Tell HN: The disparity between employees and international contractors

I live outside the US and am a programmer in a US company. Starting this job two years ago coincided with a cancer diagnosis in the family. Treatment has gone well in private hospitals, but insurance doesn't cover oncology drugs, so we pay for them out-of-pocket.

We make around 110K USD a year combined, and have spent just under 200K on medical bills over these past 24 months. We have taken out loans to get by.

Public hospitals here are a mess and are almost always out of stock of oncology drugs, most radiation machines are out of service, etc. Combine that with sanitation malpractice and it's not somewhere where you would want a loved-one treated (even if they had the oncology drug, which they don't).

In hindsight, our family should have had private health insurance coverage that includes oncology drugs. None of the local insurance providers do this, so I've looked at international providers (Bupa, Allianz, BestDoctors, etc). My budget is so tight I can't really afford to sign up for one of these now, even though it might help prevent a repeat situation. Also, they won't provide much help for someone who already has cancer.

We've looking for ways to increase family income. I signed a non-compete with the company I work for, and I'd need to check in with them before starting anything extra. My partner is looking for a better paid job, but English is the big barrier to get a remote job like me.

I wish my current employer provided employee-sponsored health insurance for me and my partner. They do that for their US employees, but not for international contractors. In an ideal world they would also cover our dependents, which would include the family member who has cancer.

Countries like the one I live in have always had these problems. It's just that now as the world opens up to remote work, the difference in circumstance between one employee and the next can be great. While you might have dental, vision, health insurance, 401K matching, your teammate working out of a developing country might be struggling to pay hospital bills and have enough for basic necessities.

> Sorry that happened to you. My family is dealing with multiple health issues too.

I'm sorry to hear that. What's worrying you the most at the moment with relation to the health issues?

> $110k USD is likely to be a very large amount in your country, as it about 150% the median household income in the US.

It is a very good income for this part of the world, and also a good income for the US as you say. While higher pay can get you part of the way, there's some things that it can't get in my experience. For example, if I take out private health insurance at Allianz, it doesn't cover pre-existing conditions. Company-sponsored health insurance does usually cover pre-existing conditions.

"I'm sorry to hear that. What's worrying you the most at the moment with relation to the health issues?"

The usual- costs, coverage, quality of life.

Are you sure nobody will cover it pre-existing? I saw Cigna has an international plan that might. It's likely the premiums will be very large. Maybe medical tourism could help with costs, like in Thailand.

On a side note, maybe it's possible to manufacture the drug yourself? I mean, what will the company do - sue someone who's already broke from paying for the meds?

I guess the other option is to find a different job, with a local company, that will provide insurance.

Thanks for this, it's given me food for thought and options to explore.

> Employers offering Healthcare options to employees is more of a failure of the healthcare system in the US than a positive employment perk.

I think this is a failure in many countries including the one I'm in. Employee-sponsored health insurance seems to be the best workaround.

> Your company chooses the Healthcare provider they partner with. You are likely ineligible to be covered by their provider.

Fair, my employer's health care partner probably can't insure people outside the US. There are new health care providers that cater for remote companies and their employees [1] but I don't have a good understanding of how good their offering is.

> Contractors do not get benefits. This has nothing to do with you being international. If you were based in the US, you would not be provided with Healthcare either.

Good point. I'm not sure if my employer is treating me like an international contractor though. I have a boss, don't get overtime, can't work for other clients, signed a non-compete, etc.

The latter part of your response is fair. I think I got the mindset that I'm a de facto employee. I work on a team where everyone else is an employee and I don't seem to be treated differently. Here's where I think I need to explore alternatives and see what my options are.

[1] https://safetywing.com/remote-health