Healthcare Reform and Nannies

Nannies have been emailing and calling Be the Best Nanny Newsletter asking to clarify what President Obama’s speech last night about healthcare reform meant. One nanny said on our voicemail, “I am more confused now than before.”

Currently our October 2009 Be the Best Nanny Newsletter monthly poll (which can be found on the top, right hand column of our blog at: shows that most household workers, that have taken our survey about health insurance, do not have health insurance benefits provided by their employers. So the topic of healthcare reform is important to many nannies.

Due to the questions we will discuss the proposed healthcare changes and the effect those changes might have on nannies and their families.

There seems to be a lot of confusion about the proposed healthcare changes and the effect those changes. Various aspects of different proposals have provoked heated and passionate debates. We will try to add some light to the debate.

One of the difficulties in this discussion is that, as of now, no healthcare law has passed. There are at least three different healthcare bills in the House, and different drafts in the Senate but no single set of proposals to consider. The absence of a final bill to consider has led to rumors and fear.

Nonetheless, we will examine the effects of those proposals we consider most likely to be enacted. First though, we will examine the reasons for the calls for healthcare changes and clarify some concepts.

Consider a moment, how would you rate healthcare in the United States? The cost of healthcare compared to the rest of the world? The cost of healthcare compared to other developed nations? The availability of healthcare in the United States?

The United Nations ranks the relative healthcare quality of all nations by measuring a broad range of statistics, services and results. The United States ranks 37th according to the United Nations rating model, the lowest of all developed nations except for South Africa.

For the year 2007, healthcare in the United States averaged $7290 per person. The average annual cost of health insurance in the United States for a family of four without employee or government subsidy is $12,680.

In France, that cost per person was $3601, the United Kingdom $2992, and Italy $2686. Nations with smaller populations, such as Luxembourg and Belgium also spent less per capita than the United States, but by not such a wide margin. Yet each nation enjoyed a higher and broader level of healthcare services than the United States. Similar disparities between the United States and other developed nations extend across the globe, from Peru to Sweden to Japan.

Determining the number of uninsured citizens is difficult. Analysts range from a low estimate of one in every seven Americans being uninsured to the highest estimates of one in five not have access to insurance. While estimates range from 21 million to 60 million uninsured, most analysts use a figure of around 44 million. These numbers do not include illegal immigrants.

Basically, there are four types of healthcare systems used throughout the world.

1. In most third world and poor nations, care is provided to those who can afford it; the rest suffer.

2. In Canada, private doctors and hospitals are paid by a single-payer, the government, financed by taxes.

3. In the British system, the government employs the healthcare providers and supplies the infrastructure and finances the system through taxes.

4. In Germany, hospitals and insurers are private companies and are financed from payroll deductions.

The United States uses all four systems in varying degrees.

1. The American Medicare program is similar to the Canadian system.

2. The Veteran’s Administration is modeled after the British healthcare system.

3. Employer-funded programs resemble the German system.

4. Public hospitals are morally, ethically, and usually legally obligated to treat the seriously ill. The financial burden of paying for the poor, whether working or unemployed, usually falls on the state or local government, often through a Medicaid program. Medicaid is for the financially poor, Medicare is for the elderly.

Many fear that healthcare reform will lead to socialized medicine. To define, socialized medicine is direct government financing and direct government supervision of healthcare services. The Veterans Administration that provides care for veterans and soldiers would be the United States example of socialized medicine.

Except for Medicare and the Veterans Administration system, the United States does not have national health insurance available to all citizens.

Traditionally, each state has its own insurance regulatory agency that promulgates rules that usually favor one insurer over another. Therefore, in many regions of the country, few health insurer choices exist. In 26 states, one insurer covers 50% or more of the residents. The largest metropolitan areas often have eight or more choices of insurers.

Employee-based insurance plans usually offer s one choice of an insurer, or the company is self-insured. Those seeking health insurance are effectively banned from shopping across state lines, and cannot carry their insurance with them if they move to a different state.

The “public option” is a controversial Federal insurance program that is being considered to be included as a central feature of healthcare changes. The advantages of such a program would be national coverage, portability, and broad-based membership that would provide competition to private insurers.

The fear of the “public-option” insurance is that such a program would be too costly for the government to implement, that it would imperil private insurers and lead to a single-payer socialized medicine model of healthcare. Lacking details of a passed bill, it is impossible to accept any any estimates of costs or cost savings as accurate. Without doubt, some supporters of “public-option” prefer a single-payer model for healthcare. Enacting a “public option” insurance plan need not inevitably lead to a single-payer system.

Other budgetary impacts of a healthcare bill are likely to include an expansion of both Medicare and Medicaid, subsidies for the indigent and the working poor to buy Federal insurance and new taxes or fees to fund the programs.

Additional likely changes would include health insurance being mandatory for every citizen, prohibiting the denial of services because of pre-existing conditions and the removal of caps on lifetime benefits. Coverage of addiction services and mental illness is likely to expand.

We have intentionally skipped mention of some programs that we consider as unlikely to be passed, such as a national non-profit co-op program and an all-ages Medicare system.

Next, we will start inspecting the likely effects of a healthcare bill on you and your family by focusing on a very untypical typical American family.

If you work as a nanny please take the survey so your input can be included in our October 2009 issue of Be the Best Nanny Newsletter, by clicking here.


  1. Great breakdown, Stephanie. I wouldn't be so fast to get rid of the co-op option. While it would work well in large states like CA or NY, it would fail in others but it's what the Republicans want and may be the happy medium.

  2. Hi it's Lori and I left the voicemail about being more confused now than ever that is quoted in the blog article. I really appreciate your trying to explain this a little.This is really helpful actually. I need to print it out and keep reading some of it, but the breakdown of comparing it to the other county's systems and how we already have all the systems in our society already. It really really helps.I keep hearing one mom saying we shouldn't be like Canada's system but didn't really understand what that meant. Makes more sense, thanks for putting this in normal english and not something I can't follow from the Wall St Journal or NY Times, just too confusing!Anyway, all the SINGLE nannies I know in town and in their '20s like me do not have health insurance. The older women with husbands tend to be on their husband's work plans. So it is important for us to get affordable healthcare. It's $125 per DR visit for me, even if I just need antibiotics. On my salary it's just impossible to go other than when it is critical.I look forward to what you have to explain next. Thanks! Lori

  3. I do think the healthcare services in America are probably better than anywhere else in the world. But our access to that health care is terrible. It is the rich get better care as things are now.

  4. I think the problem for nannies is they will have to pay taxes in order to get healthcare insurance. I am not positive, but it is ironic that nannies need health insurance desperately, but they don't pay taxes. Of course, this newsletter's readers probably pay taxes, but we know for a fact that Nannygate is thousands of nannies not paying taxes or paying less than they actually make.Everyone deserves healthcare but everyone should follow all laws including paying taxes which helps fund the reform we need.Nicole,Ft Lauderdale

  5. Nicole makes a great point. The bigger problem than "illegal immigrants" is unlawfal citizens.

  6. Good point from Polly too because I heard on news today the reporter saying that the number of illegal immigrants is counted in those uninsured. Would any of you not want an immigrant child to receive health care if he were sick?I think people are scared any time there is change and that's what is happening now. I think nannies are some of the people to need the health insurance reform more than anyone else in the country. Thanks for the explanation!Sara B. Reno Nevada

  7. Well Polly and Nicole:American citizens who work as nannies full time and don't pay taxes are no better than illegal alien immigrants. So if an American citizen is healthy enough and able enough to make a decent living they should be required to pay taxes and if they don't they don't deserve to be treated as an American citizen and the benefits of healthcare.Don't get me wrong, nannies at poverty level need help and should have low tax rates and need health insurance. They deserve it through legal means though.Every American citizen deserves health insurance and health care no matter their financial status. Illegal immigrants should not be entitled to that same level of care.No determining who is entitled are not is too difficult for a surgeon to determine. The discussion is difficult and too many nannies aren't involved in the discussion and it's to their detriment.

  8. I think nannies have been fooled too long into thinking it pays to get paid off the books and to have more money in our pockets in lieu of benefits. Set your standards when you job search! I dont know why nannies even consider taking positions where healthcare isn't covered.

  9. Thank you for being the only nanny resource I've seen so far to discuss this important (yet controversial) topic.I wrote this previously and will say it again:What I don't understand is that most nannies are on the bottom of the pay scale in this society (even poverty for some) and can't afford health insurance the most. I have asked my nanny friends and only one has that as a benefit from her job!So, we nannies (all domestics) are probably some of the people that can benenfit from the OPTION to join the government plan if healthcare reform occurs the most. It is merely an option (you won't have to change your private plan if you do not want to and won't have to join the government plan if you don't want to). For the nannies and housekeepers I know many can still stay on their husband's health plans from their husband's health insuracne and nothing will change. For single ladies with kids like me, we need the more affordable option that health care reform would allow us.All change is scary but nothing needs to change for those who like their health care the way it is. But for domestic workers this is the most important topic for most of us!

  10. How things are now nannies have to take care of themselves and not accept jobs that don't offer at least a portion of your health insurance as a benefit. I think it's ok to have a trial period of three months for example where you don't have that benefit paid by the parents, but then after three months the parents help with the cost of health insurance.If you accept a job without health insurance you are hurting yourself. You have to be your own advocate in this career. What you accept and don't accept is your decision.Newborn Specialist Felicia in Brooklyn

  11. Honestly most nannies could care less. They make little money and cannot afford health insurance and have "learned helplessness." They know how to live without much and little help and just accept their low salaries and little benefits.

  12. I am from winnipeg in canada and if people are honestly worried about 'socialized healthcare' they need a huge reality check. My dad had a heart attack last year. I could not imagine all the extra stress that would have come from worrying about money at a time like that…. from the initail hospital stay, to all the care and tests and appointments afterwards. For us (in canada) it was all free. To you i woulnd't even want to think of the debt my family would be in. i have heard of americans who had cancer, and when it went into remission told their family that if it comes back they will not be fighting it aggressivly because it would bankrupt their family. how sad. only hope for your country, and for all the people living and working in it, that a new solution is found….

  13. What concerns me is that there was a whole lot of emotion and responses to reviews of nanny book but very little for this health insurance topic which is so much more important.I think the lack of comments on this article on the blog proves that either nannies have no energy or intelligence for this discussion. Nanny friends of mine follow this blog on facebook and post articles on the topic but aren't commenting here. Nannies just don't care as a whole if their profession improves in image or character or if reforms can be made to help them in general.I agree with comments above that nannies in general have "learned helplessness" and do not care about politics or similar matters.It's a shame.

  14. I don't know what WILL BE, but I do know NOW nannies should insist on non-taxable income from their jobs. It's not hard to do, just explain to the parents for your next annual raise that you prefer the money (each year I typically get a $50 or $60 raise per week)go directly towards health insurance.You won't have to worry about losing any income, you won't be taxed on the income, and you won't have to worry about starting your own savings plan (which is hard to do because we like to spend what we make). Just explain to your employers that the income is not taxable, they should be more than willing to help you out. If they aren't find a family that is.Texas Rose Nanny

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