I have been self-employed since 2005. For much of the time since then I have worked about the same number of hours per year as a full-time “employed” person doing similar work. [But in recent years that’s been slowing way down.]
One main difference between the earnings of the employed and the self-employed is the employer-provided benefits, and a major part of that benefits-pile is free (or steeply discounted) health insurance.
Health insurance in the US is very expensive. To lower costs, I’ve been using a high-deductible health insurance policy, with the result that I have as little as possible to do with doctors, other than a yearly exam. And yet I’ll bet my monthly insurance premium of just over $1,200 would elicit shocked gasps from my employed friends. Yes, that’s right: I spend over $14K per year so that I can get an annual physical, get whatever prescriptions I need filled, and not have to worry that a bad fall would empty out my savings. And to be clear, this is to insure just myself, not my partner or family.
Welcome to United States, where free or affordable health insurance is provided by your employer (if you’re lucky—some companies don’t), and if you don’t have an employer, well, that’s just too bad for you.
It’s absurd that affordable access to the US healthcare system is provided based on one’s employment. It’s absurd that when a person loses their job, they also lose their health insurance (unless they can take over those high monthly payments). It’s frankly abhorrent that there are people who must choose between health insurance or helping their child through college—or even between insurance and eating three meals per day.
This situation is tough enough for people like me who are fortunate enough to be gainfully self-employed. I work hard so I’m doing okay. But what about the growing number of Americans who are not okay? I am paying a 4-digit monthly number for a bare-bones insurance policy… how are less fortunate self-employed people managing this?
To be clear, there are programs in place for individuals earning less than $15,060 or families earning less than $31,200. But if you earn even slightly more than that? Can you imagine earning just $38,000 per year and paying $14,000 of that for health insurance? Of course not!
In fact, healthcare in the United States is among the most expensive in the world. Here’s a chart from 2023 comparing US healthcare costs to those in other countries. (This chart is from Peterson KFF: here.)
As long as we’re on this topic, not only is healthcare in the US among the most expensive, the quality of that care is not so great. I’m not going to go into that here, but this study from the Commonwealth Fund goes into detail, comparing health outcomes and showing the US coming in dead last in the list.
So, where am I going with this? Frankly, I’m not really sure. I guess I’m just complaining that I pay too much for merely adequate health care. I don’t know what the solution is. Some countries that provide healthcare to its citizens are doing a great job, but others are not, with wait times and restrictions that are far worse than what we see here.
I don’t know what the solution is. I just hope that this situation improves as my granddaughter grows up…
The image I used on this post is adapted from a graphic by Dave Simmonds on this page. I edited it to remove the European reference and political leanings and to make it smaller — but the original is definitely superior.