ABOR #8: Healthcare is a human right.

Mike Dershowitz
Agent Bill of Rights
9 min readDec 12, 2018


Elma Mae “Mimi” Pinto used to work at another BPO company in Iloilo before she got hired at Rethink (now known as Fair Trade Outsourcing). She was already a QA Specialist at that time, being promoted from a phones Agent. She usually went to work at around 12 midnight. She was riding her scooter to work one night when she got into a vehicular accident.

At first, Mimi didn’t feel anything was wrong with her. She was speaking normally, laughing and having a selfie with the Iloilo City Emergency Rescue (ICER) team. It was possible she was in shock, and the adrenaline might have caused an endorphin rush, which numbed her ability to feel pain.

After the emergency response team checked her and didn’t find any injury, Mimi was sent home. She had blood in her saliva, but the rescuers told her that’s normal because she had gum lacerations. At home, her jawline started to show some bruising, which prompted her mother to bring her to the hospital. They had to wait a few hours before an ENT specialist arrived. By then, her jawline has swelled, and the bruise was darker and bigger than before. Mimi made her living by talking to people, so this is when she began to get really scared.

Her jaw was x-rayed, and the results were not good. The x-ray showed Mimi had 3 hairline fractures in her jaw. She had to undergo surgery immediately to fix her mandibular fracture. Unfortunately, the company she worked for didn’t have health insurance for its employees, so she had to rely on PhilHealth — the national health care system which has a bad reputation.

To protect her, all Mimi had back then were the benefits provided by PhilHealth and the Social Security System. But they were not enough. Because of the expensive medication and lab tests prescribed to her, she quickly reached her coverage limit, and she had to pay for the remaining costs of her surgery out of her own pocket.

Sadly, she didn’t have any savings at that time; so she and her family had to borrow money from their friends and relatives. Mimi was even forced to accept help from an ex-boyfriend. She had no other option: she either swallowed her pride to ask for help, or she risked losing any normal function to her jaw, possibly preventing her from speaking normally for the rest of her life. This, of course, would have significantly impacted her ability to keep a job in the BPO industry.

In total, her medical expenses amounted to more than 3 times her monthly salary at that time, not including costly medications, creating a huge financial burden. PhilHealth covered some of the costs, but not much, and Mimi came from a family without large financial means, leaving her quite vulnerable.

That accident gave Mimi an unforgettable lesson on healthcare and financial preparedness. When she had to have a second surgery, she knew what she had to do. More importantly, she was better prepared financially.

Her second surgery fixed one of the titanium plates in her mouth that didn’t set correctly while she healed. By then, she was already working at Rethink Staffing, which provides an “HMO” (like we have here in the US) free to employees. That, plus her job where she was earning a middle-class salary, meant that she was just less vulnerable. She had insurance and some backup money if there were out of pocket expenses.

The HMO made the costs of her second surgical procedure a lighter burden to bear. Clearance procedures were a breeze, and she recuperated in a semi-private room, which is way more comfortable and cleaner than the public ward she stayed at after her first surgery. While there were still some out-of-pocket costs, they were manageable, and the corrective surgery became something in Mimi’s life she simply had to accomplish and then move on.

While the other BPO company is not unique in its inability to provide HMO benefits, it’s not like the entire BPO industry in the developing world denies the employees access to good healthcare services. Most of the large and medium-sized companies in the BPO industry does provide employer healthcare with some costs for the employees. At the larger BPOs, health care is used as a retention tool. The longer you’re there, the more benefits you have for you and your family. And, the less you have to pay when something happens.

Health care is a complicated issue in any society these days, except maybe those of Northern Europe and Canada, whose systems function well and consequently, whose citizens live much longer, and report higher levels of happiness, than the rest of the world.

In the developing world, and in the Philippines, while there is a “universal” health care system called “PhilHealth,” it is notoriously bad, poorly funded, and ill-equipped. I remember once meeting British nurses in a mall in Iloilo who were working in a PhilHealth facility, telling me that patients who couldn’t afford the extra cost of oxygen machines, but needed them, would have to have family hand-pump the oxygen, round-the-clock, to keep them alive.

Regardless of my personal belief that health care is a human right, we all have to live within the existing economic realities, until we are in a position to change them. Within our industry, at Rethink Staffing we knew early on that we wanted to include in our business model the costs to ensure that our employees were well cared for.

I believe that many BPO leaders may be making the same decision, but in my conversations with them, it mostly comes down to the retention issue. They have no hope of retaining the long-term managerial, quality and support employees they need to, the people that really keep the delivery of services going unless they bite the bullet and provide them with middle-class health benefits conformant to what’s available in their respective societies.

It all goes back to people since we’re in a people business. You have to make the people feel secure in their lives and their jobs if you want them to perform. Health care is a large part of that, which is why we take it so seriously at Rethink Staffing and guarantee it as a right to our employees.

ABOR #8: “Healthcare is a human right” is both deeply personal to me as a business leader, and also deeply entrenched in my personal political beliefs.

Having lived in several European societies at various times in my life, I’ve long been disappointed in the US healthcare system whenever I come home. In 2018, things are actually getting worse, not better, in the way the system is performing. Yes, Obamacare is insuring more Americans than even the predictions, but of course, how changes by the current administration have undercut its core benefits, started to screw up the health care markets again. They’re playing with fire with an industry that is 1/6th of the American economy.

This means that the number of overall insured are dropping again. But more importantly, the way new rules are undercutting what services people can get at what price is again creating cruel, unequal, and inhumane outcomes. I think the changes over the last two years to the American health care system are one of the clear ways a ruling minority can weaken an out-of-power majority, literally by making them sicker.

In the American Healthcare system, the rich always get better service. The rise of “concierge” medicine is a bastardization of market forces for personal gain — both for the providers and for the patient. It’s also un-American because this country was founded on the Enlightenment principles of equality for all people.

The Philippines health care system is following a similar path, and it’s shameful. Except in the Philippines, the rich simply go abroad for care and pay cash, they don’t need a concierge. Additionally, the rise of the “private” hospital in the Philippines, where global standards of care can be had, make it so that the rich don’t even have to leave the country. The system is quickly becoming quite unequal.

Of course, none of this is available to the poor. And, as a company dedicated to employing poor people, lifting them out of poverty, and moving them into a sustainable middle-class, we see access to Health Care as an important part of the conversation, and what we try to accomplish for our agents.

It’s also good business. An employee who is sick less frequently, takes care of their health, and most importantly, like Mimi, knows that if they get sick, they will be cared for, is an employee who can focus on their work and delivering outperforming results for clients.

At Rethink Staffing, we currently provide free HMO to the Agent, and 50% paid for the first dependent that the Agent wants to cover. In the coming two years, if we continue along our current path, my plan is to fully cover 2 dependents for the Agent, on top of fully covering the Agents’ HMO payments.

In addition to HMO, we provide what’s knows as a “Catastrophic Health Fund” that we created ourselves. You see, in the Philippines like most Asian societies, family bonds are quite strong. That, coupled with the fact that the poor tend to live in extended family units (because there’s then more people to rely upon), means that a crisis with a member of the extended family can often extend to the Agent.

Like Mimi — it’s very common to ask for and receive help when a crisis strikes. One may say it’s expected to a certain extent. 62% of Rethink Staffing’s agents are the primary breadwinner in their extended family, and 70% of them are financially caring for an average of 3 dependents. For the poor, the rule is generally “whoever can help, helps.”

Every month, RTS gives cash grants to employees where a crisis has struck in their extended family. This includes hospital bills, giving money to rebuild a house after a fire, and once we even gave money to rebuild a small restaurant owned by a family member of the agent after a car accidentally ran through the front wall of the store!

We don’t do it because we want to be thought of charitably. We do it because if people know they have somewhere to turn when crisis strikes, that’s one more bit of security they can feel while they work to make themselves secure in our economically advantaged system.

Right now you may be wondering what the cost of all of this is? The reality is that the cost isn’t that much different than other BPO companies. In fact, on a pricing basis, Rethink Staffing has more competitive pricing, because other BPO’s generate costs for themselves because of the way they treat their workers — like higher absenteeism and attrition.

Absenteeism forces BPO’s to carry “redundancy” staff — essentially people to cover for other people when they’re absent. Rethink Staffing’s absenteeism is 1/8th the industry average, which means that when we have redundancy on large accounts — it’s about 1/8th the same cost.

Attrition works in the same way. RTS’ attrition rate is less than 6% per year — other BPO’s face attrition about 10x that on average. That reduces our training costs too — because when we have to pay for a “replacement” training class, we do it much less frequently, and that too costs us less.

Other BPO’s have to build all of that into their pricing. At RTS, we don’t have to. While we have yet to formally study this (but need to), the early directional data we have is showing me that our unique model for managing a call center is more competitive, and more profitable, than the way a traditional BPO is run. But then again, it’s early days for RTS.

I keep saying in this series that the Agent Bill of Rights is not just about caring for people and breaking the cycle of poverty — which it is — but it’s also about good business. In this case, when you make healthcare a human right, and prioritize the company’s role in providing it, it gives Agents a sense of security that allows them to perform well in their jobs. That, in turn, lowers the company costs as well as increases its profits.

Honestly, RTS is not doing anything unique. We’re just applying an old, successful formula to an existing industry that has gone radically in the other direction when it comes to its people. In a labor business — a business that provides people, those people have to be healthy to work. Like I said: It’s not just good for people, it’s good for business.



Mike Dershowitz
Agent Bill of Rights

Mike is the CEO of Fair Trade Outsourcing, a people-first BPO company that uses the power of the free market to fight poverty and promote moral leadership.