19 September 2008

Mangakas Without Medicine

In Japan, they call a comic book author a Mangaka, and many of the highest income earners in the country write comic books. In the U.S., however, life as a mangaka is tougher. Most are young, often about to get married or just starting families, and cobbling together sufficient health care is a struggle.

The husband wife team that write Misfile, one of the most popular webcomics, have a newborn who recently came home from NICU. Their situation, as husband Chris Hazelton explains, referencing his wife, who goes by Third Child on line, and their daughter Avery:

Health insurance is a pain in the ass. Every since Third lost her job back in May, I’ve been without, and we’ve been paying for hers out of pocket. Now that Avery has been born, the price has doubled and the new payment is killing us. The worst part is after all that extra money I still have no personal health insurance. >_< As I always say, if anything goes wrong with me, throw me in the car and say I was hit, because it’s the only way I’m covered.

Of course, like everyone who has had a major medical event, Chris and Third are also engaged in endless paperwork dickering with their insurance company.

Equally often, they don't have health insurance, leaving folks like musician and comic community member Tom Smith in a bind when an injury sent him to the hospital. One can throw a fundraiser and ask for help, but there are limits to how much that raises.

There isn't actually anything special about comic book writers. Their plight is one shared by a large portion of all people who, like them, are self-employed. A comic book writer is fundamentally a small business person in our economy, and anyone striking out on their own in a small business is at grave risk of losing that safety net. Premiums for small businesses for health insurance are far greater than those for big businesses.

It isn't impossible to get health insurance, but it can be very difficult to get insurance that covers all the risk you have a reasonable likelihood of facing without hitting you very hard financially if you get sick. After seeing a link at Square State, for example, I reviewed the offerings at eHealthInsurance, which markets individual and family health insurance plans, and connects people to brokers for group health insurance plans.

The individual health insurance plans have lower premiums (from $2,000 to $6,600 a year, compared to about $19,600 a year for a family four to COBRA at large employer group rates with a fairly modest plan where there are only small deductibles and are co-payments for most services). They also have big deductibles that you pay before you get any coverage, most in the $2,500 to $7,500 range (often, per person, not per family), often require you to pay 20%-30% of the charges after the deductible, still require you to stay in a network of physicians, and frequently don't cover pregnancies, prescription drugs, mental health care, or pre-existing conditions without a hefty additional premium, if you can get health insurance at all. Some of these plans also have fairly low caps on the maximum payout, so your insurance may end in the midst of a really serious illness or injury when you need it most.

Now, some health insurance is usually better than nothing. If you have some health insurance you usually pay the real price from health care providers, instead of the exaggerated prices charged to the uninsured. Indeed, having health insurance is often necessary to even get an appointment with a health care provider -- many won't take new patients who lack insurance.

Also, if you have a major medical incident, most individual policies can easily put you out of pocket $10,000 or more. But, some of this can be made up for by saving your premium savings to use for out of pocket costs, and it is much easier to pay $10,000 with help from credit cards, home equity loans, friends, family, bake sales, pawn shops, overtime and extra jobs, than it is to pay the $50,000 to $100,000 you might owe otherwise.

While most people contemplating starting a small business may not known the precise numbers involved, most do know in general terms that going into business for yourself means paying more for a weaker safety net. The big price our economy pays as a result is that many people simply don't start that business, even if it would otherwise make economic sense for them to do so. Since small businesses create far more jobs proportionate to their economic size than big businesses, and are far less likely to offshore their labor, this lack of affordable health care for small businesses kills millions of American jobs every year.

1 comment:

Dave Barnes said...

No comprendo.

I am 59+ years of age.
My wife is 50+.

We had no problem buying insurance.
HSA. $585/mo with $100/mo going into the HSA. $5K deductible.