How Health Insurance Kills the American Dream

Congressional leaders competing with anecdotes of tragedy during the healthcare debate last week reminded me of the way I viewed this issue before embarking on the Recession Roadtrip. It was only after six months of listening to the aspirations and anxieties of people across the country that I began to recognize how deeply the employer-based insurance system impacts our cultural identity and the nation's prospects for future prosperity.

For the Brothers Tartamella in Brooklyn, their excitement to become green business entrepreneurs is tainted only by fear of health insurance complications. Two encounters with non-Hodgkins lymphoma a decade ago drove James Tartamella to bankruptcy--despite the full insurance coverage he had at the time. Even though he and his brother, Joe, view their foray into green industry as a partnership, it's a necessarily unofficial one because James has that bankruptcy on his credit record.

Surviving cancer made him "uninsurable" by private insurance industry standards, but James qualifies for Medicare and disability because of the lingering effects from debilitating stem cell treatments. If he wanted, James could sit on his butt indefinitely, cashing government disability checks to subsidize his cannoli habit. But James--crediting the work ethic taught by his Italian immigrant father--has too much ambition for that, though pursuing the new opportunity will mean surrendering the security of Medicare. A small business of less than five employees can't afford health insurance, particularly not for a double cancer survivor, so James has accepted that he will soon join the uninsured--"unless Obama gets his thing passed," he told me.

James's comment reiterated ones made by Darwin Moore in northern Indiana, who also expressed a hopeful desperation for Obama's healthcare agenda to pass quickly. Like James, Darwin and his wife, Laura, are accepting extreme personal risk in exchange for the opportunity to pursue their dream of small business ownership. Darwin is "uninsurable" because he survived a brain aneurysm last year. Though his doctor has scheduled follow-up exams to monitor the status of his aneurysm, Darwin won't be able to accept that care because his family can't afford thousands out-of-pocket for the necessary brain scans. Laura told me that prayer would have to be the main means of health insurance for her husband "until Obama fixes the system."  I worry that if the fixes don't come soon enough, Laura could end up running their small business alone.

For most of his adult life Shawn Burke has known he could never hope to start his own small business. More than twenty years ago an insurer stuck Shawn with over $750,000 in medical bills after ruling that his policy's fine-print clause about problem pregnancies absolved the company of responsibility for paying the expenses of his prematurely-born son. (I saw another family profiled in the news last week going through a nearly identical situation.) "That f*cked up my entire life," Shawn told me. As a result, the 48-year-old has never even been able to secure a credit card.

Specific experiences such as the above make it fairly easy to illustrate how the business practices of a for-profit health insurance industry can create roadblocks that hinder entrepreneurship. I find it a greater challenge to convey the more profound detrimental impact the current status quo has on individual ambition, freedom, and the pursuit of happiness. Turns of tragedy have solid facts to report, while chronicles of unexploited potential rest on the demise of ephemeral aspirations.

I encountered dozens of individuals across the country who nurtured secret dreams and ambitions of the kind that could lead to great personal satisfaction but uncertain material wealth or stability. Without exception, as Hollywood cliches would dictate, every one expressed that they wouldn't need much money if they could live their dream...until they thought about health insurance. That's when their dreams hit a wall of reality.

Fear of losing--or not being able to afford--health insurance was the most common reason given for not embarking on an individual initiative or small business dream. Melissa Hinebauch, a stay-at-home-mom with a recently laid off husband in Concord, New Hampshire, helped give me perspective on the refrain I'd been hearing in the 40+ states I crossed before meeting her.

Melissa had missed being in a professional environment and always intended to return when her small children reached school age, but her pressing reality was that her family's COBRA coverage was nearing the end of its subsidized period. Her husband's job prospects were unclear, so she was re-entering the workforce to secure any job that provided health benefits.

"I have dreams and aspirations of my own," Melissa explained. "I've been putting off my own self-actualization. And the reality is I will still have to do that for awhile because of the circumstances, which is disheartening, but it's reality."

Perhaps Melissa will miraculously find a fulfilling job with health benefits, or blissfully temporary crap employment will get her family through the recession. But maybe she will get bogged down by unforeseen circumstances, give up her own aspirations, and surrender to the relative security of life as a cog in a corporate entity with a comprehensive HMO.

I have no way to estimate from a national perspective how significantly that fear of being uninsured suppresses individual initiative; I can only report that I've met many who cited it as their major reason for not pursuing a dream. I've watched people explaining what they really want to do with the lives, cycling through the excitement of their dream and then falling into despair as they admit the impossibility of leaping into such an unknown without the benefit of health insurance. It happened frequently enough to make me recognize how thoroughly the system of employer-based health insurance can suppress the creativity, ingenuity, and entrepreneurial instincts rooted deeply in the American character. Where would we be now if our inventors, innovators, and entrepreneurialists of past eras had been too afraid to strike out on their own? We're supposed to be a culture of individualists, but surviving the American healthcare system has forced us to become a nation of individuals terrified of losing the protection of our group insurance plans.