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)
In the United States, when an unmarried man has a baby, his partner can give it up without his consent—unless he happens to know about an obscure system called the responsible father registry.
Christopher Emanuel first met his girlfriend in the fall of 2012, when they were both driving forklifts at a warehouse in Trenton, South Carolina. She was one of a handful of women on the job; she was white and he was black. She ignored him at first, and Emanuel saw it as a challenge. It took multiple attempts to get her phone number. He says he “wasn’t lonely, but everybody wants somebody. Nothing wrong with being friends.”
Emanuel, who is now 25, describes himself as a non-discriminatory flirt. He was popular in high school and a state track champion. According to the Aiken High School 2008 yearbook, he was voted “Most Attractive” and “Best Dressed.” Even his former English teacher Francesca Pataro describes him as a “ray of sunshine.” Emanuel says he’s “talked”—euphemistically speaking—with a lot of women: “Black, Puerto Rican, Egyptian, and Vietnamese.” But before he met this girlfriend, he says, he had never seriously dated a white girl.
“Here is what I would like for you to know: In America, it is traditional to destroy the black body—it is heritage.”
Last Sunday the host of a popular news show asked me what it meant to lose my body. The host was broadcasting from Washington, D.C., and I was seated in a remote studio on the Far West Side of Manhattan. A satellite closed the miles between us, but no machinery could close the gap between her world and the world for which I had been summoned to speak. When the host asked me about my body, her face faded from the screen, and was replaced by a scroll of words, written by me earlier that week.
As the Vermont senator gains momentum, Claire McCaskill rushes to the frontrunner’s defense.
Obscured by the recent avalanche of momentous news is this intriguing development from the campaign trail: The Hillary Clinton campaign now considers Bernie Sanders threatening enough to attack. Fresh off news that Sanders is now virtually tied with Hillary in New Hampshire, Claire McCaskill went on Morning Joe on June 25 to declare that “the media is giving Bernie a pass … they’re not giving the same scrutiny to Bernie that they’re certainly giving to Hillary.”
The irony here is thick. In 2006, McCaskill said on Meet the Press that while Bill Clinton was a great president, “I don’t want my daughter near him.” Upon hearing the news, according to John Heilemann and Mark Halperin’s book Game Change, Hillary exclaimed, “Fuck her,” and cancelled a fundraiser for the Missouri senator. McCaskill later apologized to Bill Clinton, and was wooed intensely by Hillary during the 2008 primaries. But she infuriated the Clintons again by endorsing Barack Obama. In their book HRC, Aimee Parnes and Jonathan Allen write that, “‘Hate’ is too weak a word to describe the feelings that Hillary’s core loyalists still have for McCaskill.”
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.
Most adults can’t remember much of what happened to them before age 3 or so. What happens to the memories formed in those earliest years?
My first memory is of the day my brother was born: November 14, 1991. I can remember my father driving my grandparents and me over to the hospital in Highland Park, Illinois, that night to see my newborn brother. I can remember being taken to my mother’s hospital room, and going to gaze upon my only sibling in his bedside cot. But mostly, I remember what was on the television. It was the final two minutes of a Thomas the Tank Engine episode. I can even remember the precise story: “Percy Takes the Plunge,” which feels appropriate, given that I too was about to recklessly throw myself into the adventure of being a big brother.
In sentimental moments, I’m tempted to say my brother’s birth is my first memory because it was the first thing in my life worth remembering. There could be a sliver of truth to that: Research into the formation and retention of our earliest memories suggests that people’s memories often begin with significant personal events, and the birth of a sibling is a textbook example. But it was also good timing. Most people’s first memories date to when they were about 3.5 years old, and that was my age, almost to the day, when my brother was born.
Ten years ago, prescription painkiller dependence swept rural America. As the government cracked down on doctors and drug companies, people went searching for a cheaper, more accessible high. Now, many areas are struggling with an unprecedented heroin crisis.
In a beige conference room in Morgantown, West Virginia, Katie Chiasson-Downs, a slight, blond woman with a dimpled smile, read out the good news first. “Sarah is getting married next month, so I expect her to be a little stressed,” she said to the room. “Rebecca is moving along with her pregnancy. This is Betty’s last group with us.”
“Felicia is having difficulties with doctors following up with her care for what she thinks is MRSA,” Chiasson-Downs continued. “Charlie wasn’t here last time, he cancelled. Hank ...”
“Hank needs a sponsor, bad,” said Carl Sullivan, a middle-aged doctor with auburn hair and a deep drawl. “It kind of bothers me that he never gets one.”
“This was Tom’s first time back in the group, he seemed happy to be there,” Chiasson-Downs went on, reading from her list.
America’s mainstream religious denominations used to teach the faithful that they would be rewarded in the afterlife. But over the past generation, a different strain of Christian faith has proliferated—one that promises to make believers rich in the here and now. Known as the prosperity gospel, and claiming tens of millions of adherents, it fosters risk-taking and intense material optimism. It pumped air into the housing bubble. And one year into the worst downturn since the Depression, it’s still going strong.
Like the ambitions of many immigrants who attend services there, Casa del Padre’s success can be measured by upgrades in real estate. The mostly Latino church, in Charlottesville, Virginia, has moved from the pastor’s basement, where it was founded in 2001, to a rented warehouse across the street from a small mercado five years later, to a middle-class suburban street last year, where the pastor now rents space from a lovely old Baptist church that can’t otherwise fill its pews. Every Sunday, the parishioners drive slowly into the parking lot, never parking on the sidewalk or grass—“because Americanos don’t do that,” one told me—and file quietly into church. Some drive newly leased SUVs, others old work trucks with paint buckets still in the bed. The pastor, Fernando Garay, arrives last and parks in front, his dark-blue Mercedes Benz always freshly washed, the hubcaps polished enough to reflect his wingtips.
As opiate abuse swells in the United States, women are particularly at risk.
Throughout the history of modern medicine, substance-abuse researchers have focused their investigations almost exclusively on men. It wasn't until the 1990s that scientists, prompted by federal funding aimed at enrolling more women in studies, began widely exploring how drug dependence and abuse affects women.
And it turns out that gender differences can be profound.
Women tend to become dependent on drugs more quickly than men, according to the most recent data from the Substance Abuse Mental-Health Services Administration. This is especially the case among those who abuse alcohol, marijuana, and opioids like heroin. Women also find it harder to quit and can be more susceptible than men to relapse, according to Harvard Medical School.
A mid-air collision in South Carolina is a reminder that there’s only so much airspace to go around.
Mid-air collisions are among the rarest but most horrific aviation perils. The most famous collision involving airliners in the United States, the crash of planes from United Airlines and TWA over the Grand Canyon nearly 60 years ago that killed everyone on board, led to dramatic changes in U.S. air-traffic control procedures. (There were twoother U.S. airline collisions in the 1960s). In 2002, a Russian passenger airliner and a DHL cargo jet collided over Überlingen, Germany. Investigators eventually traced the cause to shortcomings in the Swiss air-traffic control system. Two years later, a Russian architect whose wife and children had died in the crash stabbed to death the Swiss controller who had been on duty at the time, even though an investigation had found the controller not personally at fault.