As heartening as it is to see universal health care back on the national agenda, it's puzzling that when the presidential candidates talk about their health-care proposals, they only talk about poor kids and Wal-Mart workers. This doesn't square with my experience of the health-care crisis. I know plenty of people who are sweating health-care coverage. None of them are poor kids. And they don't work at Wal-Mart.The people I know who are worried sick about coverage work for themselves, many in creative fields. Most of these freelancers and entrepreneurs are in the cross hairs of our health-care crisis-and you wouldn't know it from watching the presidential campaign.But you would know it if you bothered to look at the statistics. While the French just held an election in which one of the central issues was their anemic rate of self-employment, America acts as if all is well when in fact we're one of the only developed countries with a rate of self-employment even lower than France's. While surveys show that Americans are nearly twice as entrepreneurial as Europeans, we're only half as likely to actually become self-employed.
What is holding Americans back? In two words: health care. If you're lucky enough to be healthy, you can purchase insurance on the private market. But even then, the costs are rising out of control. As a freelance writer, I buy my own insurance. My premium went up 25 percent this year and I didn't even get the pleasure of taking up smoking or skydiving.There are groups for the self-employed that offer coverage, but often those who need it most can't get it. A self-employed friend of mine gets his insurance through the local chamber of commerce. Its website explains that its insurance plan is explicitly "designed for young healthy individuals." Even laudable attempts to get mass coverage for the self-employed are often prohibitively expensive. The least expensive coverage offered by the New York-based Freelancers Union costs more than $1,000 a year for individuals and $4,000 for families-and it comes with a $10,000 deductible. There's only so much even well-meaning organizations can do when our government is out to lunch.In other developed countries, where self-employment rates tend to be higher, taking the leap to working for yourself doesn't affect your health care coverage or your family's. In publicly funded health care systems, entrepreneurs pay less into the system during the few lean years that often accompany starting a business. Once you get off the ground, you pay more. That benefits the country's health and its economy. But here, if you can even get coverage, you pay a flat fee regardless of whether your business had a good year or a bad one. And if you get seriously ill, your business makes less and you owe more. No surprise that half of American bankruptcies are the result of health-care bills.The problem with our health-care debate isn't just that it glosses over a huge portion of people who are affected by the crisis, but that by not taking them into account, we may end up achieving universal coverage without unleashing the talented and entrepreneurial. Just requiring everyone to have health insurance won't solve the problem. That's what Massachusetts recently did statewide and what some candidates are suggesting on a national level. But under such a system, unless you're very poor, you still pay more if you have a family; you still have to pay a flat fee unrelated to your business income; and you still have the catch-22 of paying more when you get sick and are earning less. Without a solution funded through progressive taxation, simply requiring everyone to get insurance will still hold back our millions of would-be entre-preneurs. Health-insurance payments will continue to act as an "ambition tax."Lately, Americans have come to think of the governmental safety net as being not for the ambitious but for people who can't take care of themselves-like poor kids. But the metaphor "safety net" comes from the piece of circus equipment that lets the trapeze artist attempt his or her most daring feats.It's time the proverbial trapeze artists among us spoke up. And time the candidates listened.
|I know plenty of people who are sweating health-care coverage. None of them are poor kids.|