Rebecca the Bartender….My “go to” healthcare expert

By Steven L. Athey

I finished a mid-week meeting in central Louisiana earlier than expected and was sitting in an airport restaurant/bar waiting for a flight home. I had some time. The only other patron in the bar, a non descript middle aged guy several seats down finishes his sandwich and hands the bartender, Rebecca, his credit card to pay for his drinks and meal and Rebecca drops it. The card bounces off the bar and on to the floor with a metallic sound and I look and see her picking up his American Express “Black Card” which is officially called the Centurion Card. It really is all black, it’s made of titanium, and is extended to only the wealthiest consumers on an “invited-only” basis. It’s a little like Bigfoot, often rumored – but rarely seen or acknowledged.

I now find myself watching him very closely and wondering just how much money he really has and what his life must be like. As he is gathering his suitcases my internal “judgment meter” is starting to really hum. They say money can’t buy happiness, and whether or not this is true, you would have to imagine “Mr. Black Card” doesn’t worry about the little things in life like mortgages, retirement, kids tuition and the like. I’m certain he doesn’t worry about healthcare coverage and the changes brought about by the Affordable Care Act. I wonder if he even knows the basics of what is happening. He leaves and I snap out of my momentary “I wish I…” moment and order a sandwich.

Rebecca refills my iced tea and takes my order. She nods in the direction of the guy and says, “Wow, that was a black card”, I said “yea, I noticed”. Just the two of us now and Rebecca leans on the bar and starts talking to kill the time. She’s friendly and has that bartender way of making easy conversation. I learn a great deal about her in a short period of time.

Rebecca was born and raised in rural Louisiana and has lived her entire life in a hundred mile radius from where she was born and although she works at an airport has never been on an airplane. She is 34 years old and a single Mom who has four kids ranging in age from 10 to 19 years old. I automatically did the math in my head; she had her first child at fifteen. She proudly shows me pictures of her kids on her phone and tells me a little about each one. As she scrolls through the screens she feels it necessary to quietly explain that the kids were all “from different Fathers”.

Rebecca works as a bartender in the afternoon and evenings and works a retail job in the mornings; two jobs six days a week and she struggles to make ends meet. She is in love with the New Orleans Saints and their quarterback Drew Brees. She has three tattoos, two of which are of Drew, only one of which could be tastefully shown. As I did with “Mr. Black Card”, my “judgment meter” is now in overdrive. I drew a set of conclusions like I’m sure many of you would but in the end I walked away with a very different perspective.

Rebecca is the “working poor”, (her words) and things I don’t worry about effect her greatly – just as items that effect me never cross the mind of “Mr. Black Card”. A CNN crawl comes across the muted television screen about healthcare and she asks me, “What do you think about Obamacare?” I give her a broad, vague answer dropping lines like “the jury is still out”, “something had to be done”, and “I’m not sure this plan is the answer”. All throw away lines without many facts or thoughts because I am not directly threatened by the changes and therefore haven’t spent the time really digging deeply into the details.

Rebecca launches into a very detailed analysis of the Affordable Care Act (ACA) and the direct effect it is going to have on her and her family. You see she is the type of person all the healthcare discussions and changes were intended to help. She is on Medicaid her kids are on LaCHIP and she has obtained medical care for her and her family by knowing “how to work her way through the system”. These changes impact her.

Now, I have had hundreds of discussions with peers and industry leaders about this healthcare program and it is always at the 30,000 foot view, barely skimming what it really means on the ground. I am sure Rebecca understands the plan better than all of them – because it means more to her than it does the others – directly. In fact I have heard the answer “it depends” a hundred times when people are asked about specifics (in fact I have used it myself). Rebecca understands the program at the visceral level.

She knows more about the workings of the Act on the ground level then I ever have – because I can afford health insurance – she cannot. I know what I have read or heard on the news; she’s living it. Historically she has worked the system getting healthcare with whatever state assistance she can get for her and her kids knowing exactly what she has to pay and how she can minimize the cost for health and dental care. Now, she starts looking for healthcare on the “exchange” and realizes in 2014 she will be asked to pay at least $600 a month that she doesn’t have and must meet a $2,500 deductable she cannot afford. Her only other option is to pay the fine for being uninsured. She knows this because she has done the math and she now struggles with those options. The real options. Rebecca has a far clearer understanding of the healthcare challenges in America than I and most of my industry friends do – and certainly a better understanding than “Mr. Black Card” I’m sure.

The place fills up and we don’t finish our conversation, I pay my bill and tip heavily. Since I was sitting next to the cash register I saw what “Mr. Black Card” left for a tip ….I made sure I tipped more. Six months later I still wonder what Rebecca chose to do about her situation and whether she is “better off” than she was before. Either way I hope so.

If you had a difficult time deciding if I am in favor of the Act or not, or if I thought Rebecca was a hard working member of society or a drain on the tax payers – good. I didn’t intend this to be an opinion piece on either topic. I am not smart enough to know the answers to all of this. I guess the answer really is “it depends”

Steven Athey is the president of the EMS Consulting Firm, Health Care Visions. Steve has worked in the ambulance industry since 1971 and has managed large and small EMS organizations. Steve holds his undergraduate degree and his MBA from Texas Wesleyan University where he holds an adjunct faculty position in the School of Business. Steve will probably never carry a “Black Card”. Steve can be reached at

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