It all comes down to health care costs and how we choose to pay them. A friend was saying that she and her Millennial friends earn just enough money to stay on Medicaid and pay rent, food, car, and college loans. They dwell communally, growing their own food in a giant garden with chickens, living a clean life with as little impact on the planet as possible. They deliberately avoid the trappings of corporate culture. Why, she wonders, would she give her life choices over to the whims of “a bunch of old, white men in suits” when she can live as she’d like? She is industrious, creative, and tireless in her pursuit of personal perfection. She wants for nothing and is content. She pays taxes, and her minimal medical costs are covered by the government.
Another young Millennial friend works in corporate culture. He earns a fair salary that includes low-cost health benefits, plus a modest retirement plan. Despite the storied age and prestige of his firm, the work environment is modern and hip; there is profit sharing. His firm, however, pays less wage than others in the industry because it subscribes to ethical and sustainable business practices. It is more about creating a livable world than generating dollars for its shareholders and board of directors. It has neither of these. What it does have is equity; profits are divided amongst all employees. This friend, too, lives a very good life, in a communal environment, and enjoys his free time because he works very hard when he’s at work. He is seldom physically ill, using his insurance co-pays mostly for mental health therapy – which keeps him well, too.
An older friend is approaching retirement age and has been with the same business for a number of years. She has 30 percent of her wages taken to pay federal and state taxes, retirement, and healthcare. The healthcare comes with a hefty deductible. No copay, so all costs are out of pocket until she reaches that deductible. Wellness is encouraged. She recently went to see her doctor for a routine consultation. The 10-minute visit cost $375. In this time of Covid-19, medical practices are tanking due to their patients sheltering in place, and thus avoiding exposure to illness. Nobody is going in for those elective procedures or annual labs, the bread and butter of the modern medical office.
In the old days, Dr. Kelly would make a house-call when we were sick. My mother had six kids; she didn’t have time to coddle. You’re sick; go to bed, read a book. I’ll call Dr. Kelly and do the laundry, cook dinner, and care for the other 5 kids until he gets here. That same mother, now 94, pays for additional concierge medical care to supplement her earned Medicare coverage, so she can call her present-day Dr. Kelly whenever she needs him. Today, those of us who are covered, get our insurance from either our employer or the government, or like my mother, both.
The high costs of health care, it is argued, go toward testing and medical advances. They are also high because of chronic or long-term conditions like pregnancy or substance abuse, and high-ticket illness like cancer (with its long-haul treatments) drain the pool of available profit dollars. The insurance companies gamble with our hard-earned pay to cover the cost of this longer-term care. Research and development have built so many gadgets and potions to determine the cure that a patient is broke once healed.
Our country is fueled by the fear of getting sick, and those worries are substantiated when the breath-taking medical bills arrive. An insurance salesperson once said to me when I asked about the “catastrophic” low-cost health insurance option (for someone who isn’t often sick), “I’d hate to see something happen to you, you could lose your house!” It used to be that you died from one of a handful of things: cancer, accident, old age. Now, we can die from millions of things. And all of those things have to be tested, treated and cured. Cure is a good thing, but should the patient bear the brunt of its cost, supplementing the giant pharmaceutical companies and other medical institutions?
Besides Big Pharma fueling a fear-induced culture, Alice blames IBM and the like for once-upon-a-time creating worker benefits and making them an expected ingredient of corporate culture. It was a fine idea to create a “family” in the workplace: celebrate birthdays, play softball, and support each other outside of work. Or was it really a way to ensure employees stay in one place; earn an up-front parking spot, help the company prosper, and retire with a pension. Employers determining healthcare choices, and future financial landscapes for their employees is now as built-in to the American dream as a home or our own and a new car every four years.
More companies could green-up and be rewarded with tax incentives when they build a healthy work environment. Microsoft is creating its own in-house insurance plan that could revolutionize how we look at our health plans. Big companies could chip in to pay for the medical research & development advancements, in order to keep employees and their families well. There could be a shift away from how health care is managed now, and Alice says, the sooner the better.
The big business corporations could also supplement social security taxes and build their employees an old age campus, so they can live out their lives with dignity, and with friends; lounge by the pool, and be celebrated and cherished for their knowledge and devotion. My mother-in-law, 94, uses her retirement income to pay Visiting Angels (and they are angels) for her daily care. A friend told me recently that the majority of Visiting Angels’ clients are white. The black, brown, and native communities tend to their elders out of respect, duty, and love instead of working too many hours to afford the cost of someone else caring for their parents.
It makes more sense to pay employees a fair wage without all the “extras” and allow them to spend it as they choose. Like her younger counterparts, my friend wants the freedom to accept or deny the costly “benefits” offered by mainstream human resources. She can make her own choices; create her own health and retirement plan. She’s a loyal employee in an evolving company who pays her income taxes. She helps build up the company, so she wants to be part of the success when it’s time to dole out the profits. Then, if something does happen to her physically as she ages, she can call her Dr. Kelly as she needs him, and not worry about losing her house.