What if I canceled my health insurance and paid off more of my public health student loans?

The business of healthcare sometimes takes away from the point of what it’s meant for, to support the health and well-being of the nation. Health is a human right — as we constantly said in public health school and even repeated out loud in the public health oath.

Yet healthcare or health insurance is a privilege that can cost a single self-employed or unemployed person upwards of $400 per month in the US.

And as millions of people lost their jobs during the pandemic, that now means millions of people need to pay for their own health insurance and can’t rely on employer-based health insurance. Women filed nearly 59% of unemployment claims, despite being only half of the labor force.

Paying Your Own Health Insurance

I started paying for my own health insurance in 2018. Not only was the price tag a shock, but the process was cumbersome and my options were awful.

On top of that, because I received my health insurance through the marketplace, if I wanted to see a specialist like a dermatologist it was nearly impossible.

About a year ago, I needed to get a few skin issues checked out. After attempting to make appointments at several places and being dismissed by the receptionist like,

“oh, we actually can’t book you because of your health insurance?”

“Not even if I just pay?”

“Yes, we have an agreement with them that we can’t take anyone from that health insurance.”

I even attempted to go down the route of getting a referral from my physician. Which apparently, is not a thing anymore and not how the system works.

While physicians can make referrals, it’s up to the health insurance whether they approve it or not. How is that helpful? My physician can refer me but my health insurance can say it’s not important enough see the specialist?

Literally what he told me was, “most people end up going to Mexico to see a dermatologist.”

“Well that’s perfect, I’m going to Mexico in a few months!” I said.

His recommendation, essentially his referral “just wait until you get there. It doesn’t seem like anything will happen from now until then.”

Luckily, my skin issue was nothing threatening like skin cancer but if it was? It seems nearly impossible to take precautions and preventative measures with the support of a doctor in the US. And as Yaseen Hayajneh, associate professor of health administration at Western Connecticut State University said this is a “cure-driven system, not a prevention-driven system.”

Health Insurance, Higher Education, and Taxes in Other Countries

As of 2021, 45 million Americans carry student loan debt and with the Biden Administration considering making changes or at least continuing to postpone repayments, it seems timely to explore these two topics: student loans and health insurance.

What is it like in other countries?

Well, according to Finland author Anu Partean their taxes paid for:

“nearly a full year of paid parental leave for each child (plus a smaller monthly payment for an additional two years, were I or the father of my child to choose to stay at home with our child longer),
affordable high-quality day care for my kids,
one of the world’s best public K-12 education systems,
free college,
free graduate school,
nearly free world-class health care delivered through a pretty decent universal network, and a full year of partially paid disability leave.”

And while yes, she admits that taxes are just slightly higher than a state like NYC — it paid for “top-notch” individual services like this. My taxes on the other hand, selfishly I’m not sure where they go but I gladly pay them every quarter knowing it must be for something.

So, when did employer-based health insurance start in the US?

Employer-based healthcare came out of a market-driven response by employers after World War II. It grew out of a strong economy, low unemployment rates, and intense competition for talent. And then, it just stayed…

In 2017, of the people that are privately insured 56% were insured by their employer — more than half!

Being that it’s private health insurance, it’s functioning under a free market. One thing about a free market though is you need to know the price of something BUT insurance makes prices and payment opaque for people paying and also for doctors. So, is health care a free market?

The cost of health, education, and amplification

Studying public health gave me a depth and a new lens to see the world — everything impacts our health.

From personal choices, to how we grow in our mother’s womb, how close and accessible grocery stores are, to racial disparities. All of what researchers call social determinants of health. And what I studied within the field of public health. Infectious diseases and chronic diseases more obviously are within public health. I wouldn’t change anything about my choice in attending school. It provided me with a lens that I view the world now.

When I decided to travel for an extended amount of time in 2021, I canceled my health insurance and what I thought was going to be just the last few months of the year.

I’ve danced the pros and cons multiple times as I stepped into paying my own health insurance as a self-employed person. I always ended up paying feeling that bit of guilt thinking “what if something happens to me.” “What if I get run over by a truck.” “I’m gonna drown in debt paying off those health loans!”

But I’m already drowning in student loan debt from my public health degree.

What amplifying your own voice means

Attending Columbia was a conscious choice for me on two fronts:

it’s a great institution with a reputation that many people know
it was a way to give me a voice in a system and institutions that first makes assumptions based on categories of humans but not the human itself (check race box, check income box, check marital status box, check gender box).

I remember the former women CEO of a company I worked at was once quoted saying, “we don’t hire based on education or university attendance because we believe that skills are gained on the job.”

An ok sentiment, but that is such an unconscious remark from a very privileged person that has never been questioned, or looked down upon based on assumptions.

I recall in high school, many of the teachers (yes, teachers!) had a rumor that I would be the first teenage mom. I wonder whether that assumption would be made about one of my white friends.

Did they assume that I would be going to Columbia?

How long does it take to pay off loans?

On average, it takes people about 20 years to repay student loans. Some professional graduates take over 45 years to repay student loans with $96,700 as average debt for master’s degree holders attending private institutions (very close to what I have).

Women take about two years longer than men to repay student loans and the wealth gap playing a role in student debt for women of color. Having less family wealth to rely on explains why Black women and Latinas, for example, need to borrow to finance their education. Along with many other factors that I won’t go into details here but The American Association of University Women has some really great stats.

What’s the opportunity cost

In 2021 my health care spending was $5,422.00 (I guess it helps when I have to itemize all my deductions as a self-employed business owner). That was about 17% of my expenses, the second-highest expense.

Interjecting Thought: Should health even be an expense? Why am I seeing health next to dues & subscriptions?!

This includes monthly premium payments, out-of-pocket biweekly mental health therapy, out-of-pocket dental visits, wellness visits like acupuncture, and extra visits and clinics like ZoomCare.

That doesn’t include other items I consider health — yoga, meditation, energy healing, community health.

And yet, I still paid the IRS $8K in taxes. What my tax money went to, I’m still not sure. If it’s not health insurance, education, or public initiatives….

Canceling my health insurance meant that I could now pay off more of my student loan debt.

During this time period without interest rates, I’ve lowered my principal balance by $8K. For some, that may seem small but that feels like a freaking huge milestone to me after seeing the loan actually increase because of interest over the past 5 years.

Defining what is mine — was it worth it?

When I first got accepted to Columbia, my parents had no idea what it was or what that meant. But as they told more people, bosses, colleagues, and friends and noticed the reaction and everyone telling them “oh she must be smart!” Whether it’s some micro-aggressive compliment, it was a time in my life that I needed to physically embody certain things.

Whether you agree with a higher-education degree or not, whether you’ve gone to school or not — when someone says “I went to Columbia” your assumption isn’t that they are dumb.

And in a world (or maybe US world) that wants to silence me for being a person of color, first-generation US American, a woman, a petite woman — my intersections could keep going— in a way, I paid to give myself a voice, the voice I knew I already had inside me but often silenced based on the assumptions people have because of my born identity.

And when assumptions are continually made about someone even as young as high school, before they even have the chance to openly share and discover who they are in their heart — they start to believe it or lose their voice in the process.

I needed to reclaim aspects of myself that even to this day people don’t realize their tone-deafness. It was worth it on some fronts and this degree was just one aspect of me stepping into reclaiming myself.

And as Congresswomen Ayanna Pressley says, “If you don’t see a seat at the table, don’t pull up a chair. Build a new table.”

And well, about our broken health system….I am privileged, able-bodied, and “healthy” in that I don’t necessarily need to pay for health insurance. That doesn’t mean I don’t need health care though and the way things are currently structured for patients and doctors — there is less of an incentive for young, healthy people to pay for health insurance, while doctors are incentivized by the CEO and business than practicing independently on value-based care. So essentially, to be continued…

The Public Health Oath

Health is a human right. The public health community exists to safeguard that right. I believe it is a defining element of a civil society. Public health represents the collective actions necessary to protect the health of all people. Through prevention science and practice we can accomplish this goal. As a public health professional, guided by these principles, I declare the following:

I will work to ensure that people have the chance to live full and productive lives, free from avoidable disease, injury, and disability and supported in their pursuit of physical, mental, and social well-being.

I will hold myself to the highest ethics, standards, values, and responsibilities as I move forward the science and practice of public health.

I will respect the rights, values, beliefs, and cultures of those individuals and communities with whom I work.

I will rely on evidence to support my decisions and actions and translate that evidence into policies and programs that improve health for all.

I will add to the body of research and knowledge and share my discoveries freely.

I will continuously seek new information and be open to ideas that can better protect and promote the health of populations. I will advance health literacy for all and seek equity and justice for vulnerable populations.

With this oath, I commit to the ideals and mission of public health.