Just say Yes, And

Now that I’m on my own, after either working for an organization or being in grad school, I have a new challenge: Healthcare coverage. I have spent multiple days looking into how to manage my and my family’s healthcare now that I don’t have a job.

It’s all super stressful.

And timely too. Considering the recent vendetta killing of a healthcare insurer CEO by a Deny. Defend. Depose. bullet motto’ed murderer. The outpouring of shared anger against our profit driven healthcare model from across the nation is maybe not surprising. Healthcare, even when “provided” by your company, is outrageously expensive. And the model of a “deductible” for paying for care is just, well, gross.

I have been lucky (knock on wood) to have a pretty healthy family, so we never “maxxed” our deductible. We ended up paying a lot monthly as ‘insurance’ and therefore contributing to those healthy numbers posted by health insurance companies. As I used to tell my business school students, just because your business is a non-profit doesn’t mean you can’t make money. It just means you don’t have shareholders. It also means that you can make a lot of money by working for or leading such a profitable non-profit. I just searched Blue Cross Blue Shield of MA – which was my insurance company – and on their website they report they have made $7.2 Billion already this year!

Working or managing healthcare companies can be lucrative even when they are “non-profit” since they don’t have shareholders, they can offer very large bonuses from their earnings. A lot of CEO info and salary data has been removed since the killing of the United Healthcare CEO, but I remember being dumbfounded looking up the Blue Cross Blue Shield CEO salary during my lecture about corporate forms and seeing the man at the top was then making over $20 million/year! Some salary data can still be found – check out this compilation of healthcare CEO salaries and your jaw will drop too.

Then, when you look at how much you have to pay to have health insurance – even when your employer “pays” for your health insurance – you realize it’s a LOT. It’s basically a rent or mortgage payment that you have to account for just for “insuring” you and your family can get the medical help you need, should you be so unlucky as to need it.

There are certainly other factors in this health insurance structure that we now find ourselves in that contribute to the mess. The structural roots of for profit healthcare come from the Republican icon of capitalism and greed, Richard Nixon. Michael Moore’s Sicko documentary movie has the logic Nixon used to justify the creation of the for-profit healthcare system that exists today from its 1971 origin – it makes me sick to watch it now. Nixon says, Not Bad. But the reality is that it is Not Good!

NO!

Not Good.

I am lucky enough to live in Massachusetts where we have MassConnect – the model for the Obama Care / Affordable Care Act system the US government established to enable people to obtain a healthcare plan when their employer doesn’t offer one. What’s nice is that my husband and I realized we could get healthcare through it…But it’s still expensive.

Which leads me to a point I have been reflecting about as I begin my own entrepreneurial journey – how much the issue of having healthcare coverage affects whether or not you pursue a career on your own. It’s expensive and daunting to consider paying for healthcare insurance on top of all your other living expenses – as you set out on your own and don’t have an salaried income.

My time working on entrepreneurship policy in federal government was rewarding to see the conversation in those policy discussions begin incorporate how to support paying for childcare coverage. Affordable childcare is another challenge for every parent. It’s a particularly big impediment for anyone wanting to start a business. It starts to feel overwhelming to contemplate how you will pay for childcare or eldercare (or dog care you get the picture) when you are on your own. It all adds up.

These costs all impact our career choices. It certainly impacts whether or not you are willing to try your hand at your own business. The entrepreneurial journey is not all about finding a problem solving/winning product or service. It’s also about whether or not you can afford your life (healthcare, familycare, rent…) when you set out on your own. My friend’s Jen Tosti-Kharas’s recent book Is Your Work Worth It explores this topic of how people make career decisions. Surprisingly relevant for the costs to consider relative to the benefits of entrepreneuring.

Jen and her co-author Christopher Wong Michaelson present a number of case study stories of different career paths people have taken to make their work ‘worth it.’ Jen and Christopher study the meaning of work – taking deep dives into how and why people have careers. They began their studies considering the obituaries of people who died while working on 9/11! As my father told me many years ago – no one has ever been in their death bed wishing they had spent more time at work.

For entrepreneurs, the desire to work more and make more money are rooted in the need to support your life (be a career, or a livelihood) and show returns for investors in our capitalistic, for profit, market driven economy. I’ll tackle the role of our drive for money and the ridiculousness of this excessive drive for money and growth for entrepreneurs next time.