Why People Under 30 are Uninsured

I had a spirited debate this morning over whether people under 30 are irresponsible if they stay uninsured. My answer: in the current system, heck no. Why?

-- People under 30 are most likely to hold down jobs that give no insurance. Internships, adjuncting, freelancing, trial period, all of it: as our economy weakens, benefits decrease, and the disproportionate victims of weaker benefits are new workers.

-- Individual insurance is considerably more expensive than employer-paid benefits.

-- People under 30 are healthier than people over 30; additionally, people under 30 feel more bulletproof than people over 30 -- out of innocence, they don't see the need for health insurance.

-- High-deductable catastrophic insurance is the biggest racket the insurance industry has going: when you take small premiums from many, and pay large benefits to very very few, it becomes extremely profitable to hire lawyers and deny coverage in the case of the few. Most people with catastrophic insurance never figure out just how little their policies cover, or how susceptible they are to shenanigans.

-- Many of the most serious health issues that appear between the ages of 20 and 25 are psychological or neurological: the onset of serious depression, schizophrenia, and bipolar disorder is all likely to take place. These are not only difficult diseases, often severely undercovered by private insurers, but they also make it less likely that a young person will go through the conflict and struggle that's required to get a policy in the first place.

-- A young person's insurance situation needs to be taken care of the minute their insurance through their parents (if they're lucky enough to have it) elapses, or else they can be rejected for pre-existing conditions (here, just as an example, is a letter to the editor from a young person denied a half-dozen times for having easily treatable skin conditions, the middle letter on the page).

It is not good that people under 30 often go without insurance, especially those who can pay for it -- but when given the choice between sinking large percentages of their incomes into exploitative and ultimately useless private health insurance, I can understand how a sense of invulnerability could make them forego insurance entirely. A public option -- something that would be affordable, and a plan that would promise that young people could get out what they put in to the system (as opposed to contributing to insurance company profits) would make a real difference.

Specifically, Women

The public option is good for society at large -- it would vastly decrease the number of uninsured in America, reduce reliance on expensive emergency-room treatment, and compete with health insurance companies that use monopoly market shares to abuse the health and finances of regular Americans. It's for everyone. HOWEVER, there are some groups that, because they're treated particularly unfairly in the present system, would receive particular benefits from a public option.

Specifically, women.

Whether or not you think one parent should stay at home and take primary responsibility for child rearing, it still happens quite a bit, and happens disproportionately to women -- and I think everybody agrees that neither men nor women should be forced into marriage, or kept from leaving one that s/he no longer wants to be a part of. There are a lot a lot a lot of reasons for this, but let's radically oversimplify them all into just one: your spouse has become abusive or presents a danger to your children. No left-right issues about saving the family, or religion, or anything else. Time to get out.

Now, we fortunately live in a society where it is possible -- not easy, or even particularly likely, but possible -- for a parent who lives and works at home to get a divorce, get child support, find a job, get an apartment, find child care and whew. Survive. It's a lot of work, and we still lack lots of critical services, but it's a big improvement over earlier times when women leaving a marriage encountered nothing but resistance and judgment. What is, however, practically impossible for that woman to get -- the most regressive part of the way our society treats stay-at-home parents -- is health insurance.

Divorced spouses and their children are eligible for COBRA -- which means that they have the right to be charged 102% (no kidding -- the insurance companies have the right to raise the cost of their plans by 2% for COBRA enrollees) of the cost of the insurance that they just lost by getting divorced. What this means is that if you don't want any gap in coverage (which is when your health problems become 'preexisting conditions,' and therefore uninsurable), you are responsible to pay the full premium for you and your children in cash the moment you ink your divorce papers. Congratulations! You have escaped a loveless and destructive marriage. Please send a $1200 check to Wellpoint Corporation....

Thirty-six months later, this insurance runs out whether you can pay for it or not. And COBRA is for the lucky ones -- people whose spouses worked at a business with 20 or more employees. If your spouse worked in the restaurant industry, you're just out of luck. And keep in mind that while it may be worth it for many women to go without health insurance for a brief period just for the benefits of avoiding Johnny, the presence and needs of children makes this problem life-or-death, damned if you do, damned if you don't.

All of this applies, less frequently but in the exact same way, for any men who get their insurance through their spouse, as well -- whether they're caregivers for children or not. If you've been at home with paralyzing nerve damage from a car accident, getting your insurance through Janie, and Janie starts disappearing for entire weekends with Tom, you're probably better off just pretending you don't know. You need Janie: you depend on her. More precisely, you depend on her insurance because our system of insurance is a joke.

But there are more indignities and injustices in our present health care system that specifically target women: the Truth-o-Meter at politifact.com measures claims about the health care debate, and one of the only statements it has completely verified is that it is nearly impossible for women who are pregnant to get health insurance. This, to me, seems like blunt, no-brainer proof that our system is designed for the profit and convenience of health insurance companies, and works at the expense of people.

Add to this the fact that a public option -- because it would be purchasable by an individual, at reasonable cost -- would ease the suffering and difficulty of thousands of people in nontraditional, nonmarriage relationships, gay and otherwise, by offering the opportunity for each American to get affordable insurance, whether or not they are married, whether or not they are employed by large businesses.

What's the Public Option, Anyway?

Fivethirtyeight.com has an essay up about people's misperceptions and misconceptions about the public option, and how it's not even accurately defined in poll questions, much less in the answers of regular voters. So here's my best crack at a short definition of the public option as it appears in the House bill that passed earlier this August:

The public option is a set of government-run health insurance options available to those who make less than 400% of the poverty line and who have no employer-provided health insurance.

Estimates of the number of people who would actually choose this option vary widely, but the range of estimates I see is somewhere less than twenty million, and somewhere more than seven million. No seniors would be affected (although they might be affected by other parts of health care reform). No person would be 'forced' into public option insurance -- there will also be standardized private options made available to the same people.

So when I see people up in arms about socialized medicine, or a government takeover, I feel like there's a certain amount of disinformation at work -- this is a policy that bends over backwards to make sure that everybody gets to choose the insurance they want. It simply creates opportunities for working families, small business employees, and others who make too much to be eligible for Medicaid, but not enough to be able to afford terrifically overpriced private insurance. The argument that the public option will put private insurers out of business assumes 1) that the government-run insurance option will be so successful that private insurers can't compete, and 2) that our system of private insurance is somehow financially dependent on the working poor and the lower middle class -- that they'll collapse if 10-15% of the population, many of whom are uninsured or underinsured, choose a government option. That doesn't, to me, make sense -- how can you price a group of customers out of the market, deny them the opportunity to be covered, and then turn around and argue that you can't survive without them?

For more, here's a description of the bill at OpenCongress and a journalist from the Nation describing the public option.

Friday Short

Quick because I have to make dinner and I spent all afternoon taking the 212 bus to go watch pure light. (Note: also not a euphemism. Admission cost me $8.)

By my count, there are three reasons we make an industry public (i.e. give the government significant power over it). 1) when the thing the industry sells is absolutely necessary for survival and people who need it will pay any amount of money for it (i.e. water, perhaps electricity). 2) when the item or items it sells are a finite resource that has to be shared (water, roads + highways). 3) when the nature of the industry is such that a monopoly corporation in that industry would have too much control over the nation (defense, the post office).

Health insurance clearly fits all three categories: the vast majority of us rely at some point or another on some form of health care; we have come to the point where we realize that this is not an infinite resource that we can continue sinking 15% of our GDP into funding it; and increasing monopolization and control by large health insurance companies (Wellpoint, United, Blue Cross) has meant that they, not us, are setting national health policy.

The public option for national health insurance, because it would be operated by the government, would be more socialist than the current system. That's true. But no more socialist than our water system -- and you'll still be able to buy the bottled stuff if you want it.

EDIT: PS -- a veterans' organization is in the news today for defending their own socialized medicine against flat out lies by opponents of the public option (in this case Republican National Committee Chairman Michael Steele).

Mailsack

Surprisingly fat mailsack this morning, raising two very discussable questions.

First, from a debonair conservative gentleman: why put the government into health insurance? Why not simply legalize cross-state competition in the insurance market, and enact tort reform?

My answer is that while the two reforms could be useful, neither will nearly be enough to manage costs and provide more care. While cross-state competition (which I mentioned in this post) would certainly make the industry more competitive and could drive down prices, it would also likely increase a problem already acute in the current system: localities that are difficult or unprofitable to serve could still have one or two large for-profit insurers, and it has been pretty conclusively proven that the insurance industry will shake down communities where there is little competition in the attempt to maximize profits. The only difference for these citizens would be that they'd now be dealing with a much larger corporation, and one unregulated by state law. To see what the possible changes/efficiencies from a plan like this might be, consider insurance costs in extremely large states (since we would essentially, where insurance is concerned, be making the country one big state market) -- for example, this argument by Governor Schwarzenegger that California's health care system is broken, in part because of unstoppably rising costs. That's a big, unified market -- but costs are still out of control, and people are still uninsured, and the state and taxpayers are still footing the bill for insurance industry profits. The Terminator, who is not exactly a socialist, is exactly right when he says that Californians already pay a 'hidden tax' to provide care for the uninsured -- it's just done in the most inefficient, secretive, dehumanizing way possible.

Tort reform, although it could also help control costs, would have an even smaller impact. Several states (and there are conservative thinkers in favor of tort reform that believe that a state solution, instead of a national one, would be best) have made significant strides towards reform, foremost among which is Texas. There are some positive indicators that their reform has helped increase numbers of doctors in the state, and decreased the cost of malpractice insurance, but Texas still has four of the top ten most expensive health care markets in the nation, 25% of its citizens are uninsured, and its costs increased 6.1% in 2007. Maybe, it stands to reason, a combination of a national health insurance market and tort reform would decrease costs, but Texas is a pretty large state, too -- its GDP is the size of Canada's.

Long story short, a national health insurance market and tort reform might both be great, but neither is more than a small and incremental improvement to a system which is methodically and swiftly bankrupting and sickening America. The insurance industry, in my opinion, will allow the passage of both types of reform -- neither is likely to cut into their profits in a significant way, and backing them will make the industry look like it cares about us while it blocks the reform we need -- a government-run health insurance option for all Americans.

That brings me to the other piece of mail that was lodged in my bulging mailsack -- an east-coast liberal contrarian/grammarian who wants to point out the difference between health care and health insurance. The public option is a government provision to provide health insurance -- what we are debating, in most cases, is reform to the national system of health insurance -- basically, who pays for treatment, and not who delivers medical care. I'm roundly guilty of confusing the two, because I think that one of the reasons me and mine have received such poor health care during our young adulthood is because we had completely shoddy, or no health insurance. But he is right that even though health insurance might affect health care, we are actually engaged in a very unsexy movement to ensure equitable and affordable health insurance. "National Health Care" in the Canadian or British sense, where government owns the overwhelming majority of care providers, is not under consideration by either house of Congress and makes up no part of the current debate.

An End and No End

"For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives and the dream shall never die."

-- Senator Edward Kennedy, 1932-2009

"I called Blue Shield today to find out when they would resume paying UCLA for Janni's care. Surprise, surprise, they knew nothing about the State's Department of Managed Health overturning their denial. They asked me to fax the letter from the state to them, then told me that UCLA had not sent medical records to them for the last 15 days so they were about to deny care again! I don't understand how they can deny when they have already denied. That would be a denial of the denial."

--Michael Schofield, father of January Schofield, aged six

AHIP's Army

I had thought that the insurance industries were satisfied with direct lobbying and cash donations ($133 million in the last quarter!) in order to unfairly sway reform bills towards corporate profits, but apparently they're instructing corporate employees to attend town halls in an attempt to simulate the existence of a pro-insurance company constituency, and they have 50,000 shills walking in lockstep. I'd dismiss this as conspiracy if the effort wasn't large enough to be a matter of public record.

I've met a lot of people who don't support a public option or who don't support reform, but I've never heard anyone rationalize that opposition by saying good things about the health insurance industry. Unless, of course, (and this includes Joe Lieberman) they are PAID by the health insurance industry.

Baby and Bathwater

This from 538.com:

From progressives' point of view, they have been waiting many, many years for this moment -- for an ostensibly fairly liberal Democratic president, an ostensibly filibuster-proof majority in the Senate, an ostensibly lock-solid majority in the House, and a discredited opposition party. For a variety of reasons, the situation isn't as good for progressives as it appears on paper and never was. But that doesn't mean that expectations aren't very high. And yet they've seen little progress on climate change, on gay rights, on torture policy, on regulating the banks -- and now they're running into a stiff headwind on health care. It's 1994 all over again. To the progressive mind, it seems to be -- pardon my French -- the same old bullshit re-asserting itself. The moment is on the verge of being lost.

Silver's question, couched in (another) poker metaphor, is this: will progressives will go all-out batshit and absolutely insist on a public option that doesn't have a terribly strong chance of passing? I think that his analysis, which breaks up possibilities into discrete options, misses some of the gray areas that will doubtlessly be hammered out as a final bill is offered to the Senate: first, that there is such a thing as a strong and weak public option, just as there is such a thing as strong and weak reform (I'm speaking here from what he would call the 'progressive' point of view, and what I would call the 'pro-reform' point of view), and second, that these are all on the same spectrum. Enter the spectrum:

This is a simplification, of course, but it's a different one than Silver's -- I can't control Congress, not exactly, but I feel like my support for the public option, even if we end up with no strong public option, pushes the conversation to the right (on the chart, that is). I'll take an end to the way that health insurance companies profit from our fractured state-based insurance system, for example, and I'll support any politician brave enough to enact it -- even though I want more.

That's maybe the difference between now and 1994 -- because we have so many options on the table, there is much greater space for moderates of all kinds, and a much larger chance of getting some reform, even if it's not ideal reform, passed by the fall.

The only problem, really, is the fake reformers like Lieberman -- Democrats and Republicans (or in his case, neither) who accept large amounts of insurance company money and then it's all aww, shucks, do we really have the cash for this sort of thing? Ooo, it seems so complicated -- let's wait until it's impossible to pass reform, and then pass some reform.

Sunday Short

Very short post today because I'm going to a cat show for the lord's day. (note: not code. Literal truth.)

In this article, in response to hero Senator John Rockefeller's request for statistics from health insurance companies about profit/care ratios, AHIP (America's Health Insurance Plans) group spokesman Robert Zirkelbach said, "Some in Washington are trying to shift the focus to the insurance industry rather than talk about solutions to the health care concerns raised by the American people."

Kind of looks like, from my reading, the health care concern most commonly cited by the American people IS the insurance industry.

Awakening?

A short link round-up, today, because oddly -- and I maybe have to chalk this up to more thoughtful parts of the media taking a little bit longer to mull over complicated issues like health care -- there seems to be an awful lot of really good writing about national health care reform in the electrowebs today.

First, a super-brilliant post on Metafilter demonstrating that some of the most untrue stories about health care reform come, in fact, directly from health insurance companies and related industry media organs. The post has links to a John Stewart interview with the originator of the "death panels" story, who one day later resigned from the board of directors of Cantel Medical.

Second -- and I'm not ashamed to say I look to a movie critic as a moral touchstone -- Roger Ebert made a pair of posts (part one, part two) that, among other things, point out that the "end" of the public option caused a big gain in health insurance industry stocks, compare "death panels" to the slogan "king of beers", and find the ethical roots of communally shared health care in Matthew 25, verses 31-46. It's kind of a tour de force.

Third -- Andrew Sullivan has collected and archived his posts on health care, which include the "views from your sickbeds" -- stories of what it's like to go through critical illness with American health insurance.

Finally, this op-ed by Gail Collins isn't as good as some of the stuff above, but she makes the point that the 'Gang of Six' that has been responsible for slowing down reform directly represents 2.77 percent of the American people. Thanks, guys! Allowing a small elite to paralyze reforms that serve the majority was exactly what James Madison had in mind when he argued for a bicameral legislature.

Heavy Is the Chest that Wears the Gunk

I taught myself to use the GIMP to create this masterpiece:

Well worth it, well worth it.

So why junk up a perfectly good centrist? Because centrism doesn't mean chase money and votes in a completely self-servingly strategic fashion. Here's the NYTimes analysis of why Lieberman voted repeatedly to limit damages that could be awarded to people that sue insurers:

"Many of Mr. Lieberman's friends said he had no alternative but to take this position because it was the one favored by the insurance industry. The industry is important to Connecticut's economy and has generously donated to Mr. Lieberman's campaigns over the years."

Well, you know, everybody has constituents, right? At least he's a continuous and strong supporter of private health insurers, right? Lieberman in 2004, during the Democratic primary:

"LIEBERMAN: There is a morally scandalous fact-that that 43 million Americans don't have health insurance, 2 million more than when George Bush became president. I'm proposing to create a national health insurance pool like the one that members of Congress get our insurance from. If you don't have insurance now, you'll be able to get it, probably free, if you're among the low-income working poor. If you're a child, you will be covered by insurance at birth. If you are fired from your work or lose your job, you will not lose your health insurance."

Sounds great, Joe. People really should have health insurance, and since this is the electoral primary and public options for health care are really popular among Democrats, I'm sure this will really help your primary numbers! But what's this business about "probably free"? Oh, right. It's wiggle room, so that he can crawl back to the insurers that fund his campaigns, tongue lolling like an overheated spaniel:

"I don't favor a public option," Lieberman told Bloomberg News in an interview broadcast this weekend. And I don't favor a public option because I think there's plenty of competition in the private insurance market. We have a unique opportunity, a real opportunity to do this year what we've been trying to do for years, which is to reform American healthcare, I think the one thing that will stop that is pressure on the so-called public option. Let's get something done instead of having a debate,"

So the new message is threefold. One: we are doing GREAT. Helluva job. It is absolutely not true that the senators most likely to oppose the public option come from states with the least competition in health insurance or that Lieberman's home state of Connecticut is dominated by Wellpoint, which commands more than 50% of the state market (although the people of Connecticut are fed up -- their state legislature just overrode a Republican veto to establish universal healthcare statewide). Second: Lieberman is on the side of a nebulously defined 'we' -- which doesn't mean Democrats, exactly (Lieberman is technically an independent) or his constituents (see above state policy, which is overwhelmingly supported by residents of Connecticut). I'm guessing that health insurance companies make up a good bit of this 'we', and it's true -- they've been trying to write health policy for decades. Third: shut up already! Why is everybody debating what's best and not just jumping in with some halfhearted, bandaid-on-a-sucking-chest-wound reform-lite package? This, I think, is a very respectful echo of what we could call the Bush Doctrine.

So all told, until you get on board, Joe, you're going to have a chest full of poorly Photoshopped gunk.

EDIT: Also, there is a rhymey bunch trying to kick you out of the Democratic Party.

Nothing's Over

I took a few days and posted pieces I had saved up so that I could mull over what's happened to the public option in the last week -- after the Obama administration hinted that it was willing to drop a public option as part of a health reform bill and then said that nothing was settled yet. I didn't want to flip the hell out without really thinking about it.

And I'm not flipping out. It's U. S. politics. We didn't suddenly get a better political system once President Obama was elected, and I've never doubted that if he was Imperial Lord, we'd probably already have a health insurance guarantee for every American. I've looked at questions about whether the administration is working hard enough on our behalf, and tried to figure out, but I just don't know.

Here's what I can answer, though. Am I working hard enough to be able to say that I've done everything I can to ensure that all American children have health insurance? That my friends and neighbors don't have to put off doctor visits or lose their homes over medical bills? The answer to that would be no.

One thing that has held me back a great deal was the assumption that what proponents of a public option have been working against is the attitudes and beliefs of other citizens, but this isn't entirely true. This statistical analysis at fivethirtyeight.com makes an argument that should be familiar to most of us: insurance company PAC money and direct donation have had a significant impact on health care reform votes in the Senate. Democrat Mark Warner of Virginia has raised $69,000 in health insurance contributions in the six months since he entered the U. S. Senate -- that's $10,000 a month, and he's not up for reelection for another five years. This article breaks down contributions accepted by the Gang of Six, the bipartisan committee that called for a slowdown of public option legislation in July. Republicans accept health insurance corporate funds across the board -- and that certainly has strengthened their resolve to oppose a public option -- but what is surprising is that Democrats like Joe Lieberman of Connecticut and Ben Nelson of Nebraska have each, over the course of their careers, raised more than two million dollars from donors in the pharmaceutical and health insurance industries. This is more than a debate between people who want a government option for health insurance and those who want an unrestricted free market; all citizens who want what they feel is best for their nation are pitted against corporate interests who are attempting to purchase favorable policies for themselves.

If you aren't convinced that health insurance companies intentionally and aggressively court industry-positive policies in Washington, check out this interview with a former executive for CIGNA who helped end reforms during the first Clinton administration, and is now speaking out about the excesses and cruelties of the current US health system.

So no basic principles, for me, have changed -- I support affordable health care for every American, and a competitive government option for the provision of that health care. I oppose profits earned by encouraging human suffering, and the disproportionate voice that monied interests have in our government.

What has changed is that I no longer trust my elected officials to make good law without the energetic oversight and intervention of people like me and you. So let's get to intervenin'.

German National Treasures

This source from yesterday's globetrotting survey of world health policies has the following line in it. It describes the German system of national health insurance:

"...premiums for children are covered by government out of general revenues, on the theory that children are not the human analogue of pets whose health care should be their owners’ (parents’) fiscal responsibility. Instead, children are viewed as national treasures whose health care should be the entire nation’s fiscal responsibility."

So, whereas 0% of German children suffer without healthcare, 11% of US children were uninsured at some point in 2007. I spent a little bit of time last week leaving comments in conservative territory, and I can pretty much ventriloquize what they'd say about the statistic above: forget them, they're illegal fucking beaners (this is really how they talk on their own blogs, although some do use rudimentary code language -- I'll spare you a link to the sites themselves). And although I think the 'fuck beaners' crowd is just a slim little minority in the US today, can the rest of us honestly say as a group that we consider our children to be 'national treasures'? The far right has the advantage of ignorance and race hate -- operating under the assumption that all uninsured children are of other, detested groups (although wrongly -- 7% of white children were uninsured last year), they have deluded themselves into thinking that no child they care about is going without yearly checkups, or worse, without lifesaving care. The rest of us don't really have those illusions to excuse inaction.

But they speak up -- the same tired, racist fears that poor or illegal immigrant children will steal health care from our embattled system -- and we stay silent, and we never remind anyone that there are sick little kids out there, and we never make the argument that it is always a good thing to give health care to any child, and that treating children who are placed into the system under false pretenses is the right thing to do, especially when it allows us to offer care for all American children.

Every stingy measure we pass to exclude certain children from public health care -- tests of citizenship, proof of parental income -- creates paperwork and increases the likelihood that some children won't make it through the process of getting covered. The humanitarian -- hell, the human system -- is that anyone under 4' gets free healthcare that we all pay for. The system would, ideally, be a reverse version of this:

Image thanks to

http://www.flickr.com/photos/futurowoman/ / CC BY-NC-ND 2.0

More on my thoughts on this new co-op compromise tomorrow.

Around the World

I'm kind of spinning my wheels trying to figure out what the new legislative direction in Congress will actually look like -- so I thought now would be a good time to figure out how some other industrialized nations structure their health systems. There's been a lot of talk about Canada and the UK, so I'll leave them out and focus on some other nations. This is initial research, and just an attempt to put some summaries side-by-side, so leave a comment if you feel the urge to disagree. Massive oversimplifications to follow:

FRANCE -- The French system is made up generally of private practices for ambulatory care, and public hospitals for acute care; the government provides a national health insurance plan that pays 60-70% of health care costs, and almost 80% of the population supplements that with additional insurance from a private source. Although they've had cost increases similar to (although smaller than) cost increases experienced in the American system, government negotiation with care providers and drug manufacturers have helped limit prices. Because France has three times as many doctors per capita than the US, and because its citizens lead the world in use of prescription medicine (note -- not necessarily a good thing), the WHO called it the world's #1 health care system in 2000, and many Americans who have lived there or studied their policies advocate strongly for their system.

JAPAN -- In Japan, insurers are not allowed to profit from health insurance, and health insurance is guaranteed through one of two national systems, one that covers large employers, and one that covers small employers and the uninsured. While access to basic care is reasonably equitable, the system has considerable problems ranging from overutilization of some services (because doctors are paid by the service) to poor resource allocation (leading many to be turned away from emergency rooms) to insufficient oversight (doctors receive a lifetime medical certificate that requires no re-certification, and many believe they operate at an unacceptably low standard). All this having been said, Japanese citizens are actually some of the world's healthiest -- they lead the UN's list of the nations with the longest lived citizens.

GERMANY -- Germany's first universal guarantee of health care was apparently instituted by Otto von Bismarck, here seen pensive in a pointy helmet. The modern system guarantees insurance for all, paid for through a combination of payroll tax and employer support. Their social insurance system is something like the Japanese, but instead of being assigned a government option, insurance can be purchased from one of over 200 "sickness funds" which are independent, not-for-profit, and which compete with each other for clients. The government does engage in top-down negotiations to decrease costs, and these have been reasonably successful in keeping costs considerably below those in the US.

What do these systems all seem to have in common? First, all industrialized nations I've read about guarantee all their citizens at least a minimal amount of care. Second, the nations above tend to keep electronic or otherwise portable records, like the French carte vitale or the German eHealth card (which has admittedly hit lots of snags). Third, almost all these nations pay their doctors less, but cover medical training of all kinds, often completely. Finally, most of these systems, with some exceptions, were created gradually, using a series of reforms that increased coverage bit by bit.

Ok, last thing, can't resist: Around the World by Daft Punk. The video is intended to metaphorically represent the legislative process of the US Congress.

EDIT: Worst health care systems in the world. We made the list! Wooo.

Good News or Bad News?

This made a banner headline at the NY Times -- which has apparently started to feel guilty about failing to more aggressively report the truth about the false "death panels" claim, because they slip a rehash in at the bottom. Medium-length story made short, the administration seems like they're willing to drop support for a public option in favor of a network of private, not-for-profit cooperative insurers.

What does that mean? Are health insurance co-ops -- non-profit organizations that provide an alternative to private insurers -- going to serve the US in the same way that the public option will?

Looking into it just a little bit, I can already see a few differences. 1) Negotiation power. The NYT makes this point -- small co-ops, regional or local co-ops, have less muscle to force price cutting by hospitals and pharmaceutical companies. 2) Regional inequity. The co-cops here in Los Angeles will likely be really nice -- there are a lot of motivated people and a lot of resources pressed up together. In Arkansas, though, or Georgia, they'll probably be considerably less nice, because enrollees will have less money with which to support the co-op, more problems, and the talent and dedication needed to run the co-op itself will be spread over larger areas. 3) Secret profit. Lots of 'non-profit' organizations are actually highly motivated by profits in the form of individual and executive salary -- this could provide the same incentives to deny care in order to 'keep the co-op afloat', i.e. maintain the for-profit employment of the not-for profit's employees. Because there will likely be many of these co-ops, government oversight will be a challenge.

These are significant concerns. They can be addressed -- a national purchasing system that unites the co-ops, for example, or some kind of federal sliding scale for funding them. Whether that will happen or not remains to be seen. What I am not interested in, very specifically, is analysis of this nature, from Cenk Uygur. Here's the key spot where he and I part company:

"But that's still not the main reason why the public option is so important. It's because it is a standard bearer. It is a road sign. It tells you what Obama is all about. Is he willing to compromise something he knows is essential to get a deal done so that he can brag in the next election that he got "healthcare reform" passed? Or does he actually give a damn about policy and getting it right? That is the central question."

This is not a standard bearer -- this is a policy. Uygur has here joined the ranks of people who are playing political football with health care reform -- I've become used to calling them "Republicans" -- and who are interested in forging win/lose politics and short-term horse-race headlines out of this very complex issue. A public option has to be for everyone, and that includes the farm family in Iowa who doesn't trust the government, or the 46% of the nation that voted for John McCain. That the far left is willing to sniffle and return to their tents because they lost a legislative battle, and that they can only conceptualize opposition to their chosen reform as an unwillingness by their elected officials to "insist" on a public option, shows a certain lack of civic engagement.

Which is to say that we should all maintain strong support for a policy that will cut costs, insure the uninsured, increase the quality of care, and strengthen competition against and between insurance companies. The reason for that? Comments like this one, from a man who had to fight his insurance company to receive lifesaving and medically necessary treatment. The goal of the public option is identical to the goal of health care reform -- better care for people. Narrow-minded dependence on scorecard politics isn't going to improve our health care.

Why's Wayne Worried?

Talked to a friend the other day whose father, who we'll call Wayne, is still a bit on the fence about significant national health care reform -- he doesn't want to lose his current insurance. I think he's probably representative of a good portion of the lukewarm opposition to a public option -- it'll be hard and expensive to make a big switch, learn a new system, and he's doing fine now.

One of the reasons that this kind of attitude can persist is that health insurance companies hide costs and show benefits -- your health insurance payments don't appear, itemized, on your paycheck, so you're often not exactly sure how much your employer's paying per year. Plus, a good portion of insurance company cost-saving measures (abandoning paying customers -- rescission -- and refusing to cover drugs and procedures because of the costs) are hidden, and blamed on the customers and the drugs, respectively. This means that the customer who develops an expensive, life-threatening condition is found, by some slight of hand, to be at fault, and expensive treatments are labeled as 'insufficiently tested' or 'unnecessary'. There is currently no way to measure or compare how, and how much, insurance companies use these methods. So we don't really know how much we're paying, and we don't really know what we're getting.

What we do see is that when we go to the doctor's, our insurance coverage knocks off a significant amount of the price -- my doctor's visit goes from $80 to $10. That feels like a great benefit. But if you're paying $2400 a year (and that'd be a pretty cheap policy), it's nothing -- you'd need to go to the doctor's 32 times in a year to break even, which is a little more than once every other week. What you're paying for is what happens if you get very sick. Brain scans and protracted physical therapy and hospital stays, etc. etc. Wayne's never gotten that sick: he doesn't know how quickly the insurance company turns from a no-hassle discount into a tight-fisted adversary.

That's why there's this immense flood of stories of people who have been heartlessly screwed by their insurance companies. We are promised that we will be covered, and then we're not -- and it's shocking (note the family in the last link that is dropped from their insurance provider of 35 years), and we are surprised, and we want to tell someone.

Because of the system, though, this will happen over and over again -- until Wayne hears enough stories to realize that this can and will happen to him unless he works hard to ensure a public option for himself and his family.

PS: I also have found one person who got screwed by our health care system and then fell in love with it later -- but I think he's more or less one-of-a-kind.

What can we do?

Most of my posts are about why it's good to support a public option for national health care -- but I just read this brilliant post, which gives a solid set of guidelines about having health care debates with those who don't support reform, and it reminded me of this AskMetafilter question, which asks what supporters of the public option can do to ensure that it becomes law. Here's my brief list:

1) Write your representative and senators. If they support a public option/legislature you like, write a letter of support; if they don't, call on them to change their minds. Here's a brief introduction that will help get you started -- all I would add to their list is to be persistent! Every polite letter gets read and considered, if only briefly.

2) Write a letter to the editor or op-ed piece for the press you read -- including alternative weeklies, magazines, newsletters, church bulletins, and anything else. Another brief introduction, to which I would add that many letters in city newspapers refer specifically to an article run in the paper, and that you have an advantage in writing to a paper that you already read.

3) Visit a town hall -- here are lists of upcoming Democratic and Republican town halls all over the country, and they run through late September, so there's plenty of time. I'm of the opinion (I've never been) that just going and sitting quietly and listening to what your representative has to say has a positive impact on the debate -- six people screaming makes a lot less sense when they're in a crowd of two hundred who came to listen.

4) Get organized with a Public Interest Research Group -- they're organized by state, like MoPIRG (Missouri) and CalPIRG (California). They're running campaigns right now in support of the public option, and are usually happy to accept letters, volunteers and donations.

5) Leave me a comment! Well, that's more of a gesture of support than it is actual support. Start with 1-4, and then use 5 to let me know what happened.

EDIT: 6) Or, if you're a Whole Foods customer, write them and let them know that you think this op-ed is a stellar piece of trash (which is to say, stellar trash, which is to say a plume of hot waste gas).

Melting to the Money

Dr. Rob left this comment a few days ago, and this was the most thought-provoking part to me: "[I] hope the congress will avoid melting to the money and actually push primary care." I agree with him -- I hope that primary care is a priority in the new system (and since the legislation is still being debated, it's not certain that the final draft of the reform bill will prioritize primary care), but it took me a while to figure out why ignoring primary care would be "melting to the money."

Here's what I figured out: since we have, excepting Medicare and Medicaid, a largely for-profit health care and insurance system, the most profitable parts of the health economy become larger, and the less profitable parts shrink in size -- the system flows towards the money. Examples:

1) Notice how you never see television advertisements for prescription drugs that cure disease or fix a problem? The drugs worth advertising -- the most profitable ones -- are new treatments for chronic disease like irritable bowel syndrome, fibromyalgia, erectile dysfunction, etc. These are treatments one has to take over and over again, and the reason only new drugs are advertised is because the profit margin is highest on drugs that are still under patent. This book puts it particularly well:

Jurgen Drews, a physician who has been the research director of a major global pharmaceutical company...argues that in recent years an obsessive, and ultimately self-defeating, focus on the bottom line, and the increasing costs of launching a new product, have led pharmaceutical companies to devote their research efforts increasingly to so called "me too" remedies for conditions such as high cholesterol and hypertension for which useful therapies already exist.

Because it's quicker, and more profitable, to seize control of a market that already exists than it is to undertake the long process of truly improving public health.

2) Why is it that a trip to the dermatologist, even a very simple one, is likely to cost three times as much as a trip to a general practitioner? Supply and demand -- there are fewer dermatologists, and they can demand a higher price, even though their specialty is no more complicated than general practice medicine, and they don't have more training, just different training. It is weird that we have plastic surgeons driving around in Benzes while some rural counties with obvious need have a crisis-level doctor shortage. I'm not arguing that people should be stopped from paying for health care, I'm just pointing out that under the current system, the most profitable branch of medicine is cardiology, followed by radiology, orthopedic surgery, ophthalmology, anesthesiology, and dermatology. Those are all great, and deeply necessary for good health care, but they're not the medical care that we need most. They're the kind of care that is most specialized -- when you need a specific surgery on your eye, there's a very limited number of people who can do it, and they can charge whatever they like. Meanwhile, your primary care physician is deeply involved in saving your life in a number of ways (monitoring your blood pressure, providing early cancer diagnoses, catching diabetes before serious symptoms set in) but they're not paid a premium for it -- because there's lots of general practitioners.

3) Public health initiatives -- education and availability of the most simple, most effective health interventions -- make zero profit (because they address a need before the point of crisis) for private industry and provide measureless profit to the community. So we leave it to non-profit, often non-medical groups to do things like encourage HIV prevention, provide flu shots (which are organized in my neighborhood by the LA County government), educate expecting mothers (a service of the March of Dimes), etc. etc. Resources -- money -- literally melts away from these needs, because they don't fit into our current profit-based model. This is not cost-effective -- if we had an organized, national health care system that could ensure that folic acid was provided for every pregnant mother, we would pay less in emergency room visits, government-sponsored care for premature newborns, lost work and wages, etc. etc. etc. The problem is that it's not profitable to tell women to take a multivitamin in the first weeks of pregnancy -- at least not profitable in the narrow, free-market sense.

I probably come off sounding a little bit critical of the free market in the examples above, and I'm really not -- private companies can be, under certain conditions, terrifically helpful. Unfortunately, too much money has melted to the shape of that free market, and we're missing all the benefits that can be had from a not-for-profit, community option for health care. That's the public option -- and to get it, we're going to have to overcome the entrenched interests (and the money they've accumulated) that profit from the current system -- namely, insurance companies and the politicians they support.

Small Business and the Self-Employed

I got a visit from Zach Everson today, which reminded me how much I learned from his archive post about freelancers and health insurance. His argument is that our system of employer-based health insurance makes people more likely to tolerate jobs they're overqualified for, and less likely to strike out on their own.

Because it's so hard to get individual health insurance -- because we have so few legal and competitive protections in the current health care system, and have to depend on employers to negotiate on our behalf with health insurance companies -- the status quo makes it hard not just for freelancers, but for small business as well. In a business with one owner and five employees, just acquiring and maintaining health coverage is a significant amount of expense and work -- and in a small business, labor and resources are often in short supply. The fact that so few small businesses are in a position to give health benefits makes them considerably less competitive for workers than larger employers -- would you really choose to work as a bookkeeper at an Internet startup when you could get health insurance running receipts at the Gap?

I think both political parties are in favor of entrepreneurship and small business innovation -- but the current system of health insurance discourages those values. Being able to rely on a standardized, centralized option for health insurance would be a godsend for a lot of small businesspeople. When opponents of the public option claim that they are pro-business, they're really only talking about one kind of business -- health insurance companies!

UPDATE: James Kwak's essay "You Do Not Have Health Insurance" got picked up at the Washington Post -- very excellent!

Gunk Club redux

Still thinking about FIRM, Objectivism, and health care reform. A few things:

-- It occurs to me that what liberals and conservatives disagree over are which community values should be most important -- equality? Christian morality? Financial security? Competitiveness? Defense? -- but I think that liberals and conservatives would both easily agree that we should have community values in the first place. That's where both groups differ with the Objectivists, and the reason that Objectivists almost never identify themselves or their philosophy when they write articles. They don't hide it -- at least they don't put much effort into hiding it -- but they prefer to identify themselves with meaningless abstractions like 'reason' or 'objectivity'. I suspect that there are fiscal and social conservatives who read articles by Hsieh and company who would probably disagree with FIRM's fundamental beliefs, and I know that there are much stronger arguments against a public option than "doing things for other people is an immoral weakness."

-- Here's an interesting post on Objectivism in popular culture, in the video game Bioshock and the movie The Incredibles.

-- It occurred to me this morning how weird it is to call yourself FIRM. I mean, don't get me wrong -- I'm the founder of RIPPED (Rationalists In Peril of Perpetrating Educated Debate) and a signatory member of TURGID (Tactical Understatement Really Gets It Done), but FIRM strikes me as odd, somehow.

-- I found this entertaining tidbit on reddit.

In non-FIRM news (inFIRM? UnFIRM?), the New York Times published a solid introduction to health care reform today -- good on them for replacing their horse-race analysis of whether the bill will pass and who will win or lose with an actual investigation of the issue at hand.

The Gunk Club

I had thought there was an almost infinite amount of health reform debate on the web -- but I was sort of wrong, because it seems that about 25% of it is the work of Dr. Paul Hsieh, the co-founder, most prolific author, and most furious reposter of the group FIRM (Freedom and Individual Rights in Medicine). So hey, I like freedom, and I'm real big on individual rights -- what's not to love?

Oh, right. Gunk. FIRM's other co-founder is Lin Zinser, JD (if you squint hard enough, it looks like 'MD'), who is an employee of the Ayn Rand Institute (scroll to the bottom) in charge of "outreach to professional communities". In fact, almost all links going to and coming from FIRM's web presence go to magazines and communities associated with Ayn Rand's philosophy, Objectivism. But hey, I like philosophy. No philosophy could possibly be made of gunk, could it? It couldn't, under any circumstances, be positively dripping with gunk, now, could it?

The gunkiest part of Objectivism, first theorized by Russian-American exile Ayn Rand during the height of the Cold War (she served, actually, as a friendly witness to the House Un-American Affairs Committee, which kicked off the Red Scare), is its ethics. Objectivist ethics are founded on what they call rational self-interest, with an emphasis on the self-interest. One of her most famous characters, John Galt, makes this oath: "I swear — by my life and my love of it — that I will never live for the sake of another man, nor ask another man to live for mine." In another of her novels, The Fountainhead, when architect Howard Roark feels that the vision of the building he's designed has been altered, he blows it up, regardless of the fact that he didn't physically build it and doesn't own it.

"Rational" self-interest is what Objectivists like Hsieh and Zinser are talking about when they publish articles like "Health Care is not a Right" or insist that "the law must respect the individual rights of doctors and other providers, allowing them the freedom to practice medicine. This includes the right to choose their patients, to determine the best treatment for their patients, and to bill their patients accordingly." The vision of a doctor as someone who serves others out of love for humankind, or in order to create a more perfect society, never enters into the equation: doctors have the skills to heal, and they exchange them for profit. That's all. If it is more profitable for doctors to enrich themselves by treating a few people and ignoring the rest, then they should do it -- they have to do it, it's their moral responsibility.

What is most infuriating, though, about Objectivist self-interest is that it willfully ignores the contributions of others towards creating the very privilege that gives doctors their special knowledge and skills. Paul Hsieh got his MD from the University of Michigan, and Lin Zinsler attended not one but two state schools -- taxpayer funded, socialist education -- but even if they had been private school graduates, and hadn't received any government loan options, scholarships, or other community support, they would still be constantly dependent on the rest of us for day to day survival. Paul Hsieh is a radiologist -- he spends his days, I would guess, with complex CT, MRI, X-ray and other scanning machinery, each having hundreds to millions of parts, each part requiring its own manufacture, its own raw materials, and its own know-how. It is incontrovertable that one of those miners, manufacturers, plastics assemblers, or welders is uninsured or underinsured. That without the labor of people who Objectivists look down on, and intentionally refrain from helping, they would be unable to perform the tasks that bring them such pride and wealth.

Saying that doctors should have 100%, individual, self-interested control over who to treat and when is counter to the Hippocratic oath, which promises that "in every house where I come I will enter only for the good of my patients." To accept public funds and support for your own medical education, and then claim that public health care is immoral, is what we call the classic, creamy-style, industrial grade gunk.

You Do Not Have Health Insurance

I wanted very quickly--it's hard sometimes to keep from posting more than once a day, and I've got work to do -- to direct you to this argument at The Baseline Scenario, which does a better job than I could of showing what a long, arduous road it can be from the day you pay your insurance premium to the day you are reimbursed for health care.

He hits the nail on the head when he points out that "as long as your health insurance depends on your job, your health is only insured insofar as your job is insured – and your job isn’t insured." Employer-based health care has some positives -- for one thing, our employers are likely to be organizations large enough to negotiate professionally with insurers -- but it shouldn't be the only game in town.

It just takes a minute to imagine what your life would be like if you got too sick to work. Try it now: if you can't work, how can you get insurance? Without insurance, how are you going to get medical care? Without medical care, how can you get back to work?

Noise

Some disturbing news from my hometown, where a fistfight ended a town hall meeting on healthcare reform.

A lot of the negative commentary below the article centers on buzzwords -- socialism, 'Dimocrats', welfare, freedom vs. tyranny -- that I'm not really interested in. Where health care is concerned, I don't care which party wins a legislative victory, or whether a policy is capitalist/socialist, or any of that. Here's what I care about:

1) I don't have the money to get insurance from anyone except my school. I have never had enough money to get insurance from anyone except an employer; I probably never will.

2) I do not trust the insurance company my school has hired. I have never trusted an insurance company, and I have never seen or heard stories about an insurance company acting selflessly in the best interests of its clients.*

3) I want something else. I want a health insurance system that is not based on corporate profits, where I'm not working against a large, parasitic industry designed to extract as much money as possible from me. I see the public option as the best way to escape their control.

That's what's important to me. To my mind, the rest of it -- the partisan bickering, the resentment towards Obama, the screaming, the noise -- it's not good for anybody except the insurance companies.



* Feel free to leave counterexamples in the comments! There has to be, somewhere, one good and helpful private provider of health insurance, and I would like to know their name.

Rescission

Rescission! Hah! Good God! What is it good for?

Profit profit profit.

Rescission is the insurance company practice of denying coverage to insured policyholders, and it is overwhelmingly applied in situations where the policyholder has a right to significant payment.

Here's the step by step:

1) You or your employer pay thousands of dollars in dues to an insurance company.
2) You get sick.
3) Your insurance company decides that in retrospect, you weren't eligible for coverage from the start, sometimes because you didn't fill out forms correctly, sometimes because they identify a previous condition that you didn't know about, and call you ineligible because of it.
4) The insurance company keeps all those dues, and you are suddenly sick, uninsured, and broke (because those dues weren't cheap!)

Rescission is different from the argument that expensive treatments aren't covered, it is a complete denial of all insurance and it's much more profitable for insurance companies. This article is the best explanation I've seen about rescission's impact on insurance company profits -- all the companies have to do is get rid of about half of a percent of their sickest patients, and their financial outlook becomes much rosier. Remember, though -- one of the things you pay for when you or your employer sends a check to the insurance company is a promise that if you become part of that expensive 0.5%, you'll be taken care of.

And let's not forget -- we live in a country where even 'not for profit' health insurance CEOs make millions and for-profit CEOs take hundreds of millions of dollars in stock options, while the number one cause of bankruptcy is health care bills.

Gunk

There are some things about Sandy Szwarc's blog "Junkfood Science" that I really like -- but where the public option for health care reform is concerned, she's gone off the deep end.

"An ongoing debate has been unfolding among the public and medical professionals about whether the healthcare reform bill really requires mandatory counseling for every senior that will steer them to make advance healthcare decisions that could end their lives sooner, perhaps in order to lower healthcare costs."

This immediately makes my nostrils dilate, as if I have smelled fresh feces in strong sunlight. What she is opposed to is counseling? And is it even possible to force anyone into counseling outside of the legal system? I don't see any words like 'mandatory' in the legislation she quotes -- the only use of 'shall' I see is one that describes what counseling session 'shall' include, and I certainly don't see an enforcement mechanism -- i.e., what happens if people don't go. She claims that they will be identified as "noncompliant", which doesn't sound so bad to me.

While we're asking questions, though, who are "the public and medical professionals" that Sandy is talking about? They're debating, you say? Who exactly are those professionals? After a long excerpt from the legislation, she name-drops the "Bioethics Defense Fund" (I won't link you to them, because I find them pretty lame), which is an anti-stem cell, anti-choice, anti-cloning outfit that seems to be made up of as many lawyers as it is doctors. Any "Ethics Defense Fund" worth paying attention to doesn't resort to lame tactics like calling American health reform "Obamacare" or sponsoring bills to avoid "Octomom abuses". She also dings Wesley J. Smith, who works for the pro-intelligent design Discovery Institute. I would expect, if health legislation threatened the individual right to life, to see real organizations like the ACLU or the Catholic Church to step in -- not these ultra-right think tanks.

But they're not wasting their time, because this fear and outrage is just made up. Seniors will benefit greatly from the public option -- from not having to change doctors like they do now during the transition to Medicaid, from not being targeted by greedy and unethical 'additional insurance' scams, and most of all, from cheaper drugs whose cost is driven down by the government's ability to negotiate prices.

In any event, the shrill, alarmist tone, completely weak argument (Counseling! The horror!), and constant dependence on untrustworthy source material all lead me to sadly pin the first Medal of Gunk on the lapel of "Junkfood Science".


Image courtesy of:

http://www.flickr.com/photos/woodysworld1778/ / CC BY-SA 2.0

POSTSCRIPT: The people at Pulitzer Prize-winning PolitiFact look into claims similar to those that Szwarc makes and find them to be unequivocally false.

The Invisible Hand

Some of the resistance to a national public health option that I've seen goes like this: free competition naturally makes services cheaper and more effective, and government interference ends incentives to excel (because nobody has to compete to succeed -- they just line up for free government money). This, I think, is true for transistor radios, furniture, cars, etc. But what about health care?

Unmoderated, unrestrained free-market competition is the last thing we want for health care. Can you imagine what would happen if one corporation gained a majority share in all the nation's hospitals? What would it be like if there was only one company (something like Microsoft in its heyday) that you had to deal with every time you needed an MRI or an X-ray? Compared to furniture, medical treatment is not a luxury -- when one of your feet goes numb and stays that way, it's likely that you'll pay whatever you have to.

We allow this kind of competition -- i.e. we allow insurance companies to grow until they have an unacceptable level of power over us and our lives -- right now. The AMA released an analysis (here) that says that two insurance companies -- WellPoint and United -- control 36% of the national market for health insurance. With mergers taking place faster than ever before, this amount could easily increase.

That's the national scene, though -- it gets worse in the cities. 16% of American metropolitan areas are dominated by an insurance company with a market share over 90% -- so if you want to get insurance in Texarkana, TX, or Battle Creek, MI you can pretty much only deal with Blue Cross/ Blue Shield. And if they don't want you? Tough!

Republicans and Democrats alike love to talk about the free market and free competition as if it is a basic American belief. It's not. Our innovations and our competition -- from cars to computers -- are built on a system of government-maintained roads and railways, protected by a government-run military, and managed by laws that we all agree upon. For some parts of our economy, this is the best choice -- to have government intervention. Health care is one of those parts!

But the insurance companies, greedy as all hell, hang outside our window -- don't you want free trade, they say? Don't you believe in the invisible hand?

Smoking

I smoked for about seven years, and quit almost three years ago. Like many smokers, as time went on I started to get bronchitis every year, or an upper respiratory infection, or something -- I'm still not exactly sure what it was/is, because every time I went into the doctor's there was an odd unwillingness to talk about it. I'm pretty sure they knew I was a smoker, and I'm pretty sure they didn't want to put that down in my chart.

Now, I understand that people don't want to share costs for illnesses that come from bad behavior -- I regret every single cigarette I've ever smoked -- but in our present system, my doctors were unwilling to diagnose me as a smoker, unwilling to give me help in quitting, and unwilling to talk about the long-term risks of smoking. These are all free services, especially considering I was at the doctor's already. Why not even mention smoking? To protect me from the insurance company, of course, and to avoid increased premiums.

But wait -- doesn't the insurance company work for me? No, no they don't. They own me -- I don't have the resources to find insurance any other way than through my school, and everyone knows this, my doctors included. That's why I need to be protected from the company -- I'm at their mercy.

Or we could all work together to give everyone another option.

How do you get your insurance?

How do Americans get their health insurance? Mine comes from my school -- but I'm going to graduate soon, and many of the entry-level jobs in my field (education) don't offer health benefits. This thread at Cynical-C has people sharing their situations and, most often, their resentments:

What are your insurance stories?

I had no idea that there were circumstances under which an employee wasn't eligible for COBRA, but Tom Woolf writes in:

"The company I worked for was the subject of a hostile takeover (”hostile” in this case making the Hatfields and McCoys seem like a petty disagreement). In the end, I kept my job, but it was very very iffy for a while. Because of that, I got my own health insurance. Folks who did not make the transition did not have Cobra as an option, and the original entity ended up going under, with all the assets being purchased by the takeover company."

The best way to get health insurance seems to be through Canadian citizenship -- I'm getting a little bit sick of the surprise and pity of Canadians that learn how bad the system in the US really is. They're particularly smug in these Metafilter comments:

Canadians pity USians!

Our system is perfect in one respect -- perfect for health insurance companies, who insure the well-employed, the healthy and the young, and leave the unemployed, the sick, and the elderly to be paid for by the government.

Insurance Companies Kill

It might seem like a dramatic title -- do insurance companies really kill people? -- but the video below is one of the reasons I started this blog in the first place:

Linda Peeno confesses to manslaughter

They are stealing from us. Our government doesn't allow any of the things we need to live to be monopolized by businesses. We subsidize food -- we share water -- we give the air away for free. Why do we have a system in which one company determines the extent of your health care?

Basic Principles

Hi, everyone.

My name is Nick, and I've been reading about health care reform pretty intensely over the last couple of months. I care about it because many of my friends have been uninsured for periods ranging from weeks to years. For reasons that will hopefully become very clear, I believe America and Americans need a public option for health care, and I don't intend to be particularly considerate of opposing views. In situations concerning abortion, drug arrests, euthanasia, welfare, or HUD, liberals and conservatives have real and reasonable differences. Where national health care is concerned, though, the United States is the ONLY developed nation that doesn't guarantee its citizens access to basic health care. At the same time, though, there are estimates (like this from Bloomberg) that the US will spend 20% of its GDP on health care by the year 2018.

Why? From my reading -- and I'm no expert -- I think there is one reason we are in this crisis.

The reason is that insurance companies have complete control over who gets care and who is paid for receiving care. Insurance companies have monetized and profitized our very lives -- if you need a kidney transplant, you have to call a bureaucrat at the home office and convince him that it's going to save the corporation some money. If you have leukemia -- and I'm sorry for using strong language -- go fuck yourself. No private insurance company will cover you -- you have to apply for Medicaid.

Insurance companies, some of the most profitable companies in America, make money when they insure the healthy, and lose money when they insure people who need significant amounts of health care. In this situation, they have chosen to ensure mainly the young and healthy, and have put great energy into denying the insurance claims of the sick. It's good business -- why would you insure a person you knew would get ill, and cost you money? Why wouldn't you try to reject them from your corporate program?

But we all get ill. We all need health care. Healthy twenty-year olds turn into very sick eighty-year olds. The most profitable attitude for an insurance company is to insure the twenty year old and reject the eighty-year old. Insurance companies have a lot of methods and justifications for doing this -- they are all unfair, and many are illegal. My blog hopes to shed some light on regular people's stories, and show why insurance companies are bad managers of our nation's health and well-being.

Anyway, I've talked too long. I hope you learn something from my blog, and I hope it makes you willing to talk to your senator and your representative. We can pass significant health care reform -- we have a President who wants it, and a Congress that generally prefers a public option. All we need is the strength of American citizens, demanding that ALL OF US deserve medical care.