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)
Demonizing processed food may be dooming many to obesity and disease. Could embracing the drive-thru make us all healthier?
Late last year, in a small health-food eatery called Cafe Sprouts in Oberlin, Ohio, I had what may well have been the most wholesome beverage of my life. The friendly server patiently guided me to an apple-blueberry-kale-carrot smoothie-juice combination, which she spent the next several minutes preparing, mostly by shepherding farm-fresh produce into machinery. The result was tasty, but at 300 calories (by my rough calculation) in a 16-ounce cup, it was more than my diet could regularly absorb without consequences, nor was I about to make a habit of $9 shakes, healthy or not.
Inspired by the experience nonetheless, I tried again two months later at L.A.’s Real Food Daily, a popular vegan restaurant near Hollywood. I was initially wary of a low-calorie juice made almost entirely from green vegetables, but the server assured me it was a popular treat. I like to brag that I can eat anything, and I scarf down all sorts of raw vegetables like candy, but I could stomach only about a third of this oddly foamy, bitter concoction. It smelled like lawn clippings and tasted like liquid celery. It goes for $7.95, and I waited 10 minutes for it.
In the name of emotional well-being, college students are increasingly demanding protection from words and ideas they don’t like. Here’s why that’s disastrous for education—and mental health.
Something strange is happening at America’s colleges and universities. A movement is arising, undirected and driven largely by students, to scrub campuses clean of words, ideas, and subjects that might cause discomfort or give offense. Last December, Jeannie Suk wrote in an online article for The New Yorker about law students asking her fellow professors at Harvard not to teach rape law—or, in one case, even use the word violate (as in “that violates the law”) lest it cause students distress. In February, Laura Kipnis, a professor at Northwestern University, wrote an essay in The Chronicle of Higher Education describing a new campus politics of sexual paranoia—and was then subjected to a long investigation after students who were offended by the article and by a tweet she’d sent filed Title IX complaints against her. In June, a professor protecting himself with a pseudonym wrote an essay for Vox describing how gingerly he now has to teach. “I’m a Liberal Professor, and My Liberal Students Terrify Me,” the headline said. A number of popular comedians, including Chris Rock, have stopped performing on college campuses (see Caitlin Flanagan’s article in this month’s issue). Jerry Seinfeld and Bill Maher have publicly condemned the oversensitivity of college students, saying too many of them can’t take a joke.
Some Republican candidates are promoting a policy change that would hurt workers by disguising it with a pleasant-sounding phrase.
Americans like their Social Security benefits quite a bit: They oppose cuts to them by a margin of two to one. Even Millennials, who won’t be seeing benefits anytime soon, feel protective of Social Security, according to a poll from the Pew Research Center.
One way to effectively cut Social Security benefits is to raise the age at which they kick in. And yet, when asked specifically about raising the retirement age, Americans are mixed.
Perhaps confusion arises because “raising the age of retirement” sounds like a nice jobs program for older Americans, or an end to forced retirement. I sympathize with that position: Anyone who wants to retire later and work into old age should have a job. But that’s not what raising the retirement age would entail—the fact is, raising the Social Security retirement age represents a reduction in benefits: Because the monthly payments a person receives grow bigger the later in life he or she retires, raising the age cutoff reduces the total amount of money paid out.
Heather Armstrong’s Dooce once drew millions of readers. Her blog’s semi-retirement speaks to the challenges of earning money as an individual blogger today.
The success story of Dooce.com was once blogger lore, told and re-told in playgroups and Meetups—anywhere hyper-verbal people with Wordpress accounts gathered. “It happened for that Dooce lady,” they would say. “It could happen for your blog, too.”
Dooce has its origin in the late 1990s, when a young lapsed Mormon named Heather Armstrong taught herself HTML code and moved to Los Angeles. She got a job in web design and began blogging about her life on her personal site, Dooce.com.
The site’s name evolved out of her friends’ AOL Instant-Messenger slang for dude, or its more incredulous cousin, "doooood!” About a year later, Armstrong was fired for writing about her co-workers on the site—an experience that, for a good portion of the ‘aughts, came known as “getting dooced.” She eloped with her now ex-husband, Jon, moved to Salt Lake City, and eventually started blogging full time again.
In continuing to tinker with the universe she built eight years after it ended, J.K. Rowling might be falling into the same trap as Star Wars’s George Lucas.
September 1st, 2015 marked a curious footnote in Harry Potter marginalia: According to the series’s elaborate timeline, rarely referenced in the books themselves, it was the day James S. Potter, Harry’s eldest son, started school at Hogwarts. It’s not an event directly written about in the books, nor one of particular importance, but their creator, J.K. Rowling, dutifully took to Twitter to announce what amounts to footnote details: that James was sorted into House Gryffindor, just like his father, to the disappointment of Teddy Lupin, Harry’s godson, apparently a Hufflepuff.
It’s not earth-shattering information that Harry’s kid would end up in the same house his father was in, and the Harry Potter series’s insistence on sorting all of its characters into four broad personality quadrants largely based on their family names has always struggled to stand up to scrutiny. Still, Rowling’s tweet prompted much garment-rending among the books’ devoted fans. Can a tweet really amount to a piece of canonical information for a book? There isn’t much harm in Rowling providing these little embellishments years after her books were published, but even idle tinkering can be a dangerous path to take, with the obvious example being the insistent tweaks wrought by George Lucas on his Star Wars series.
Encouraging a focus on white identity is a dangerous approach for a country in which white supremacy has been a toxic force.
Donald Trump and the disaffected white people who make up his base of support have got me thinking about race in America. “Trump presents a choice for the Republican Party about which path to follow––” Ben Domenech writes in an insightful piece at The Federalist, “a path toward a coalition that is broad, classically liberal, and consistent with the party’s history, or a path toward a coalition that is reduced to the narrow interests of identity politics for white people.”
When I was growing up in Republican Orange County during the Reagan and Bush Administrations, lots of white parents sat their kids in front of The Cosby Show, explained that black people are just like white people, and inveighed against judging anyone by the color of their skin rather than the content of their character. The approach didn’t convey the full reality of race as minorities experience it. But it represented a significant generational improvement in race relations.
After a lackluster summer, the famous neurosurgeon is finally surging—but his reliance on the conservative grassroots might be a burden as much as a boon.
The Ben Carson surge that everyone was waiting for is finally here.
The conservative neurosurgeon has been a source of fascination for both the Republican grassroots and the media ever since he critiqued President Obama, who was seated only a few feet away, at the National Prayer Breakfast in 2013. He’s been a steady, if middling, presence in GOP primary polls for most of the year—always earning at least 5 percent, but rarely more than 10. Yet over the last two weeks, Carson has secured a second-place spot after Donald Trump, both nationally and in the crucial opening battleground of Iowa, where he is a favorite of the state’s sizable evangelical community. A Monmouth University poll released this week even showed him tied with Trump for the lead in Iowa, at 23 percent.
According to Franklin, what mattered in business was humility, restraint, and discipline. But today’s Type-A MBAs would find him qualified for little more than a career in middle management.
When he retired from the printing business at the age of 42, Benjamin Franklin set his sights on becoming what he called a “Man of Leisure.” To modern ears, that title might suggest Franklin aimed to spend his autumn years sleeping in or stopping by the tavern, but to colonial contemporaries, it would have intimated aristocratic pretension. A “Man of Leisure” was typically a member of the landed elite, someone who spent his days fox hunting and affecting boredom. He didn’t have to work for a living, and, frankly, he wouldn’t dream of doing so.
Having worked as a successful shopkeeper with a keen eye for investments, Franklin had earned his leisure, but rather than cultivate the fine arts of indolence, retirement, he said, was “time for doing something useful.” Hence, the many activities of Franklin’s retirement: scientist, statesman, and sage, as well as one-man civic society for the city of Philadelphia. His post-employment accomplishments earned him the sobriquet of “The First American” in his own lifetime, and yet, for succeeding generations, the endeavor that was considered his most “useful” was the working life he left behind when he embarked on a life of leisure.
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.
The man who made computers personal was a genius and a jerk. A new documentary wonders whether his legacy can accommodate both realities.
An iPhone is a machine much like any other: motherboard, modem, microphone, microchip, battery, wire of gold and silver and copper twisting and snaking, the whole assembly arranged under a piece of glass whose surface—coated with an oxide of indium and tin to make it electrically conductive—sparks to life at the touch of a warm-blooded finger. But an iPhone, too, is much more than a machine. The neat ecosystem that hums under its heat-activated glass holds grocery lists and photos and games and jokes and news and books and music and secrets and the voices of loved ones and, quite possibly, every text you’ve ever exchanged with your best friend. Thought, memory, empathy, the stuff we sometimes shorthand as “the soul”: There it all is, zapping through metal whose curves and coils were designed to be held in a human hand.