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)
For decades the Man of Steel has failed to find his groove, thanks to a continual misunderstanding of his strengths.
Superman should be invincible. Since his car-smashing debut in 1938, he’s starred in at least one regular monthly comic, three blockbuster films, and four television shows. His crest is recognized across the globe, his supporting cast is legendary, and anybody even vaguely familiar with comics can recount the broad strokes of his origin. (The writer Grant Morrison accomplished it in eight words: “Doomed Planet. Desperate Scientists. Last Hope. Kindly Couple.”) He’s the first of the superheroes, a genre that’s grown into a modern mass-media juggernaut.
And yet, for a character who gains his power from the light of the sun, Superman is curiously eclipsed by other heroes. According to numbers provided by Diamond Distributors, the long-running Superman comic sold only 55,000 copies a month in 2015, down from around 70,000 in 2010—a mediocre showing even for the famously anemic comic-book market. That’s significantly less than his colleague Batman, who last year moved issues at a comparatively brisk 150,000 a month. Mass media hasn’t been much kinder: The longest-running Superman television show, 2001’s Smallville, kept him out of his iconic suit for a decade. Superman Returns recouped its budget at the box office, but proved mostly forgettable.2013’s Man of Steel drew sharp criticism from critics and audiences alike for its bleak tone and rampaging finale. Trailers for the sequel, Batman v Superman: Dawn of Justice, have shifted the focus (and top billing) to the Dark Knight. Worst of all, conventional wisdom puts the blame on Superman himself. He’s boring, people say; he’s unrelatable, nothing like the Marvel characters dominating the sales charts and the box office. More than anything, he seems embarrassing. Look at him. Truth? Justice? He wears his underwear on the outside.
The charismatic senator’s candidacy was flying high—until he hit turbulence at Saturday’s debate. Will it stall his surge?
MANCHESTER, New Hampshire—Until Saturday’s debate, it was clear that this was Marco Rubio’s moment.
The moment he had waited for, planned for, anticipated for months, for years: It was happening. He had surged into a strong third-place finish in Iowa, outpacing the polls and nearly passing second-place Donald Trump. He’d ridden into New Hampshire on a full head of steam, drawing bigger and bigger crowds at every stop, ticking steadily up into second in most polls, behind the still-dominant Trump. The other candidates were training their fire on him, hoping to stop the golden boy in his tracks.
And then, in the debate, he faced the test he knew was imminent. They came right at him. First it was the moderator, David Muir of ABC News, leveling the accusation put forth by his rivals: that Rubio was merely a good talker with nothing to show for it, just like another eloquent, inexperienced young senator, Barack Obama.
Hillary Clinton’s realistic attitude is the only thing that can effect change in today’s political climate.
Bernie Sanders and Ted Cruz have something in common. Both have an electoral strategy predicated on the ability of a purist candidate to revolutionize the electorate—bringing droves of chronic non-voters to the polls because at last they have a choice, not an echo—and along the way transforming the political system. Sanders can point to his large crowds and impressive, even astonishing, success at tapping into a small-donor base that exceeds, in breadth and depth, the remarkable one built in 2008 by Barack Obama. Cruz points to his extraordinarily sophisticated voter-identification operation, one that certainly seemed to do the trick in Iowa.
But is there any real evidence that there is a hidden “sleeper cell” of potential voters who are waiting for the signal to emerge and transform the electorate? No. Small-donor contributions are meaningful and a sign of underlying enthusiasm among a slice of the electorate, but they represent a tiny sliver even of that slice; Ron Paul’s success at fundraising (and his big crowds at rallies) misled many analysts into believing that he would make a strong showing in Republican primaries when he ran for president. He flopped.
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 championship game descends on a city failing to deal with questions of affordability and inclusion.
SAN FRANCISCO—The protest kicked off just a few feet from Super Bowl City, the commercial playground behind security fences on the Embarcadero, where football fans were milling about drinking beer, noshing on $18 bacon cheeseburgers, and lining up for a ride on a zip line down Market Street.
The protesters held up big green camping tents painted with slogans such as “End the Class War” and “Stop Stealing Our Homes,” and chanted phrases blaming San Francisco Mayor Ed Lee for a whole range of problems, including the catchy “Hey Hey, Mayor Lee, No Penalty for Poverty.” They blocked the sidewalk, battling with tourists, joggers, and city workers, some of whom were trying to wheel their bikes through the crowd to get to the ferries that would take them home.
Thenew Daily Show host, Trevor Noah, is smooth and charming, but he hasn’t found his edge.
It’s a psychic law of the American workplace: By the time you give your notice, you’ve already left. You’ve checked out, and for the days or weeks that remain, a kind of placeholder-you, a you-cipher, will be doing your job. It’s a law that applies equally to dog walkers, accountants, and spoof TV anchormen. Jon Stewart announced that he was quitting The Daily Show in February 2015, but he stuck around until early August, and those last months had a restless, frazzled, long-lingering feel. A smell of ashes was in the air. The host himself suddenly looked quite old: beaky, pique-y, hollow-cheeky. For 16 years he had shaken his bells, jumped and jangled in his little host’s chair, the only man on TV who could caper while sitting behind a desk. Flash back to his first episode as the Daily Show host, succeeding Craig Kilborn: January 11, 1999, Stewart with floppy, luscious black hair, twitching in a new suit (“I feel like this is my bar mitzvah … I have a rash like you wouldn’t believe.”) while he interviews Michael J. Fox.
The armed standoff in Burns, Oregon, is a perfect case study for why all defendants need excellent representation—and why the current criminal-justice state is no panacea.
In the early hours of the morning, law professors wonder whether anything we do makes the world a better place.
Today, I feel pretty sure that the answer is yes. That’s because, on January 28, I awoke to a televised image of Ammon Bundy’s lawyer, Mike Arnold of Eugene, Oregon, reading a statement urging the other Malheur protesters to stand down. Arnold is a former student of mine. So is Tiffany Harris of Portland, who represents Shawna Cox, the 59-year-old woman who was arrested in the car with LaVoy Finicum, the militant spokesman who was shot during a traffic stop near the occupied Malheur National Wildlife Refuge.
I couldn’t be prouder.
That’s not because I like their clients. I taught Mike and Tiffany during 16 happy years at the University of Oregon School of Law. During that time, I also taught students who had grown up on ranches in the eastern desert, on farms in the state’s irrigated south, on hippie settlements on the rain-drenched Oregon coast, on the state’s Indian reservations, in the Willamette Valley wine country, and in the sophisticated urban areas around Portland. Oregon, a state the size of Italy, supports a population roughly half the size of New York City. Much of the state is desert or forest; its ecosystems are exquisite but fragile. It is a place that needs careful tending. And by and large, those who live there take that responsibility seriously. Land-policy issues—and there are many—tend to be resolved through painstaking negotiations among local farmers and ranchers, Indian tribes, urban dwellers, and state and local governments.
Two hundred fifty years of slavery. Ninety years of Jim Crow. Sixty years of separate but equal. Thirty-five years of racist housing policy. Until we reckon with our compounding moral debts, America will never be whole.
And if thy brother, a Hebrew man, or a Hebrew woman, be sold unto thee, and serve thee six years; then in the seventh year thou shalt let him go free from thee. And when thou sendest him out free from thee, thou shalt not let him go away empty: thou shalt furnish him liberally out of thy flock, and out of thy floor, and out of thy winepress: of that wherewith the LORD thy God hath blessed thee thou shalt give unto him. And thou shalt remember that thou wast a bondman in the land of Egypt, and the LORD thy God redeemed thee: therefore I command thee this thing today.
— Deuteronomy 15: 12–15
Besides the crime which consists in violating the law, and varying from the right rule of reason, whereby a man so far becomes degenerate, and declares himself to quit the principles of human nature, and to be a noxious creature, there is commonly injury done to some person or other, and some other man receives damage by his transgression: in which case he who hath received any damage, has, besides the right of punishment common to him with other men, a particular right to seek reparation.
The three leading candidates—Trump, Cruz, and Rubio—stumbled, as the governors in the race made their presence felt.
When is it bad to be a frontrunner? During a presidential debate three days before the New Hampshire primary, evidently. At Saturday night’s forum in Manchester, Marco Rubio, Ted Cruz, and Donald Trump all hit rough patches, while three often-overshadowed governors—Chris Christie, Jeb Bush, and John Kasich—delivered some of their strongest moments of the campaign so far.
Rubio, surging nationwide and in New Hampshire, believed he had a target pinned to his back coming in, and he was right. Christie was the hatchet man, coming after Rubio in the earliest moments of the debate and never letting up. (At one point, Christie even pivoted from responding to an attack by John Kasich to slam Rubio.) Christie jabbed that Rubio, as a senator, doesn’t have the executive experience needed to be president, citing Barack Obama as a cautionary tale. Rubio was ready with an answer to that: “This notion that Barack Obama doesn't know what he's doing?” he said. “He knows exactly what he's doing.” Rubio isn’t the only candidate to suggest that Obama is more evil genius than bumbling fool—Ted Cruz has done the same—but the crowd wasn’t buying it. Maybe Rubio’s phrasing was just too clever.
What happens when the big game’s primary cultural spectacles get translated into emoji?
Super Bowl 50—the game, this year, has reverted back to Arabic numerals to avoid the assorted awkwardnesses of the name “Super Bowl L”—will likely bring many of the things you’d expect from it. Clydesdales that restore your faith in humanity. Celebrity cameos that restore your nostalgia for mid-’90s TV sitcoms. Beer ads that restore your faith in beer. Oh, definitely, there will be a football game included among all the pageantry—spread out, dependably, like the beany bottom of a seven-layer dip—but what will make this bowl really Super, for most viewers, is the same that makes it Super every year: the ads. The weep-worthy stories of adversity overcome, the bikini-clad models sloppy-eating bacon cheeseburgers, the tiny tales of American culture told in 30-second snippets.