Mined from the notebooks. Thursday, March 23, 2017. Posted Tuesday, April 18.
Photographed but not ordered---I swear!---by Lance Mannion. Thursday morning, March 23, 2017.
In what’s become a Thursday morning routine for us, on the way to dropping Mrs M off at the bus depot to catch her bus to work in the Big City this morning, we stopped at an internationally famous pancake house for a quick breakfast. To those of you concerned about how I’m handling my diabetes (and who’ve been policing my sugar intake. Busy bodies.), relax. I didn’t have one of those candy drinks. I had a regular cup of coffee with Splenda and milk. (Yes. I know. I should drink it black. Again. Busy bodies.) For breakfast I ordered two eggs over easy and sausage (Yes, You’re right. Too much fat and salt. See previous parenthetical asides.) and two pancakes over which I waved the little pitcher of the concoction of maple-flavored high fructose corn syrup and food coloring they call Old-Fashioned Syrup to taunt them and myself with the with day-dreams of sweetness withheld. I’d have loved to drown my pancakes in ersatz syrup but I was feeling guilty about the slice of berry pie I’d had last night at a nearby diner while waiting to pick up Mrs M at the depot.
Playing personal Uber driver for Mrs M is turning out to be bad for my health.
That slice of pie is the point of this post. I’m writing to apologize to you for having it.
And for the cookie I had at Barnes & Noble the other day. And the candy bar I bought reflexively when I was at the convenience mart picking up a gallon of milk And the cheese and crackers and chips and salsa I’ve been snacking on during the basketball games---not direct violations of the diabetes rules I’ve set for myself but, you know, still too much carbs, salt, and fat. I’m sorry for all of it.
There’s a new Dunkin on the route to Oliver’s college that’s turning out not to be as easy to resist as I’d thought. I’ve been good. Pretty good, anyway. But I’ve succumbed a couple times and I apologize for that too.
I need to get back on track towards keeping my blood sugar level down. I’ve been backsliding. I apologize for that.
Basically, I apologize for having diabetes.
And for my high blood pressure.
And for my back problems and the surgery that I’m still recovering from.
And for Mrs M’s various health problems and her trip in the ambulance to the emergency room at Christmas. And for Ken’s ADD and anxiety and Asperger’s and the medications he takes to help him cope and the monthly visits to the counselor to help him maintain and cope. And for Oliver’s eye exam next month.
I’m sorry and I’m grateful to all of you for helping us pay for it.
We have insurance. Private insurance. A good policy. But there’s no way our premiums plus our co-pays are covering the whole cost of it all.
You know where this is going, right?
Paul Ryan is an idiot.
The question is whether he’s an idiot because he’s just not very bright or if he’s being an idiot because he lets his ideology and politics do his thinking for him, as usual.
Republicans say ridiculous things whenever they try to defend the indefensible. Which is most of the time since their fundamental guiding principles are indefensible: Making money is the purpose of life. Rich people and corporations should be able to do whatever they want to make as much money as they want. Government’s only job is to see to it that the rich stay rich and grow richer, and if people who aren’t rich have to die so that can happen, then let them die.
Doesn’t fit on a bumper sticker.
Now, it may well be that Ryan doesn’t know how insurance works. He hasn’t had to think about it in a while. He’s been on the government payroll since 1999 and his insurance decisions have been taken care of for him. Republicans politicians tout it as a good idea that people should do more comparative shopping when making decisions about their health care---as if a heart operation is like buying a new car---but most of them don’t have to worry about it themselves. But then neither do most Americans who get their insurance through their employers who do the shopping for them.
Brendan Buck, Ryan’s counselor (legal, not spiritual or psychological, and he’s counselor to the Speaker of the House not Paul Ryan the private citizen), says Ryan’s remarks were misconstrued. Of course Ryan knows how insurance works. What he was saying was that it’s not working the way it’s supposed to within the circle of people insured through Obamacare. Not enough young, healthy people are paying into the kitty to cover the health care costs of the older, sick people drawing out. And that is a problem. The goal is to persuade more young, healthy people to buy insurance and the obvious way to do that is by offering them good insurance at lower premiums. It’s the way to do that that’s the sticking point.
The Republican solution is basically to throw the older, sick people to the wolves.
Or maybe it’s to set them adrift on ice flows.
Choose your own metaphor.
Basically, it’s to take away their insurance.
In case you think that’s just cruel, don’t worry. Ryan has a magic plan to save them. Some of them, at any rate.
But it wouldn’t surprise me if most people don’t truly understand how their health insurance works Wouldn’t surprise me if most people don’t truly understand how their insurance plans work---because they don’t have to think about it. HR does the thinking for them---and take it for granted that they’re paying for their insurance straight out of their pockets, that the money taken out of their paychecks for their premiums plus their co-pays are somehow covering whatever medical expenses they rack up. This is what seems to happen. And if you go long enough without needing a major treatment of any kind, you’re not wholly wrong to think the money you’ve paid in is sitting somewhere waiting for you for when you need it, as if it’s in a bank account with your name on it. This is one of the reasons Republicans are enamored of individual health savings accounts. They think of them as just a version of the way things work for them, so why shouldn’t it work for others?
Of course, this overlooks the difference between banks and insurance companies. Banks make their money off your money by investing it. Insurance companies make their money by keeping as much of your money as they can. It’s in their interest not to ever give you back any of the money you’ve paid in. This leads to the fundamental evil of the American system. People earn their Christmas bonuses by saving the insurance company they work for money, and they do that by denying claims and those denials often lead to other people going bankrupt or going without the treatment they need, which is to say, they suffer and die. Happy Holidays!
But on a simple practical level of just doing business, insurance companies, like all other big businesses, have to meet their expenses every day, have to show a profit quarterly, have to attract and keep investors, which means keeping the price of their stock not just up but rising. The money you pay them is going right out the door. They can’t pay you back what you’ve paid in right away unless they have the money on hand, which they only do---or rather seem to do---because they happen to be holding onto all this money paid in by other customers who don’t need their money back at the moment.
I know you know all this stuff, but bear with me. This isn’t a post about how insurance works. It’s about how Republicans think and what’s morally wrong with it.
I’ve seen arguments that the insurance industry is a giant Ponzi scheme, but that’s generally how capitalism works. You rob Peter---or borrow from him---to pay Paul, with the expectation that you will pay Peter back with interest later.
Now, here’s one of the points where it gets complicated. (Don’t feel bad if you didn’t know health care was complicated. Neither did the President.) Very few people stay with the same insurance company their whole working lives.
I’ve roughly calculated that my back surgery last summer, adding up the costs of the surgeon, the anesthesiologist, the four-day hospital stay, the tests leading up to the operation, including three MRIs, the follow-up check-ups, and the physical therapy, cost our insurance company over $150,000. Over the course of thirty odd years of paying health insurance premiums, we’ve handed over much more than that to the insurance companies, even accounting for all the other times we’ve needed to draw money from our “account”, including several trips to the emergency room, a couple of less major operations---Ken’s appendectomy, for one---two births, one with complications, and countless trips to the doctors for check-ups and minor illnesses. Notice, though, I said insurance companies.
I’ve lost track of how many different insurance companies have covered us over the years. It seems we’ve had to put new cards in our wallets every two or three years. Several of these switches have been due to job changes. But most of them happened when the employer of the moment made a change in order to save itself money or get a better deal for its employees or, usually, both. We’d been with the company that covered my surgery for less than two years and in that time we didn’t come close to paying in $150,000 in premiums. And it’s not as though the insurance company had the money on hand because our previous company gave them all the money we’d paid them but hadn’t had to use.
We’d only been with that previous company a few years anyway, so they wouldn’t have had a lot of our money to transfer. And anyway it was long since spent, as was the money we’d paid the company we were with before that, and the one before that, and little of it was spent by us on us.
It was spent on other customers who needed back surgery or cancer treatment or bones set or maternity care.
Which is just fine with us.
Because that’s how it works.
The way things are, that’s the only way it can work.
I helped pay their medical bills knowing that when the time came they would help pay for mine.
And that’s what I’m getting at, the moral failure in the thinking behind “Why should healthy people pay the medical bills for sick people?” which should be read as “Why should I pay for your medical care?”
Basically, this is a reiteration of the Republican creed: I got mine. You get yours.
The health care debate isn’t a debate over money, except that money is the be-all and end-all for many Republicans. Nor is it a debate over what is the purpose of the federal government, which, according to Republicans is to protect wealth and property and see to it the wealthy and the propertied get to have things their own way, particularly when it comes to increasing their own wealth and acquiring more property, so it does come back down to money, at least for them.
It’s a debate about what people are for. Why are we here? Why are any of us here?
Always a good time to quote Dr Vonnegut, the novelist’s son. “We’re here to help each other get through this thing, whatever it is.”
For the most part, Democrats think along those lines. We’re here to look out for each other, and take care of each other, and help each other out in times of trouble and distress---which is to say, at all times---and that’s why we have government, because it’s easier, more efficient, and more effective to do all that as a nation than as individuals. We’re stronger together, as some woman who ran for President liked to say.
Democrats see us as a WE, as in WE the People, and government as the expression of Our need and desire to help each other get through this thing, whatever it is.
And for the most part, Republicans see as us as multitude of isolates pursuing their own individual and selfish ends whose self-interests happen to coincide from time to time, that is, as 300 million mutually suspicious me’s and mines who don’t do anything without getting a convincingly specific and immediately materially rewarding answer to the question, “What’s in it for me?”
Nothing works if that’s the only question that matters. Not health insurance. Not government. Not friendship. Not family. Not communities. Not civil society.