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An Adjunct’s Health-Care Education

Recent moves by colleges to cut adjunct hours in advance of the Obamacare employer mandate offer a reminder of why contingent faculty labor is the gift that keeps on giving to the corporate university: Not only do part-time adjuncts receive a fraction of the pay expected by full-timers for the same work; they also do not encumber the institution with health-care costs. A majority of today’s teaching faculty members are thus vulnerable not only to the first round of pink slips mandated by budget cuts but also to the predations of our health-care system.

Just over a year ago, I graduated officially from my Ph.D. program and became a full-fledged member of the academic precariat. I had already been employed as an adjunct for two years, but I was now cut off from the insurance I had still been receiving as an enrolled graduate student. I considered doing without: In the previous eight years, I had been to the doctor exactly once, to have a harmless cyst on my back drained.

On the other hand, I had recently been awakened to the astonishing costs of emergency care. My wife fell off her bicycle the previous year and had been rushed to the hospital by overeager paramedics, only to be told there was nothing wrong with her. The bill? $3,000 for the three-mile ambulance ride and $11,000 for an hour in the hospital. Her insurance had a deductible, so we paid the first $4,000. We were still making monthly payments, at 10-percent interest, when I had to make my own decision about insurance.

The difference between $15,000 in total costs and $4,000 out of pocket was enough to persuade me to purchase a “catastrophic,” i.e. high-deductible, plan. I thought the insurance companies would be desperate to have me as a customer, young and robust as I seemingly was, but the process involved a long delay and then two rounds of interrogation by stern actuaries.

My only medical intervention of recent times led to rigorous questioning: “Was the cyst biopsied to determine if it was malignant?” “No, a sebaceous cyst is by definition noncancerous.” “So it was not biopsied?” “No.” “So it was not determined whether the cyst was malignant?” “No, but it was determined, just not by biopsy.” “So it was not biopsied?”

Then there was the year of talk therapy I received after my mother died: “You were in psychological treatment for what diagnosis?” “There was no diagnosis. I went because of grief following my mother’s death.” “The diagnosis was grief?” “No, no one diagnosed me. I just went.” “Did the treatment relieve the grief symptoms?” “Yes, I felt better.” “So you stopped experiencing grief symptoms?” “Well, not totally—she’s still dead.” “So it did not relieve the grief symptoms?” And so on.

I was finally offered an insurance policy that would cost me $240 a month, more than 10 percent of my annual income. It had a $6,000 deductible, meaning that I’d pay the first $6,000 out of pocket. I took three different jobs, partly in order to be able to afford the insurance.

By April I was feeling crushed with exhaustion. I put it down to overwork. But when the teaching started winding down, in May, I felt worse. Before long, I could barely stand up for a few seconds without feeling dizzy. I was bedridden for days on end. In the end, I started seeing a doctor and getting round after round of tests. It took about a month to reach a conclusive diagnosis: Addison’s disease, a chronic deficiency of the adrenal gland, cause unknown. I started taking replacements for the missing hormones, and soon felt better. I will be taking the pills for the rest of my life.

It took a month or two for the bills to start arriving, but when they did, I had sticker shock again. For the test that diagnosed the disease I was charged $1,700. The other procedures cost less but added up. I will probably have around $5,000 in medical bills this year, $1,000 shy of my deductible and about 25 percent of my annual income as an adjunct. Add the cost of my insurance to that, and 35 percent of my meager salary is now swallowed up by medical costs.

The current business model of higher education depends on leaving those least able to pay the high costs of health care in this country most likely to have to pay them. This is American exceptionalism in action: subsidized medicine for the haves, “individual responsibility” for the have-nots. Most tenured faculty members surely object to that model, but the graduate programs they run are operationally complicit in the hypocritical cult of “individual responsibility.”

Graduate students are conditioned by the high-pressure milieu of their studies to view individual effort and intelligence as the only relevant factors in landing a tenure-track job. Those who fail to do so must have simply lacked sufficient effort or smarts, the reasoning goes. A Ph.D. who does not obtain a job or a postdoc therefore inevitably experiences shame: She is now a failure in the eyes of the program that trained her. Graduate programs perversely behave as if becoming an underemployed, uninsured adjunct is the consequence of an individual’s shortcomings, rather than an outcome both statistically guaranteed for a large number of students and economically required by the downsizing pressures of the current regime.

My point here is not to tell a sob story. I am feeling fine, and my medical debts could be worse. Instead, my point is that graduate programs need to change their culture to reflect the realities faced by the adjunct majority that many of their students will join. Michael Bérubé’s call to “value the work of … our colleagues off the tenure track” is a helpful start, but tenured faculty members also need to make clear to their graduate students that being an adjunct is not an unfortunate fate to be avoided by working harder but a relatively likely part of the future of most of today’s aspiring faculty members.

In practical terms, this might mean holding information sessions on current levels of adjunct pay in different institutions and regions, or offering workshops in which current or previous uninsured adjuncts give advice on navigating the intransigent medical-industrial complex. It would also entail fostering an environment in which the privileges enjoyed by the tenured few at the expense of the untenured majority are a subject for vigorous debate.

I’m sure that stories of medical hardship and massive indebtedness far more devastating than mine are being played out on campuses across the country as I write this. Those stories need to be told, and our full-time colleagues need to listen, and ask graduate students to listen too. The proletarianization of university instructors is a moral crisis that graduate programs—the incubators of academia’s surplus labor force—need to confront directly and immediately.

Geoff Shullenberger is an adjunct instructor in the English department at Monterey Peninsula College.

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