“People tend to trivialize the issue,” says Karen Davis, president of the Commonwealth Fund, a research foundation that recently published a comprehensive report on uninsured young adults. “The most common misperception is that they’re pretty healthy all in all and end up getting decent care without insurance. Yes, when you’re injured in an accident, you won’t be left in the street. But getting good rehab? That may not be an option. Most of the uninsured aren’t getting regular Pap smears, they skip tests and treatments, they tend to end up in the emergency room because they wait until the last possible minute—they are developing unhealthy habits that are likely to stick with them as they grow up and start having more-serious health problems.”
New York, unsurprisingly, is an especially fertile breeding ground for the uninsured young. “A lot of the professions that draw young people to New York—everything from retail to the arts to restaurants to software development—tend to have spottier coverage,” says James R. Tallon, the president of the United Hospital Fund, a health-care think tank. Even large corporations are increasingly reluctant to offer coverage. (At a company like MTV, for instance, many full-time employees work in a nebulous state of hourly wages and no benefits, an arrangement that can last years.) Those without employer-sponsored coverage are thrown into a market where individual premiums can cost anywhere from $250 (for a bare-bones catastrophic policy) to $900 a month, among the highest rates in the nation, and likely out of reach for someone just starting out. And so going without health coverage becomes one of those casual sacrifices that come with being young in New York—on par with funneling half your income into a 400-square-foot apartment.
As an informal litmus test, I recently sent an e-mail to a handful of people in their twenties asking three vague questions: Are you uninsured? Know someone who is? How has it affected your life? Forward it to anyone, I encouraged. I imagined I would get a fair number of replies—one in four New Yorkers is uninsured, so I wasn’t exactly shooting in the dark, and as a 27-year-old former young invincible myself, I had an undoubtedly skewed sample—but I was unprepared for the sheer volume of response: more than 100 replies within a couple of days, mostly from people I had never met. There were complaints, conspiracy theories, details of unpaid debts, stories of untreated injuries, shoddy care, one insurance-inspired marriage (he needed surgery), and, in the case of a musician friend, wisdom teeth that should have been pulled years ago. The messages led to interviews with more than 50 uninsured New Yorkers. If there was a dominant theme to these conversations, it was that being uninsured has a distinct way of tweaking one’s perception of the city: New York becomes a kind of phobia-forming obstacle course, one navigated with the goal of keeping doctors at bay.
Nichole Schulze, a 31-year-old former publicist and current student at the Fashion Institute of Technology, was quick to rattle off a battery of quasi-logical preventive measures: “You won’t see me snowboarding or mountain biking or even jaywalking. My friends think I’m a freak because I’m the only person in New York who actually waits until the light changes to cross the street. Oh, and I eat a kiwi every morning because I read somewhere that they contain twice the vitamin C of oranges. And if it’s snowing? I’m the one walking on the inside of the sidewalk, just in case a cab decides to swerve and hop the curb.” Should any of these methods fail? “I carry an expired Blue Cross card in my wallet. You never know, maybe they’ll think I have insurance and I’ll get better care.”
Andrew Kuo, a 29-year-old painter, told me he made a vow to be insured by the time he turned 30. “But that was when 30 seemed like a ways away,” he added. “Now I find myself making all these stupid calculations. Like, it would cost me around $3,000 a year to have insurance, right? Okay, isn’t that about what it would cost out of pocket if I broke my wrist? Chances are I’m not going to break my wrist once a year, so why not save the money for that onetime emergency?” Like many I spoke with, Kuo said he’d happily pay for insurance, if only the cost-benefit analysis tilted more in its favor. “What’s ironic is that I would never live without my cell phone, but I won’t consider buying health insurance. It sounds ridiculous to say that out loud, but the fact is insurance is just too expensive. If it was the same price as my phone”—$150 a month sounded reasonable to him—“I’d buy it in a second.”