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)
During the multi-country press tour for Mission Impossible: Rogue Nation, not even Jon Stewart has dared ask Tom Cruise about Scientology.
During the media blitz for Mission Impossible: Rogue Nation over the past two weeks, Tom Cruise has seemingly been everywhere. In London, he participated in a live interview at the British Film Institute with the presenter Alex Zane, the movie’s director, Christopher McQuarrie, and a handful of his fellow cast members. In New York, he faced off with Jimmy Fallon in a lip-sync battle on The Tonight Show and attended the Monday night premiere in Times Square. And, on Tuesday afternoon, the actor recorded an appearance on The Daily Show With Jon Stewart, where he discussed his exercise regimen, the importance of a healthy diet, and how he still has all his own hair at 53.
Stewart, who during his career has won two Peabody Awards for public service and the Orwell Award for “distinguished contribution to honesty and clarity in public language,” represented the most challenging interviewer Cruise has faced on the tour, during a challenging year for the actor. In April, HBO broadcast Alex Gibney’s documentary Going Clear, a film based on the book of the same title by Lawrence Wright exploring the Church of Scientology, of which Cruise is a high-profile member. The movie alleges, among other things, that the actor personally profited from slave labor (church members who were paid 40 cents an hour to outfit the star’s airplane hangar and motorcycle), and that his former girlfriend, the actress Nazanin Boniadi, was punished by the Church by being forced to do menial work after telling a friend about her relationship troubles with Cruise. For Cruise “not to address the allegations of abuse,” Gibney said in January, “seems to me palpably irresponsible.” But in The Daily Show interview, as with all of Cruise’s other appearances, Scientology wasn’t mentioned.
Even when a dentist kills an adored lion, and everyone is furious, there’s loftier righteousness to be had.
Now is the point in the story of Cecil the lion—amid non-stop news coverage and passionate social-media advocacy—when people get tired of hearing about Cecil the lion. Even if they hesitate to say it.
But Cecil fatigue is only going to get worse. On Friday morning, Zimbabwe’s environment minister, Oppah Muchinguri, called for the extradition of the man who killed him, the Minnesota dentist Walter Palmer. Muchinguri would like Palmer to be “held accountable for his illegal action”—paying a reported $50,000 to kill Cecil with an arrow after luring him away from protected land. And she’s far from alone in demanding accountability. This week, the Internet has served as a bastion of judgment and vigilante justice—just like usual, except that this was a perfect storm directed at a single person. It might be called an outrage singularity.
Forget credit hours—in a quest to cut costs, universities are simply asking students to prove their mastery of a subject.
MANCHESTER, Mich.—Had Daniella Kippnick followed in the footsteps of the hundreds of millions of students who have earned university degrees in the past millennium, she might be slumping in a lecture hall somewhere while a professor droned. But Kippnick has no course lectures. She has no courses to attend at all. No classroom, no college quad, no grades. Her university has no deadlines or tenure-track professors.
Instead, Kippnick makes her way through different subject matters on the way to a bachelor’s in accounting. When she feels she’s mastered a certain subject, she takes a test at home, where a proctor watches her from afar by monitoring her computer and watching her over a video feed. If she proves she’s competent—by getting the equivalent of a B—she passes and moves on to the next subject.
The Wall Street Journal’s eyebrow-raising story of how the presidential candidate and her husband accepted cash from UBS without any regard for the appearance of impropriety that it created.
The Swiss bank UBS is one of the biggest, most powerful financial institutions in the world. As secretary of state, Hillary Clinton intervened to help it out with the IRS. And after that, the Swiss bank paid Bill Clinton $1.5 million for speaking gigs. TheWall Street Journal reported all that and more Thursday in an article that highlights huge conflicts of interest that the Clintons have created in the recent past.
The piece begins by detailing how Clinton helped the global bank.
“A few weeks after Hillary Clinton was sworn in as secretary of state in early 2009, she was summoned to Geneva by her Swiss counterpart to discuss an urgent matter. The Internal Revenue Service was suing UBS AG to get the identities of Americans with secret accounts,” the newspaper reports. “If the case proceeded, Switzerland’s largest bank would face an impossible choice: Violate Swiss secrecy laws by handing over the names, or refuse and face criminal charges in U.S. federal court. Within months, Mrs. Clinton announced a tentative legal settlement—an unusual intervention by the top U.S. diplomat. UBS ultimately turned over information on 4,450 accounts, a fraction of the 52,000 sought by the IRS.”
Bernie Sanders and Jeb Bush look abroad for inspiration, heralding the end of American exceptionalism.
This election cycle, two candidates have dared to touch a third rail in American politics.
Not Social Security reform. Not Medicare. Not ethanol subsidies. The shibboleth that politicians are suddenly willing to discuss is the idea that America might have something to learn from other countries.
The most notable example is Bernie Sanders, who renewed his praise for Western Europe in a recent interview with Ezra Klein. “Where is the UK? Where is France? Germany is the economic powerhouse in Europe,” Sanders said. “They provide health care to all of their people, they provide free college education to their kids.”
On ABC’s This Week in May, George Stephanopoulos asked Sanders about this sort of rhetoric. “I can hear the Republican attack ad right now: ‘He wants American to look more like Scandinavia,’” the host said. Sanders didn’t flinch:
Israeli settlers are suspected in the latest attack in the West Bank in which a Palestinian toddler was killed. But how the attack is labeled raises legal as well as semantic questions.
Early Friday morning, two houses in the West Bank were firebombed. An 18-month-old Palestinian child was killed, while his mother, father, and brothers survived with critical burns. Police say they suspect the attack is the work of Jewish extremist settlers. Hebrew graffiti left on the scene read, “revenge,” “long live the messiah,” and “price tag.”
The last of those is a tip-off. “Price-tag attacks” is the term given to a string of anti-Palestinian incidents over the past several years. As The New York Times defined it in 2011, the campaign “seeks to exact a price from local Palestinians for violence against settlers or from Israeli security forces for taking action against illegal construction in Jewish outposts in the West Bank.” It’s a double bind for Palestinians, who are vulnerable to reprisals for actions of the Israeli government. As Uri Friedman has noted, the attacks can be traced as far back as 2005, though the more common start date is 2008. Definitions of the campaign vary. One 2013 tally found nearly 800 cases of suspected price-tag attacks, and 276 arrests, in an 18-month span. In 2014, Israeli security officials blamed a group of about 100 hardliners for most of the attacks.
A hawkish senator doesn't apply the lessons of Iraq
Earlier this week, Senator Lindsey Graham, a hawkish Republican from South Carolina, used a Senate Armed Services Committee hearing to stage a theatrical display of his disdain for the Obama administration’s nuclear deal with Iran.
The most telling part of his time in the spotlight came when he pressed Defense Secretary Ashton Carter to declare who would win if the United States and Iran fought a war:
Here’s a transcript of the relevant part:
Graham: Could we win a war with Iran? Who wins the war between us and Iran? Who wins? Do you have any doubt who wins?
Carter: No. The United States.
Graham: We. Win.
Little more than a decade ago, when Senator Graham urged the invasion of Iraq, he may well have asked a general, “Could we win a war against Saddam Hussein? Who wins?” The answer would’ve been the same: “The United States.” And the U.S. did rout Hussein’s army. It drove the dictator into a hole, and he was executed by the government that the United States installed. And yet, the fact that the Iraqi government of 2002 lost the Iraq War didn’t turn out to mean that the U.S. won it. It incurred trillions in costs; thousands of dead Americans; thousands more with missing limbs and post-traumatic stress disorder and years of deployments away from spouses and children; and in the end, a broken Iraq with large swaths of its territory controlled by ISIS, a force the Iraqis cannot seem to defeat. That’s what happened last time a Lindsey Graham-backed war was waged.
The Islamic State is no mere collection of psychopaths. It is a religious group with carefully considered beliefs, among them that it is a key agent of the coming apocalypse. Here’s what that means for its strategy—and for how to stop it.
What is the Islamic State?
Where did it come from, and what are its intentions? The simplicity of these questions can be deceiving, and few Western leaders seem to know the answers. In December, The New York Times published confidential comments by Major General Michael K. Nagata, the Special Operations commander for the United States in the Middle East, admitting that he had hardly begun figuring out the Islamic State’s appeal. “We have not defeated the idea,” he said. “We do not even understand the idea.” In the past year, President Obama has referred to the Islamic State, variously, as “not Islamic” and as al-Qaeda’s “jayvee team,” statements that reflected confusion about the group, and may have contributed to significant strategic errors.
50 years after closing its schools to fight racial integration, a Virginia county still feels the effects.
I was sitting in the dark den of the last living founder of the white private school I had attended, an academy established after public schools in my Virginia hometown were closed in 1959 to avoid desegregation. Having worked as a reporter for years, I was used to uncomfortable conversations. But this one felt different. This conversation was personal.
I wanted to interview Robert E. Taylor about desegregation in Prince Edward County and to find out how he felt about it in 2006, decades later. Weeks before his death, he told me he was still a “segregationist” and expressed no remorse for the school closings. Breathing with the help of an oxygen machine, he used tired stereotypes to describe black teenagers in my hometown as dating white teens, impregnating them, and leaving the teenage girls’ families with “pinto” babies that nobody would want.
The Vermont senator’s revolutionary zeal has met its moment.
There’s no way this man could be president, right? Just look at him: rumpled and scowling, bald pate topped by an entropic nimbus of white hair. Just listen to him: ranting, in his gravelly Brooklyn accent, about socialism. Socialism!
And yet here we are: In the biggest surprise of the race for the Democratic presidential nomination, this thoroughly implausible man, Bernie Sanders, is a sensation.
He is drawing enormous crowds—11,000 in Phoenix, 8,000 in Dallas, 2,500 in Council Bluffs, Iowa—the largest turnout of any candidate from any party in the first-to-vote primary state. He has raised $15 million in mostly small donations, to Hillary Clinton’s $45 million—and unlike her, he did it without holding a single fundraiser. Shocking the political establishment, it is Sanders—not Martin O’Malley, the fresh-faced former two-term governor of Maryland; not Joe Biden, the sitting vice president—to whom discontented Democratic voters looking for an alternative to Clinton have turned.