You could keep all of the fees you earn in cash, but then you wouldn't have some important protections and benefits. Paid time off is a price of freedom. When you don't work, you don't get paid. You can build paid time off into your professional fees if the market will allow. Healthcare Medical insurance can be very expensive, especially if you are accustomed to getting it for little or nothing each month.
Employers typically pay at least two-thirds of the cost of medical insurance.
On your own, you not only must buy your own insurance, but you must also pay individual rates that are much higher than the group rates most employers receive. Obtaining insurance for yourself and your family will be more complicated if you or one of your family members has a pre-existing medical condition. Even if you work for yourself, you may still be able to purchase medical insurance at group rates through a professional association. Or, if you have an employed spouse who can extend this benefit to you, you can focus on bringing in cash. The combination plan does not lock you into making the mandatory contributions.