Tam Harbert

I wonder how much difference the new healthcare legislation is going to make in a system in which doctors are indifferent to costs and in fact often favor expensive and elaborate treatments over individualized patient care and common sense.

When I see a doctor, I pay attention to prices. My high-deductible insurance plan means I pay for the first $2,600 of my health costs every year. Often, the healthcare system doesn’t like it when I insist on knowing what things cost. This story is an extreme but telling example.

I went to a specialist for treatment of my herniated discs. The specialist was highly rated by a local magazine, so I expected top-notch care. What I found was a practice that seems designed to minimize contact with the patient while maximizing the amount of insurance money it can extract.

When I made the appointment and asked how much it would cost, the response was: “insurance will cover it.” When I explained that I would be paying for it and asked again for the cost, they claimed they couldn’t give me a price because it would be based on the doctor’s diagnosis after our consultation.

My first appointment was hardly a consultation. In fact, the doctor and his staff barely talked to me. I had been asked to fill out a 10-page questionnaire in preparation for our meeting. When I arrived, I reminded them of my concern over cost, and the receptionist assured me that I’d be presented with the price after the doctor had determined my treatment. I waited 45 minutes to see the doctor, who finally breezed in and spent all of 10 minutes with me. He then explained the procedure he recommended, and something about the way he said it made me think it was the exact same recommendation he would give to the 35 other patients he would see that day. Then he handed me a printout of the other things I should buy to treat the problem: a prescription pain patch, a back brace and a home transcutaneous electrical nerve stimulation (TENS) machine to relax back muscles and reduce pain. I wonder how much of a kickback he is getting from the manufacturers.

Again I asked what all this would cost. Again the standard response: “insurance will cover it.” He brushed me off when I tried to explain why that wasn’t an adequate answer.

No one ever gave me a list of the costs. I went ahead and had the procedure, because I was in pain and desperate (I later found out it cost more than $2,000), but didn’t follow the rest of his recommendations right away. I checked with my pharmacist and the pain patches cost $200. Each. When I went back for what turned out to be a five-minute followup, the nurse practitioner chided me for not following the doctor’s orders. And when I tried to explain to her my concern about cost? You guessed it: “insurance will cover it.” When it was clear I wasn’t buying, she yanked the info sheet on the TENS machine out of my hands and told me I could wait on that, but insisted I get the back brace. It came in the mail the other day. It looks expensive, but I won’t know how much it is costing me until the doctor bills my insurance company, and the insurance company in turn bills me.

My primary care doctor doesn’t even take insurance. I find that liberates both of us to cut through the insurance bullshit. He’s straightforward about costs. His rate is $90 per half hour. Period. He’s not trying to push more tests, procedures or pills on me. In fact, when I needed an MRI for my back, he gave me two different labs to call. He advised me to call both, explain that I was a “self pay,” and then dicker with them on the price. The first lab wouldn’t come down on the $1,100 sticker price. The second one dropped the price to $500.

Why is there such a lack of transparency, not to mention logic, in healthcare prices? Somebody in this system is making a lot of money from the fact that “insurance will cover it,” and those people have an obvious interest in obscuring costs. Until more patients have to pay more directly for their healthcare, which will in turn force all the players to be more accountable, I doubt that the system will change.

A couple of years ago I was approached by a woman who was looking for freelancers for a new magazine. We talked at length about the magazine’s target reader and the tone it was going to take. I even ventured a couple of story ideas, which she liked. Then we finally got around to talking about money. She told me what she was paying and asked me if that was in my ballpark.

I was so surprised that I blurted out: “Not only is that not in my ballpark, it’s not even in my state!”

Needless to say, she never called again.

I’ve learned to broach the subject of fees a lot earlier in discussions with potential clients, to avoid wasting my time and theirs. This has become even more important with the proliferation of websites that pay would-be writers nil or pennies per hit just to blather on about a given topic. This has given some inexperienced publishers the impression that writers are, quite literally, a dime a dozen. Would-be, novice writers are. Professional journalists are not.

Freelance pay rates have always been a tricky equation for both editor and writer. I know because I’ve spent more than half of my career as an editor. I know how hard it is to find and hire good, reliable writers but stay within a limited (and these days continually shrinking) budget. I also know how valuable a good freelancer can be.

Most editors need freelancers who can do more than just write well, although that’s the first prerequisite. Writers must be able to follow specific directions. They also need to be able to do the opposite: work with vague, general assignments from editors who either don’t know what they want or are not very good at communicating it. Freelancers need the background and experience to know how to report a story and to be able to shift gears (in consultation with the editor, of course) if the information doesn’t fit with the original notion (if there was one). Finally, freelance writers must be able to meet deadlines, take criticism (constructive or not) and be willing to revise a story if it doesn’t hit the mark.

Editors that try to get by with paying the lowest fees won’t get all, or any, of the above. They will typically spend so much time trying to manage the writer and then editing, revising and even rewriting the article that it costs them twice what it would have if they paid a good writer a fair wage. Most editors, including myself, know this. And that’s why good writers, including myself, will want to know upfront if the assignment is going to pay enough to be worth their time.

As I work on a story about new ways that managers are monitoring employees, I’m reminded of and increasingly grateful for one of the biggest advantages of the freelance life: my time is my own.

When I worked for a company, I generally had to be in the office by 9 in the morning. During the course of the day, I was expected to sit at my desk, work on a computer, talk on the phone, and attend meetings. If I left before 5 p.m., I had to have a good reason. (They never seemed to mind, however, if I stayed late.)

I’ve always struggled with traditional 9-to-5 hours. I have never been a morning person. I may be awake and at my desk by 9 a.m., but I’m not fully conscious until about 10 a.m. Being able to set my own hours has been a huge blessing. I can structure my day according to my own circadian rhythms. I try to start at 9 a.m., but I do undemanding work, like going through e-mails or reading my daily news sites, until 10 a.m. when my brain is up. I’ll work steadily until about 12:30, then break to go to the gym, run errands or do some housework. My energy peaks in late afternoon, so 2 till about 7 is my most productive time. I try to reserve my heaviest mental lifting for then. I’ll break for dinner and evening activities, but often go back to my computer to wrap up loose ends between 10 and midnight.

That’s my typical schedule, but it’s not set in stone. If I have a lot of work, I’m at my desk at 7 a.m. (with a huge mug of coffee) and work till midnight. If the workload is light, I take the day off. If it stays light, I spend my days marketing myself to new publications and editors. Or teaching myself new skills like how to do more with Wordpress or how to search for sources on Twitter. If the workload is medium and it’s Opening Day, I go to the ballpark.

The point is, I’m free to use my time in the most productive ways. In traditional jobs, employers are in charge of time and they decide what’s productive. They watch not only when employees are in the office, but increasingly what employees do on the computer. They use technology that blocks websites, and not just the pornographic ones or the shopping sites, but also social networking sites like Facebook and Twitter. Network administrators keep logs of what websites employees frequent. Some employers even install software that records every key stroke and captures screenshots.

If I waste two hours socializing on Facebook, nobody cares, but I may pay the price in lost productivity and lost revenue. On the other hand, I may spend an hour figuring out how to do specific searches on Twitter, which may lead me to the perfect source for a particular story. That’s productive.

As a freelancer, I have the constant pressure of meeting deadlines and earning enough income to live. But I’ll take that any day over a rigid schedule set by others and ruled by their judgments about how I should spend the most precious thing I own: my time.

For the first couple of years I was freelancing, I just signed on the dotted line when it came to contracts. I didn’t want to read the fine print because, frankly, I needed the money. It was depressing enough that virtually every contract granted copyrights to my work in any and all forms in existence now or ever to be invented in the future, throughout the universe.

But curiosity and concern finally won out, so now I’m reading the contracts more carefully. I’m alarmed at what I find in some of them:

The writer pays for the lawyers: This clause specifies that I agree to indemnify the publisher from damages, costs and expenses that the publisher incurs because of copyright infringement or even the claim of copyright infringement. Some contracts specifically state that I am to protect and defend the publisher against such lawsuits at my own expense. I have never been accused of infringement in 25 years as a journalist and will gladly promise that my work does not infringe. But editors change wording, sometimes in major ways. It’s not fair to hold me responsible for a mistake an editor introduced into the article. And what if some kook out there falsely accuses me and the publisher of infringement?

The writer sells her soul: A contract I recently declined not only asked me to indemnify the company – a multi-billion-dollar corporation that is a household name – against any claim of infringement, it also wanted rights to use my name, voice, likeness and biography to promote its website in whatever way it wanted. This was for an initial story paying $400.

The writer stops freelancing: Last year I was presented with a contract to work with a custom publishing firm to produce a corporate magazine, again for a Fortune 500 client. It was no surprise that the contract had a section covering confidential information. Routinely, the contractor promises not to divulge or use any confidential information from the client for any other purpose other than that expressed in the agreement. But this contract stipulated that I could not, ever, disclose or use any information not only about this particular client but any client of the custom publisher. It wasn’t limited to trade secrets or even to information obtained during the course of producing the magazine. It was any information, forever, about any client. And I didn’t even know who the other clients were.

Most publishers are reasonable when I call their attention to these inequitable clauses. They are willing to work with me to make changes that satisfy both our needs, even though they sometimes say I’m the only writer who’s ever raised such questions. Although I have lost some business from a couple of inflexible publishers, so far I’ve been able to afford to do that. I hope that luxury lasts.