I was going to write about this later, but I just had a woman cry on the phone to me about this, so I don’t want to put it off any longer.
I’m a writer. (No kidding, right? Check out the images of book covers all over my website.) As a pro, I get all sorts of things from Random House, my publisher: I get deadlines, and publication dates, and a smart editor who gives me fantastic notes, and a copyeditor who cares about the difference between “among” and “between”, and publicity, and front-of-store displays, and a beautifully-designed book (seriously, wait till you see the inside of GAME OF CAGES) and I get those covers. Did I mention the covers?
What I don’t get from Random House is health and dental benefits for my family. I’m an independent contractor to them, not an employee, and we currently have a (mostly) employment-based health care insurance system.
My wife has a pretty good job (and is damn good at it) but she doesn’t get health and dental–not that we’d want it. Her employer has contracted with a terrible plan.
That means I have a day job. It’s part-time, but I the basic health care insurance is my only reason for staying. It costs, when I combine my employer and my contributions, over $1,600 a month. What is this part-time job? I answer phones for a primary care clinic.
Which is why I just listened to a woman crying on the phone, because she wants to get immunizations for her 18 year old son, but we don’t take her insurance. She’s out of work, divorced, and caring for two teenagers; she’s fallen on hard times and is getting state insurance for the poor. We’ll take Medicaid for children, but can’t accept any more for adults.
Why? Because the state doesn’t pay very much for those patients’ care.
Before you get to thinking about all the filthy profit we’re raking in, be adviced that not only are we a non-profit clinic, but we lose nearly a million dollars a year. The foundation that funds us expected to lose this much. It’s business as usual. And while we are required to see a certain percentage of state patients, we actually see well above our quota. Profit? Not so much.
And now a personal story. Two years ago my wife, son and I visited friends in British Columbia. While there, my son became sick. We took him to the local clinic. How much did this cost us? Well, since we’re Americans and not on (Canadian) Medicare, we had to pay $60 CDN for the visit.
At the U.S. clinic where I work, it costs $125 for a patient without insurance just to walk in the door. What’s more, that’s just a deposit against the cost of the visit–if the entire cost of the visit comes to more (and it almost always does) we send a bill. And what I’ve been told is that the $125 basically covers the insurance the clinic needs in case the patient stiffs them.
The health care we have costs more. The insurance is more easily lost (and in this time terrible recession, many many laid-off workers have lost their insurance) because it’s tied to employment.
Have I mentioned that I’m about to be laid off?
I’m “lucky” enough that I’m one of those who’s going to be rehired (after being outsourced to the state). I’ll have the same shifts, and new but roughly equivalent benefits. Unfortunately, I’ll be a state employee; good thing state payrolls are so stable right now, hey?
Of course, the Affordable Care Act is coming, and even though a lot of people are worried about it, I’m provisionally excited. Currently, the private, non-employer-based market is a DMZ. Maybe, though, the reforms will work. At least partly. Maybe, come 2014, the regulated independent insurance markets will be sane enough that I can become a self-employed person, a full-time writer, an entrepreneur.
Until then, I’m locked into this job, where mothers weep into my ear over their sick children, when I could be working on my next book.
 And that’s always how the costs should be calculated. It’s all part of an employee’s conpensation.