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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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USA Politics The World

Congresswoman Alexandria Ocasio-Cortez will pay her interns. This is sadly uncommon.

Between Instagram live stories and participating in a sit-in during her training, Congresswoman Alexandria Ocasio-Cortez is proving to not be an average politician.  Besides also not being an elderly white man, Alexandria said that she will pay her interns at least $15 an hour, which is above minimum wage in Washington, D.C.

The Pay Our Interns’ 2017 report revealed that in the United States Senate, 51 percent of Republicans paid their interns and 31 percent of Democrats paid their interns. In the House, it was even more dismal. Eight percent of Republican representatives paid their interns, and less than four percent of Democrat representatives paid their interns. I never thought Republicans would be better at doing something good than Democrats. But hey, it’s not bad to be proven wrong.

The incentive to find an internship is clear: internship experience often leads to jobs, and for many college students, employment is one of the first things on our minds when we think about the future. This often leads to university students taking advantage of any internship offer they can find, even if it is unpaid.

For many students and their families, this can be a major financial sacrifice. A student may decide to choose to pursue an unpaid DC-based internship for their local congressman or congresswomen over a paid service job. A CNN article, which was published this fall, revealed sacrifices that some of these interns had to make, like skipping meals. Former House intern Sophie Peters, who was interviewed for the CNN piece, was able to get a grant but had to babysit outside of her 40-hour work week in order to pay for her rent and other expenses.

Peters also said that competition for Congressional internships doesn’t seem to be driven by talent but instead by “who can afford to work for free when they’re 20 years old.” This hints at a more major problem: people who are able to take unpaid internships are often those who are from well-off (mostly white) families. This is why it’s so important that Alexandria plans to pay her interns.

Reporter Llewellyn Hinkes-Jones explained in an editorial piece for The Awl that the lack of representation in interns plays a role in whose voices are heard down the road. “This ultimately exacerbates social inequality because key professions get filled up with people from privileged backgrounds,” Llewellyn wrote. “It not only affects who gets ahead and does well, it also plays a big role in terms of the voices we hear in the media, politics, arts, etc.”

It makes sense that Alexandria would want to pay her interns, given her background and her path to Congress. She comes from a working-class family and managed to trounce incumbent U.S. Representative Joseph Crowley.  Crowley is someone who could be considered an establishment politician – he is the son of a lawyer and has held his seat for twenty years. Alexandria’s win speaks to the desire for change that many of us want. We want politicians who will stand up for us, just like how Alexandria is standing up for her interns by promising to pay them.

Unpaid internships shouldn’t be a thing anywhere, as labor needs to be valued. Good for Alexandria for wanting to pay her interns a livable wage, and hopefully this will help put a stop to unpaid internships in Washington, D.C. and the world.


Here’s why unpaid internships are such a problem

“So do you have like, uh, a major?” interrupted the illustrator. That morning when he had walked into the office, he veered straight for his computer. No interest in the unfamiliar young body in the office. Just an intern.

I decided I wanted to try my own hand at a career I could possibly more-than-stand (if you haven’t heard, we do live under capitalism) when my undergraduate tenure was already at its end. Whatever ‘in’ there may have been at university, into the carefully gatekept and strangling media industry, had already passed for me.

I was—and still am—luckier than most. I could go home with my degree (to New Jersey, which is only or inconveniently a train ride into New York City). I can live in my parents’ house and eat my parents’ food, make money irregularly and watch my savings shrink, all the while blindly applying to hundreds of jobs and internships and fellowships I likely will not get, all in hopes of breaking into an industry that appears every day to be at capacity.

“If you’re really serious, the only way is [DEBT, DEBT, DEBT]” was the flat advice from the director of NYT fellowships and internships, whose Twitterfeed is riddled with excitement, promotions, and advice for new journalists, or the 13 young people who have already managed to snag a possible livelihood.

“There are no jobs in journalism!” joke high-profile staff writers to their high-profile writer friends everyday on Twitter. “Go away if you know what’s good for you!” Oops.

So when I was offered an internship with an independent, ‘leftist’ publisher, after receiving more and more proof that there truly are no writing jobs [for me], I accepted eagerly. At the end of the interview, an editor mentioned casually the position was unpaid before describing a Christmas party four months away.

When it comes to internships, not all of them are unpaid. In a Fall 2017 issue of CUTE Magazine, Amélie Poirier and Camille Tremblay-Fournier describe the gendered nature of labor that is deemed valuable enough to pay for. Certainly, internships in engineering or computer science are “almost always paid.” Perhaps, the issue is industry money. After all, new declarations of journalism’s approaching demise are announced daily. Presumably, independent book publishers sacrifice the potential financial security of corporate collaboration.

And yet, Poirier and Tremblay-Fournier argue that who exactly gets paid for their work is no coincidence. As of 2010, in the US 77% of unpaid interns are women. As my supervisor introduced me to the editors, publicists, and accountants in our small office, he quickly came upon Christina, a young woman about my age. Another intern, I was told, though one who had interned throughout the summer as well. An hour later, in our first staff meeting, our publisher re-introduced Christina to me. “She’s, uh, sort of an intern, but now paid as a part-time freelancer. Like a paid intern.”

I looked around to see if anyone else, in this supposedly leftist publishing house, might wince at Christina and I existing at the table side-by-side. No one batted an eye. Of course interns need to earn payment, and Christina has proved herself.

I don’t think this is a question of money. Perhaps this is publishing culture, but new and old books are shipped out all day—gratís—on a moment’s notice, to whomever may desire a copy. My internship program is not new, in fact my publishing house relies on the seasonal fresh-faces of “college students or recent graduates.” This semester, there has been a struggle to reproduce their youthful cohort, and apologetic expressions form on the faces of full-time staff unloading their clerical duties onto the current three (one paid and two…not) interns. It seems to me that, if the issue were money, a truly independent company would not encourage free labor. It seems to me that, if the issue were money, a company would not hire staff they could not afford to pay.

Rather, the office presumption seems to be that we interns are their occasional students who are conveniently around all day to mail press orders, answer phones, arrange travel, research potential reviewers, walk around the street corner to the book basement, proofread e-blasts, type up hard copies (only sometimes…this is a special task), and bind manuscripts. I get $120 dollars a month for travel apparently—at the end of month, which I have yet to receive to pay my train tab (just kidding, there are no train tabs).

An actual student, contend Poirier and Tremblay-Fournier, is producing value. They are reproducing the workforce, along with giving professors someone to teach and colleges a reason to exist. Perhaps a small amount of editorial knowledge is trickling down into my equally small, young brain, but I do not think it is the most radical thing in the world to desire payment and recognition for building the foundation of this cute little bookstore. If payment were radical…do you think a leftist company might go for it?

I can afford to swallow compensation for 25 hours of work a week, and the actual self-investments sobbing for me to come back. My GRE whispers to me all day, I’m sure you’ll do fine. My graduate school applications sink further into my Chrome tabs, you’re coming back when you can focus. Canceled shifts and paid jobs smugly move on without me. Most and many others, the people that would transform an industry that is overwhelmingly white and suckish, cannot bear the dependency on an not-paying employer, and cannot eat or pay rent or have a baby or get ill with hopes of future payment. 

All of this might just seem an unfortunate experience, one I have certainly and stupidly volunteered myself for, but the constant implication that people at their place of work are “resisting,” are doing The Good Work of Good People simply by turning a profit, is grinding. Congratulations are offered around the table, to staff for having done the good work of advocating for justice at the last book fair. Were I written into a book, I would be more real.