at the end if any of that was confusing.)  Evidently, higher education does make people of every race considerably less likely to be unemployed, but certainly not equally less likely to be unemployed.

Reasons these statistics are what they are will be or have been debated on another blog at another time.  The real question for me is, should we continue to hype education, especially to black youth, the way we do? To commodify it as the single, strongest, most assured pathway to professional and financial success?

For some perspective, I turned to Andrea Houston, president of the Education First Foundation and founder of its main educational program, the Showcase of HBCU.  The Showcase is a college and career fair geared mainly toward African American youth.  “Educating students about the need to make education their first priority” is among the program’s objectives.

Houston called the lack of job opportunities for college graduates in the current economy an American issue, not just a black one.  Having recently discussed the subject with other local members of the National Association of Women Business Owners, she said, “the ladies of NAWBO are still sending their children to college, so we have to still keep sending our socio-economically disadvantaged students to college—those who are college material.”

Houston recommended that those who are not college material “do the Booker T. Washington thing and get a skill” but warned that a degree could be “the weed-out process for the next blue-collar generation.”  She said, “We’re not going to have a blue-collar generation; it’s going to be green-collar, and they’ll want to know that you have some type of education.”

And although that type of education will probably be through an associates degree or certificate program at a community college and not a four-year school, Houston can still head the Showcase with confidence.  Referring to children from at-risk populations, she explained, “You can’t just tell them to work hard.  You have to still show them opportunities.”  As The Capital Preparatory Magnet School proves by sharing its campus with a community college and allowing all students to take college-level classes, when you expose kids to opportunities, it occurs to them to take advantage of the opportunities.

I can’t quite call education “the great equalizer.”  It’s not the end-all, be-all for professional and financial success.  And even though I’m among the 7.2 percent of college-educated blacks over 25 who are living life laid off, I don’t think education is a (complete) waste of money either.  I had higher expectations of my degree, but I’ve also had more opportunities—some I didn’t take advantage of—and I’ve been exposed to more positive influences than anyone from my lower-class neighborhood who didn’t go to college has been exposed to.  I’m certainly a better researcher and statistician for my time, and perhaps a better writer too.  But to be employed in a job that requires a college degree and more than pays for the outstanding loans I took on to obtain it?  At this point, only that will erase all my doubts.  Until then, I won’t hype education or commodify it, but I still won’t tell youth from disadvantaged backgrounds anything different.

(And as much as I would sometimes like to, I won’t follow this example and sue my alma mater either.)

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Unemployment rate by race and educational attainment, pre-recession and during

March 2007     March 2009

Black college educated                                   2.7                   7.2

White college educated                                  1.6                   3.8

Black general pop                                           8.4                   13.3

White general pop                                           3.8                   7.9

All numbers reflect the seasonally adjusted rates

General population is ages 16 and up

Jobless rate by educational attainment available for ages 25 and up from the Bureau of Labor Statistics

Black Enterprise cites the Economic Policy Institute for its statistics

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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Would you RATHER be living life laid off?

By Mariam Williams

I’ve had jobs I loathed so much that I would cry when my weekday alarm clock signaled the time had come to get up and get dressed to go to the office of misery.  Is unemployment better than that?  Definitely, even with all the hassles of sitting for hours at a time at the local unemployment office, all the glitches in the system, an automated system that only understands hourly work, never being able to earn extra income, and knowing I’m one out of something like 10 million people.  But it’s only better because I can still afford all the food I need and like, and I can still pay rent and most of my monthly bills without familial or charitable assistance.  If that weren’t the case, I would probably be waking up and crying just as hard as I once did over a depressing, unfulfilling job.

Since October 2008, I’ve tried to avoid going back to that situation by not applying for jobs that I know would leave me depressed.  (I’m presently wondering if that’s the reason there are supposedly millions of job openings out there that the unemployed aren’t filling.)  I have focused instead on jobs that match my interests, experience and skills, and even ones that I think would be fun.  For me, that’s the ideal: fun employment.

Not quite the same as funemployment, a new term I learned from an article in Sunday’s Courier-Journal.  The funemployed have learned to enjoy their employment hiatus by spending time with their children, on their hobbies or at various, mostly free attractions.  From what I gather, all of the funemployed featured in the article share my mindset: they’re still paying their bills on time and taking care of the essentials first.  And one has the enviable position of having a gainfully employed and supportive spouse who’s bringing home enough for the family.

Understand, I’m not saying housewifery—or house husbandry—or lollygagging along on government assistance is the ideal setup for every American household.  I am, however, suggesting that the ideal isn’t just to have a job that’s fun to go to every day; it’s to have a steady source of income and the time and ability to enjoy your passions each day, even if you don’t go to any job anywhere.

Puzzled as to how to be funemployed?  It’s really just a combination of a positive attitude and knowing how to fill your free time now that you’re living life laid off.  Here are some suggestions.  I’ve obviously done number 13.  Numbers 37, 41 and 84 are quite useful.  And I strongly recommend AVOIDING number 46, but clearly it’s all up to you.

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© Mariam Williams, aka The Pink-Slipped Girl, and The Pink Slip Blog – Living Life Laid Off, 2009. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Mariam Williams and The Pink Slip Blog – Living Life Laid Off or http://livinglifelaidoff.com, with appropriate and specific direction to the original content.  Any use and/or duplication of any photo contained within this blog without express and written permission from Mariam Williams is strictly prohibited.

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Filed under Mental & Emotional Health, money, Unemployment