It goes around in circles that make me dizzy. The poor have more health problems, and therefore health insurance for folks with lower incomes costs more. Folks with lower incomes have more health problems for a number of reasons, prominent among them that they see doctors less often because – you guessed it – they lack health insurance. The illness that could have been avoided altogether by good preventive medical care is neglected until it becomes a crisis. Lacking a family doctor, the person in crisis must go to the emergency room, the most expensive place to receive health care. The medical bills resulting from this emergency care tip the already tight family budget into chaos, which means there is no money to see a doctor or dentist, much less to purchase health insurance, and the entire circle starts to spin around again.
Goodwill’s People Team (“HR” in most organizations) is now hosting “open enrollment” discussions in all of our sites. Surprise, surprise: the cost of health insurance has risen yet again. Our folks labored hard to secure the best possible coverage at the lowest possible cost, but we are swimming against a mighty strong current. Our employees will be hit with higher co-pays, and our bottom line costs are taking a big hit. All the things that make Goodwill the unique and wonderful organization it is, including our progressive hiring practices, conspire to make our health insurance costs significantly higher than those for most other organizations. Call me small-minded, but sometimes that feels like getting punished for doing the right thing.
In my conversations with our employees, I hear stories that make me proud, stories that break my heart, and stories that make me flat-out angry. I spoke last week with an employee in her late forties who had just enrolled in our health plan – at the most basic and inexpensive level possible – and will now have at least some health insurance for the first time in her life. Will her budget be strained? Terribly. But as she said to me, “I’m not getting any younger; I’ve got to start taking care of myself.”
Another team member desperately needs extensive dental work. She receives such health insurance as she has through the state’s BadgerCare program, and has been waiting months to receive approval to proceed. Even if they grant approval, they will pay for only a portion of this very expensive work. Why did she neglect her dental care so badly? Because for many years she has been making sure her children got to the dentist regularly, which left no money for mom to take care of her own teeth. I have heard versions of this story dozens of times: we have a lot of employees with missing teeth.
I remember when I was a kid and my dad was turned down by the bank when he applied for a small loan to replace our leaking roof. “Banks only lend money to people who don’t need the money,” he said to me with a trace of bitterness. He died many years ago, so he did not get to see the era where credit card offers arrived in the mail daily and banks became eager to lend money to people who had no hope of repaying them, throwing the poor into horrible debt and ultimately melting down the entire credit market.
But it remains true that the affluent, who live healthier lifestyles overall, have wonderful access to medical care while poor folks, who face greater health and lifestyle challenges, have very limited access to quality health care. The only real solutions are political in nature: our society must come together with a common will to say that this is not just, and it is not sustainable. Yet another reason to vote for Obama, and to hope that he has the courage to provide real leadership against the entrenched interests that will oppose meaningful change every step of the way. Bluntly stated, those “entrenched interests” include folks like you and me, who take our own privileged lives for granted. There are a lot of progressive folks who are eager to demand justice for the poor, but still have not figured out that this requires surrendering some of our own privileges. My 403B make be down for the count, but I still have all my teeth, and that is privilege.
Work and Dementia
2 years ago