Health Insurance and Downgrading Your Job

In April 2010, my wife made the choice to step away from her job for the rest of the year in order to be a stay-at-home mom. She chose that period because she knew that she loved her job and that she would be itching to return after nine months.

Her employer made it possible for her to return to her previous position when her leave period ended, which was very gracious of them. Of course, that left us with a period of eight months without health insurance coverage if we did not pay out of pocket.

During that period, my income and our savings paid for our health insurance out of pocket. My wife was able to enjoy a period of staying at home with the children – and it was quite enjoyable for all of us. Our oldest child attended morning preschool and our three year old attended thrice-a-week morning preschool, but aside from that, the five of us were at home. My wife spent time with the kids and I split my time as best I could between work and spending time with all of them.

At the end of that period, my wife chose to return to work, not because we needed her income or her health insurance coverage, but because she missed the joy that she gets from her work.

During that period, the health insurance was a serious expense. If it were not for our living expenses being as low as reasonably possible and having a very healthy emergency fund, we would have really struggled to make this work. As it turned out, the reality of that period showed us that we could have done it for a few years, but my wife wanted to return to work at that point, making the question moot.

A more detailed explanation of the affect downgrading your job has on your health insurance exists in The Simple Dollar’s Guide to Health Insurance, but I’ll briefly go over the main points here:

1. Plan ahead for your health care needs. Where are you going to get health insurance from if you make a major career change? This needs to be one of the first things you think about, and it becomes more urgent the older you are.

2. A married couple only needs one person with insurance. Self-employment is much more difficult if you’re single because you don’t have a spouse’s insurance to rely on. It’s perhaps not fair (I don’t believe it is, but I don’t have a better idea that doesn’t involve a great deal of government interference), but it’s simply the fact of the situation. If you’re single, self-employment means that you have to come up with your own insurance. If you’re married, you can rely on your partner’s insurance (assuming they have them).

3. Never, ever burn bridges. When you make that leap, you may find that you wish to return to your previous career path if the new path doesn’t work out. Never, ever burn your bridges on the way out the door. Do everything you can to make the transition as smooth as possible and leave with good relationships with everyone. While this won’t mean you’ll get your old job back if things don’t work out, it does mean it’ll be easier for you to return to that career path if you need to. That’s a great hedge if you find out that health insurance isn’t working out.

4. COBRA can really be your friend. COBRA isn’t just G.I. Joe’s nemesis. It’s a federal law that, if you worked for an employer with more than 20 employees, ensures that if you quit your job, you can continue your current health insurance plan for up to eighteen months if you pay the premiums out of pocket. That can be incredibly valuable for a potential entrepreneur.

5. A healthy savings account is absolutely vital. Of course, the key is that you will have to pay premiums out of pocket under COBRA. That can be quite expensive, so the best route to take is to make sure you have enough money saved to cover that insurance for you and your family if you do downgrade your job. Know how much your total premiums actually are and plan for paying for that amount out of pocket. The passage of the Affordable Care Act has opened up other savings accounts: health savings accounts (HSAs).

Obviously, you can shop around for your own insurance and you may be able to find a better package than what you’re able to get through COBRA, but in either case, your savings is vital. It can make the difference between having health care insurance and not having it, and that can make the difference between success and failure.

6. SCHIP and Medicaid are also potentially vital. Both of these plans offer health insurance for low income folks, particularly children. I won’t get into the details of these programs, but if you see a major downward change in your employment coming in the future, you’ll want to know more about these plans.

The key, as always, is to be proactive. Such programs won’t magically appear on your doorstep. You have to be proactive and seek out such solutions. It might take a lot of phone calls, a lot of emails, and a lot of time to find out the details about such programs, but it’s far better to invest that time and effort now and ensure your coverage than to go without.

A final note on the future As I write this, the future of national health insurance in the United States is up in the air. While I am unsure about the specific provisions of the Patient Protection and Affordable Care Act (often termed “Obamacare”), I do think that some form of universal access to health care rather than the piecemeal system we have now would be very beneficial to everyone involved. It would allow entrepreneurs to jump into business plans that they might have otherwise avoided. It would also allow manufacturers to be competitive with overseas manufacturers who do not have to shoulder health care for their employees. While I’m not a politician who has to balance the beliefs and voices of a very wide political spectrum (and I’m glad of that), I do think that everyone – rich and poor – benefits if we work on finding a good solution to the health care problem rather than bickering and fighting and name-calling.

If you want to jump into self-employment or downgrade your job, let your congressperson know that you’re a potential entrepreneur in his/her district that would find starting a small business much easier if there was a palatable solution for health care that makes entrepreneurship easier and more accessible to everyone. There’s money to be made there for everyone involved – the entrepreneur and the health care provider.

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  1. Ryan says:

    Can you explain the discrepancy between “I don’t believe it is, but I don’t have a better idea that doesn’t involve a great deal of government interference”

    and

    “I do think that some form of universal access to health care rather than the piecemeal system we have now would be very beneficial”

    That sounds exactly like a single payer system, which by definition would require an entity like the government.

  2. Gretchen says:

    Here we go again with the vague polictics on a blog were you’ve stated you don’t talk polictics.

    I don’t know how anyone affords Cobra.

  3. Johanna says:

    Good point, Ryan. I got to the “government interference” line, rolled my eyes, and stopped reading, so I didn’t notice at first that the article ends on a very different note.

    Still, blaming the problem on “bickering and fighting and namecalling” ignores the fact that one of the two parties has at least some interest in implementing a solution here (although it sounds like Trent might even be well to the left of most of them), whereas the other one does not (or at least hasn’t since the early 1990s, when they proposed a system very much like what we’re now calling “Obamacare”).

  4. Amanda says:

    I think Trent makes a good point about how much potential entrepreneurship is being stifled because of worries about health coverage. I don’t claim to know what the perfect solution is either, but I think you’d see a lot more startups if people weren’t so afraid of losing coverage or not being able to afford coverage.

  5. Telephus44 says:

    I’m really glad that you put in point #2 about only one spouse needing insurance. The same thing goes for 401K and a steady paycheck. So many of the “Oh, quit your job and follow your dreams!” pieces really fail to emphasize that a lot of the reason people can afford to do something like that is because they have a spouse who is willing to get a normal job with a dependable paycheck.

  6. Josh says:

    On the flip side to #2, insurance is also a lot cheaper if you only have to insure yourself and not a spouse/family as well.

    I can get a high-deductible plan ($5,000 deductible) for less than $100/month, but am still covered for any catastrophes. Luckily, I am still young and in good health without any pre-existing conditions, and rarely need to go to the doctor. If I need to make an appointment (say to check for an ear infection or strep throat or something) I just pay the $200 or so it costs for an office visit. One free physical is included per year with the insurance as well.

  7. valleycat1 says:

    I’d take Trent’s step 1 a bit farther – actually complete an insurance application or two.

    When we tried to get insurance on our own several years ago, the insurance company misinterpreted medical records on both of us and refused to insure us even after our doctors supported us by writing additional info for our appeal. In one case the insuror had actually misread the name of a condition as one that was much more onerous than the actual one, and refused to admit they were wrong.

    Even if the preexisting condition exclusions go away, there isn’t any guarantee they won’t hike the premium if you have one, or if they think there’s something in your record that indicates you might be in the early stages but undiagnosed.

  8. Interested Reader says:

    I’ve been on COBRA, it wasn’t cheap but I didn’t really have a choice. Then COBRA expired and I had a job with health insurance that didn’t cover mental health care so I had to go on a “non group” plan with my HMO and that got to be really expensive, I needed some assistance from my family to pay for the bills.

    But like I said I didn’t have a choice.

    Or rather I had a choice of going with an insurance that didn’t cover mental health and paying for my prescriptions and doctors appointments out of pocket (appx $1000/mth for prescriptions) and then if I did get better insurance or could go back on the HMO deal with having a non covered pre existing condition where I could be denied coverage OR I would have to wait 1 year before getting covered.

  9. trish says:

    This was one of my first questions to myself when I started reading Trent’s latest series of articles.

    “But what about health insurance?”

    It would be amazing to see the number of self-employed workers if we didnt have to collectively worry about health insurance.

  10. Matt says:

    About four years ago I quit one job and started another. I was without health insurance for about a month during the transition. I looked into COBRA: it was $600/month to continue on my previous plan! I was young and in good health, so just chanced it; fortunately, nothing happened. But $600/month for a young person in good health with no history seems outrageous; I can’t imagine what it would cost me now (wife and two-month old).

    I think the health care controversy in the USA is interesting. Most people seem to agree that the current system is broken, but few people agree on how to fix it. There are just so many facets to the problem. And enormously complex problems like this are hard to quantify; people argue to no end about small pieces of the larger problem.

    To me, a capitalist health system effectively says that rich people are more worthy of life than poor people. That is, if you are rich, or at least employed with good health benefits, you have easy access to the best health care. But if you are poor and/or without insurance (the two often go hand in hand), then—at least in theory—illness could end your life.

    On the other hand, I see the argument against government-run programs. There’s fundamental issues of corruption, transparency, fairness, etc. that come up in any large organization, regardless of the issue. And the philosophical question, “what is the true role of government?” These problems have yet to be solved and there’s no unanimous agreement on the answer to the philosophical question.

    The reality of life now is: make sure you have health insurance of some sort!

  11. David says:

    I am not sure there is a very strong correlation between the percentage of a country’s workforce that is self-employed and that country’s healthcare system. In the USA under Fascist medicine, about 14% of the workforce is self-employed; in the UK under Communist medicine, about 14% of the workforce is self-employed.

    Since, however, the self-employed represent about two thirds of the total number of American millionaires, it is possible that most of them don’t need Obamacare.

  12. Johanna says:

    @Matt: For what it’s worth, rich people get better healthcare than poor people even under the various flavors of government-run systems. For example, in the UK, the NHS doesn’t cover everything. If you want some treatment that they don’t cover, you can have it, but you have to pay out of pocket (or use private medical insurance). Even if a government were to take the draconian step of forbidding doctors from offering non-covered treatments, rich people can travel to other countries for medical care.

    For many of the reasons you mention, I would have been really interested to see the US adopt a system with a public option. Not a watered-down public option (that’s only available to 2% of the population), but a real option, where anyone who wants to can buy into a Medicare-type system, run by the government but funded only by premiums. Or, if you’d rather have insurance from a for-profit company, you can have that. That way, we could see once and for all whether government or corporations provide a better deal.

  13. DOT says:

    I was set to fully retire early at the end of 2011 until my husband was diagnosed with Cancer last year. After a year of chemo it has not returned, however I can’t even imagine the cost of private health insurance with a pre-exisiting condition of Cancer.(Cobra would be $1452.00 per month for both of us)
    I have since decided to work another year at full time, to hopefully “put away” close to 100k for future medical bills / insurance.
    At the end of 2012 my husband will be eligible for medicare through his SS Disability, however I will feel much better knowing we have extra cash for any procedures / bills not covered by medicare..and increases in my health premiums.
    Fortunately,we are still in a position to retire in our upper 50’s, but it is just a shame that many financially responsible people still have to work well into their 60’s JUST to have health insurance because of certain illnesses or pre-exsisting conditions that would otherwise not be covered ( or affordable) with private insurance.

  14. Cristina says:

    I don’t understand why you would recommend COBRA so highly to someone looking to willingly quit a job. It’s so ridiculously expensive, and the only advantage I think it has over an individual health insurance plan is that it covers preexisting conditions. But then someone with a preexisting condition would probably not take the leap to self-employment without a spouse whose insurance to rely on.

  15. cv says:

    If only point #2 were true for everyone. I can’t be on my wife’s insurance, regardless of our legal marital status, because we’re a same-sex couple and she works for the federal government, which won’t allow me to be on her plan.

    Sorry to insert what you probably would classify as “politics,” but it’s a reality for me that I can’t downgrade my job unless my wife changes hers as well.

  16. Kevin says:

    Trent wrote “As it turned out, the reality of that period showed us that we could have done it for a few years, but my wife wanted to return to work at that point, making the question moot.” Choosing to not have medical insurance is a huge gamble. You may have been able to sustain this for “a few years” with whatever health issues you faced during the period, but just one truly significant event could wipe you out. I have close friends whose 6 year old daughter was just diagnosed with Acute Lymphoblastic Leukemia (ALL). 2-3 year treatment outlook. Gonna cover that out of savings and income? I don’t think so.

  17. valleycat1 says:

    #16 Kevin – I think Trent is saying they COBRA’d his wife’s insurance & paid their premiums themselves after she officially quit the job.

  18. Amy says:

    Isn’t COBRA based on the premium your employer paid plus a small surcharge? I’m thinking 2%. That doesn’t seem that much more expensive than getting your own policy. What am I missing that makes it “ridiculously expensive?”

  19. Telephus44 says:

    Amy, yes, you are correct. The problem is, oftentimes your employer’s costs are very high. Here in MA, our insurance company is required to tell us the cost of our insurance yearly. I pay about $260 a month out of my paycheck, but the actual cost of my insurance is just over $1200 a month. My employer picks up the balance. So to me, paying $1200 a month for COBRA coverage is ridiculously expensive.

  20. Quick question: You mention this wouldn’t be sustainable over the long-term. Does that mean that the cost of health insurance pushed your monthly expenditures beyond your income (thus, spending more than you earn?)

  21. Kristina says:

    I live in Canada, and after reading threads like these I am very grateful for our national health care. I have been self-employed, but have now returned to being an employee, health care was never even considered in the decision. My health will never bankrupt me or my family, and its expense will never limit my options. That piece of mind is worth far more then the taxes I pay for it.

  22. Tom S. says:

    Coupla things that would really help:

    Allow us to buy insurance across state lines.

    Allow us to buy whatever type of coverage we want. A person that is sterile shouldn’t have to pay for a policy that covers birth control.
    In my state, I’m not allowed to buy a high-deductible policy, ostensibly because the state is afraid that paying the deductible might make me go broke. Instead I’m guaranteed to go broke paying the high premiums of a low deductible policy.

    Disconnect health insurance from employers – Make all health care costs including premiums exempt from income and FICA taxes, just like the “employer-paid” portion is right now.

    Allow any organization to form a “group” for the purposes of purchasing group insurance and negotiated rates with providers.

    All these things “cost nothing” and increase liberty.

  23. Courtney20 says:

    @Steven #20 – I think the answer to that question is obvious, because he says right in the 3rd paragraph “…my income and *our savings* paid for our health insurance out of pocket.” (asterisks mine)

  24. Rebecca says:

    For most emlpoyers, the company pays a significant amt of the premium for the employee. Sometimes as much as 80% or more. So for our family of 5 our portion of health ins through my husb’s company is about $110 ever 2 weeks. But our payment is only %20 of the premium. His company covers the rest. For us to pay the $1000 or so out of pocket every month just for premiums would be impossible, especially if he was out of work. That amt is more than %30 of his take home income.

  25. Riki says:

    @#21 Kristina,

    AMEN! I am so thankful to be Canadian. I can’t even imagine worrying about the cost of healthcare or having my treatment options limited by what I can afford to pay. If I need treatment, I receive the best care possible. Period.

    Why is a single-payer system so frightening to Americans?

  26. Maureen says:

    I’m with you Kristina. I’m so grateful to be Canadian.

  27. I’m in an HMO and I pay $338 a month for a plan with a $1,500 deductible. Mammograms and annual checkups are included, and my generic maintenance meds (thyroid, blood pressure) are free; however, each time I visit the doctor there’s a $30 co-pay.
    And here I thought I was being overcharged. It sounds like I’m getting a bargain.
    Insurance is vital in this country but I know people who don’t have it. Their “preventive care” is mostly praying that they don’t get sick.

  28. Interested Reader says:

    RIki -it’s complicated and very political. Some people don’t like the government being involved in their lives too much. Some peole are worried there will be “Rationing” or restrictions on procedures or which doctors they can see (this already happens in the current system , it’s just businesses that make the decision). For a lot of people it’s too close to the European system and they don’t like that.

    Plus the insurance industry pours who knows how much money to make sure the current system stays teh way it is.

    There’s more to it than what I’ve said but it’s very complicated, very emotional and very political.

  29. Josh says:

    @Riki,

    Unless you are going south whenever you need treatment you are not getting the best care possible.

  30. jim says:

    In point 5 Trent talks about a “health savings account”. I’m not sure if Trent means an actual Health Savings Account (HSA) as defined by the IRS or if he just means an ordinary savings account you use to pay for health care. An actual HSA has specific rules to setup and use. You can use an HSA for COBRA but you can not use an HSA for normal health insurance premiums. An HSA is a good way to pay for COBRA since the HSA is tax sheltered, but you have to have an HSA eligible insurance plan and then fund the HSA in advance and that could take years to do.

    When you compare COBRA to individual policies make sure you do true apples to apples comparison. Most individual policies I see have pretty HIGH out of pocket maximums compared to my current insurance through work. So while COBRA premiums may seem to cost more at first glance the deductible and out of pocket max are better. My COBRA premiums are actually pretty competitive to individual policies that actually offer the same level of coverage. Plus I know the policy I have now is pretty good coverage and the individual policies seem to lack lots features in coverage and have more limitations. Of course it may make sense to pay $300 a month for a high deductible plan without some of the bells and whistles rather than paying $800 a month for COBRA with lower deductible, etc. But thats a financial choice you’d make based on the risk and policy you can afford, not a reflection of COBRA sucking.

  31. Riki says:

    Josh – how do you know?

    Is the Canadian system perfect? No, of course not. But I’ll take it a million times over anything like the American system.

  32. Carlos says:

    I’ll give another alternative. If you can work remotely, then just move overseas to a country that has a better system. I lived in Japan for 16 years and they have a national health plan. Quality was very high and very very low cost. I had reverse shock when I returned to the US.. always thinking ‘we have the best in the world’ Once I saw, for my own eyes what was possible, I know realize we are in a system that will keep getting worse and worse. Of course, its a 2 way street so we need to do more to be healthy. Keep up the good recommendations.

  33. Stephan F- says:

    The problem is that single-payer is a monopoly, particularly a government monopoly, and those always go bad. There are plenty of horror stories coming from single-payer countries, like the guy who called 911 for a glass of water and then died of dehydration while in the hospital, to warrant caution.

    The whole medical & insurance market is badly distorted and not even remotely like a free market. #22 ideas would be a good start. Obamacare just made it worse.

  34. jim says:

    For periods of less than 1 year a Short Term Health Insurance policy can be a very good deal.

    for example : Right now my COBRA premium would be about $625 a month. Or I could get 6 months of similar coverage via a short term policy for closer to $125 a month. Thats $500 a month cheaper! The short term policy may cut some corners for example they don’t seem to have maternity care. But overall a short term policy can be a very good deal for this kind of situation where you know you are going to be out of work for X months. My wife and I got a short term policy for her before we got married to bridge her into coverage under my plan. We paid a couple hundred for a few months of coverage.

  35. Courtney20 says:

    @Stephan F – that guy didn’t die because of single-payer health care. He died because of lousy nurses and/or a lack of communication among the staff of that particular hospital: no one checked his charts to see that he hadn’t been given fluid-regulating medications, and by the time he was delirious from dehydration they thought he was just being belligerent. Guess what – medical mistakes (and I’m talking about the kind that hospitals are liable for like this one) happen in the US too.

  36. Amanda says:

    My husband is a postdoc and makes a little less than 40k a year. Because of the screwy way postdocs are paid, he pays out of pocket for his insurance and they give him a stipend to cover it – it is about 1200 a month, I think. So, for the IRS our income looks more like 50k a year because we actually get paid a lot more including the stipend. So, now I see how much it really costs. The same works for pretty much everyone else’s job – it’s just not as transparent. You actually make an extra 10k a year or so, but it’s all on benefits. Collectively, Americans spend A LOT on health care. It astounds me. My British friend was complaining about how high taxes they pay so their post doc salary doesn’t go as far, but I think when you figure in the taxes we pay PLUS the amount we pay on health insurance, we are probably paying more.

  37. Interested Reader says:

    @Stephan, I have a cousin who died of a heart attack at age 34. He didn’t have health insurance because 1) he had pre existing conditions and wasn’t insurable and 2) in his chosen career he was considered a “contract” worker and his employers didn’t have to provide insurance. So he didn’t have insurance. He only went to a walk in clinic if it was a dire emergency.

    I won’t go into the details but he complained of his stomach bothering him and some weird pains. Then he had a heart attack and died, he was dead before the ambulance could get to the hospital.

    It came out afterwards that for a couple weeks he’d been complaining of the same symptoms. But it didn’t seem like an “emeregency” and because he didn’t have a regular doctor he just waited.

    Because he didn’t have insurance coverage he was worried about the cost of tests and doctors visits. If he had insurance he wouldn’t have had to wory abuot that.

    I can’t say that if he had insurance he would have definitly gone to the doctor, I don’t know that.

    But he may have been more willing to go.

    But I can’t help always wondering if he had insurance and he’d gone to the doctor maybe he wouldn’t have died.

  38. Andrew says:

    I’m very gratful to live in Massachusetts. In 2008 and 2009, I went through a period of severe underemployment–and yet I still made far too much for traditional Medicaid. Were it not for the state-subsidized insurance available through the health connector, I would have not been able to afford any health insurance at all.

    Long story short–I ended up needing an angioplasty and sn arterial stent. Had I not been insured I would have probably ignored the warning signs of heart trouble, crossing my fingers and praying for the best.

    Need I add that in Mass you cannot be denied insurance because of pre-existing conditions?

    By far the finest thing Mitt Romney ever did, and now he’s running away from it.

  39. jim says:

    I had said : “In point 5 Trent talks about a “health savings account”.”

    OOps… I just realized that Trent actually said “healthy savings account”

    I read “healthy savings account” and thought he said “health savings account” aka HSA. My mistake.

  40. Kristina says:

    @ Amanda – I agree, I don’t think your free enterprise health care is getting you good value for your money. Our canadian government monopoly gets us pretty good universal health care, and and our total tax cost is comparable to your health care costs alone. I pay 1500/month in taxes ~ 24% of my gross income take a lot of your cobra amounts above and add them to your taxes and you probably are paying more… and I’m not convinced you all get more.

    And another point, if people who can’t afford it don’t go to the doctor and get preventive and/or early treatment – they end up as expensive emergencies.

  41. Courtney20 says:

    @ Kristina – you are absolutely right. There was a case in my state several years ago where a mother was a) unable to afford preventative dental care for young son out of pocket and b) unable to find/get to a dentist that took the mediocre CHIP coverage offered by the state. The boy ended up with an abscessed tooth that ultimately infected his jaw and then his brain. After nearly $100K of emergency medical care and surgeries (which ultimately got absorbed by the hospital and the state taxpayers), he died – all for want of a couple $100 check-ups.

  42. Laundry Lady says:

    My family has done Cobra, we’ve bought our own insurance and been without coverage. Right now we have a family plan through my husband’s work, but we pay most of the “family portion” of the premium. We would be paying 1/5 as much if it was just my husband because his company picks up a larger portion of the premium for single workers. That being said, the real cost of healthcare in America is one most consumers don’t see and no one will talk about: law suits. Malpractice insurance eats up 60-80% of the overhead of running a medical practice, more in specialties like OBGYN. Until there is serious tort reform, the cost of medicine will continue to rise. No amount of government sponsored plans or single payer systems will chance that, and since Washington is mostly filled with lawyers, now working as politicians, no one is willing to seriously address it. People gripe about the “evil” doctors who get “paid too much” but it isn’t the doctors making the mega bucks anymore, it’s the malpractice lawyers. I realize that malpractice can be a real thing, but doctor’s are also human, and to ask them to be otherwise is unfair and unrealistic. Americans love to sue over anything under the sun, but few are willing to consider how much it costs us all in the long run.

  43. Leah says:

    I buy my own health insurance @ $150 a month (with no maternity coverage and a high deductible after I have $1k worth of office visits). This definitely hampers my cash flow. I only afford this expense because I’m super frugal in most other ways.

    Count me in on the people who would like to see more competition in the health care market OR a single payer health care system. I’m doing fine right now, but I know that I can’t keep “doing my own thing” (read: pursuing jobs and self-employment that is fulfilling) when the time comes to have kids. Thus, I’m now back in school getting more education to prepare myself for a better career path that will provide health insurance.

  44. Sharon says:

    #15–
    I don’t think this is a gay/straigh issue. I was working at an hourly shift job and had health insurance. My father who had cancer and was debating about treatment based on cost he did not have helath insurance.
    My roommate whose boyfriend left here was pregnant without health insurance.
    I was working more shifts than my co-workers because I didn’t have children to care for, but I didn’t have access to the same amount of benefits thay did. I would have loved to have paid for health insurance for my father. Or the roommate. Oh well, my mother worked for a year after my dad died to pay to for a year’s worth of treatment (he did manage to get on my mom’s insurance after the general waiting period and pre-existing condition waiting period)
    Oh, and ya’ll paid for my roommate’s childbirth costs. Thanks, American Taxpayer.
    And I worked 55+ hours a week since I could cover the shifts the mommy co-workers couldn’t work.
    Yeah, something needs to be fixed.

  45. deRuiter says:

    Dear Canadians, If your system is so superior, why the flood of Canadians who need health procedures IN A HURRY over the border into the USA? The wait times in Canada can be onerous, you can wait months for a procedure which you can get in America in weeks or days. In the UK, after a certain age (not sure what it is, but it’s relatively young) you can’t get many important medical procedures at all. I think most Canadians who comment on this blog are relatively young, so they haven’t experienced the long waits for crucial pricedures which send so many Canadians, including your politicians, over the American border for quick treatment.

  46. Lex says:

    In my country, the way it works if you’re self-employed, is no matter how much (or how little) you earn, you pay a percentage of your earnings every month. This is a pretty high percentage (20%), but it’s a decent system IMO, because that way nobody is unensured and you KNOW how much it’s going to cost.

  47. Jules says:

    Reading the comments makes me REALLY happy to live in a country where health insurance is affordable and comprehensive.

    @deRuiter (#45): If they’re elective procedures (which I’m guessing they are, because I don’t think Canadians can comprehend being so cruel to turn down lifesaving care to anybody) then why *shouldn’t* you have to wait your turn, or pay for it out-of-pocket? And, hehe, wait times in the US for elective procedures aren’t exactly a cakewalk, either. I once tore the cartilage in my knee, and after the initial appointment with the family doctor, the orthopedist, the MRI, and the orthopedist again, I was already walking normally and had started jogging again, and ended up not refusing the exploratory surgery he was recommending. I hurt my knee in January and, had I agreed to surgery, it would have happened in April, and I would have been out of commission until late June, if everything went well and I didn’t catch MRSA.

    Did I mention that I was insured at that time, too?

  48. Interested Reader says:

    People have to wait for surgery in the US and there’s fears about procedures being denied or doctor choice being taken away but that happens now. Only it’s a business that makes the decision not the government.

    At one point my Mom needed a certain procedure done and her primary doctor recommended the best doctor in town. But he didn’t take her insurance so she had to see someone else.

    One former co worker needed surgery done on her knee – there was a 4 month wait to get the first open date with her surgeon.

    At the same job was a woman who was a temp. She didn’t have insurance and her foot started hurting, but she kept hoping it would get better. and kept walking on it until the pain was so bad a family member insisted she go to the doctor. She’d fractured a bone (or some bones) her foot and if it was seen about right away she could have had a walking cast and it would have been okay. Instead with the walking she’d broken the bones and they’d been pushed down and she needed surgery to correct it.

    She was able to get some assistance and the hospital wrote off part of the bill but she still ended up on a payment plan that was going to take her years to pay off.

    Another friend of mine’s wife had fibroids and needed to have a hysterectomy. They had insurance, but the insurance found a reason to deny their claim — they appealed but it was still denied. She had to have the surgery so she did anyway. The hospital took of some of the bill but it still took them 5 or 6 years to pay it off.

  49. Miguel says:

    “Unless you are going south whenever you need treatment you are not getting the best care possible.”

    South where? Cuba?

  50. Kandace@pantrydiva says:

    My husband is self-employed. For the last six years I worked for a non-profit that didn’t offer benefits. So we paid out-of-pocket for health insurance for us and three dependents. It crept up to nearly $1,000 a month for coverage, with a $1,000 deductible.

    I started a new job a few months ago and now our health and dental run about $45 a month. I calculated what we paid out of pocket over those six years and it would have paid off our mortgage. But I wouldn’t have taken the risk NOT to have insurance, especially with kids who see the doctor a lot.

  51. Nancy says:

    We need a single-payer health care system. Period. I laughed when I read #10 Matt’s comments: “On the other hand, I see the argument against government-run programs. There’s fundamental issues of corruption, transparency, fairness, etc.”
    What do you think we have now with the private system? And for everyone who doesn’t like the government “meddling” in their life–OK, do you want to get rid of Social Security & Medicare?

    My husband & I buy health insurance privately (we do not have it through our job). Every year, on average, the monthly premium goes up about $50/month. This year, it went up $70/month. We don’t even have children. Where’s the transparency explaining why they think they need to raise the premium so much? When we were “young and healthy”, yes, you could find affordable plans. But guess what, you don’t stay “young and healthy” forever.

    Trent is absolutely right about when he says that this hampers the potential for entrepreneurs who might otherwise venture out to start a business.

    Our system needs to be vastly changed; the current system makes most people slaves to their jobs for the health care. And by not providing health care to everyone, it creates a society of have’s and have-not’s, and in my opinion that’s exactly why it won’t be changed–we live in a society based on comparison, and without an under-class, you can’t have a middle class.

  52. Mel says:

    Here’s a non-US/Canada/UK comparison.

    I’m self-employed, and not a citizen of the country I live in. I pay the equivalent of around $USD95 a month for health insurance (this is based on expected income, adjusted at tax time). If I was an employee, my employer would pay. Unemployed citizens (and I think permanent residents) don’t pay.

    That covers everything – standard doctor visits, emergencies, gynaecologist, dental, hospital stays, maternity care/childbirth. I pay roughly $USD2 each visit (yes – 2). In my 4 years living here, I have had 2 operations – one with a hospital stay of about a week, the other just overnight (for the overnight one I had to get an ECG, blood and other tests done first, all at no cost). The cost to me of the stays were about $USD10 and $USD2. I have heard many Americans saying they have had treatments here that they simply couldn’t have afforded in the US.

    Sure, there are problems: doctors probably aren’t paid enough, and there’s a “doctor knows best” attitude. But I know that if I have a health or dental concern, no matter how minor, I can get it checked out with no financial risk.

    There is an option for those who want it and can afford it to have private insurance. Very few people do though – there just isn’t enough value in it for most people.

    This is all in an ex-Communist country. There is an extremely strong anti-communist feeling (and law against spreading Communist ideals), and yet we still have a public health care system. Repeat after me: “Public health care does not equal Communist”! Please…

  53. Lou says:

    A comment about COBRA – be aware that COBRA eligibility is extended if you are disabled, ie If you left the job because you became disabled, COBRA eligibility is twice as long as normal. My former employer simply implemented it & sent me a letter explaining my rights; otherwise I would not have known. Since my disability a) required medical attention and b) prevented me from job-hunting, this was a life-saver.

  54. Will says:

    Thank you, Trent,for at least acknowledging to your readers that health insurance for your family was a “serious expense” for you when your wife was on maternity leave last year. COBRA is damn expensive each month! Also, you point out that it is indeed harder for single people to find another career path since singles do not have spouses to cover their employer-sponsored health insurace. Bear in mind, too, that there are millions who have “pre-existing” medical conditions and are not in a position to forfeit health care benefits provided by their employers. On a personal note, I am a middle aged gay man who has been living with the same lovable man for 26 years. We were legally married in Canada back in 2005. Fortunately, my employer here in New York City, has offered me domestic partner health care benefits since 1998. This is a HUGE perk because my spouse has been disabled with diabetes for a very long time; I have coronary artery disease. I am “coming out” in your blog because there are hundreds of thousands of gay men and lesbians in the majority of other states who are not able to obtain health care benefits for their spouses/partners where they work. I was indeed “proactive” in my place of employment and was able to pursuade the board of directors of my organization to offer domestic partner benefits for same-sex couples 13 years ago this month. Simply stated: not all gay/lesbian couples are as fortunate, depending upon their state — or city — of residence. Until there is universal health care available for ALL in this country, I can safely say it is very hard — not impossible — for the majority of us to strike it out on our own, especially in these tight economic times. Please take into account all different circumstances and points of view.

  55. jim says:

    Laundry Lady above claims that malpractice lawsuits and insurance are a big problem. They really aren’t. Medical malpractice costs account for about 1-2% of the cost of the US healthcare system. Malpractice premiums certainly aren’t 60-70% of the costs for doctors on average. Doctor mistakes cost more in both terms of dollars and lives. Doctors are not infallible and a rare small few are outright negligent. On the other hand health insurance company administration and profits eats up 20-30% off the top. People love to hate lawyers and imagined problems with frivolous lawsuits but they aren’t the cause of high healthcare.

  56. Marie says:

    Over the years, everytime I meet someone from a country with a healthcare system (Canada, UK, Japan, etc.) I ask them how they like it. EVERY SINGLE PERSON I talk to tells me that what they have is good and they wouldn’t want to deal with the cost and issues we encounter in the US. So before any of you who are making broad statements about the issues with those systems based on what you read and see on politically motivated sites, talk to a person who lives there first.

  57. HonestB says:

    Dear Canadians, If your system is so superior, why the flood of Canadians who need health procedures IN A HURRY over the border into the USA?

    I think characterizing it as a “flood” is a bit over the top. Certain things like MRIs are in a state of shortage though, and it’s true that Canadians with money can get them done in the States at very high expense (it’s also true that anyone who wants to can set up a private, for-profit clinic in Canada offering those services but you don’t see many). We do have rationing and I’m not going to pretend it doesn’t happen, it’s just that in Canada it’s doctors deciding how healthcare is going to be rationed based on need instead of insurance companies deciding how it’s going to rationed based on profit.

    The wait times in Canada can be onerous, you can wait months for a procedure which you can get in America in weeks or days.

    Which some Americans can get in weeks or days, and many may not be able to get at all, let’s be clear.

    In the UK, after a certain age (not sure what it is, but it’s relatively young) you can’t get many important medical procedures at all.

    This is a pretty bold statement. What procedures are you referring to?

    I think most Canadians who comment on this blog are relatively young, so they haven’t experienced the long waits for crucial pricedures which send so many Canadians, including your politicians, over the American border for quick treatment.

    I think just about everyone has had a family member who’s had to cope with long wait times even if they haven’t experienced them personally. My Grandfather had to wait quite awhile to get his knee replaced (not being hugely wealthy, he, of course, couldn’t pay out of pocket for such a procedure in the US. I’m not speaking from ignorance about the drawbacks of our system when I say I prefer it, but from the knowledge that many Americans pay more for health insurance than I pay in rent and utilities every month.

    It’s also true that many Americans order generic prescription drugs from Canada, so if people crossing the border for healthcare is an issue, I think that’s worth thinking about, too.

  58. AnnJo says:

    What I know about the Canadian health care system is both anecdotal and statistical –

    Anecdotally, every single member of the Canadian branch of my family has come the the U.S. for medical treatment of serious conditions, because the wait-times for their access to care in Canada would have left them, in two cases, dead, and in two cases, in severe pain and near-total disability for more than a year.

    Statistically, polling data has shown that Canadians are much less happy with their own medical care than are Americans, including access to doctors, access to specialists, access to innovative treatments, and several other key factors. on many of those factors, Canadians are equally or more unhappy with their care than UNINSURED Americans.

    I’ve maintained my own private health insurance all my life, and until politicians started meddling in it in the mid-1990s, it was efficient, affordable, convenient and free of coercion and totalitarian infringements on my liberty. I liked it a lot and am sorry to see it go.

    True, there are people who are not able to produce enough value to society to support themselves, and I believe each of us has a duty of charity to the unfortunate, but I fail to see how lowering the quality of care for the majority of us is necessary to accomplish that.

    And lower it will be. Notice how easy it is for some to accept that convenience and speed should be sacrificed so that we can all “wait our turn” for non-life-threatening medical care. What turn? I don’t wait my turn to eat dinner until everybody else in the country is fed the government-determined number of calories, because I buy my dinner with my own earnings. I see no reason health care should be any different.

    And as far as people claiming that lack of health insurance stifles entrepreneurship – oh, please! Someone who is terrified of losing employer-provided health insurance is simply not suited temperamentally to being self-employed. No one in my family, going back to great-grandparents and beyond, worked for others; we’ve all been self-employed. Not one of us has ever worried about health insurance; we just bought it like any other product or service.

    I’m disappointed Trent has chosen to take this site in this direction.

  59. Will says:

    Re: #58 Ann Jo’s comments

    Lucky you for being able to afford your own health insurance! I think your perspectives are harsh and high-handed. How old are you? Have you ever heard of medical “pre-existing conditions” which disqualify people from obtaining health insurance once they are diagnosed with a serious illness? Additionally, not everyone has the interest to become an entrepreneur. Time is more important to me than money at this juncture of my life. Spending time with loved ones, pursuing personal interests, volunteering my time for causes I believe in, and, basically “smelling the roses” are what matter to me at age 55. Most industrialized, civilized countries — like those of Scandinavia — already provide health care to all their citizens. As I mentioned in my previous contribution to this discussion, please take into account all different perspectives and points of view. Ann Jo, not everyone is in the same, fortunate circumstance as you are.

  60. Tracy says:

    #58 – AnnJo

    Can you link to this polling data? It’s contrary to every study I’ve ever read.

  61. AnnJo says:

    @Will, I’m older than you are, and have maintained my health insurance since I was 16. There was no ‘luck’ involved in my ‘being able to afford’ it. I simply put it at a higher priority than other possible expenditures, like cars, entertainment, quality of housing, etc. And for most of those years, until the mid-1990s when Democrats started trying to ‘fix’ it, no-frills health insurance was quite inexpensive.

    You urge me to take into account different perspectives and points of view, but you chastize me for expressing my own. My view is simply this:

    There is no free lunch. We had a system of health care that worked quite well for the vast majority of Americans, including me, and it is being systematically destroyed in order to force us all into a socialized heatlh care model. (I’m well aware the current law is not that, but it is yet another step in the destruction of the old system, which is its ultimate goal.)

    Once that socialized model is in place, health care may be “free” but only if you don’t consider the higher taxes, lower quality, longer delays, greater pain and suffering and lower rates of medical innovation as costs.

    Most poor Americans receive socialized medical care now. Their care will not improve, but the health care of the rest of us (except for the truly rich) will, over time, deteriorate to more closely approximate what the poor get today. If your top priority is making sure everybody shares the misery, then you will be happy with that system. I won’t be.

    If you want to read a different perspective on Canadian health care, run a search for “canadian medicine isn’t cheap or effective,” an article by the former chief coroner of British Columbia, that describes the lack of access and delays involved in their system.

  62. AnnJo says:

    @Tracy,
    I can’t link to it because the comment would be permanently stuck in moderation, but here’s some info:

    My statement about people’s opinions about THEIR OWN health care (not how they feel about the health care SYSTEM in general, but how they feel about their own care) come from two surveys:

    One was a survey by the Kaiser Family Foundation with ABC News and USA Today in late 2006, on Americans’ satisfaction with their own health care, and

    The second was by the Institute for Policy Innovation and Harris Polling in early 2008, designed to mirror the Kaiser one, on Canadians’ satisfaction with their own health care.

    Keep in mind, these do not speak to how people feel about their country’s health care system as a whole, but only about what they know best – their own care.

    The findings show that by and large, Canadians’ level of satisfaction with THEIR OWN care is well below the level of satisfaction that insured Americans feel, and on some things not much better than how uninsured Americans feel.

    Since about 90% of American citizens are insured (about 86% if you include all immigrants), it makes sense to consider what kind of sacrifice they will be asked ot make to improve the picture for the uninsured.

    For example, 55% of insured Americans are VERY satisfied with their ability to get a Dr’s appt. when they want one, compared to 33% of Canadians, which is barely better than how uninsured Americans (30% very satisfied) feel on that question.

    50% of insured Americans are VERY satisfied with their ability to see top-quality specialists if they need one, compared to only 17% of Canadians, again barely better than uninsured Americans at 14%.

    55% of insured Americans are VERY satisfied with their ability to get emergency medical care, compared to 26% of Canadians and 20% of uninsured Americans.

    42% of insured Americans are VERY satisfied with their ability to get the latest most sophisticated medical treatments, compared to 16% of Canadians and 11% of uninsured Americans.

    Most Americans believe, because they’ve been told over and over, that our system is dysfunctional for MOST people, therefore they are dissatisfied with the system, although not with their own experience of it. Canadians don’t much like their own experiences, but fear (unjustifiably) that they would be much worse off if their system were like ours.

    In a separate comment, I will post a link, but if it doesn’t make it through moderation, the above should give you enough to research further if you want to.

  63. AnnJo says:

    Yep, it went into moderation. Let me try it this way:

    http colon two slashes papers dot ssrn dot com slash sol3 slash papers dot cfm question mark abstract underline id equal sign 1286602

  64. Andrew says:

    AnnJo–Nothing like a heaping smelly ignorant pile of Social Darwinism to get your day going, huh?

  65. AnnJo says:

    @Will,
    You might also want to read “Sweden’s Single-Payer Health System Provides a Warning to Other Nations” for a different perspective on what you admire. Just search under the title. Author is David Hogberg.

  66. AnnJo says:

    @Andrew, if I were a Social Darwinist I would not care about the survival of the less fit. That is not the case, as you would have seen if you had read my first post through. What I disagree with is violently dragging everyone down to the lowest common denominator of care, just to that some people can feel good about their ‘compassion’ and sense of ‘social justice.’

  67. Andrew says:

    AnnJo-Actually, I regretted the comment soon after I posted it. You have my apologies!

    However, I do question your building a complex argument on the results of a few opinion polls. Polls are notorious for the inherent biases they (by their very nature) contain–the way questions are phrased can skew results dramatically in whatever direction those who have commissioned the poll prefer. Accurate sampling to get a representative view of the population is also essential, and can be very tricky.

    Think of how often you’ve gotten a telephone or email poll, and just hurried through it–or not done it at all- because you were bored, or the questions were phrased in a vague manner, or the answers that were allowed (1-to-10 scales, “very” satisfied vs. “somewhat” satisfied etc.) were too general.

    The inaccuracy of polling is why candidates for both parties, at every election, always claim that their polling shows them on top–until the moment they lose.

    Please don’t frame something as important as health care in terms of opionion polling! It’s just not credible.

  68. AnnJo says:

    @Andrew, apology accepted.

    You are, of course, completely right about the perils of opinion polling. However, in the case of the surveys I mentioned, they were both conducted by respected researchers and I’ve actually read the 2008 study, which seems methodologically sound. The results are also consistent with the personal experiences of the Canadian members of my family, and also are supported by the hard data on wait times for various procedures, lack of equipment, etc., reported in official Canadian government reports. It stands to reason that someone who has to wait in pain for 18 months for knee replacement surgery is likely to be less satisfied than someone who can get it done in six weeks.

    I have voluminous information on health care issues; I’ve been interested in the subject since 1993 when I started to see the handwriting on the wall about coming efforts to bring socialized medicine to the U.S. You can hardly expect me to cite it all in a few quick posts, though.

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