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Gig and part-time workers have been left out of the healthcare conversation in the United States for far too long

It is no secret that the healthcare system within the United States is flawed. In large contrast to other countries, there is no universal healthcare. As such, the U.S. government does not provide healthcare for most of its citizens. Instead, healthcare is provided by multiple distinct organizations. These include insurance companies, healthcare providers, hospital systems, and independent providers. Such healthcare facilities are widely owned and operated by private businesses. 

Millions of people are left vulnerable to falling through the cracks as public and private insurers set their own rates, benefit packages, and cost-sharing structures within the bounds of federal and state regulations. 

Employer-sponsored health insurance was first introduced in the United States in the 1920’s. This method indicates that employers might contract with private health plans and administer benefits for their full-time employees as well as their dependents. By 1965 public insurance programs such as Medicare and Medicaid were introduced as a means to compensate for some, but certainly not all, of the already existing flaws. 

Medicare ensures a right to hospital and medical care for all persons aged 65 and older, and later those under 65 with extreme long term disabilities or end-stage renal disease. On the other hand Medicaid, which covers around 17.9% of the American population, is state-administered and is meant to provide health care services to low-income families, the blind, low-income pregnant women and infants, and individuals with disabilities. Eligibility for Medicaid is largely dependent on criteria which vary by state. Individuals need to apply for medicaid coverage and to re-enroll annually. 

As of 2021, the U.S. ranks 22nd globally in terms of quality healthcare with countries like Finland, Japan, and Canada placing above it. In 2018, nearly 92% of the country was estimated to have health coverage, either through their employer or based upon other factors. That statistic leaves roughly 27.5 million people, or 8.5% of the population, uninsured. 

Those flaws intensify dramatically when it comes to the gig or part-time workforce. For one, it is no coincidence that struggles in regards to access to affordable healthcare also run along the lines of race, gender, and income in this country, just as it does with the countless other social issues which persist here. 

For one, those who work within a gig or part-time capacity are often not offered an employer-sponsored health insurance plan. Not to mention that they are also not salaried, so their income is often limited or unreliable, leaving these workers with little opportunity or access to the healthcare system that is in place. Such workers are either required to purchase their own health insurance or apply for Medicaid. Now, while Medicaid eligibility varies between each state, many people who are classified as low-income wind up making too much money to actually be an eligible candidate for the narrow assistance program. At the same time, however, many of the private health insurance plans are extremely expensive, leaving workers stretched thin financially or in danger medically.

This dynamic effectively allows for inequality to flourish. This is no surprise considering that the gig and part-time economy is mostly made up of minority groups, thus being complicit in the racially skewed power structures which exploit people based on their race, religion, gender, sexuality or socioecomic status. That includes single mothers, previously incarcerated people, immigrants and Indigenous, Latinx or Black adults to name a few. In fact, nearly a third or 31% of Latinx adults aged 18 or over earn money through the gig economy. This is compared to 27% of Black Americans and 21% of white adults.  

Workers rights groups in the gig and part-time sphere have been advocating in the name of things like workers compensation for various minutia including maintenance of drivers vehicles, the right to organize, access to 401K, paid family leave and proper employment classification, among other things. This is especially important when you consider that, contrary to popular belief, most people are not using their gig or part-time job as a “side hustle” to compliment their salaried and health-insurance sponsoring full-time position. Instead, this is likely their primary source of income, along with perhaps a second or even third job doing something similar. They are doing as much as they can to make ends meet and survive within a world and system which layers on barriers to their success and sustainability. One that fails to acknowledge their exhaustion and that remains complicit in their vulnerability. 

At the root of what workers are demanding is dignity on the job. 

Workers are fighting to dismantle the system of exploitation that has further isolated and damaged vulnerable communities across the country. To put this better into perspective: there is an unprecedented number of care deserts in the United States. Medical care deserts are best defined as a region which is more than 60 minutes away from the closest hospital. Nearly 1 in 5 residential areas in America, or around 640 entire counties, fall under this definition. 

Also affecting access to healthcare and employment status substantially are child care deserts. Child care deserts are areas in which there are little to no licensed child care providers. An estimated 51% of all residents in the United States live in a child care desert. Plus, child care is especially limited among particular populations such as for low-income families, rural families, and Latinx or Hispanic families. 

Each and every person is deserving of the right to proper healthcare, especially that which is free of the leaps and bounds of a system that oppresses and makes it extraordinarily difficult to access or afford. 

That said, the COVID-19 pandemic without a doubt boosted the telemedicine industry dramatically, putting more accessible and affordable healthcare on the map. A rainbow behind storm clouds, telemedicine has the potential to help people in many ways beyond what we saw over the past year. 

For one, people don’t have to worry as much about transportation, making virtual appointments not only cheaper but also less time consuming. Similarly, because such appointments can take place right from your home, the patient is offered a lot more flexibility to accommodate their work schedules and things like child care. Not to mention stressors in regards to scheduling, the possibility of domestic violence or even religion that can make traditional medical care difficult.  Therefore, due to its asynchronous nature, this intrusive care modality can be much less anxiety-inducing for patients. 

One telemedicine option, Alpha, has been offering such services for much longer than those which were forced into it by the pandemic. Alpha is a growing platform that allows for patients to receive primary care or talk therapy from home. It specializes in holistic treatments for women ranging from regular checkups to ongoing mental health appointments, nutrition and reproductive care – including postpartum depression – acknowledging that women often carry the burden of handling healthcare for their entire families (spouses, children, elderly parents, siblings, etc.) while also working. In this way, Alpha’s services are entirely patient led and personalized. 

Women’s health in particular is ignored, invalidated, and not taken seriously within the medical industry of the United States. Through the asynchronous telemedicine that Alpha offers, patients have a direct line of written conversation with their physician to ask questions or address concerns, unlike an in-person setting where phone calls are screened or a patient might see a different doctor each time they visit. This way, visits are much more private, personal, and accessible. 

Additionally, by allowing patients to pay with cash or in an a-la-carte fashion, the company stands by its mission to meet patients where they are. According to its website, Alpha has a few external/local partnerships in 43 states in the case that a patient needs a procedure done or to go to a lab to receive a test which cannot be completed from an at-home kit – remaining dedicated to combatting the issue of care deserts across the country. 

Alpha’s Chief Medical Officer, Dr. Jacobsen, highlighted a mission of the platform. “We educate patients on their medical condition. We are always involved with the patient because involving the patient in their care, making an informed and fair treatment plan and decisions about prescription medications is going to increase adherence to the plan by the patient.” 

 “And obviously,” Jacobsen continued, “support the relationship between the patient and the provider. We know that a good relationship with the provider actually shows better patient outcomes.” 

Alpha encourages all employers to consider health plans which include telemedicine, citing its inherent ability to provide a less stigmatized experience for patients. More specifically, much of the patient demographic using Alpha are people either without insurance or moving in and out of insurance.

“It is a great fit for gig workers and very convenient, given the fact that you don’t have to take time out of business hours.” Gloria Lao, co-founder and CEO, added, “you can solve your medical issues at midnight on your couch and still get cared for.” 

It is surely going to be difficult to return to fully in-person treatments after the pandemic considering the cutting-edge programs which have emerged and its potential to drive affordability. Perhaps, with a more urgent shift toward progressive politics in the United States and as the unions formed by workers across the country begin to catch fire, we can expect to see more attention focused on finally making healthcare accessible, affordable, and non-discriminatory.


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Books Pop Culture

How “The Clique” novels taught me the importance of eating the rich

The ambiguous “they” say not to judge a book by its cover, but that’s exactly what I did when I first came across Lisi Harrison’s The Clique series in my middle school library. At the time I just thought the girls on the cover (of what was actually the third book, Revenge of the Wannabes) looked pretty. A decade later, I view that otherwise unmemorable afternoon as the start of a journey that radicalized me. No, unfortunately not regarding the inanity of Eurocentric beauty standards (we’ll save that story for later) – but rather on the excesses of capitalism and the power of a PalmPilot gone unchecked.

As a quick primer, The Clique focuses on the ultra-rich and glamorous Massie Block and her equally wealthy friends, dubbed the “Pretty Committee.” Massie, the queen of the all-girls Octavian Country Day, seemingly has it all — an endless collection of credit cards and designer bags, a cute pug named Bean, and the affection of the hot guys at OCD’s all-boys counterpart, Briarwood. The only thing standing in her way to continued total domination of the 7th grade is the arrival of the shy and naive Claire Lyons and her family, who move into the Block family’s guest house as they get set up in Westchester.

It’s possible to read through the 14 books (and 5 bonus novellas!) and come away with nothing but a feeling of mild disgust. At first glance, the series does read as just Gossip Girl For The Youths. But, digging deeper into the absurd, excruciatingly detailed depictions of the ultra-rich girls and their complicated middle school friendship dynamic – based on Harrison’s own experiences at MTV, I’ve realized the brilliance of Harrison’s subtle manifesto.

For starters, The Clique taught me that power corrupts. Take Alicia Rivera, the eternal “beta” to Massie’s “alpha.” Alicia doesn’t appreciate how good she has it, with all of the benefits of being at the top of Massie’s inner circle and none of the responsibilities of running an empire. Instead, she desperately wants more influence and tries on multiple occasions to dethrone Massie, only to let her ego get in the way. She finally becomes an alpha after Massie’s departure to London, but not before spending several hundred pages proving that you can be the hottest girl in school and still be completely ugly.

[Image Description: 4 girls lie down on their backs with their heads on pillows in a circle at a slumber party]. From The Clique movie / Alloy Entertainment.
[Image Description: 4 girls lie down on their backs with their heads on pillows in a circle at a slumber party]. From The Clique movie / Alloy Entertainment.

The Clique’s most convincing call to arms, however, comes in the form of Claire Lyons. Claire, one of the only explicitly lower-income characters in the series, begins as an outcast mocked by Massie. But over the two years the series spans, Claire repeatedly turns the tables on Massie and beats her at her own game by accidentally stealing the heart of Massie’s first real crush, beating her out for the starring role in a movie, and even planting fake bedbugs in Massie’s bed so the Blocks have to fumigate their house. Claire learns to read and capitalize on her enemy’s weaknesses and there are certainly times where she fights dirty, but she never loses sight of who she is at heart.

Massie is eventually forced to recognize her true power, but even when she’s accepted into the Pretty Committee, Claire continues to eat with her “Loser Beyond Repair” best friend, Layne Abeley. She sees through the posturing of middle school social dynamics and brings truth to power. In doing so, she breaks the oppressive iron grip of the Pretty Committee from the inside. My one critique of Claire is that she’s a reformist, not abolitionist, but I trust she gets there in high school and beyond.

I like to think that I learned about as much about class warfare from The Clique as I did in my introductory sociology classes. Rereading (and literally laughing out loud at) the books as I’m home during the pandemic, I recognize how much I’ve used what I learned, first as a girl from rural Wisconsin at a fancy private white university, and now as a Desi woman who did not come from generational wealth and who started in community organizing, but somehow landed in corporate America.

I still pull on the lessons on how to talk like a rich person – and all the brand names – that I learned from The Clique when I talk to certain coworkers at the coffee station. But even more so, I pull on the reminders that it’s all BS. No matter how many microaggressions I face, I am reminded that arbitrary flexes of social status and wealth, and the power structures that amplify them – whether they’re traditional capitalist institutions or the Pretty Committee – are really all just waiting for a Claire Lyons to tear them down, start society anew, and spread the wealth.

Harrison is no Marx but there’s definitely a socialist reading of The Clique that I’m 100% willing to believe actually makes this pre-teen chick-lit series a truly revolutionary text. I will not rest until it’s made into a full Netflix Original Series. Until then, I’ll be happily rereading this gutsy manifesto about my problematic eternal faves.

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