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When Joseph McPherson landed his first kitchen job at BlackSalt at age 19, he drew an early conclusion that his value was based on each acquired skill. “I spent three years learning how to peel a carrot, dice a potato, sauté onion,” he says. “I know those were worth a dollar an hour. You’re never offered benefits, but if you know how to do these tasks, you’ll always have a job.”
After BlackSalt, McPherson cooked under Chef Frank Ruta at Palena for five years where he worked his way up to the meat station—a position for employees who’ve proven themselves. “But health insurance still didn’t come into play,” he says.
It wasn’t until McPherson left D.C. and landed a job at San Francisco’s famed Zuni Café that he was offered a plan through his employer. “No one ever offered me that,” he recalls. “That’s the first time I realized that jobs offer that, and they should.”
McPherson revered Zuni Café restaurateur Judy Rodgers for providing him with opportunities for growth and a feeling of self-worth all while she battled cancer. “She would come into work every day,” he says. “She would taste everything that came in. Every grain, every berry, she would even smell every chicken.” Rodgers died in December 2013. “That’s when I thought about dedication,” McPherson says. “The fact that even though she was in pain, she still came to work. I took on that kind of love for my career.”
What McPherson didn’t know was that six years later he too would be diagnosed with a rare form of cancer, coupled with a chronic illness, that had the potential to derail or delay his ascent in the D.C. dining scene. The 33-year-old is far from the only local hospitality employee currently confronting a health crisis or stomaching walloping hospital bills.
The service industry has historically and notoriously been an under-insured sector, with restaurateurs largely citing low profit margins as the reason why they can’t offer workers coverage. Additionally, the Affordable Care Act only mandates that “large employers” with 50 or more full-time or full-time equivalent employees offer affordable health insurance to their full-time workers. If they don’t, they may face a hefty tax penalty. The IRS defines full-time employees as individuals who work at least 30 hours per week. There’s no such requirement or consequence for businesses with less than 50 employees—a category under which most D.C. restaurants fall.
There are even more compounding factors that make facing medical emergencies and the financial insecurity that often accompanies them particularly onerous: The labor is physically demanding; insurance policies are confusing, particularly to time-strapped workers or those who don’t speak fluent English; restaurants and bars experience high employee turnover, which can leave workers with lapses in coverage; and most employees are hourly wage earners, meaning they don’t receive a paycheck if they’re off the clock while they recover.
McPherson first noticed symptoms when he moved back to the District in 2016 to be closer to family. At first he didn’t have jobs that offered insurance and he struggled to understand how to sign up for a plan on his own through DC Health Link—the local health insurance exchange.
Despite his pain, he didn’t see a doctor until he started working at sister restaurants Timber Pizza Co. and deli Call Your Mother. The casual eateries, owned by Andrew Dana and Daniela Moreira, offer an above-average plan to employees who work 30 or more hours per week after they complete a 90-day trial period. “My parents didn’t understand the life of not being able to go to the hospital,” McPherson says. “It’ll go away, my brain kept telling me.”
An eventual emergency room trip led to an oncologist appointment, lab work-up, and recommended cancer treatment of at least eight rounds of chemotherapy. McPherson now has a port under his skin just below his collar bone. “I had just gotten insurance,” he says. “I’m going to need to tell them that I’ll need to use it fully. And if I’m not at work, how am I going to pay? That built up. I started bawling at the hospital. I cried for a bit, but then went back to work and finished the shift.”
Dana and Moreira had just given McPherson more responsibility. He executed the supper clubs Call Your Mother hosted on select weeknights. There were only three weeks remaining when McPherson had to face his bosses and ask for time off. “I felt really bad,” he recalls. “Diners already bought tickets. We’re trained that guests come first.”
“My instant reaction was that this is more important than any supper club or bagel,” Dana recalls. He says he offers insurance because “it’s the right thing to do,” adding that he comes from “the corporate world where insurance is a given.”
McPherson’s plan covered 80 percent of his costs, but being on the hook for the rest was overwhelming. “I can handle being yelled at by a chef, but this was tenfold,” he says. “I didn’t see a way out.” He also didn’t feel like himself outside of the kitchen. “I got really depressed. I built my confidence, my self-esteem on being good in the kitchen. If I can’t do that, what am I?”
After his third round of chemotherapy in July, McPherson returned to work, taking on simple jobs like running food out to diners. He says his prognosis is good, but his struggle changed his outlook on restaurants: “Now I’m able to tell a cook that your value isn’t just from skills. You also have to value yourself. Don’t be afraid to ask for anything like insurance. You don’t have to work for free just because a chef has a Michelin star.”
Chef John Melfi was working at Michelin-starred Fiola a year and a half ago when he got a diagnosis that changed every aspect of his life. With stage 4 kidney disease, he can no longer eat the food he deftly prepares for others, nor can he miss a week of lab work.
After experiencing searing pain, Melfi went to the emergency room where a test revealed a blockage in his right kidney. He was born with a genetic condition where the major artery that runs down his leg wrapped around his ureter, strangling normal function like a kink in a hose. “For 37 years my kidney function was slowly deteriorating and no one knew,” he says.
“I was going to Fiola every day in tears,” he continues. “It made it hard to work at that level, hard to concentrate, hard to have patience, be a leader, do everything.” He underwent surgery four days later, which put him out of work for a month. Then he learned he also has Hinman Syndrome, which impacts bladder function.
Melfi has undergone 10 procedures so far, five or six of which occurred while he was at Fiola. “Besides the big surgery, I was at work the next day,” he says. “When you’re the chef, you’re relied on.”
Eventually Melfi sought a reprieve at RW Restaurant Group, where he was slotted into a less physically demanding role involving oversight of multiple Robert Wiedmaier concepts. “I started to get worse and it started to sink in that nothing’s worth your life,” Melfi says. His kidney function dropped to 19 percent. “Once you go below 20 it’s time to get ready for dialysis and get on a list for a kidney,” Melfi explains, referring to his Glomerular Filtration Rate (GFR). A score of 15 percent means kidney failure.
Melfi was insured for the majority of his medical care, which included several lengthy hospital stays after kidney infections and even sepsis. But he experienced what it’s like to be uninsured when he failed to send a COBRA payment to the correct address. (COBRA allows former employees to temporarily keep their old employer-based health plan as they transition to a new job.)
“I had a lapse in my insurance in January that screwed me—I didn’t know about it until it was too late,” Melfi says. He went to the hospital three times that month, resulting in a $32,000 bill. “I depleted my savings, maxed out four credit cards, and almost went bankrupt.”
Melfi left Wiedmaier’s group in search of better insurance and took at job with restaurateur Ashok Bajaj, who was about to reopen Bibiana as Modena. Around this time, Melfi’s doctors found a solution that could buy him years, decades even, before he’ll need a kidney transplant. He receives botox injections into his bladder, which stops it from being so spastic. Now his GFR holds steady at 29.
But Melfi still has to adhere to the highly restrictive renal diet, which limits foods high in sodium, phosphorus, and protein. “Every food has one of those, so pick your poison,” he says, adding that he has to get blood drawn regularly to monitor his levels. Eating a banana once sent him to the ER.
Imagine developing the menu for a brand new restaurant while on that diet. Such was the case with Modena, where Melfi is currently the executive chef. He admits his health condition stifled his creativity at times. His advice for others is to not be afraid to ask for help. “I didn’t want to talk about it,” he says. “I didn’t want to tell anybody.”
Medical emergencies nearly corner the uninsured into asking for help. The hospitality industry is quick to support their own through crowd-sourced fundraising platforms like GoFundMe. While heartwarming, these fundraisers are more of a Band-Aid than a permanent solution given the increasing number of service industry employees staying in jobs well past their 30s. Bartending, serving, and cooking can be long-term careers.
When Hanumanh front-of-house manager Matt Brown started having seizures, a friend set up a GoFundMe page that’s netted close to $4,000. Its creator, Bryan Koen, suggested giving money then “throwing some weight behind a presidential candidate who truly supports fucking Medicare for All.”
Brown, now 41, has been in the hospitality industry since he was 18. The seizures started when he suddenly stopped taking three prescription medications because he couldn’t afford them. “One costs $1,200 a month without insurance,” he says. “This happened in a gap between when I left my last job where I had health insurance and starting up a new one,” he explains. “It takes time to get a system in place.”
The most recent seizure was so severe that doctors kept Brown at the hospital for a full week. “I shudder to think how much it’s going to cost,” he says, expecting high five figures. His doctors believe drinking exacerbates his condition, so he cut out alcohol to see if his health improves. He hasn’t seen the bill yet.
Brown was uncomfortable at first when he learned that someone set up a GoFundMe page, noting it hurt his pride. “But then it almost brought me to tears,” he says. “We’re all kind of in the same situation. It’s going to happen to all of us.”
He doesn’t blame restaurant operators for failing to provide insurance. “A lot of these small places are not making a ton of money,” Brown says. Instead, he holds the insurance companies responsible for “breaking the backs of restaurant owners and employees.”
Brown is a salaried employee at Hanumanh. That means even if he’s in the hospital or home recovering, he still gets paid. The same isn’t true for hourly workers. When their names are missing from the schedule, they don’t earn a living. “If I were bartending, I’d be fucked,” he says. “For anyone hourly, this would be really damaging.”
That’s what Roy Boys bartender Lou Aliaga learned after he was involved in an accident on his way home from Rock & Roll Hotel in July. The 33-year-old says a group of men riding four-wheelers intentionally bumped the Vespa he was riding hard enough that he lost control and flew off the scooter, hitting a parked car at a dangerous angle.
When Aliaga came to and was walking down the street covered in blood, someone called an ambulance that took him to the hospital where doctors stitched and stapled the wound on his scalp closed. He stayed there for two and a half days while doctors ruled out brain damage and a spinal cord injury. Then he got the $11,000 bill. “I don’t have insurance,” he remembers thinking. “I’m gonna have to eat it. I don’t have a choice. I know I’m alive, but wow.”
Friends started two online fundraisers that generated close to $7,000 in donations combined. Most were from fellow industry professionals. He describes the tight-knit group willing to shell out for friends or acquaintances “like one big fraternity that doesn’t go away.”
Aliaga missed a month’s worth of income. “If you miss one or two months, it’s life-changing,” he says. “You can’t work from home. What am I supposed to do? Make drinks and send them to you? You’re spending all the money you have in your pocket to get better but not earning anything from work. It’s like one of those video games where you stack everything up and then it falls.”
Some D.C. restaurateurs find ways to offer health insurance, including Aaron Silverman of Rose’s Luxury, Little Pearl, and Pineapple and Pearls. He offers full coverage, plus dental and vision to anyone who works four or more shifts per week. The benefits package also includes paid vacation, parental leave, and gym memberships.
Silverman baked the cost of health insurance into his fundraising plan leading up to the opening of Rose’s Luxury in 2014. “Before we opened, we knew we wanted to do these things,” he says. “We got the support of our investors. Every person I told this idea to, I said, ‘This is going to cost a lot of money and eat into the profits.’ They were like, ‘This is the right thing to do. Won’t it help you attract good people?’ Investors believed what we believed.”
Aiming to create an enjoyable workplace, Silverman looked at his past jobs, identified their shortcomings, and sought to correct them. “Obviously one of the biggest was that I never had health insurance until Rose’s,” he says. His gut tells him it’s helped with employee retention. “The restaurant industry can do better. I want to prove to other people that you can do the right thing while still being financially successful. It’s possible to do both. It’s really freaking hard, but it’s possible.”
Silverman also puts some of the onus on diners. “It’s up to the public to understand that food should cost a lot more than it does,” he says. “I shouldn’t be able to eat as many meals out as I do. I don’t know how it’s going to happen, but [adjusting to higher menu prices] would really help operators add the benefits that everyone should have.”
Have you skipped or delayed medical care even though you have health insurance? Tell us about the quality of your plan by emailing City Desk reporter Amanda Michelle Gomez at firstname.lastname@example.org.