The Hidden Costs of the American Way of Healthcare | The Nation

Marie Myung-Ok Lee

Marie Myung-Ok Lee

Thoughts on arts, culture, medicine, politics—to name just a few.

The Hidden Costs of the American Way of Healthcare

(Reuters/Jose Luis Magana)

I grew up in a small town in northern Minnesota, which had one small hospital and one anesthesiologist—my father. Thus, I grew up watching him being called away from dinner for emergency c-sections, chainsaw accidents, appendix ruptures, you name it. This instilled in me a very real sense of how ill health or a catastrophic accident could be just around the corner—for anyone.

It seemed a bit at cross purposes that I planned as a child to be a novelist and wanted an employment situation that was stable and provided insurance. I also wanted to live in New York City, because that’s where the writers and publishers were.

I started planning early; in college, for my major, I deliberately chose economics because I felt that would give me the most flexibility in terms of job choices and make me the most marketable for a “real” (i.e., insurance-paying) job that would be remunerative enough for me to live in New York.

I worked first at Data Resources, Inc., an econometric forecasting firm that was part of McGraw-Hill. They specialized in the kind of multiple regression analyses that I used to write my honors thesis, “Economic Development and Women’s Labor Force Participation in the Third World,” and, as I did while writing my thesis, I more or less hated every minute of it.

Later, I moved to Goldman Sachs for a position in equity research, and also hated more or less every minute of that job, too, but not only was I paid well, including annual bonuses (which allowed me to squirrel away money for my eventual escape), I was also treated to the kind of gold-plated corporate health insurance that even we peons got a taste of. My McGraw-Hill medical insurance had been pretty standard, including some encouragement to join an HMO as a cost-saving measure. But at Goldman, not only could we see any doctor we wanted, we even had a full-time office to facilitate health-related issues: they handed out lists of near-to-the-office doctors who were recommended, they had preventive health resources, such as regular in-office skin cancer screenings, and it was as close to a frictionless, moneyless, paperless system as could be—no out-of-pocket premiums, no deductibles, no co-pays.

I also hadn’t had dental coverage at DRI, but now when I visited my East Side dentist not only was everything covered, including every-six-month cleanings and thousands of rads worth of X-rays, a couple of times I received money back because my dentist had somehow been overpaid by my luxurious plan.

During those years, I wrote by getting up at 4 am to get in a few good hours before my subway commute to work—for which I had to get in early and often did not leave until very late at night. By basically jettisoning most of my social life, I completed an entire novel, but efforts to find an agent and sell it were coming to naught. So I started on another novel and dreamed of a time when I could write full time. Goldman had a generous vacation policy, and I used one of my weeks to write—and ended up happily working on new my novel for the entire time. Clearly, I was ready to be a full-time writer, but the mechanics my life weren’t ready for me. Without health insurance, I didn’t know what I would do.

Sure, I rationalized, it’s soul-killing to force yourself to do a job you hate, but being at such a large, successful firm meant I could write and not have to live with the precariousness of a starving artist. One year, my boyfriend and I decided to go to Belize, and the Goldman nurse not only gave us free gamma globulin shots to protect against some kind of Belizean disease (and checked me for melanomas when I got back), but she sent us to the Stock Exchange, where they had a travel clinic for banking employees, and we received matching dengue fever shots. My boyfriend, who worked at an independent publisher, just took it all in, gawping.

Eventually, despite my lack of publication, my desire to write became more important than my full-time job and the security of its lavish benefits. A small fellowship for my novel-in-progress eventually was psychically all it took for me to launch Plan B. I took my accumulated savings and started myself on COBRA, which lets you pay out-of-pocket for your insurance for twelve months—but because this had always been an invisible benefit, I remember being shocked by the monthly amount. Further, Goldman has a separate plan for its top executives for which it pays about $40,500 in annual premiums per family—compare this with the median family income of $51,000 with 48 million Americans lacking insurance at all.

When I was on my own, I wasn’t able to afford any insurance that would allow me to choose my own doctors (or see any of my previous ones), so I joined an HMO, which was terrible—interminable waits in a waiting room that itself looked infectious, a doctor who was allotted five minutes to examine me and ascribed my headaches and fatigue (Epstein-Barr) to sinus infections and kept prescribing useless antibiotics. But after writing full-time with little to show for it, even that became unaffordable for me.

Eventually, I drifted to a “catastrophic” plan, which cost me about $5,000 a year, the money I earned by, well, doing freelance work for a different investment bank. That plan gave me some mental serenity—I’d be covered up to a million dollars if I was hit by a bus or had cancer. But being young and healthy, I didn’t realize that cancer or an accident could easily breach the million-dollar mark, and luckily I stayed healthy. Penny wise and pound foolish, I also skipped routine screenings and physicals, toughed out illnesses because I didn’t want to pay the money. If I were still at Goldman, I’d probably be happily having my mole screening done right in my office.

But here’s the rub: if I’d stayed at Goldman, I probably wouldn’t be writing this right now, either. And if the Affordable Healthcare Act had been around, I probably would have run out of there even sooner—maybe a novel or two’s sooner.

The GOP’s obstruction of Obamacare is cruel and illogical. Senator Ted Cruz and others keep insisting that what is more important is not to make healthcare accessible but to grow the economy so there will be better jobs.

However, that entrepreneurial and job-creating spirit they so cherish is stultified by our odd (the only industrialized country—with dozens of choices—that decides to do it this way) employer-based system. The most innovative and creative types tend not to fit well within the traditional corporate model. But if their healthcare depends on hewing to this model, it’s logical that they’ll stay put as a wage-earner instead of going out and starting a new company. Or creating the kind of art that 1 percenters will pay good money to see or acquire.

It would take me too long to catalog the myriad ways creative people I know have been compromised by our system. A diabetic friend has to shop for jobs not by the work but by the insurance coverage. A friend’s daughter wants to be a musician, but can’t afford the medicines she needs to take for a hormonal condition on her waitress’s salary. A number of friends’ kids can’t even find jobs, no less one that they find fulfilling and with adequate insurance coverage. We need to ask ourselves: How many Steve Jobs—who himself had very complex health problems—might we be losing because of our healthcare system?

I myself am now a full-time novelist and essayist beholden to no employer, so how did I achieve health insurance equilibrium? Senator Cruz famously and proudly announced that he doesn’t take any government handouts and that he opted out of the rather lavish congressional health insurance (one that doesn’t quit during furloughs and sequesters). I also worked hard and got my insurance coverage the old-fashioned way, just like Senator Cruz: I got married. Although, sadly, my spouse is an academic while Senator Cruz’s wife is a top-level executive at—wait for it!—Goldman Sachs. My spouse and I have pretty big co-pays. I surmise the Cruzes do not have to ever open their wallets at a doctor’s office.

Instead of focusing on taking and keeping healthcare away from people, perhaps we should take a minute to feel what having accessible healthcare can be. An American poet friend, New Yorker–published, had, for whatever reason, stopped writing for the last five years. She recently moved to Canada and recounted to me how amazed she was at how quickly and efficiently she was seen by the list of medical specialists that, in true American fashion, she had put off for years because of the costs. There was no six-month wait, she received excellent care, and she mentioned how strange and then how freeing it was to have no insurance paperwork or money changing hands. It almost seemed like healthcare was a right. Who knows if lifting this mental burden of worrying about healthcare made a material change in her life? But after she moved to Canada, she did start writing again.

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When I quit my job at Goldman, my colleague, Anne, an aspiring poet, had shared dreams of us leaving together. Poetry, of course, is even more of a financially perilous career than prose, and I understand why she stayed. Years later, she attended my first book signing. Still at Goldman, but I expected her imminent departure. I left New York to go on a Fulbright, and we lost touch shortly after that.

Recently, while going through some papers, I found some lovely, old-fashioned letters Anne had written me, as well as the drafts of a few poems she’d shared. Moving back to New York plus seeing the documentary Inside Job, which included many Goldman characters that populated our world, spurred me to try get back in touch with her. Google was my first stop, and I hoped it would reveal that some of her poetry had made it out into the world. Instead, I found her obituary. After she’d left Goldman, it said, she’d gone on to work for a pharmaceutical company. Insurance, I thought immediately. She was a responsible woman—her father was a doctor, too—the Obamacare obstructionists would say, see? She had healthcare, that was great. Is anyone but me going to mourn for the poems that went unwritten?

Read more from Marie Myung-Ok Lee on how Prabhjot Singh is breaking the cycle of hate.

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