My brilliant, beautiful and generous twenty-nine year old daughter shares an apartment in New York City with three other wonderful young women. All are college graduates and hold full-time jobs, though none earns enough even to dream of having her own place.
When COVID came to New York, they decided that they would quarantine together. They established strict rules for their household: No one else allowed into the apartment; masks and gloves when outside; frequent hand-washing; disinfecting door knobs and other surfaces. When Governor Cuomo loosened restrictions, they decided as a household to participate in Black Lives Matter protests and as a household to leave if they saw people not wearing masks or if the protest turned violent.
From the start of COVID they understood that they are in this together. They know that COVID is especially likely to spread within households, so if one gets infected it’s likely that all will become infected. They know that if one or more become sick, the others will be the primary caregivers. And they know that they cannot leave to move in with their parents, all of whom are elderly or otherwise at high risk.
Paradoxically, incomprehensively, cruelly – these four women share mortal risks and responsibilities, but they cannot share health care coverage.
A Dangerous System
Health insurance in the United States is linked both to full time, permanent employment and to the nuclear family – although only a minority of Americans actually live in nuclear family households.
Links between health care and employment result in higher rates of debt, deteriorating health, and even death for Americans who do not have the good fortune to hold good jobs. Our current system disproportionately harms people of color and low-income Americans, especially during the current health crisis with historically high rates of lay-offs and unemployment.
The dangers of linking health care to nuclear family structures are less acknowledged, perhaps due to lingering false nostalgia for the brief slice of time in which households made up of an employed adult and his dependents (that is, spouse and minor children) were the norm – or at least the aspiration in America. Though this family model has expanded to include recognized domestic partners (typically same-sex spouses) the problems remain the same: Health care chaos when families break up (more than a third of American marriages do not last), and reduced access to coverage for adults and children who do not fit the nuclear family mold. Millennials, African Americans, LGBTQ Americans and Americans without college degrees are less likely to live in nuclear family households than are white, educated, middle-aged and hetero-normative Americans, which means that they are more likely to lose out in the health insurance sweepstakes.
How We Actually Live
But that is online viagra not an end of life. Impotency is brought on by a blockage in the vein that consequently blocks the blood flow to the sildenafil without prescription male genitals. I remember order cialis appalachianmagazine.com telling a beautiful patient of mine years ago that she had breast cancer. This herbal supplement also helps to increase semen volume and enjoy soft viagra http://appalachianmagazine.com/2015/11/18/us-releases-osama-bin-ladens-bodyguard-from-gitmo-this-week/ intense sexual pleasure in lovemaking.Like my daughter and her housemates, Americans today often live in a household with someone whose access to health care differs from their own. More of us are doubling up in shared living quarters that include an “extra adult” such as an adult child, elderly parent, friend, roommate or boarder (*see below for more on this theme*). And like my daughter’s household, these homes are made up of people who share intimate space, risks and responsibilities, but not health insurance.
Sixty-four million Americans – an all time high — now live in multigenerational households. But even for family members, sharing a household does not mean sharing health care coverage. Due to the high costs of housing and the scarcity of secure, well-paying jobs, many young adults – especially men without college educations — have moved in with their parents. Whatever the circumstances – job training, saving up for their own homes, health challenges — these young adults cannot remain on their parents’ health insurance beyond age twenty-six.
Multigenerational households also are increasing as elderly Americans leave nursing homes that have become COVID hothouses and move in with their adult children. If these children need to quit their jobs to become full time caregivers, they cannot receive health coverage through the elders’ Medicare insurance. The opposite also is true: If the adult children have dental, vision or other coverage that is not included in Medicare, they cannot share it with their elderly parents even in an emergency. All of this may sound obvious to those of us accustomed to American health care, but in the midst of a global pandemic these constraints to multigenerational support are potentially lethal.
When an individual becomes sick, the immediate hands-on caregivers are likely to be other household members, yet those caregivers may suffer financial and health disasters if they do not have good insurance. In some scenarios, housemates may decide that it is too risky to care for those who are sick and leave the sick individual to manage (or not) on her own. Neither of these should be seen as acceptable options.
Looking Forward
At some point in the future, my daughter’s household likely will break up. Each housemate may decide to move in with a different set of housemates, settle down with a spouse, become a live-in caregiver for an elderly relative, have children of her own, or figure out another kind of household that we haven’t yet dreamed up.
We need policies that recognize and strengthen households – however they are constructed – because households are core units of mutual caring. We need policies that do not link health care access to a particular family configuration, especially one that is declining in frequency, time bound to a particular life stage, and favors well-off individuals. For the sake of my daughter and her housemates, we need a comprehensive and equitable system of universal health care coverage so that they won’t have to figure out which of them can most or least afford to get sick in the midst of a global pandemic.
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* An online survey that I disseminated in May 2020 reveals some of the diverse and creative ways in which 249 respondents from across the country construct their households. Few reported living in nuclear family households before the age of 40. These younger respondents described living in households made up of, for example, “My fiancé and a roommate,” “My mother, an elderly aunt, and my sibling who is a young adult,” “My child,” and “My spouse and in-laws.”
In the 40 – 64 year age group nuclear families were common but not ubiquitous, especially during COVID. One middle-aged respondent, for example, reported living with “My spouse, young children, adult children (college and grad school), and during COVID also one adult child’s significant other.” Among the oldest respondents (aged 65 and up) a substantial number – mostly women — reported living alone. Others described living with, for instance, “My disabled adult child and multiple grandchildren,””My boyfriend,” or “My adult children and [one] child’s girlfriend.”