Yeouch

Thought I'd be working today, but had to share this. I've seen more than a few insurance industry employees supporting their industries in the debate over the public option. That's their prerogative, but this news kind of indicates that they shouldn't necessarily picture themselves as members of a big corporate 'family'.

In the memo from Randy Brown, WellPoint's chief human resources officer, the company said it would lower its contribution toward worker premiums and raise deductibles in two of its three benefit plans. "Your cost per paycheck will probably increase," the memo said.

Hard times for everyone, but I have to point out -- if you make pens, you usually get some free pens. If you're a cook, free soup. I get free database access. My partner gets free textbooks. Shouldn't insurance employees have, you know, particularly good insurance? Or maybe the legal fees, top-level salaries, and lobbying expenditures (they made the exceptional step this year of phoning 3 million of their own customers with a push-poll robocall opposing reform) are getting a little bit too expensive for Wellpoint to cover?

Giving One

I've been reading about the demonstration yesterday, and trying to think about what I want to say about Dick Armey (it looks like the demonstration was somewhere between 60,000 and 75,000), and was poking around at Metafilter when I realized: man, I don't give one. The interests and arguments of the FreedomWorks demonstrators sound a little bit like this to me, or something like this:
(from Cake Wrecks)

Where opponents of the public option are concerned, these protesters are neither the most numerous (rank-and-file Republicans) nor the most committed (the insurance industry) nor the most authoritative (perhaps the AMA, although they only represent about 15% of practicing doctors). But I don't even really give one about them, either -- at the heart of it, their own interests (power, profit, and profit, respectively) drive their objections.

After the coffee runs out and my rancor subsides, basically all I really give one about is the people who will be affected by public option reform. Consider:

-- We currently guarantee universal health care to all Americans by making it illegal to turn away ill patients from emergency rooms. We know and accept that it is wrong for a person who is sick or dying to be refused treatment. However, we make that guarantee in the most inefficient, expensive, and dehumanizing way possible. We know that we are morally responsible for the health of our fellow Americans -- I'd like to see even a committed tea-partier withhold antibiotics from someone with an infected wound -- but we refuse to care for them.

-- Our society provides guaranteed health care to our congressmen, but not our cab drivers; to our child molesters, but not our children. If you are schizophrenic and stab a stranger on the street, you will be locked up and given medical care which can vastly improve your condition. If you are schizophrenic and do not stab a stranger on the street, if you manage to hold down a job, then you will be left alone with the torments of your treatable illness.

-- The reason we do all this? The profit of the few. The health insurance industry employs about 400,000 people nationwide, a FIFTH as many people as are uninsured in Los Angeles County RIGHT NOW. Insurance companies provide no service; they heal no wounds; they are a financial artifact intended to share risk among large pools of people, and they should not be allowed to keep 30 cents out of every dollar we give them.

So call your senator, find an event, or make your voice heard. There's no mechanism in the Constitution or in Congress that will make sure that we do what's right: people have to make that happen.

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.

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.

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.

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?