US healthcare: hazardous to your health

When I got my first non-temporary job in the US, I had health insurance, but I soon started to experience the pains of for-profit healthcare. I was recently returned from study abroad in India, with lingering exotic health problems requiring expensive testing, which I had to pay up front and then wait to be reimbursed. This was a recipe for disaster when I was living paycheck to paycheck.

The insurer was slow to pay, and I was short $300 to pay my rent. After a fruitless phone call to hurry them up, I started crying in the office – I had no other resources. My manager personally loaned me the money to tide me over. Which was very kind of him (thank you, Larry!) but it was absurd that I’d needed it.

When I joined a tiny startup, I had no health insurance at all. I became aware of how unsafe this was when a new colleague confided that she had $7000 in medical debt for the perfectly normal but uninsured birth of her child. When I became pregnant, Enrico and I hurried to get married so I could join his health plan. Then we moved to Italy where we were all covered by the excellent public healthcare system – just like everyone else in the country.

There’s a huge advantage to public healthcare which I did not fully appreciate even when I needed and used it most: losing a job in Italy has zero effect on your healthcare. You can still go see doctors and specialists and afford medications just as you did before. You don’t need to go into debt or bankruptcy if you or a family member has a medical catastrophe. I worked for six years as a contractor without needing health insurance. My tax bill for public health in Italy was around $3000 a year, even when I had a high income. When I quit my Silicon Valley job in 2001 and my subsequent contracting work ebbed away, I was worried about my dwindling savings, but not about healthcare. And I continued to be baffled about why Americans are so afraid of “socialized medicine.”

When I returned to the US in 2008 to work for Sun Microsystems, I had good health insurance – the larger the company, the better the insurance, thanks to the larger risk pool. (Yes, Amazon has very good insurance.) But I soon came up against the fatal flaw in the US health insurance system: no matter how good your company’s plan, it is a company plan and not a public one.

In 2010, as Sun Microsystems was going through the Oracle acquisition, I was very ill with a sinus infection. With the acquisition less than six months past, my manager was not sure I qualified for paid medical leave: in California, you have to have been in a job for at least six months before you can claim this benefit, which pays a portion of your salary. I later learned that she was wrong – our Sun tenure counted – but neither of us knew it, and I could not afford to take leave without pay, so I kept working. I finally took  five weeks’ leave in October, after sinus surgery and after the six months had elapsed. My surgeon told me that recovery for this kind of surgery was usually a matter of days, but because I had waited so long and been through so much without any rest, I needed weeks.

That was the first time that the US health system forced me to keep working when I should not have, to the detriment of my health. But it wasn’t the last. 

I quit Oracle on November 29th, 2010, to go to a new job at Joyent that would start December 1st. I happened to have an appointment with my sinus doctor on November 30th, the one day I was between jobs. I’d heard that health insurance continues through the final day of the month in which you leave a job, so I did not think to change this appointment. I was later surprised to get a bill for $400 for that visit – it wasn’t covered after all. When I called the Oracle insurer to ask why, they told me that, unlike most employers, Oracle cuts off your insurance at midnight on your last day of employment. Keeping insurance going to the end of the month is something “nice” an employer can choose to do for its ex-employees, but it’s their choice, not the law. I was able to negotiate that bill down, and later gave timely warnings to friends about the insurance coverage as they were planning to leave Oracle.

In 2014, my time at Joyent was coming to a close. That job had been toxic (for many people) for a long time. Brendan had left in March for Netflix. Our mutual manager blamed me for that and henceforth shunned me. He never looked at me or spoke to me even though our desks were within eyeshot of each other. If I emailed him, he didn’t answer. Once when I sat next to him at the company lunch table, he physically moved away from me. I didn’t particularly want his attention, but it’s not easy to get a job done when your manager won’t speak to you. Everyone else in the company was so oblivious or so cowed that no one spoke up for me – in spite of the many times I had spoken up for them, carrying their concerns to management. I felt like a pariah. 

It’s psychologically damaging to spend day after day in an environment where people are at best ignoring you and making it clear that you’re not welcome. The constant stress is also physically damaging. I remember vividly that one day as I was heading out to lunch, by myself, I felt a strange, burning pain in my chest and thought: “This job is killing me. I have to get out.” 

I had been trying to, but finding a job has rarely been easy for me. I have plenty of skills and experience, but I don’t fit neatly into job descriptions, so recruiters just don’t know what to do with me. My best route to a new job was to be hired or recommended by someone who had worked with me before and understood what I can bring to a job. Jason Hoffman by that time was working at Ericsson, where he eventually brought me on board. But it took weeks (months?) of interviews and negotiation, and by the time I was finally able to leave Joyent, I’d suffered a lot. In April of that year I’d had my usual annual mammogram and been told it showed nothing abnormal. In October, I was found to have a 2.5cm fast-growing malignant tumor

As far as I have been able to find out, there is no causal link between stress and breast cancer. But there is some evidence that stress contributes to the rapid growth of malignancies. I suspect that my instinct that the Joyent job had become dangerous to me was correct – the body knows when something is wrong. But I was afraid to leave; there was no guarantee that I’d find another job quickly. I couldn’t afford to be without work for long, let alone pay for COBRA. That had become cheaper under the ACA, but still would have run me about $600 a month (the max is 102% of what your employer was paying). 

I finally started work at Ericsson in June, 2014. I was diagnosed with cancer in late October – less than six months into the new job. Once again, I was screwed by that six-month waiting period – if I went on leave, it would have to be without pay. Fortunately, Ericsson is a Swedish company with a Swedish attitude towards its employees’ well-being. Even though my US health insurer wouldn’t technically permit it, my managers (on up to Jason) told me to manage my time as needed. I wanted to keep working anyway, but I was able to schedule it around chemo etc. However, this was completely at my employer’s discretion: any less-understanding company could have made my life very, very difficult. (I will always be grateful to Ericsson, Jason, and Geoff.)

I came roaring back from cancer to take on a big project for Ericsson, managing a website launch and ongoing marketing, with $millions in budget. I was very happy in the job and expected to stay there. But things started to go badly for Ericsson at a level far above me. With the first bad earnings report, we US employees knew that we would be in danger, because we were considered expensive compared with Ericsson employees elsewhere in the world. Once again I was on the hunt. It took over six months to get me into AWS (again, through personal connections), and I was worried that I might lose the Ericsson job before the new one came through. 

Now I’m in Australia and back to being part of a public health system. I don’t expect to lose my job, but it is a huge relief to know that, if I do, I will not have to worry about paying for healthcare. I’ll just have it. Like everyone else in the country. Which is as it should be. And that, frankly, is one of the big reasons we’re here.

2 Replies to “US healthcare: hazardous to your health”

  1. How nice of you to share your troubles with health insurance in US. In India very few companies offer Group insurance. You have to take one yourself and there is the waiting period, and if all goes well and you need hospitilization then 10 per cent of the bill comes out of your pocket. Regarding check ups, routine medical tests one has to read the policy’s fine print. The Ins. Co will not tell you. India is following down pat.

  2. Thanks. I hope you never need your Australian health care! Meanwhile I’m getting familiar with the socialized-but-private Frankenstein that is Medicare……

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