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Archive for August 28th, 2009

Hold on…  lifts hand with index finger raised
Hold on…   I’m be with you in a minute — I’m just reading through these papers…  I’m choosing between some of these military protection plans.  I’ll be getting all the standard coverage of course: basic national defense, overseas campaigns, that sort of thing.  And I’m including all branches of the military on that and the Coast Guard as well.  But… do I want to add the foreign and domestic terrorism riders?  I mean, domestic terrorists could hit anywhere really, so I think I’m going to go with that, but…  do I think foreign terrorists are going to go for Western Pennsylvania?  Probably not, so I could save some money there.  Except, wait… the G20 summit is being held in Pittsburgh next month, so maybe I do need to worry about foreign terrorists.  And… oh, what’s that in the fine print?  The domestic terrorism rider does not cover terrorist activities of any person, foreign or domestic, who received training at any time lasting more than two months in any of the following countries: Pakistan, Afghanistan, Yemen… Hmmm, that complicates things.  I don’t know how likely…  Mmmm… Well, I’m not sure what to choose there…

Choosing the school options was much easier.  The girls are bright and I want to give them the best chance in life, so I went for the most comprehensive choices I could get.  I didn’t take the remedial tutoring option, of course — they won’t be needing that and I feel confident I can ensure that by taking a greater hand in their studies at home.  And I saved quite a bit by opting out of the school lunch option — with their allergies, they can’t eat the school lunches anyway, and I don’t want to be paying for anyone else’s peanutbutter sandwiches.  I’m only going to pay for what’s right for us!

Choosing the police coverage was pretty straightforward — we want full coverage there — and I chose the elite force even though it costs a bit more, because the faster response time is worth it.  Same with fire, although I did opt out of the cat-stuck-in-a-tree rider, seeing as we can’t have the cat with us anymore-.  For public roads, I went for all the entire local road network, and added the option for occasional roaming.  It doesn’t include the Erie-Cleveland network though — I can’t see us ever needing to go there…

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The response to my blog post on the NHS was overwhelming, and I found it fascinating to read the comments as they came pouring in.  It’s been equally interesting to Google my blog post and see all the various sites that have linked to it, and then read the comments that have been left there as well.  But time and time again, there have been replies from people who say that they like the current American system because they want “choice” in their healthcare.  They want to “choose the right plan” that suits their personal situation.   Being  covered for anything and everything that might happen in their lives doesn’t fit that scenario — they want to be able to specify exactly what ill may befall them and what benefits they’ll be entitled to.

Several people said they liked choice in healthcare because they didn’t want to pay for someone else’s maternity care or stomach-stapling operation.  It makes me wonder if they just don’t understand how the insurance they’re buying actually works.   If they’re getting major medical, of course they are paying for other people’s benefits, even the ones they don’t receive themselves or perhaps don’t want to support.  Insurance companies take everyone’s money — whether they’re paying a lot for comprehensive coverage or a just little for bare-bones coverage — and then put it into one big pot to use when they have to pay out on claims.  In choosing a plan, these people are only limiting the benefits they will receive, not controlling how their premiums will be spent.

But to the rest — the ones who do understand how insurance works and are still saying that, instead of being covered for everything, they want choose  a plan that will suit the healthcare they personally will need — to them I want to ask, how do they know?  Yes, major medical covers a wide spectrum and catches the most likely scenarios in its net.  And yes, there are armies of actuaries working out the probability that one person will be more likely to contract Disease A over Disease B, so that people can make “informed” choices.  But nature can (and does) defy even mathematical probabilities.  The unexpected does happen.  The unforeseen is… well, unforeseen.   Aside from the obvious probability that most single men and nuns won’t require maternity cover, it defies my understanding how someone can actually know ahead of time what kind of medical care they will need in the future.

The girls’ insurance does not cover seeing a nutritionist.  It’s a moot point as to whether I would have chosen a plan that did, because this was the single only long-term policy that I could find that would cover them under our circumstances, but if it had been a few years ago and I’d have been in a position to choose between several plans, I never would have even considered that we’d one day need — be desperate — to see a nutritionist.  I mean, I know how to cook, we have a varied diet, and we’re none of us really overweight.  What do I need a nutritionist for?  A few years ago, I’d never have guessed that I’d have a baby who would suffer from food allergies so severe that she’d drop from the 98th percentile to the 1st percentile in her first year, who would stop gaining weight for seven months and grow so thin I could count her ribs, who wouldn’t double her birth weight (something most babies achieve by four months) until she was nearly two years old.  And so, not knowing that, but guessing that we wouldn’t need a nutritionist, I would have happily foregone that option.  And though it wouldn’t have been a disaster in our case (nutritionists being at the more affordable end of medical care), it serves as an example that people simply cannot really know what kind of care they’ll need in the future.

Or even that they’ll need care.  When we were preparing for our move and I was speaking to insurance agent after insurance agent (before I realised that none of their policies could cover us due to residency requirements), they all asked me the same questions: “Are you generally healthy?” and “How often do you feel you’ll need to the see the doctor?”  I hardly knew how to respond.  The first question implied that past performance predicts future results — in which case I’d have made millions in the stockmarket — and the second assumed I could see the future — in which case I’d have made sure I’d won the lottery by now.  But we were relatively healthy and we didn’t see the doctor that often, and that satisfied the agents.  “Then you probably won’t need very extensive cover,” they all predicted, and suggested low-premium high-deductible plans.  And then we immediately turned all that on its head by developing significant health problems as soon as we arrived, and running up thousands in medical bills within a couple of months.

Now I realise that most of the time, when people talk about choosing a plan, the “needs” they are talking about are not the diseases they think they’ll get, or even the structure of their care, but the premiums and deductible they can or want to pay.  They are not making choices about their care — they are weighing up their probable future health against what’s in their wallets and then hoping what they’ve bought will align with whatever may befall them in the future.  And therein lies the unappealing truth that we all know: in the choice between care and money, we tell ourselves that it’s all about care, but the system — and thus the choice — is all about the money.  The idea of having that choice, of picking amongst a series of plans — with varying (and often confusing) benefits, various (and confusing) restrictions, and a range of prices — is appealing because it gives people the feeling that they are in control, they are tailoring their coverage for themselves.  And it blinds them the fact that the NHS system that I described — and so many disagree with — gives no such choice because it’s simply not necessary, because the system’s mission is to cover everything, for everyone, for their entire lives — and that where it is restrictive, it is no more restrictive than the insurance companies who take their money and then decide — sometimes retroactively — whether their claims match the fine print.

We fund the police, the military, and our public schools in a collective, socialised way, and we accept that when we receive the services they provide, they will be comprehensive — we don’t pick and choose the “package” we want because we know they will cover (or attempt to cover) whatever needs may arise.  In fact, the concept of trying to anticipate our potential future needs to these services and limiting our access that way just might look a little silly, if someone were to write it out.

Does it make a person lefty to support comprehensive universal health?  No more than it makes a person lefty to support their local schools, their police and fire departments, or our military.  These are socialised institutions that have been in our midst for generations, and which we have chosen to support and fund this way because they are so vital to the fabric of our society that we are willing to work collectively to ensure these key services remain in place.  And yet our national character has survived!  Having a public schools, collectively funded police and fire services, and socialised military has not wrought havoc on the nation — our country has remained capitalist.  Healthcare — with its ability to bankrupt overnight; with its ability to create a life-sentence of astronomical on-going costs; with its central role in the health of the nation and of its workforce and its economy — is one of these same essential services.  We have ignored that fact for too long and now that we face this rare opportunity to reform healthcare, it’s essential that we see the situation for exactly what it really is.  A public healthcare option — like public schools, like our police and military —  is not something to be feared as some sort of Great Socialisation of America.  It is simply a logical step that will ensure this one other essential service is accessible to all Americans — for the betterment of our countrymen, our businesses, our economy, and our country.

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