I've been spending the last several weeks in a series of meetings with the various union health and welfare funds that I represent discussing the Patient Protection and Affordable Care Act -- a/k/a health care reform and what it will mean for them.
It's a huge law and it is going to take a while to fully master all of its nuances and timelines.
One fascinating thing has been the virulent reaction -- especially among my southern, white male, union clientele -- to the mandatory extension of coverage for children up through age 26. Outrage would be a pretty accurate characterization of it.
It's interesting -- as the parent of a 17-year old boy who has had some health issues over the years (and who seems destined to have a less than linear progression through higher education), I am thrilled by this provision. Not so many of my clients, who view it as absurd and a sop to slacker youth who will never get out of the house as long as they are getting covered by Dad's health insurance.
I tried to explain that many twenty-somethings are either working in jobs without health insurance, working part time, or attending school full time, making such coverage vital to providing universal health care. I also pointed out that twenty-somethings are generally not an expensive group to insure (I would be surprised if I made five trips to the doctor in my twenties), but that when they are sick or injured it is often severely. (I used the example of former NARAL head Kate Michelman (not by name just by illustration) who has been reduced to penury by a tragic horseback riding accident suffered by her daughter as an uninsured twenty-something. To add insult to injury, Michelman's husband also suffers from advanced Parkinson's Disease, which has also been financially devastating.) I also noted that my wife had been in a near fatal car accident as an uninsured 26-year old and only spared her parents some pretty devastating bills by having serendipitously decided to take the insurance coverage on her rental car.
I further pointed out that I had been on my father's insurance until I was 25 and 1/2 years old, all through law school -- and I was hardly a slacker, working all throughout my second and third years while attending school full time. A client said, well "you're from the upper crust." Ouch! That stung! And hardly true, but I was quite lucky that my Dad had very good insurance at that time.
One of my partners reports that he received the same reaction when discussing the bill with his clients. There seems to be a sense that extending coverage to these "adult children" (we are struggling with terminology here) -- especially young men -- is an affront to their adulthood and particularly masculine self-sufficiency.
Anyway, I found it quite interesting and slightly disturbing. I want to raise my son to be a self-sufficient adult. But more importantly, I want him to be protected from the vagaries of illness or accident, while not bankrupting me in the process.
What do you all think?
Addendum: I don't usually do this, but several of you raised comments that I thought were worth addressing up here in the post because I think they speak to the psychological complexity of this particular issue. First, some have suggested that this is a typical Randian or right wing cultural reaction to the idea of giving something to the undeserving. I don't think that's persuasive in this instance for a couple of reasons. One, these guys are very much imbued with a group ethic -- one that is pretty unique in the culture. As I've discussed before, virtually all of my union medical plans subsidize the health care of retired members. And this is not some hidden number. Each year, the trustees will get a report on the level of retiree subsidy -- so for example, if my employer contributes $5.00 an hour for my health coverage, it may well be that $.50 or $.75 an hour actually goes to keep the retiree premiums down. Most of my plans subsidize the retirees to the tune of about 70% of their costs and no one objects, even if that has meant taking a reduction in in-pocket wages sometimes -- I've seen it happen on multiple occasions over my career. So these are not a bunch of John Galts with wrenches in their hands. The sense of inter-generational commitment runs very deep in these institutions.
Second, virtually all of these groups contribute some portion of their hourly wage to an apprenticeship and training program for new members, meaning that the inter-generational commitment runs in two directions. And many of them would bend over backwards to get their own sons into the trade. Indeed, one of the biggest reasons for backlash against affirmative action programs in the 1970s in the trades wasn't racism (not that it wasn't there), but that it would deprive my son or nephew of a shot at working at the trade in what has historically been a pretty decent way of life for those with a high school diploma.
So you are not dealing with people who are steeped in an ethic of radical individualism, nor people who don't care about the well-being of their children or who wouldn't try to give their sons a leg up (and I am being quite deliberate about gender here) if they could. Nor are you dealing with a mandate for the benefit of "strangers" for lack of a better term -- this is a benefit strictly for your own flesh and blood, which is why I wasn't really prepared for such a negative reaction to it.
It seems to me that there is something in this particular circumstance that really attacks at a core level notions of masculine self-sufficiency (albeit as part of a community) that these guys find very offensive. I guess that it stems from an idea that at 20-something, a man should be shouldering part of the collective burden, not adding to it. In a world in which increasing levels of education seem likely to be necessary to making a decent living, these attitudes may prove to be a significant impediment to their children.
Back to work.