President Obama is going to Capitol Hill tomorrow to try to convince legislators, and the associated national audience, to support health care reform. He's got a tough battle in front of him...in part because of people's fears about what that change might mean. We might lose the health care and choices we have now. We might have to wait to see doctors, or to have operations. And so on.
But all of that presupposes that we (we being the working, insured population of America) have something worth keeping, choice, and access now. And the option, if reform doesn't happen, of keeping our insurance and service delivery the same.
Neither of which is necessarily true.
The company through which I get my health insurance was recently acquired by another corporation. The new HR department told us that while we would have a new insurance carrier, our plans would be rolled over into a similar kind of coverage at the new company. But when I went to arrange a doctor's appointment, I was told that I now needed to see a primary care physician first, because I'd been switched from a Preferred Provider Organization (PPO) to a Health Maintenance Organization (HMO). There's a big difference between those two types of health care plans. (In a PPO, there's a network of preferred providers, all of whom can be in individual, private practices. Reimbursement for using that network (providers who've agreed to the insurance company's reimbursement rates) is higher than going out of network, but you can go to anyone you want, at any time, and get some compensation. In an HMO, you need to see a primary provider first and get a referral to someone else in a very structured network, all associated with that HMO company. And you have to use a physician in that HMO network in order to get any compensation.)
I called the benefits person and said there had been a mistake, and I wanted to change my health insurance back to a PPO plan, even though I recognized that it would cost me more in premiums.
"You can't do that," she answered. "We don't offer a PPO. We only offer an HMO."
"I don't have any choice at all?" I asked.
"Sure you do. You can opt out in the next open enrollment session, which is in three months."
"Opt out of our health plan altogether."
"So then what insurance would I have?"
"You wouldn't have any."
I called the benefits folks at the old corporate owner, just to make sure I wasn't imagining that I used to have it better. If I recalled, I told the woman I spoke with there, we'd had several types of plans to choose from, back in the days when they were in charge.
"Well, we actually discontinued that. Now we only offer people one health plan, too. It's just that the plan we offered happened to be the one you had anyway."
So despite the fact that I'm a gainfully employed, working adult with supposedly "good" health insurance, I actually have no choice about the kind of health care plan, and therefore the kind of health care, I can get. What's more, the type and quality of that insurance coverage obviously can be arbitrarily and summarily altered, at any time, without any input from me. So ... even if an overhaul of our health care coverage reduced choice and control (which is not at all a given), it wouldn't really be any different than what I'm facing now.
As a matter of fact, my parents, who are on the government-run system called Medicare, have more choice and control in their health care I do. Of course, when my dad needed a knee replacement, and I found the doctor who seemed best for the job, I was told, in July, that the first office appointment available was in early November, and the first potential surgery date would be in late January. So even when we have reasonable choice, we don't necessarily have reasonable, or easy, access.
Which leads me to wonder, what the heck are people so afraid of losing?
James Surowieki offered some interesting potential answers to that question in last week's New Yorker. Multiple psychological studies he referenced have apparently shown that most humans are susceptible to something called the "endowment effect," which means we tend to over-value things we own. We wouldn't imagine selling old Aunt Martha's silver collection for less than $5,000, for example, even though we wouldn't pay more than $500 for an identical set from someone else's attic.
So we tend to think our insurance is better than it is, simply because it's ours. But Surowieki thinks there's another psychological effect at play, as well: something known as the "status quo bias." In short, we fear losing more than we care about gaining, so we fear changing what we have for an unproven "other," even if what we have isn't so terrific. Nobel prize winners Daniel Kahneman and Avos Tversky called this inclination "Prospect Theory," explaining that people had to feel like they would gain far more than they stood to lose before they would gamble on the outcome. Which, in the context of health care, means that in order to get enthusiastic about changing the system, the perceived benefit would have to be not just equal, or a little bit better for less money, but several times greater than any perceived cost, risk, or negative trade-offs. That's a pretty high bar to clear.
We also are susceptible to a clear and simple fear of the unknown. Known misery, or "the devil you know," is more comfortable to us, in many ways, than the great unknown, even if the unknown offers the possibility of far greater improvement or rewards. It's why so many people stay in bad relationships or jobs. Among other things.
Important to note, however, is that all of those effects are irrational tendencies, not recommended strategies. We may overvalue the status quo and fear changing it, but that doesn't always lead to a happy ending ... especially when the world is changing around us, or the status quo is a sinking ship.
And that's the other important point worth considering in all of this. It's not even a matter of changing the status quo. The status quo is changing itself. So we don't really have the option of not changing. Not because the system is broken, or will bankrupt our children, but because our insurance is being altered on us now, whether we like it or not. Employers are cutting back benefits and options, and that trend isn't going to reverse itself without some serious restructuring.
So ironically, the only way to keep our health care from changing is to change the system; take the control of our choices away from our employers and give us more choice in what kind of insurance we opt in for. Or as Surowiecki put it: "if we want to protect the status quo, we need to reform it."
Note: I will be offline for the next week, returning September 18th. Photo Credit: Flickr User Oswaldo Ordonez (Orcoo)
An etiquette update: Brevity is the highest virtue.
I recently cut the amount of time I spent on email by almost half, and I think a lot of people could do the same.
I’m sure my approach has made some people hate me, because I come off curt. But if everyone thought about email in the same way, what I’m suggesting wouldn’t be rude. Here are the basic guidelines that are working for me and, so, I propose for all of the world to adopt immediately:
Best? Cheers? Thanks?
None of the above. You can write your name if it feels too naked or abrupt not to have something down there. But it shouldn’t, and it wouldn’t if it were the norm.
Don’t waste time considering if “Dear,” or “Hey” or “[name]!” is appropriate. Just get right into it. Write the recipient’s name if you must. But most people already know their names. Like they already know your name.
The Commission on Presidential Debates issued a cryptic statement acknowledging some audio issues Monday night.
After critics savaged his performance at Monday’s first presidential debate, Republican nominee Donald Trump alighted on several culprits: Hillary Clinton, the moderator, and especially his microphone.
The claim was met with some skepticism, but on Friday afternoon, the Commission on Presidential Debates seemed to confirm his claim, at least in part. The commission, which controls the debates, released a cryptic statement that reads in full:
Statement about first debate
Sep 30, 2016
Regarding the first debate, there were issues regarding Donald Trump's audio that affected the sound level in the debate hall.
We’ve called the commission to ask what that means, but have not heard back yet. Presumably, they are receiving dozens of such queries.
With the death of Shimon Peres, Israel has lost its chief optimist. And the prime minister remains paralyzed by pessimism.
The Book of Proverbs teaches us that where there is no vision, the people perish. The people of Israel, now bereft of Shimon Peres, will not perish, because survival—or, at least, muddling through—is a Jewish specialty. But the death of Israel’s greatest visionary, a man who understood that it would never be morally or spiritually sufficient for the Jews to build for themselves the perfect ghetto and then wash their hands of the often-merciless world, means that Israel has lost its chief optimist.
Peres was, for so many years, a prophet without honor in his own country, but he was someone who, late in life, came to symbolize Israel’s big-hearted, free-thinking, inventive, and democratic promise. Peres came to this role in part because he had prescience, verbal acuity, a feel for poetry, and a restless curiosity, but also because, gradually but steadily, he became surrounded by small men. One of the distressing realities of Israel today is that, in so many fields—technology, medicine, agriculture, literature, music, cinema—the country is excelling. But to Israeli politics go the mediocrities.
Business students are not agreeable, art students are neurotic, and other findings from a recent meta-analysis.
They say it doesn't matter what you major in during college. It might matter, however, if you want your personality to match your chosen field—lest you end up the lone nod-greeter in a marketing class full of exploding fistbumps.
According to a new meta-analysis, there are significant personality differences between students in different academic majors. For the review paper, Anna Vedel, a psychologist from Aarhus University in Denmark, analyzed 12 studies examining the correlation between personality traits and college majors. Eleven of them found significant differences between majors. The review examined the so-called “Big Five” traits: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness.
Lawmakers overrode an Obama veto for the first time on Wednesday. A day later, they already had regrets.
The enactment on Wednesday of the Justice Against Sponsors of Terrorism Act should have been a triumphant moment for Republican leaders in Congress. They had succeeded, after years of trying, in overriding a presidential veto for the first time and forcing a bill into law over the strenuous objections of Barack Obama.
But the morning after brought no such celebration for HouseSpeaker Paul Ryan and Senate Majority Leader McConnell—only pangs of regret.
“It appears as if there may be some unintended ramifications,” McConnell lamented at a press conference barely 24 hours after all but one senator voted to reject the president’s veto of the legislation, which would allow victims of the September 11, 2001 terrorist attacks to sue Saudi Arabia in U.S. court. On the other side of the Capitol, Ryan said that he hoped there could be a “fix” to the very law he allowed to pass through the House—one that would protect U.S. soldiers abroad from legal retribution that the Obama administration had warned for months would follow as a result of the law.
It's natural for humans to pay attention to all their romantic options, and new research shows Facebook helps them do that.
One episode in season five of How I Met Your Mother, called “Hooked,” revolves around people being kept “on the hook,” romantically speaking, by members of the show’s central gang of friends. “I can’t be with you … right now” is the phrase the pals keep using to string these people along, the “right now” leaving the door cracked open just enough that apparently some poor guy is willing to continue to do Robin’s laundry and rub her feet for the vague possibility of a someday relationship.
This does not make the friends look very good, obviously, but keeping track of and keeping in touch with alternative romantic prospects is a common thing for humans to do, even if it is rarely in such an exaggerated, sitcommy way. A recent study published in Computers in Human Behavior dubs these interactions “backburner relationships." A backburner, as defined by the study, is “a person to whom one is not presently committed, and with whom one maintains some degree of communication, in order to keep or establish the possibility of future romantic and/or sexual involvement.”
The Trump Foundation mostly takes in other people’s money, but it appears it doesn’t have legal permission to solicit donations.
The problem with telling people to follow the money is they just might take you up on it. Donald Trump’s campaign has adopted that mantra in reference to the Clinton Foundation, but it applies to him in uncomfortable ways, too.
First, there’s the fact that he won’t release his tax returns, making it hard to follow the money and raising questions about what might be hidden there. Second, there are his forays into Cuba, apparently in violation of the embargo. Third, there’s the latest scoop from The Washington Post’s David Fahrenthold, who finds that the Donald J. Trump Foundation was operating without a required license.
As Fahrenthold previously reported, the Trump Foundation is peculiar: Unlike many other similar charities, it’s stocked with other people’s money. Trump himself has given barely any money to it since the mid-2000s, although he did direct income from places like Comedy Central to the charity, possibly without paying taxes on it. Instead, he has raised money from other donors, which he has used to, among other things, settle legal cases against him, all while basking in the glow of his apparent charity.
Despite an array of calculating tools, comparing financial-aid packages is still an incredibly dense and circular process.
As almost any parent of a high-school senior knows, figuring out the true college price tag is confusing. While the full annual sticker price can be as much as $60,000 or $70,000 at a private college and more than $55,000 at an out-of-state public college, experts say that many students will end up paying considerably less. Sizable merit and need-based aid packages take the sting out of those big numbers.
Students, however, typically have to wait until the spring, when their acceptance letters arrive, to learn the amount of those awards, making it difficult for families to effectively plan a long-term budget and posing significant obstacles for first-generation students who may not be aware of all the financial options.
After Andrea Wulf won the Royal Society’s highest honor for her book The Invention of Nature, a writer at The Guardian attributed it to a new fondness for “female-friendly” biographies among prize juries.
Last week, the Royal Society held its ceremony to honor the best popular-science book of the year. I was there, having had the good fortune to be one of the finalists for my recent book, The Hunt for Vulcan. I didn’t expect to win—partly because of my baseline pessimism, partly because of the strength of the competition, and partly because I had set out to write a kind of miniature, a brief book on a quirky topic. Whatever the reason, I was right: I didn’t.
The event itself was good fun. Each of the authors read a passage from their work; the head judge for the prize, author Bill Bryson, led us in a brief question-and-answer session, in which we compared notes on what moved us to write about science. Then came the moment of truth. Venkatraman Ramakrishnan, the president of the Royal Society, approached the podium, opened the envelope, and announced that Andrea Wulf had won for The Invention of Nature.