my fact-free thoughts about health care

My health insurance is about to run out. I’ve been looking into so-called “gap” insurance to cover the magical period between now and whenever a job finally beckons. It’s very confusing–I have to look up nearly every term on a given plan. And since I don’t have a job, I really can’t afford any plan for too long.

In order to select the right plan, I have to take a guess what kinds of terrible things might happen to me. This is one place where my imagination already runs free. When I sit down, I instinctively bend my feet toward other other, instead of placing them flat on the ground. What if, one day, I leap out of bed and land on my ankles instead of my feet? What if I have diabetes, and this bending is what happens before my limbs rot off? I am actually worried about stuff like this.

But it’s far more likely that I’ll be terribly injured in a car crash while I’m on my way to the library. This is my #1 trending future cause of injury. So I need a health plan that will help me prepare for this nigh-inevitable occurence. Unfortunately all of these health care plans are structured around how much money I’ll be spending if I get hurt, not on how totally rotten it is that this ordinary accident happens to me. If I need health insurance, it will be for something big and terrible. So even though I require a bare-bones health insurance plan, it has to be expensive.

Why do we have health insurance anyway? The idea of health insurance, I mean. Health insurance itself has probably survived because people are justifiably scared of going into massive debt, and it’s profitable to the insurance companies that provide it. But I’m pretty sure that we think health insurance is worth debating because it’s a way of fighting the randomness of life. Sure, people grumble that for some people and some types of injuries, health insurance fails to cancels out moral hazards, leading to more expense and more injury. And there’s been a lot of worry lately that insurers will screen out customers by identifying “pre-existing conditions” genetically. But I think a whole lot of people would agree that  if you get in a terrible car accident, or if you wake up one day with cancer, that this is part of life’s random cruelty and we should band together to fight it. At some point here, the question of “health insurance” folds into the larger question of “health care”.

It’s my idealistic position that we have no other option but to band together. Sometimes health care is presented as primarily an economic issue–at stake is how we allocate scarce resources. In my flip way, I think this is ill-conceived; health care is an ethical issue first. We must allocate those resources to everyone, and we have to suspend economic judgment if there’s to be any human sense in the whole affair.

If Congress had moved on health care reform before the August recess (which is what Obama asked of them, lest we forget), we might have stood a better chance of seeing it pass. For that, Pelosi, I blame you. But we also would have missed out on a fascinating and infuriating debate, one that could eventually turn us toward big questions like “why have health insurance in the first place?” At first glance, the recent town hall meetings only produce irrational, delibitating fear and anger. They’re democracy in drag (which is an insult to drag queens and kings, but oh well), and they’re tearing apart an already severely-compromised bill. But I do see two positive things of note coming out of these meetings.

1) If any citizens weren’t previously aware that Congress is debating health care reform, they are now. Of course, this doesn’t mean that everyone has a sensible position, or that anyone’s guaranteed to eventually have one, but it’s a start. We can move from superficial talking points like the “death panels” to more vital ones. Anyone who doesn’t believe we can probably never thought we’d reform health care in the first place. The only way that this happens, though, is if we don’t stop talking about it. Instead of waiting another 17 years, let’s do it all over again–next month.

2) Town hall meetings are great! Let’s have them all the time. The town hall meeting had fallen on some pretty hard times in this country. It was once an actual way to get things done. Lately, though, it’s merely been trotted out every presidential campaign cycle so people can see the candidates in person and maybe ask a pre-approved question or two. What would happen if we had regular town hall meetings with our representatives?

For starters, astroturfing would become cost-prohibitive. That leaves only the authentic wackos like you and me. Second, after a few weeks of yelling at each other, we’d probably start recognizing the worst offenders, seeing them around town–in short, getting to know them. This just might prevent us all from coming to blows, and maybe even instill in us some common feeling. Third, they increase our chances of becoming startlingly well-informed about legislation, which can only be a good thing. In the days and hours before a town hall meeting, communities would start studying the issues at hand (and yeah, picking up new talking points from the media), really grasping and engaging with them. One more potential benefit: since these meetings would be happening all over the country, maybe people from Massachusetts would really feel like they had something in common with people in North Dakota.

This is all very sanguine, I know. But I’m in an experimental mood.


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August 2009
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