I have a friend, we’ll call her Sarah, with a number of serious medical conditions. She’s been in and out of hospital her whole life, she needs a stable supply of a number of medications, and in the next year or so, she’s facing a couple of critically-needed surgeries. Sarah’s mum wasn’t exactly rich when she was born, and her mum has health problems of her own, so the two receive government assistance, designed precisely for people like them: because here in the United States, we like to pretend that we don’t let people rot in the gutters.
Sarah’s work is, well, I don’t want to say too much about it, but it doesn’t pay that well, and a lot of the money comes under the table. Yes, she’s one of those people, getting monies the government doesn’t know about and sucking off the government teat. Quickly, let us all come to judge her.
She was in school for a while, and ended up with significant debt, and she’s been searching for a career she really loves.
She knows what kind of work she wants to do, and has her eyes set on it. Has for a couple of years, actually, and she’d be really good at it. I think she’d progress rapidly, and she’d be a great asset to the kinds of places she’d be working for, and people would be silly not to hire her. But she hasn’t applied anywhere or worked her considerable network of professional contacts or done anything meaningful to get work.
Why not, you ask?
Because Sarah needs her health care.
Here’s the thing; government benefits in the United States create enforced poverty. I know I’ve talked about this before, and I’ve discussed how angry it makes me, but basically, Sarah is in a position shared by a lot of people. If she starts working seriously and for real, she’ll be ineligible for benefits because she’ll be making too much money; the government argues this is necessary to ensure that people with means don’t crowd the rolls and make it impossible for the government to provide care to the ‘truly poor,’ the people who need it.
And if Sarah was a person with average health care needs, she totally would have the means to afford to pay for them if she took a job in the field she loves. Her job would probably have health insurance that would kick in to cover most if not all of her needs, and she could afford the periodic copays and out of pocket expenses for whatever her insurer didn’t provide. If her work didn’t have insurance, she could get her own policy, or maybe even just pay out of pocket as a cash patient for, say, her annual exam and the periodic visit for a persistent cough or a flu or what have you.
But Sarah’s health care needs are not average. They are significant. Any company she worked for wouldn’t cover them, and she wouldn’t be able to pay for her care herself. She’s trapped in low-paying work that doesn’t get her where she wants to go because she wants to stay alive. Silly her. Her existence is mediated by the limited funds available, and while she would love to work in a better field, to challenge herself, she can’t do that because the government effectively won’t allow her to. If she works, she’ll die, to put it bluntly.
If Sarah had a median, somewhere between; the opportunity to work while still receiving at least partial or major coverage, maybe she could go legit, as we like to say. She could work and declare all her earnings and develop her career and still get health care; and she could potentially shoulder a higher percentage of cost because of her higher wages, without being cut off entirely. Over time, maybe she could advance in her career to the point where she wouldn’t need government benefits at all—though I still believe that health care coverage should be provided universally to all people in the US.
And Sarah’s case is actually a great argument for why. Imagine, for a moment, that everyone in the US got the same level of care Sarah did. There’d no longer be pressure to not work for people who very much want to, there’d be no penalty for having a career and developing your life and doing the things you want to do. And with all of us paying into the system, especially with cost controls on the skyrocketing price of medical care, Sarah’s care would be absorbed and balanced out by the minimal care for so many other patients who would all be within the same system.
Those who wanted private insurance would of course be welcome to it, and they could pursue any additional treatment and procedures they wanted. Nothing to stop a secondary health care market for what the government won’t cover or won’t cover in full, or for people who want additional amenities with their health care. But with all of us within the same system, fully covered, there would be no Sarahs.
I find it troubling that this argument is not viewed as very compelling by people who happily use other government benefits; we all benefit from roads, for example, and no one has a problem with that. Yet, we can’t all benefit from medical care, a much larger expense overall, and a much larger drain on society currently? We shouldn’t be forcing people into poverty and then complaining about how they’re poor and not contributing to society; and we shouldn’t be using the fact that people are poor as a weapon against them.
Sarah’s trapped in a system that actively excludes people like her, and she’s trying her best with a deck stacked against her.