Pre-existing conditions is a thing, again
February 25, 2020 5:34 AM   Subscribe

Trump has gutted Obamacare for many. In 2018, President Donald Trump’s administration rolled back Affordable Care Act regulations and allowed so-called “junk plans” in the market. Consumers mistakenly assume that the plans with lower monthly costs will be better than no insurance at all in case of a medical catastrophe, but often the plans aren’t very different from going without insurance altogether.

The limited plan’s requirement to provide three years of medical records before coverage kicks in, [Georgetown University professor and co-director of the Center on Health Insurance Reforms Sabrina] Corlette said, is not uncommon. The professor said she’s seen it come up for conditions like cancers that were never diagnosed but might have been hinted at in doctors’ visits from years past.

“That’s the critical difference between [Affordable Care Act] plans and junk plans,” she said. “[Junk plans] will not cover preexisting conditions.”
posted by Kirth Gerson (92 comments total) 29 users marked this as a favorite
 
I don't understand how people go to work at health insurance jobs where the business plan is "how many people can we kill today?"
posted by seanmpuckett at 5:40 AM on February 25, 2020 [42 favorites]


My older sister, who is a goddamn inspiration to me, has been dealing with fibromyalgia since she was a teenager. She’s been organizing, setting up groups and informational meetings to promote sign ups, getting speakers to talk about why the aca is so important, all on her own time. She’s been trying to get a non-profit organized so that she can devote herself to it and maybe transition to that full time.

And yeah, she recently had to decide to drop her insurance because the deductible was so high, she couldn’t afford to go to the doctor, and couldn’t afford to keep making payments. When her cold made its way to our mother’s COPD lungs, she ended up needing to be hospitalized, where the doctor treating our mom heard my sister talking, and ended up giving her “samples” of antibiotics she wouldn’t otherwise have been able to afford.

No one “likes” their insurance. No one dances for joy every time they have to place chess with their company just to see if they’ll be covered *this* time. Anyone who says differently is either a shill, or someone so wealthy they don’t have to worry. National health insurance isn’t just not impossible, it’s the actual just and moral thing to have. Health insurance companies profiting by denying coverage to their own customers is incomprehensibly evil, and anyone supporting that speaks a different moral language than I do.
posted by Ghidorah at 5:58 AM on February 25, 2020 [72 favorites]


I'm sure that's not how they see their jobs, but avoiding the realization that those jobs depend on allowing people to die makes me wonder about their humanity.
posted by Kirth Gerson at 5:59 AM on February 25, 2020 [1 favorite]


Remember, Trump promised to replace the ACA with something better. And Republicans have been insisting for years now that they "care" about people with pre-existing conditions (which is not the same as promising not to take away their coverage, not that the so-called "liberal media" makes much of the difference).

Democrats should be able to win the White House and Senate this year on the issue of health care alone, if the issue were reported even remotely accurately, because the American people agree overwhelmingly with the Democrats' agenda rather than the Republican one of "die sick and broke."
posted by Gelatin at 6:04 AM on February 25, 2020 [16 favorites]


Azcue said he earns about $55,000 a year working for a medical device company that does not offer health insurance

What the fuck?! A medical device company not offering insurance to employees? Jesus Christ.

And yeah, people afraid to seek medical help because of fear of cost is just the thing that needs to happen in the early stages of what could end up as a pandemic. I think I need to step away from this for awhile. After this, it’s all just inarticulate rage.
posted by Ghidorah at 6:04 AM on February 25, 2020 [13 favorites]


No one “likes” their insurance.

Liking insurance is comparative. I don’t “like” my insurance, but I like it compared to many other options, and I wish that the proposed national healthcare plans would, for cover and cost, mimic the best plans rather than the kind of okay one. There’s a reason a lot of people’s insurance plans offer “bump-ups” for Medicare after people turn 65. There’s a lot it doesn’t cover.

I’m willing to lose it so people don’t die, but I wish that people acknowledged that there is real loss for some, even people who aren’t wealthy.
posted by corb at 6:15 AM on February 25, 2020 [7 favorites]


But if that was the case, corb, how could the Republicans claim that government is inefficient so effectively?
posted by sciatrix at 6:19 AM on February 25, 2020 [5 favorites]


I know a hospital whose offered insurance doesn't cover itself as an in network provider for employees.

This country. With current news I really worry about people just not seeking services.

Medical bankruptcy is a very real thing and so is death from not getting the care one needs.
posted by AlexiaSky at 6:20 AM on February 25, 2020 [11 favorites]


I was mauled by a bear, fought it off, and drove 4 miles down a mountain with my face hanging off. AMA
(Q) How much were you medical bills?
(A) My crappy insurance company only covered about 20% of what I needed done (Google: Mauled by a bear then mauled by Blue Cross), so I'll be paying these bills off for the rest of my life. So far expenses have been about 300K and counting.
(Q) That's horrible! Wtf?? Is living near bears considered a pre-existing condition or something??
(A) My policy doesn't cover dental, optical, or cosmetic -- the major injuries I suffered. "Health" insurance is the biggest scam on the planet. The company makes their money by denying their policyholders service.
(Q) What do you find the hardest to overcome on your path back to recovery?
(A) Blue Cross. Hands down.
posted by sebastienbailard at 6:22 AM on February 25, 2020 [83 favorites]


This is such a classic Republican strategy; underfund and otherwise hobble a successful government program and then point to it and say "look government programs don't work".
posted by octothorpe at 6:40 AM on February 25, 2020 [34 favorites]


The health insurance I had with my first job (about 20 years ago) was amazing and I never ran into a scenario where things weren't covered. Granted, I was younger with less health needs, but that was my gold standard.

Fast forward to now, 5 jobs/companies later, where I had to dedicate an hour every week (during my provider's extended call-in hours) to argue my coverage/payments for my son's OT. (I ended up with a unpublished fax number that I could send in paperwork because emailed or documents attached to web forms weren't accepted and things mysteriously got lost went sent to the published fax number.)

Or the time my son's therapist and I had to sit together and call the insurance agency during business hours because (apparently?) there is information the provider could only provide to the patient and other information only available to the doctor. So the therapist and I were literally passing the phone back and forth to facilitate the rigmarole of getting coverage approved.

I'm not expecting to get my gold standard with M4A, but it can't be any worse than what I currently pay the privileged to have.
posted by TofuGolem at 6:40 AM on February 25, 2020 [5 favorites]


Upon consideration, it's worse than "how many people can we kill today" because dead people don't pay premiums. So it's really "how many people can we almost kill today." It's making trillions of dollars off of human suffering. Rather than the comparatively decent military industrial complex, which makes things that are honest and transparent in their intent to kill.
posted by seanmpuckett at 6:47 AM on February 25, 2020 [20 favorites]


I’m willing to lose it

I don't understand what makes people think that this will happen. You will still be able to buy insurance just like people already do who are on medicare.

If M4A doesn't give as much coverage as your current health insurance you can bet your bottom dollar that health insurance companies will be on hand to take your money to fill that gap.

I mean, I know we're all "death to capitalism" around here but this is something capitalism does really well. You've stated a demand for a product/service, you're not unique so I think it's fair to assume that you represent a sizable chunk of people. Therefore we can assume there is demand. You can count on the free market to supply something to meet that demand. I wouldn't even be surprised if this new medicare+private insurance ends up costing about the same as what you're paying now for about the same coverage.
posted by VTX at 6:49 AM on February 25, 2020 [2 favorites]


FFS we don't need medicare + x + y + z + free market juju we need to be able to go to the goddamn doctor and not fucking worry about it bankrupting us. We need a health care system that is trying to make people healthy, not extract profits. Capitalism quite clearly does not do healthcare "really well" since it is trying to suck money out of sick people.
posted by grumpybear69 at 6:56 AM on February 25, 2020 [64 favorites]


Those premiums shot up to $400 a month when his full year salary kicked in, so he canceled his plan in November, he said. Azcue said he now pays $180 per month for the limited plan from National General Insurance.
Health insurance is a scam but this is kind of a "reap what you sow". It's like those people who switch to GEICO and find out saving 15% involved their liability limits going from $300K to the state minimums and then learning the hard way when they hit some executive in a Mercedes.
posted by Your Childhood Pet Rock at 6:57 AM on February 25, 2020 [1 favorite]


Let's please make sure we focus the attention and blame at the decision-makers at the top, not at just anyone working at these companies. The people on the other end of the phone when you call your insurance's help line are working people trying to help you, unless you'd rather the phone just ring forever.
posted by bright flowers at 6:58 AM on February 25, 2020 [8 favorites]


Insurance is socialism, except certain people make more money off of health insurance in its current structure. The Netherlands is an example of private health insurance that is well-regulated.


Let's please make sure we focus the attention and blame at the decision-makers at the top, not at just anyone working at these companies. The people on the other end of the phone when you call your insurance's help line are working people trying to help you, unless you'd rather the phone just ring forever.

Except they have rules and responsibilities to minimize pay-outs by insurance. Yes, the direction is coming from above, but they're part of a broken system. You can do your best to not get mad at them, but I wouldn't say they're there to help you in all instances.
posted by filthy light thief at 7:01 AM on February 25, 2020 [7 favorites]


There’s a reason a lot of people’s insurance plans offer “bump-ups” for Medicare after people turn 65. There’s a lot it doesn’t cover.

The Medicare carve-outs are different from shitty-coverage non-Medicare plans in important ways that would likely be different if the country expanded Medicare the way the Medicare for All plans seek to, though. It’s not that they restrict you to crappy or cheap providers, it’s that Medicare breaks up type of care, for example, setting prescription drug coverage apart from hospital care apart from care you get from going to the doctor’s office. It’s all complicated by the fact that decades ago, large companies used to offer retirement benefits including lifetime post-retirement prescription drug coverage and the like, which has just vanished in the past couple decades. So seniors supplement Medicare with these blocks of other coverage, like substitutes or add-ons for Part D. If we had wholesale prescription drug coverage reform (which at least a few of the candidates are committed to), that would go a long way towards allaying this issue.

Medicare programs and CMS in general are absolutely stellar in administration—that’s partly because having this under wholesale government control allows CMS to dictate the timelines they need (changing a Medicare plan requires something like two year lead time, I believe) and negotiate for the appropriate cost of care. (That latter issue is where I think we’d see the most tumult if Medicare for All goes into practice, because insurers and providers would no longer be able to upcharge private insureds to balance out the low Medicare rates.)

I’ve known multiple very conservative people who expressed shock and then grudging respect at how effectively Medicare was run once they got firsthand experience working with CMS.

The reckoning is coming. I’m sure there are incredibly ethical people working in private insurance and all the related industries, and maybe they argue things would be worse without them. But spend enough time seeing the incredible amounts of money bilked from insureds, including very sick people, and then blown out on things like lavish CEO salaries or doomed to fail mergers or lobbying and you can’t deny it is a very sick industry that makes money from hurting people.
posted by sallybrown at 7:04 AM on February 25, 2020 [20 favorites]


I don't understand how people go to work at health insurance jobs where the business plan is "how many people can we kill today?"

Short answer from the inside: taking advantage of people desperate for jobs and health insurance of their own, gaslighting with company propaganda that says we're here to help our members, and abusive work environments. It's the very definition of a sick system.

The for-profit model is evil, and it abuses its own employees almost as badly as it abuses its members. My colleagues report serious, stress-related health issues they don't have time or money to treat from the long hours we work. The long hours we work to make money for the company so the company can develop new technology so they can lay people off. The same layoffs that have been happening for a few years now, targeting people who have been with the company a decade or more. The same layoffs that have gutted the company to the point that work can't get done. The same layoffs that will ensure more members die because things will slip through the cracks.

It was easy to lie to myself for a few years, saying I didn't work with medical insurance, I worked with the insurance products that actually took care of our members. But those insurance products don't make money for the company, and the stuff that hurts people does.

I can't stomach it anymore and I'm tired of being abused. I'm lucky because I'm getting out in a few weeks, and am absolutely terrified my life will blow up in the process. Our hours are so long it makes job-hunting impossible, so I have to quit without lining something else up first. Hope to Dog my Fuck-Off Fund holds.

Since we're among friends, I can say the two things that would get me fired immediately and frogmarched out the door:

1. Medicare for all
2. Unionize all the things now
posted by Orange Dinosaur Slide at 7:05 AM on February 25, 2020 [69 favorites]


Liking insurance is comparative. I don’t “like” my insurance, but I like it compared to many other options

I've had the same experience, except my point of comparison is the care biscotti's folks get under OHIP. So I'm very comfortable saying that my relatively gold-plated state-employee health insurance is a dogshit sandwich. Especially sooooo fucking tired of having to fight with insurers and providers most of the time either of us have any interaction that isn't just an office visit.
posted by GCU Sweet and Full of Grace at 7:06 AM on February 25, 2020


Your Childhood Pet Rock: Health insurance is a scam but this is kind of a "reap what you sow".

Sometimes one thing really is cheaper than another. Take a look at the ACA plans in your area, if they're like mine then you'll see they vary wildly in price with seemingly only loose connections to benefits offered. Charging $220 more for an equivalent or actually worse plan would not be unusual. It's definitely unlike what you might see offered at a nice workplace where the plans are in sensible tiers.
posted by bright flowers at 7:08 AM on February 25, 2020


Let's please make sure we focus the attention and blame at the decision-makers at the top, not at just anyone working at these companies. The people on the other end of the phone when you call your insurance's help line are working people trying to help you, unless you'd rather the phone just ring forever.

I hope we get universal healthcare but I also work in the industry because I deigned to accept a job I was offered when I was unemployed. The numbers I’ve seen are that nearly 3 million people work in this industry—it needs to change, massively, but I am at least grateful that most of the Democrats are attempting to do that without calling us immoral and inhumane.
posted by girlmightlive at 7:13 AM on February 25, 2020 [5 favorites]


Mod note: One deleted. I am choosing to have confidence in all y'all's ability to discuss this without attacking each other. Please prove me right.
posted by Eyebrows McGee (staff) at 7:35 AM on February 25, 2020 [5 favorites]


^ And this right here is what they want. They want us attacking each other and arguing over scraps so we don't go after the real villains.

Do you know what the industry term is for a plan that actually pays for real, non-bankrupting healthcare? It's the same adjective insurance companies use to describe an organization shopping for insurance when they insist upon purchasing a plan that takes decent care of employees, and that such a thing should exist without costing a fortune: paternalistic. The entire industry has reduced the desire for decent healthcare to an insult.
posted by Orange Dinosaur Slide at 7:44 AM on February 25, 2020 [28 favorites]


Remember, Trump promised to replace the ACA with something better. And Republicans have been insisting for years now that they "care" about people with pre-existing conditions (which is not the same as promising not to take away their coverage, not that the so-called "liberal media" makes much of the difference).

The trick is, Republicans want their new plan (not that they have one) to be better.... for the insurance company CEOs and investors.

All of us poor working stiffs are just numbers to them, and as long as there are more of us than there are jobs, hey, our lives don’t mean anything to them. It’s unfathomable to them what our real costs are because they have no idea what life in even the middle class is like - they can’t contemplate what it is to not be wealthy, and they see not being wealthy as a moral failing. So when we can’t pay for care out of pocket, they imagine that it’s because we shouldn’t have bought that extra house and not that we’re looking at bankruptcy and homelessness.

What they want is to go back to the system we had and scream some rah rah America bullshit about capitalism while we die of rationing insulin, keep us too busy fighting to survive so we don’t have time to fight them.
posted by bile and syntax at 8:08 AM on February 25, 2020 [9 favorites]


I don't know if this is the election where people decide that yeah, it's time to get started on socialized healthcare. But that day is coming sooner or later (hopefully sooner.) The horror stories we're hearing about the healthcare system and insurance are getting not only worse, but more and more frequent and common. We have *relatively* decent insurance and the premiums are my largest expense, more so than housing. Plus there's a $4,000 deductible, so I'm spending well over $10,000 before anything is covered except the yearly physical. Health insurance is keeping us from getting ahead. My raises keep getting mostly eaten by premium increases. For people whose continued well-being relies on being able to get chronic conditions or disabilities treated on a regular basis... I can't even imagine how they do it. We should be better than this.
posted by azpenguin at 8:08 AM on February 25, 2020 [6 favorites]


We need a health care system that is trying to make people healthy, not extract profits.

Right, I agree. But that's not what I'm talking about. I'm talking about what comes after that problem is solved.

Some folks seem to have this concern that by creating some nationalized healthcare system that will be the ONLY source for healthcare and while it may do a great job of making people healthy it might not do so in the ways that those people would prefer but they don't have any say in the matter.

The point I'm trying to make is that that is NOT a good reason to be wary of a nationalized healthcare system. You don't even have to sacrifice anything. Once we've taken away the health insurance company's ability to extract profits by denying service if there is still demand for products and services *above and beyond* what our hypothetical future nationalized healthcare system I see no reason not to let the free market figure out what that should look like just like in most other countries that have a nationalized healthcare system.

If you have shitty insurance/no insurance now then M4A should be a BIG step up in the care you receive.

If you have great insurance now then M4A should be basically no change but now instead of your employer and you splitting the cost of that plan you're splitting it between your own private insurance and M4A and over time that total cost should still go down.
posted by VTX at 8:10 AM on February 25, 2020 [4 favorites]


One related issue I note Sanders especially stressing is home health care for the elderly. I know retirees now who were secure enough in their care and coverage their whole lives to never worry about their insurance but who are still thinking now “how the hell am I going to pay for a nurse’s aide or a nursing home when I’m very old?” People are living much longer and the cost of late in life everyday care is terrifying even to financially stable families.
posted by sallybrown at 8:14 AM on February 25, 2020 [6 favorites]


VTX: I think it's legit to be concerned about M4A if you have a private plan you like. Not, concerned like you should vote against it, but concerned in that you might face some negative personal consequences. There's a strong argument to abolish private plans, or at least really limit them, which is to avoid the death spiral effect we sometimes see with public schools or public transportation, where the people with money and influence go private and the public system is neglected and develops a stigma.

For example you can imagine a M4A system where all prescription drugs are initially covered but you can pay for private supplemental insurance, maybe if you have some preference for brand name drugs even when generics are available. Then, over time it seems that "everyone" -- meaning, everyone who has money and influence -- is paying for the supplemental insurance, so why bother having drug coverage in the public plans at all? Turn it all over to the private companies and provide vouchers or free clinics to the people who need them. Before you know it, we're right back where we are now.
posted by bright flowers at 8:31 AM on February 25, 2020 [7 favorites]


MetaFilter: After this, it’s all just inarticulate rage.
posted by Gelatin at 8:42 AM on February 25, 2020 [4 favorites]


As the former COO of a large cancer research and treatment facility, I can tell you that single payer can't come soon enough. Everything we did was based around how we could best game the insurance companies and not necessarily around patient care.
posted by Manic Pixie Hollow at 8:42 AM on February 25, 2020 [19 favorites]


M4A really needs a constitutional amendment so that it can't be easily chipped away at and dismantled over time. It has to be something that new generations are born understanding as a fundamental human right.
posted by grumpybear69 at 8:45 AM on February 25, 2020 [11 favorites]


If you have shitty insurance/no insurance now then M4A should be a BIG step up in the care you receive.

Yes, absolutely. I was doing social security cases on the east coast and we were constantly dealing with clients who didn’t have access to healthcare in every state except Massachusetts. The care in Massachusetts might not have been great, but it was fantastic compared to no care at all in the rest of northern New England.

Also, once we have it in place we can improve on it. It doesn’t have to be a race to the bottom.
posted by bile and syntax at 8:49 AM on February 25, 2020 [5 favorites]


I like my insurance, due to the fact that management at my company is understanding. Our insurance plan has a $9,000 family deductible. Separately, we have a $9,000 health care spending account. There is, of course, our copay of 20% for employees and 30% for family members. It is fair and affordable. I also pay the bills for the company, and I know that our total per employee expense is high.
posted by Midnight Skulker at 8:53 AM on February 25, 2020


For example you can imagine a M4A system where all prescription drugs are initially covered but you can pay for private supplemental insurance, maybe if you have some preference for brand name drugs even when generics are available. Then, over time it seems that "everyone" -- meaning, everyone who has money and influence -- is paying for the supplemental insurance, so why bother having drug coverage in the public plans at all? Turn it all over to the private companies and provide vouchers or free clinics to the people who need them. Before you know it, we're right back where we are now.

This is exactly the situation now with Medicare and Medicare Advantage plans. Fundamentally the concept of a risk pool large enough to spread the costs across society has to be embraced and secondly most everyone,(I would say with the exception of CNA's,) within the medical system are going to have to have their OX gored.
posted by Pembquist at 8:54 AM on February 25, 2020 [1 favorite]


The Netherlands is an example of private health insurance that is well-regulated.

I support publicly owned healthcare but I think the important thing to remember here is that any sort of system can be made to work if properly regulated. It's not (entirely) impossible for an American style system to work, even.

The problem is the American political culture and I guarantee if that doesn't change and you get M4A through some act of god, you will destroy it too. No system is going to work until you guys start trusting and taking pride in your institutions and caring about each other.
posted by klanawa at 8:58 AM on February 25, 2020 [12 favorites]


klanawa: Well, maybe, but I think a simpler system would have a better chance of surviving a low trust environment. There are similar arguments in favor of universal basic income and removing means-testing for free school lunches.
posted by bright flowers at 9:07 AM on February 25, 2020 [2 favorites]




Insurance is socialism, except certain people make more money off of health insurance in its current structure. The Netherlands is an example of private health insurance that is well-regulated.


Obamacare/Romneycare/HeritageFoundationCare was explicitly modeled after the Netherlands system.
posted by ocschwar at 9:13 AM on February 25, 2020


Why don't the Republicans call their health care plan what it is? Thoughts and prayers.
posted by SonInLawOfSam at 9:29 AM on February 25, 2020 [7 favorites]


Our insurance plan has a $9,000 family deductible.

Which, unless you have a whole heck of a lot going on healthwise, is basically no insurance.
posted by schoolgirl report at 9:46 AM on February 25, 2020 [16 favorites]


I think a simpler system would have a better chance of surviving a low trust environment.

If dissolution is the enemy, the problem isn't the choice between sugar and salt, it's the water.
posted by klanawa at 9:46 AM on February 25, 2020


I like my insurance, due to the fact that management at my company is understanding. Our insurance plan has a $9,000 family deductible. Separately, we have a $9,000 health care spending account. There is, of course, our copay of 20% for employees and 30% for family members. It is fair and affordable. I also pay the bills for the company, and I know that our total per employee expense is high.

You say "fair and affordable" but for a huge chunk of the population, that is completely unaffordable. That $9,000 deductible is a huge stop sign for many people needing care beyond a basic office visit (unless the company gives the $9,000 for the spending account, which is rare.) You say you know your total employee expense is high. I completely believe that. The problem is that this should not be tied to a job in the first place.
posted by azpenguin at 9:47 AM on February 25, 2020 [28 favorites]


klanawa: If dissolution is the enemy, the problem isn't the choice between sugar and salt, it's the water.

Although, once the system takes hold and everyone starts liking it, it will be harder to get rid of. For example I understand that politics in the UK have been brutal over the past several years but even so the NHS is still much loved by almost everyone.
posted by bright flowers at 10:05 AM on February 25, 2020


That's true. There are a lot of people in Canada trying to destroy our system. We have a tendency to think of ourselves as the kind of people who believe in this system, but I'm not 100% confident in our ability to mobilize to protect it.

To an extent, our faith in the institution is regional. In my experience (for what little it's worth) the people most opposed to public health care are those with the strongest affinity to right-wing American culture -- mostly people in the resource sector-dependent areas and wherever the fuck Doug Ford's base lives.
posted by klanawa at 10:17 AM on February 25, 2020 [4 favorites]


Although, once the system takes hold and everyone starts liking it, it will be harder to get rid of. For example I understand that politics in the UK have been brutal over the past several years but even so the NHS is still much loved by almost everyone.

I wouldn't go that far about the ACA, but despite their nearly decade-long propaganda scare campaign against it -- parroted by the so-called "liberal media," of course -- Republicans in the 2016 and 2018 elections had to promise to improve on Obamacare, not get rid of it.

(I believe I've read that much of the ACA's unpopularity had to do with it not going far enough, and that once the Republicans were in a position to end the program, those opinions changed to support.)

All of which goes, strangely enough, to prove Bill Kristol right about something for a change. In a memo to Republicans urging lockstep opposition to any health care proposal by the Clinton Administration, he predicted that 1) it'd become a popular government program and difficult to eliminate, and b) that as such it'd undercut the Republican position that government never works.

The Democrats need to hit that second point harder -- our for-profit health care system is historically lousy at covering people without bankrupting them, and government does that job much better. And the proof is, among other things, in the phrase "preexisting conditions," which Republicans want to go uncovered but have to pretend the opposite.
posted by Gelatin at 10:17 AM on February 25, 2020 [1 favorite]


@klawana I worked with a guy from Calgary who hated paying taxes and actively shuffled his finances around to avoid them, with glee, but in the same breath would laud the free healthcare which had reconstructed his face after a bar fight and his leg after a heliskiing accident. I tried to point the contradiction in his views but he was not receptive.
posted by grumpybear69 at 10:20 AM on February 25, 2020 [6 favorites]


If Trump is re-elected in November I'm moving back to Europe. I'm not the only one, I work in a technical organization with many international folks and I reckon one third of us will go right away and most of the rest before their kids age out of existing health care. A few say they will stay but send their kids home for college as they dont want them being early professuonals here. I'm one of a tiny handful of people in my entire state with my skill set, many of my colleagues are in similar sought after technical fields. We have a ton of Canadians leaving already as their research centres have been on a hiring spree.

The US is about to lose a lot of well educated mid-career specialists in the next couple years. But hey shareholders will be happy and I guess that's what counts
posted by fshgrl at 10:24 AM on February 25, 2020 [6 favorites]


One of my friends needed a job and took one at an insurance company. His position was one of the grunts coordinating with the doctors that the company hired to look at cases to provide justification for the company to deny coverage for procedures, etc. It's illustrative how dehumanizing it was/is that he was timed to the second for all breaks and anything away from his station, including going to the bathroom. Needless to say, he doesn't work there anymore. But yes, fuck desperation.
posted by theartandsound at 11:01 AM on February 25, 2020 [2 favorites]


Take a look at the ACA plans in your area, if they're like mine then you'll see they vary wildly in price with seemingly only loose connections to benefits offered.

One thing to keep in mind is that the federal ACA does not select or control the plans available in your area. That is controlled by your state insurance commissioner, who is either elected or appointed by your governor.

You insurance commissioner determines what companies and what plans are offered, how wide or narrow the service provider networks and the prices.

If you have a bad insurance commissioner, generally in a Republican run state, you will have bad ACA plans. They want them to be bad so you will hate Obamacare. They want you to have bad plans so their friends the insurance CEOs will be nice to them.

For most people, their state insurance commissioner is probably the most important government official you know nothing about. If you have bad plans, you should know who to blame and what to do about it.
posted by JackFlash at 11:08 AM on February 25, 2020 [14 favorites]


No one “likes” their insurance.

I do, and unless President Bernie literally nationalizes Kaiser Permanente and imprisions its employees, I will continue to "like" it no matter what happens on the M4A front.
posted by sideshow at 11:08 AM on February 25, 2020 [2 favorites]


I wouldn't say they're there to help you in all instances

Hi! I worked for two miserable years as a CSR at Anthem Blue Cross. It's true that every day I was gently explaining to people how my employer had screwed them again, but I also tried everything possible to make sure claims were processed correctly and that bad decisions got appealed. It was a soul-crushing, immiserating experience, but the only way I was able to talk myself into getting out of bed in the morning is that the people I was talking to needed my help to navigate the innards of the hideous monster that is for-profit health care. Please be kind to the CSRs at your evil insurer, even if they are the human face of something reprehensible. It is a hateful job to have.
posted by zeusianfog at 11:10 AM on February 25, 2020 [24 favorites]


And most people just can't sift through all the legal mumbo jumbo to get to the bare bones of their policy. Health insurance shouldn't be more confusing than a Dan Brown novel.
posted by Beholder at 11:28 AM on February 25, 2020 [1 favorite]


Prior threads discussed the pros and cons of getting a formal diagnosis for a certain congenital brain condition, one that becomes pre-existing the moment there is any lapse in insurance. This con is the big one.
posted by ocschwar at 2:16 PM on February 25, 2020 [4 favorites]


"I'm a Canadian. Ask me anything about a single-payer health care system. Except because I'm just a consumer of health care and don't work in the field I probably won't be able to answer most of your questions."
posted by morspin at 3:16 PM on February 25, 2020


"I'm a Canadian. Ask me anything about a single-payer health care system. Except because I'm just a consumer of health care and don't work in the field I probably won't be able to answer most of your questions."

Haha. In the US, you are required to know the billing codes to identify and deny (or confirm and pay $100+ each) tests which cost extra money over your 'free yearly checkups' [there is an open 'askme' about this], and to review the billing codes on each statement to see if you actually received that service or if it was added in error every time you go to the doctor.
posted by The_Vegetables at 3:20 PM on February 25, 2020 [2 favorites]


I’ve only seen one comment so far about the problem of tying insurance to a job in the first place. I have had the same career 20+ years and am told I’m highly competent. I get paid well. But I’ve been laid off 3 times since 2005 and each employer has changed insurance providers one or more times. So it’s laughable that workers in big companies “choose” a health care plan and like or don’t like it. Unless you’ve bought your own plan or are one of the, like, 5 people in the US who’s had the same employer and insurance for 20 years, I don’t understand the framing that implies we pick plans. When the plans change, sometimes your doctor changes. Sometimes you can’t go to Walgreens anymore because CVS supplies your drug benefits. It sucks.

Also I’m doing fine money wise now, but I can remember delaying a $600 set of tires for 2+ years as that was an unfathomable amount of money to just have. That’s working 40+ hard fucking hours a week with zero dependents to take care of. So a $9000 deductible as mentioned up thread s is just .... insane for a lot of non-professional working people.
posted by freecellwizard at 3:55 PM on February 25, 2020 [19 favorites]


When the plans change, sometimes your doctor changes. Sometimes you can’t go to Walgreens anymore because CVS supplies your drug benefits.

Oh, preach it. I had to switch pharmacies multiple times at my last job because they kept switching plans every year.
posted by azpenguin at 4:22 PM on February 25, 2020 [6 favorites]


Which, unless you have a whole heck of a lot going on healthwise, is basically no insurance.

High deductible plans can be fine, when they are bundled with a similarly large employer-funded HSA. My SO had a plan like that for a while. Saved her and her employer about $10k a year on insurance cost, even with the extra $9000 over and above the premiums.

Most people don't have employers who make it a priority to have as close to zero out of pocket medical expenses for their employees as is reasonably possible, though, so high deductible plans usually don't work so well for most people even if they can be set up to be done well.
posted by wierdo at 5:40 PM on February 25, 2020


I buy my own. There is basically one choice in Philadelphia, Blue Cross. The only options are how much you want to pay for coverage. Hospitals and associated providers are segregated into tiers, with tier 1 being the cheapest and tier 3 being most expensive. All of the good hospitals are tier 3, there are vanishingly few tier 2, and two tier 1 hospitals recently shut down. Also there is the concept of "capitation" which means that, for example, even if a specialist takes my insurance I cannot go to them because they are not capitated to my provider. Gettint PT for knee pain was cheaper to do out of pocket than through my insurance. It is a shitshow.
posted by grumpybear69 at 5:49 PM on February 25, 2020


Not to be unkind, but high deductible health plans only work for the healthy and the rich. If you are healthy, then you don't have to burn through your entire deductible every year. If you are unlucky, it costs you thousands per year.

And HSAs are primarily a tax loophole for high income households. The higher your tax bracket, the higher the tax deduction you get for contributions. It's a regressive tax subsidy. And for the rich, they have enough other money that they never have to spend a dime from their HSA. Their HSA becomes a tax-free IRA they can invest in and compound for 40 years or more. This could amount to a million dollars in a tax free retirement fund.
posted by JackFlash at 6:14 PM on February 25, 2020 [6 favorites]


This video provides a really good, in depth look at the solution to the current healthcare crisis.
posted by Conrad-Casserole at 6:15 PM on February 25, 2020


Unless you’ve bought your own plan or are one of the, like, 5 people in the US who’s had the same employer and insurance for 20 years

Me, I've had the same employer and insurance for nearly 20 years. It's really amazing (yes, Kaiser).
However I didn't come here to gloat, the 15 years before that I was working catch as catch can and had no insurance. This system is untenable, and frankly morally despicable. We need universal coverage (hey look mods, I'm not advocating burning that shit down, thinking it, not saying it). We need it yesterday. I am voting for the people that are offering this as part of their platform, as opposed to wilting wallflowers who offer excuses why we can't. If you believe in this, step up. Vote for it. I guarantee if you don't you won't get it, and we'll be in the same leaky goddamned boat, with a few more inches of water.
posted by evilDoug at 6:23 PM on February 25, 2020 [3 favorites]


Yeah, maxing out your HSA, if you have the money, is basically a no-brainer investment.

...it's pretty wrong, but here we are.
posted by aramaic at 7:36 PM on February 25, 2020


I got to keep the military's health care when I retired. I'm pretty dang happy with it. Sure, maybe I have to go to a military hospital and not everyone has that readily available, but I pay $300/year. The wait times are not bad at all and the care I have recieved is excellent. (This is not the VA, which is a complete other thing)

So basically, I'm a fan of the government being involved in the health care business. It works. Or at least, it does until the republicans can move the norm of "reasonable idea" enough to touch the third rail of "disrespecting the troops". They've been getting closer every year. Trump's certainly willing to loudly threaten the extra mile to make each inch go unnoticed.
posted by ctmf at 7:54 PM on February 25, 2020 [3 favorites]


Mod note: One deleted. Do not attack other members.
posted by taz (staff) at 2:24 AM on February 26, 2020


If you have great insurance now then M4A should be basically no change but now instead of your employer and you splitting the cost of that plan you're splitting it between your own private insurance and M4A and over time that total cost should still go down.

So I think that insurance is one of those areas that has really suffered from the taboo about not talking about money in America. I think most people don't really tend to know the actual price that most other people pay, largely for the same reasons people don't talk about salary - people don't want to pay either less or more than their neighbor and feel bad about it.

But: right now I pay 400$ a year for basic health insurance for my family, with zero charge for off-brand medications regardless of what they are. There are things they don't cover (some kinds of fertility assistance) but everything else is covered as long as I go to specific hospitals and clinics. If my family member goes to a hospital, I pay the cost of their meals during the time they're in the hospital. I pay 50$ if they use an ambulance. I pay much more for vision & dental. (about 3600$ a year)

So the question of whether or not I and my family would personally benefit from a new system is really complex. If it covers full dental and vision, then I would save a little bit on premiums, but potentially pay more on the actual services, and Medicare would not actually fix my problems and would probably lead to worse health outcomes for me and my family.

For example: right now, if you're hospitalized under Medicare, you pay a deductible of $1,364, and it looks like in general, they pay 80% of costs. That's a lot for people with shittier health insurances! But it's way, way more than what I pay now. A family member of mine had to be hospitalized with what he thought was going to be a minor surgery, but turned out to be live-saving surgery a few years ago. 20% of the full cost would have been about 5K. The only reason he consented to going through with the surgery that turned out to save his life was because we didn't have to pay much money to do it. We definitely didn't have five thousand dollars. He would have said no, and walked away from the hospital, and died.

Again, this is the situation most Americans are in, so I'm willing to give it up if it means people aren't dying of preventable illnesses and injuries. But I really, really would appreciate if people would be very upfront that yes, some people will lose out, and there is in fact real sacrifice. No private insurance that I'll be able to purchase is going to pay for every single one of my medications. No private insurance that I'll be able to purchase is going to pay full cost for hospitalization and surgeries. Not that those won't exist - probably yes, capitalism will develop some solution for the rich - but they're going to cost a lot more than I can afford.
posted by corb at 8:23 AM on February 26, 2020 [2 favorites]


Corb, to find out the real cost of your insurance, look at your current tax W-2 Form, Box 12, Code DD. That tells you how much your health insurance costs, combining your employer's contribution and your own contribution.

The average employer family plan is $20,600 per year.
posted by JackFlash at 9:05 AM on February 26, 2020 [1 favorite]


But I really, really would appreciate if people would be very upfront that yes, some people will lose out, and there is in fact real sacrifice.

I think everything that you said is true and I appreciate how you thoughtfully described your situation. I think you are absolutely right that we don't talk about money and that is a major problem. My mom who has been sucked in to Fox news and has had government sponsored healthcare since she was 28 (military spouse) can't even put her mind around how my "healthcare" is insured and paid for. It just doesn't make any sense compared to what she "knows" and what she is told from Fox News. She was so surprised that I had to pay $6000 out of pocket for my daughter's birth. I was surprised, too, because we really had to work to get my partner into employment with "good" health insurance and lots of my friends were having babies and were paying nothing for their births! Well, who knows what all is in the fine print and babies will come so I spent a year paying that off.

But, I highlighted your line above because here's the thing right now: circumstances change. Jobs change. Health insurers change. This is part of the problem. You might have it good right now but I'm assuming, unless you already have government-sponsored healthcare, that things could change and what felt like a really good deal today slowly or suddenly becomes not a good deal. Government sponsored programs tend to change more slowly and you get more input (in theory). Private companies can change the rules at any point. And good luck trying to get them to pay attention to you if you don't like their changes.
posted by amanda at 9:07 AM on February 26, 2020 [2 favorites]


For anyone who doesn't know, you can browse ACA plans for any location, demographic and family combination by going to HealthCare.gov here. You don't need to create an account.
posted by bright flowers at 9:09 AM on February 26, 2020 [1 favorite]


I think everything that you said is true and I appreciate how you thoughtfully described your situation.

I disagree. It's a silly tone argument that is undercut by saying that the dentist/vision portion of the bill is $4k a year.
posted by The_Vegetables at 9:14 AM on February 26, 2020 [1 favorite]


Not to be unkind, but high deductible health plans only work for the healthy and the rich. If you are healthy, then you don't have to burn through your entire deductible every year. If you are unlucky, it costs you thousands per year.

When your employer gives you a pot of cash equal to the amount of your out of pocket maximum that you can't spend on anything but covered services, it doesn't matter whether you're rich or healthy, the bills get paid out of someone else's pocket.
posted by wierdo at 9:42 AM on February 26, 2020 [1 favorite]


I disagree. It's a silly tone argument that is undercut by saying that the dentist/vision portion of the bill is $4k a year.

I'm willing to listen to corb on how that coverage is $3600 a year (maybe it's really really good coverage, far better than most people get?) but I have trouble seeing it. Our dental coverage provides us with $2000 per year of benefits each, so that's a maximum of $4000 benefit. Cleanings and preventative are covered 100% as long as you haven't hit your maximum. Work like fillings, root canals, simple stuff is covered at 80%. "Major" services like crowns are covered at 50%. With a single tooth already this year, I've used $1100 of my benefits and I'm out of pocket $800. Vision coverage is not great. Like I said, I'm willing to listen on this, it's just hard to see.
posted by azpenguin at 9:43 AM on February 26, 2020


I don't understand how it is reasonable to ask people to pay for ANY of their medical care. I want my taxes to cover it. It should not be tied to whether I have a job, or how good that job is. It's insane to think we accept that people should pay anything.
posted by tiny frying pan at 9:55 AM on February 26, 2020 [12 favorites]


right now, if you're hospitalized under Medicare, you pay a deductible of $1,364,

This information is incorrect. The Medicare Part B deductible is only $198. After that, Medicare pays 80% of costs.
You can buy Medigap supplemental insurance for about $180 per month that will cover the other 20% of costs.

So Part B costs $145 per month and the Medigap costs $180 per month for a total of $325 per month for full coverage and a small deductible of a couple hundred dollars. And this is for a population pool that is the oldest and most costly to cover. This is a screaming good deal for the elderly compared to the private insurance market for everyone else.
posted by JackFlash at 10:01 AM on February 26, 2020 [3 favorites]


Tell that to my parents, who paid over $10,000 out of pocket for Medicare expenses last year.
posted by tiny frying pan at 10:04 AM on February 26, 2020


I'm willing to listen to corb on how that coverage is $3600 a year

It's a government package. Federal/state benefits, from what I understand, are about 10-20 years behind the curve of 'cut everything and make everyone bleed for it' - not that they aren't starting to get there, because they are - I can see insurance getting slightly worse every year. But as someone noted above, government packages are much slower to change because people are on the hook for changing them and at least theoretically have to answer for it.

Again, I'm not saying that Medicare isn't a much better deal than a lot of people are getting. I'm saying that I personally will have a really difficult time if Medicare replaces my current insurance, and that while I support the government providing healthcare for everyone, and think it would be very doable if they were willing to invest in it, I don't think Medicare alone is going to solve the problems people are facing. It's also worth noting that Medicare flat out doesn't cover long term nursing care, which is currently the most costly thing the elderly and anyone who cares for the elderly are facing.
posted by corb at 10:08 AM on February 26, 2020 [1 favorite]


When your employer gives you a pot of cash equal to the amount of your out of pocket maximum that you can't spend on anything but covered services, it doesn't matter whether you're rich or healthy, the bills get paid out of someone else's pocket.

It does make a difference. I assume you are talking about a high deductible plan with an HSA that the employer funds for you.

That money is put into your HSA tax-free. If the employer puts in $1000, then that saves the minimum wage employee about $75. For a high income employee, it saves them $440, more than six times as much. It is a regressive subsidy that pays bigger benefits the higher your income.

But there's more. The minimum wage employee probably has to spend down their $1000 HSA account each year. But the high income individual has enough other money that they don't have to spend their HSA at all. They can treat their HSA as a tax-free IRA. Since they can fund up to $7000 per year in their HSA, this could amount to nearly a million dollars over their lifetime.

High deductible plans really are made for the healthy and the rich.
posted by JackFlash at 10:12 AM on February 26, 2020 [2 favorites]


To follow up on the HSA thing - for a great many people who have these plans, the employer does not fund the HSA. I'm in that boat. The HSA plan is about $130 less per month for me vs. a typical HMO/PPO co-pay type of plan. I've put the difference (plus a little extra) in the HSA because I'm just hoping that I'll still have some of that difference left over at the end of the year. I do not have the ability to max out the HSA, not even close. If you're making six figures and can afford the deductible... the HSA is a huge tax benefit. Not so much if you're someone like me. These plans have been touted as a way to help fix the system. They are not. They are a way to shift costs onto the employee while being a tax shelter for rich healthy folks.
posted by azpenguin at 10:23 AM on February 26, 2020 [2 favorites]


For example: right now, if you're hospitalized under Medicare, you pay a deductible of $1,364, and it looks like in general, they pay 80% of costs. That's a lot for people with shittier health insurances! But it's way, way more than what I pay now.

What I'm hearing is that you have a demand for a certain level of product/service at the price that you are currently paying.

If some flavor of M4A gets passed, what I'm saying is that at a basic level you still have that same level of demand at the same price point. Capitalism being what it is, someone is going to figure out a way to get you that same level of product/service at that same price point. The difference is that some of that product/service is going to be paid by M4A and some will out of your own pocket.

Let's look at just the dental and vision part. You're paying $3,600/yr now for everything you need. If M4A does cover vision and dental at the same level as what you have now then I think it's fair to assume that, initially, you should expect about a $3,600 increase in your taxes. No net change to your costs or services. You still see the same medical professionals in the same places, get the same services and the same products. In theory, however, that cost will stop increasing as rapidly or even decrease over time.

But if M4A doesn't include any vision or dental then there's no change and you'll just keep paying the same $3,600/yr for what you have now.

If M4A covers one or both but at a lower level and comes with, let's say half the cost burden of our hypothetical "full fat" M4A. So now you're paying $1,800 in taxes for that part of M4A and the market should also create some manner of supplemental insurance that will cost you about $1,800/yr so that you're back to seeing the same folks and getting the same products and services for about the same $3,600/year.

Now, are the taxes going to shake out just-so like that? No, I'm over-simplifying the shit out of all the details because the real thing will be messy as hell. This is a pretty optimistic scenario that isn't really realistic but I don't think it's any more or LESS realistic than thinking that M4A is going to lead to everyone but the very rich being stuck with it as their one and only source of coverage.

Right now there is a certain level of demand for medical services at level X at price Y. Implementing M4A doesn't change that fact and we're still nominally capitalist so the free market should figure out a way to get you the products/services the market has demand for.
posted by VTX at 10:31 AM on February 26, 2020 [1 favorite]


It's a government package.

You've got to appreciate the irony of complaining about the potential horrors of government healthcare when one is on government healthcare that they really like.
posted by JackFlash at 10:44 AM on February 26, 2020 [3 favorites]


You've got to appreciate the irony of complaining about the potential horrors of government healthcare when one is on government healthcare that they really like.

This feels like a really uncharitable take on "Medicare doesn't go far enough and government healthcare should be provided for all at a higher/better level than people currently enjoy"
posted by corb at 10:48 AM on February 26, 2020 [2 favorites]


How is it uncharitable? You presented false numbers about the coverage of Medicare, implying that it is bad insurance, slandering a plan that would be of great benefit to people. The actual numbers show that it is very good insurance.
posted by JackFlash at 10:53 AM on February 26, 2020 [1 favorite]


.High deductible plans really are made for the healthy and the rich.

Yes, the rules that allow an HSA to be a backdoor IRA are an issue. That has literally zero bearing on how well the fully-funded HSA/HDHP combo works for a person as a health plan, regardless of income.

Not that it really matters in 2020. What was an economical alternative (and thanks to a few choice rule changes became a backdoor tax cut for some people) to the closest equivalent level of benefits one could get from a PPO is now as expensive as that PPO they were trying to get away from a decade ago.

Moving to a government provided plan equally as efficient as Medicare will thankfully lop off the windfall profits many insurers are making off the total bill, but won't itself fix the underlying cost inflation that is driving the entire system into crisis. It will buy us time and rescue those who are being left out, which are both laudable goals. Let's just not kid ourselves and believe that the work ends there, though.
posted by wierdo at 11:00 AM on February 26, 2020 [1 favorite]


“Fully funded” is the issue, though. If you don’t make a lot of money, fully funding your HSA is the issue. A lot of people can’t afford to do that. And a lot of employers will not do that. That compounds the cost issue even more.
posted by azpenguin at 11:34 AM on February 26, 2020 [1 favorite]


You presented false numbers about the coverage of Medicare, implying that it is bad insurance, slandering a plan that would be of great benefit to people. The actual numbers show that it is very good insurance.

Firstly, looking up Medicare gap insurance reveals that only one type, Plan F, covers all deductibles and costs. It is also currently being phased out, because it turns out that the government doesn't actually like it when you don't have to pay copays, because you use it more, and they still have to pay 80% of the cost.
People who turn 65 after 2019 won’t be allowed to pick Medigap supplement Plan F, the most popular supplemental plan that helps retirees cover medical costs that Medicare doesn’t pay.
Secondly, I tried to look up exactly how much Plan F costs, and found great difficulty, because apparently it is different according to age, familial status, gender, the state you happen to live in, and a host of other factors. The fact that Medicare is so complex that we can both be presenting valid numbers and it's not clear how much, precisely, is the most someone might have to spend on the plan, means that in my eyes, it is bad insurance.

Good health insurance, for me, means that you know precisely how much you will pay in a year, and it's the same amount that everyone else pays, with no complicating factors. It means it's not high enough to be burdensome for the poor and struggling. It means that you don't pay more when you visit the doctor more. It means that you can be sure of getting seen in a reasonable amount of time by a competent doctor who isn't trying to rush you out to get to the next patient, who covers each and every health issue that is impacting you.

So no, it's not slandering a plan to say that I would prefer a more generous one: that while I think Medicare for All is a cool intermediary step, I'd support Tricare for All a lot more, or some other plan that actually takes the fear and burden off of families. And I'd go further than that: I think the care of the aged is a societal good, and I would fully fund long term nursing care, without requiring seniors to sell the family homes, which most insurances do not.
posted by corb at 11:38 AM on February 26, 2020 [1 favorite]


Plan F had no deductible. This has been replaced with the Plan G that requires a $198 deductible. After that, you are covered 100%.

Do you have an insurance plan that has only $198 deductible and then pays 100% of the rest? No co-pays? Unlimited network. You can choose any doctor you like. I bet most people would be delighted to have that generous of a plan.

How can you say that you want a more generous plan when you seem to be stubbornly ignorant about what Medicare insurance provides? You keep giving wrong information about what you believe Medicare does.
posted by JackFlash at 12:17 PM on February 26, 2020 [5 favorites]


This is not the Medicare system in reality though. Numbers on a page don't speak to reality. My parents would be thrilled to have what you describe. Their Medicare is not what you describe.
posted by tiny frying pan at 12:28 PM on February 26, 2020


“Fully funded” is the issue, though. If you don’t make a lot of money, fully funding your HSA is the issue. A lot of people can’t afford to do that. And a lot of employers will not do that. That compounds the cost issue even more.

At no point has anyone said otherwise. The fact is, however, that some companies do fund their employees' HSA in a sufficient amount to cover all costs not paid by the HDHP. Perhaps that knowledge will help you and others be less baffled by people who don't have a practical problem with their personal insurance situation and therefore need some confidence-inspiring words to willingly give up a security blanket that almost nobody in the US gets any more, at least as long as they remain employed..
posted by wierdo at 5:36 PM on February 26, 2020


I am not baffled at all about that. I know that is the case. I never said otherwise. If you like your insurance, that’s fantastic.
posted by azpenguin at 5:39 PM on February 26, 2020


Perhaps that knowledge will help you and others be less baffled by people who don't have a practical problem with their personal insurance situation

I don't get why people keep bringing this up. You could make the same point about college educations, or homes prices, or property taxes, or income, or fame, or body weight, or personal outlook, or health or any other issue. That some people are much more fortunate than the average is not news and the message about that does not need to be massaged for the masses to soothe the fortunate ones' pain.
posted by The_Vegetables at 8:35 AM on February 27, 2020 [3 favorites]


Perhaps that knowledge will help you and others be less baffled by people who don't have a practical problem with their personal insurance situation

There's a whole lot of Americans who don't have a practical problem with what they imagine their health insurance situation is that would have immense problems with the realities of actually using that insurance for anything significant.

Maaaaaybe doesn't apply to Kaiser.
posted by GCU Sweet and Full of Grace at 8:44 AM on February 27, 2020 [3 favorites]


That some people are much more fortunate than the average is not news and the message about that does not need to be massaged for the masses to soothe the fortunate ones' pain.

Our fears about about loss. Our aversion to loss is so high that it short-circuits our ability to imagine potential gains. We are so attuned to fear loss that we empathize with the billionaire and the millionaire that any loss they feel is inherently wrong and unjust and we agree to ameliorate their losses even as it exacerbates the potential of our own. If someone say, "I could/would lose....X, Y, or Z," we feel so badly it's like we could lose, too.

Much as it is literally impossible to imagine what the number 1 billion represents, it is just about literally impossible to imagine the costs to our society as a whole to support our wonky, super-unbalanced, pain-inflicting system of "health" "care." If your neighbor goes bankrupt, you will likely suffer a loss, it might be in your property value if they can't keep up. If your cousin needs life-saving surgery and you put in money to their gofundme, you've suffered a loss. If your elderly parent can't get the care they need, and you put money toward their care that could be going to your living expenses, your retirement fund, your kids college fund, that's a loss. If you forgo a trip to the doctor because you fear the unknown costs, that's a loss. If the driver of your bus to work doesn't get tested for the flu because they are afraid of cascading medical bills, loss of employment if they are sick, etc.., well a pandemic is a loss. But it hasn't happened yet! And so we have a hard time imagining how these things play out and how they are a loss such that we are swayed because it's just so hard to imagine the sick system in aggregate. Not when your friend is saying, my insurance is great and it's affordable and I'm afraid to lose that.
posted by amanda at 9:15 AM on February 27, 2020 [2 favorites]


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