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)
He lives near San Francisco, makes more than $50,000 per year, and is voting for the billionaire to fight against political correctness.
For several days, I’ve been corresponding with a 22-year-old Donald Trump supporter. He is white, has a bachelor’s degree, and earns $50,000 to $60,000 per year.
He lives near San Francisco.
“I recently became engaged to my Asian fiancée who is making roughly 3 times what I make, and I am completely supportive of her and proud she is doing so well,” he wrote. “We’ve both benefitted a lot from globalization. We are young, urban, and have a happy future planned. We seem molded to be perfect young Hillary supporters,” he observed, “but we're not. In 2016, we're both going for Trump.”
At first, we discussed Bill Clinton.
Last week, I wrote an article asking why Trump supporters aren’t bothered that their candidate called Clinton a shameful abuser of women who may well be a rapist. After all, Trump used to insist that Clinton was a victim of unfair treatment during his sex scandals. Either Trump spent years defending a man that he believed to be a sexual predator, even welcoming him as a guest at his wedding, or Trump is now cynically exploiting a rape allegation that he believes to be false.
Finally, an explanation for Bitchy Resting Face Nation
Here’s something that has always puzzled me, growing up in the U.S. as a child of Russian parents. Whenever I or my friends were having our photos taken, we were told to say “cheese” and smile. But if my parents also happened to be in the photo, they were stone-faced. So were my Russian relatives, in their vacation photos. My parents’ high-school graduation pictures show them frolicking about in bellbottoms with their young classmates, looking absolutely crestfallen.
It’s not just photos: Russian women do not have to worry about being instructed by random men to “smile.” It is Bitchy Resting Face Nation, seemingly forever responding “um, I guess?” to any question the universe might pose.
This does not mean we are all unhappy! Quite the opposite: The virile ruler, the vodka, the endless mounds of sour cream—they are pleasing to some. It’s just that grinning without cause is not a skill Russians possess or feel compelled to cultivate. There’s even a Russian proverb that translates, roughly, to “laughing for no reason is a sign of stupidity.”
A real-time chronicle of Donald Trump’s unpresidential statements.
People will look back on this era in our history, to see what was known about Donald Trump while Americans were deciding whether to choose him as president. Here’s a running chronicle from James Fallows on the ways in which Trump has been unpresidential in an unprecedented way. (If you’d like to flag examples to include, please let us know.)
But while it’s easy to hurl insults at 20-somethings (and 30-somethings) still crashing with their parents, the image of a spoiled upper-middle class adult spending all day on the couch playing video games is pretty far from the reality of most Millennials who wind up back home.
In fact, the very same data from Pew’s recent report doesn’t support that portrayal. Instead, the Millennials who are most likely to wind up living with their relatives are those who come from already marginalized groups that are plagued with low employment, low incomes, and low prospects for moving up the economic ladder. Millennials who live at home are also more likely to be minorities, more likely to be unemployed, and less likely to have a college degree. Living at home is particularly understandable for those who started school and took out loans, but didn’t finish their bachelor’s degree. These Millennials shoulder the burden of student-loan debt without the added benefits of increased job prospects, which can make living with a parent the most viable option.
A conversation about how Game of Thrones’s latest twist fits in with George R.R. Martin’s typically cliché-busting portrayal of disability
In 2014, a few media outlets ran stories diagnosing Game of Thrones’s Hodor as having expressive aphasia, a neurological condition restricting speech. Some aphasia experts pushed back, saying that while Hodor has often been described as “simple-minded” or “slow of wits,” aphasia only affects linguistic communication—not intelligence.
The new version of the 1977 classic miniseries is the rare work that focuses on slavery from the perspective of the enslaved.
In January ‘77, I was old enough to be allowed to watch grown-up TV with my sister, brother, and parents. During our viewings, I would either sit in Mama’s lap, or on the floor, my back resting against her legs because it was comfortable, and because she could easily clasp her hand over my eyes if something was too intense for me to see. On one of those nights, we were all engrossed watching a man named Kunta Kinte try to escape slavery again and again. Suddenly, in one scene, we saw an ax heading toward Kunta’s foot. I turned away from the screen and buried my face in Mama’s legs and cried. Everybody cried.
Such was my experience watching Roots for the first time. Adapted from the Alex Haley book of the same name, the miniseries traced the story of the writer’s ancestors over multiple generations, starting with Kunta Kinte, a young African man sold into slavery. Boasting a cast filled with TV stars and cultural icons (including O.J. Simpson and Maya Angelou), Roots went on to become the most-watched miniseries of all time. But in the almost 40 years since Roots first aired, its cultural impact is easy to forget, especially as it’s become an easy relic for a cable network to trot out every year for Black History Month.
Narcissism, disagreeableness, grandiosity—a psychologist investigates how Trump’s extraordinary personality might shape his possible presidency.
In 2006, Donald Trump made plans to purchase the Menie Estate, near Aberdeen, Scotland, aiming to convert the dunes and grassland into a luxury golf resort. He and the estate’s owner, Tom Griffin, sat down to discuss the transaction at the Cock & Bull restaurant. Griffin recalls that Trump was a hard-nosed negotiator, reluctant to give in on even the tiniest details. But, as Michael D’Antonio writes in his recent biography of Trump, Never Enough, Griffin’s most vivid recollection of the evening pertains to the theatrics. It was as if the golden-haired guest sitting across the table were an actor playing a part on the London stage.
“It was Donald Trump playing Donald Trump,” Griffin observed. There was something unreal about it.
I got my first mobile phone when I was in high school. It was 2005, and the feeling of “cool” overwhelmed me. Text messaging was something sacred in those days. I was allotted 200 messages per month. I powered off during classes, and charged my phone three times a week.
Today, I use my smartphone so much that I can’t imagine leaving the house without my charger. But it wasn’t until I conducted an experiment to learn calligraphy that I realized how deeply technology affects my life and my relationships.
I decided to blend a newfound interest in calligraphy with my lifelong passion for written correspondence to create a new kind of text messaging. The idea: I wanted to message friends using calligraphic texts for one week. The average 18-to-24-year-old sends and gets something like 4,000 messages a month, which includes sending more than 500 texts a week, according to Experian. The week of my experiment, I only sent 100. (I was 24 at the time.)
A 1979 book on presidential selection inadvertently predicted the rise of Trump—and the weakness of a popular primary system.
Predictions are dangerous business, especially in the hall of mirrors that American politics has become. Suffice it to say, no one called this U.S. presidential election cycle—not Trump, not Sanders, not any of it.
Except, perhaps, in a round-about way, a 1979 book about the presidential-primary system. James Ceaser, a University of Virginia professor, outlined the history and potential weaknesses of various nomination processes, including one that largely relies on popular primaries. Starting in the early 1970s, Democrats and Republicans began reforming their primary-election processes, transferring influence over nominations away from party leaders to voters. This kind of system is theoretically more democratic, but it also has weaknesses—some of which have been on display in 2016. When I spoke with a couple of conservative political-science professors about their field last month, one of them remarked, with just a hint of jealousy, “I expect Jim Ceaser to take a victory lap around the country saying I told you so.”