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Playing Health Care Like Lotto


The aftermath of a motorcycle crash on Abbot Kinney (not the one mentioned in the piece below). The guy who looks like he's combing the pavement for loose eyeballs is just a friend of the motorcycle-crashing rider (in the gray sweatshirt). The guy on the bike, according to a witness who spoke to me, nearly hit a pedestrian at the crosswalk, and in avoiding the pedestrian, slid on his bike under the older couple's car.

Via Overlawyered, a helmetless 400-lb. man has a motorcycle crash, and the doctor who gives her all to try to save him almost ends up paying with her career. This doctor, Anna Maria Voltura, tells how the experience changed her, and encourages other doctors to stand up against opportunistic lawyers:

I still can't help but think that the only thing I did wrong was try to save his life.

...Herein lies one of many dilemmas. How do you keep a 6-foot, 400-pound man who lacks a visible neck in cervical spinal precautions? We had no collar on hand to fit him. He was as strong as an ox, and shook his head violently whenever he wasn't chemically paralyzed. We had to remove the head rolls to place a central line and perform a transesophageal echocardiogram. A nurse had to hold his head and neck in line to maintain C-spine precautions.

...It was profoundly enlightening to realize that my career was in the hands of 12 strangers who were expected to understand and interpret in three weeks what had taken me 10 long years to learn; and even longer to practice and internalize. Maybe it was akin to a 400-pound man coming to me as a stranger, asking that I save his life and keep it as it was before he was thrown off that motorcycle going 40 miles an hour.

I testified in court for four grueling hours. I was well prepared but nevertheless terrified I would say something wrong. I felt the need to repeat what took place over and over again just to make sure the jurors understood the sequence of events. The plaintiff's attorney—attractive, articulate, and dressed in an expensive suit—tried every trick in the book to get me to slip up, to say something she could twist into a lie. Anything she could to make me look inept, inexperienced, evil. Yes, evil. During closing arguments she played a scene of the Lord of the Rings: The Return of the King and equated the doctors in the case to the monsters. I sat there astounded that someone would actually say that I was an evil person wreaking havoc on innocent people behind the guise of a medical license.

She was found not guilty, but writes that she's never been the same:

I have never practiced the same. Now I'm more careful about my documentation. I discuss things ad infinitum with patients to make sure they understand. And I order more tests than before. Some people would call this defensive medicine, but it's what we've been forced to do to protect ourselves.

I walked away from my experience hardened, less trusting of patients, and stripped of my idealism about helping others. But I'm trying to restore what was lost. I'm transitioning from general surgery to breast cancer care, which is what I want to do exclusively. I enjoy this subspecialty, and my patients sense that. I've also cut back my hours to take care of myself—to exercise, for one thing. So you'll find me bicycling around town more.

But what about our uneasy relationship with patients these days? I don't think we do enough to win back their trust. One way to do that is to refuse to settle malpractice lawsuits when we know we did nothing wrong. A lot of people view these suits as a kind of get-rich-quick lottery. We add to that perception when we settle for no good reason.

If you want to let yourself blow up to 400 pounds, then go cycling around without a helmet -- it's only fair you assume the risks. It's bad enough that the cost of the unhelmeted gets passed on to the rest of us in higher insurance costs -- but for the guy to try to turn a doctor who aparently did the best she could under the circustances into a form of winning the lottery...that makes for worse care for all of us.

As I've said before, I'd like to see a repeal of motorcycle helmet laws, and in their place, a no-helmet option: If you ride without a helmet, either you pay some kind of supplemental insurance that kicks in for your care after an accident, or we just leave you where you fell until the street cleaning guys sweep up what's left of you.

The alternative is forcing the rest of us to pay for your stupidity. We've got enough to pay for already, what with all the poor and uninsured -- and then, all the not-so-poor gambling that they won't need health insurance. Then again, why pay $150 a month for an HMO (assuming you're in your 20s) or get a low-cost, high-deductible health insurance plan when the taxpayers can be made to pick up your care?

Yes, that's Ben Ehrenreich and his girlfriend we're talking about. As Kate Coe puts it on Fishbowl LA:

Ben Ehrenreich's op-ed in today's LA Times is meant to point out that poor minorities suffer the most in hospital emergency rooms. His unnamed Chicana girlfriend (her name doesn't matter, but her ethnicity does?) broke her ankle, and being "between jobs and between health insurance plans", had no choice but to shuffle off to County-USC at 4 am, because Ehrenreich took some friend's advice on the best time to go. They waited 5 hours for a gurney. Ehrenreich, his blue eyes and well-known last name "required an introduction to this sort of indignity." Ehrenreich needs an introduction to a dope slap. At 4 am in an urban ER, bleeding takes priority, anything else can wait.

Free-lancer Cathy Seipp, who has her own health insurance and with a rather more serious complaint, waited the same amount of time at Cedars. She too has blue eyes, but pain and suffering are no respecters of persons.

...Hospital emergency rooms are burdened enough trying to care for those who have no other choice for medical care. Writers who chose those services just because they'd rather not borrow money, max out their credit cards or work out a payment plan shouldn't be adding to that burden.

Exactly. And don't give me the whine about health insurance being so terribly expensive. I've ALWAYS had health insurance -- even at my most struggling, when I wasn't making enough money writing, and had to take a job one day with Amazon All-Girls Moving Company for $5/hr. And let's just say, I'm not exactly Miss Hercules.

I don't have Cadillac health insurance; more like Ford Focus insurance: Kaiser Permanente HMO. I believe it cost me just over $100 when I was in my 20s, and now, at 42, it's $258 a month. As I posted on Cathy's blog, paying it means I have to forgo a pair of shoes, or dining out every night, but it's just the right thing to do. The personal responsibility thing, you know?

Oh yeah, and back to Ehren-sponge, another good point made by Kate in yet another FBLA entry:

But here's the interesting part, when Ehrenreich writes:

A few weeks later, I was doing a little research to find out where to send a friend who had broken her ankle in New Mexico and needed surgery in Los Angeles.

So the girlfriend showed up at an Emergency Room with not much of an emergency, it seems.

I guessed Ehrenreich's e-mail address and wrote to him -- Can you please tell me if your girlfriend paid anything for her care...and if so, what did she pay? -- to get a sense of how much we, the taxpayers, got fucked because his girlfriend didn't have health insurance, and got this back:

In a message dated 2/18/07 3:36:03 PM, writes:

I am out of town and will not be able to check email until I return at the end of the month.

Yeah, I bet he is. I wonder if he can get us taxpayers to fund his vacations, too?

Posted by aalkon at February 19, 2007 3:00 PM


"Indignity" is the magic word. Attitudes like his can teach you to hate optimism.

The dark side of life doesn't get enough credit. Horrible things are going to happen to us, and we should be more conversational about it -- Not in a gossipy, emotionally massaging way, but stoically. One reason that doctors are held accountable for typical bad fates is that people don't understand how probable they are, so when one comes down, it's assumed that somebody dropped the ball. The only way out is that large door in the back of the room, and your ticket's already been punched.

Hitchens: "This ends badly."

Posted by: Crid at February 19, 2007 5:48 AM

Also, it's raining like Hell here! So go out and have a great Monday morning!


Posted by: Crid at February 19, 2007 7:37 AM

Crid - so right. People have this idealized view of the medical sciences that leads them to believe that no matter how badly damaged, "we have the technology" to make them exactly as they were.

Amy - I ride, and sometimes I skip the helmet. Risk? Yep. I'm willing to accept that I may end up in a box with dirt on my head. Luckily, I live in one of the few states that hasn't gone full-nanny.

I don't have insurance because I cannot justify giving some company $300 a month on the off chance that something happens to me. I don't go to the doctor unless something hurts, so why should I pay $3,000-4,000 a year for a whole bunch of coverages I don't need? And at the other end of the spectrum, you get $5,000 deductibles and 20% co-insurance. And for the $50 a month they charge, it's cheaper to just go into debt for the whole bag. Note, I won't allow the government to pick up the tab for me if I have any say in the matter. But that's just me.

Here's what I'd like for an insurance policy (adjusted for risk as approprate, oh, wait, we can't do that thanks to the gummint): A reasonable deductible (hell, even 5 grand is reasonable if I get the rest of it), and 100% coverage for any major catastrophe (broken limbs, heart surgery, etc). No coverage for doctor visits, prescriptions, etc. I'm not saying this should be for everyone - but if I could get that coverage for under $100 a month, I'd buy it.

With HMO coverage, I'd have to get a physical every month to break even. HMO and Medicaid have taken the true costs of health care and hidden them from view. Since people don't know what care really costs, they go to the ER for the sniffles, and they go to the doctor when they feel lonely.

Of course, a bit of tort reform would help too, but don't expect that when the entirety of all elected officials are either lawyers, on the take, or both.

Posted by: brian at February 19, 2007 7:48 AM

Dude, it's not an "off chance"... It's coming. I feel bad, but it's going to happen to you. We feel bad for everyone else, too.

One reason it's so fucking expensive is that people don't buy it, so those of us who do have to cover the cost for everyone. Seriously, this is elementary citizenship. You gotta be ready. Either that, or in Michael Lewis' perfect phrase...

No tears.

Posted by: Crid at February 19, 2007 8:03 AM

I don't have insurance because I cannot justify giving some company $300 a month on the off chance that something happens to me.

But, you can justify the chance that the rest of us will have to pay thousands upon thousands for your care?

See Crid: One reason it's so fucking expensive is that people don't buy it, so those of us who do have to cover the cost for everyone. Seriously, this is elementary citizenship. You gotta be ready.

And if you do get in an accident, the rest of us are going to pay. I think that's really shitty of you...don't you?

With HMO coverage, I'd have to get a physical every month to break even.

It's not about breaking even. It's about paying your way when something does happen -- and then, paying for people like you who don't have health insurance. I have an HMO because something catastrophic could happen to me, and if it does, I don't want my family to be put in the position where they'd have to mortgage their house, etc., to save my life. Or have other taxpayers pick up the tab. That's premeditated theft.

Posted by: Amy Alkon at February 19, 2007 8:08 AM

This loon isn't exercising "health care lotto" so much as "malpractice lotto".

The litigous nature of "medicine" is out of control in this country. They don't have these kinds of problems in western Europe—lunatics aren't permitted to file lawsuits of this nature.

I've posted here numerous times about my disgust for the nature of "health care" in this country, so I won't bore you with it again.

Posted by: Deirdre B. at February 19, 2007 8:14 AM

My mom's health insurance costs 15k a year. Now granted, she has the premium plan so she doesn't have to remember to bring money when she goes to the doc. But my Dad figures he's getting a good deal since she's got major health issues stemming from a car accident 20 years ago that resulted in a recent stroke. (And she's only 56) I don't even want to consider how much her two month hospital stay after her stroke would have cost, plus all the therapy, and the three different doctors she was seeing. And she just had more surgery so she could walk without pain.

Major health problems don't come and then just go away. When you have a serious accident like hers the costs last the rest of your life. And it can be hard to get insurance when you already have existing medical problems. Sure, it is another expense, but by staying insured at least you'll be covered before and AFTER any major event. (Though you may have to pay more)

I personally will never go a day without health insurance if I can help it. The way my family's luck runs it would be the day I had a major heart attack and broke my leg.

Posted by: Shinobi at February 19, 2007 8:27 AM

I want to know who Ehrenreich's "Chicana girlfriend" is. I want County USC to know her name, too, so they can send her a bill. Maybe she is paying something -- but if she is, it's probably still subsidized by the rest of us...and at the expense of people who really needed urgent-care. Anybody know her name?

I suspect Ehrenreich knew that what he was doing -- premeditated emergency room use for a non-emergency -- was a form of theft, and didn't reveal her name for that reason.

Come on, she was in New Mexico, then...peripatetic, poetic and chic...came back to Los Angeles for medical treatment? What was she doing in New Mexico, working in the fields? I doubt that. Did Ehrenreich drive her back in some beaten-down old station wagon, with her moaning all the way, or did she take a plane?

And what's with the "Chicana" reference? Who calls people "Chicana"? Oh, hurl.

Posted by: Amy Alkon at February 19, 2007 8:28 AM

Dude, it's not an "off chance"... It's coming. I feel bad, but it's going to happen to you. We feel bad for everyone else, too.

Yep. Especially the older you get, the more likely the machine (you) starts to need some work. I turn 50 next month, and the doctor visits are becoming more frequent. Due to melanoma in my family, I now go to the dermatologist twice a year, which usually results in some "spot removals" that have to be biopsied (so far, so good). Last year during a routine physical my primary doc felt a lump in my thyroid which resulted in a thyroidectomy, and the pathology determined that I had a small thyroid cancer (interestingly, not in the lump that was palpable) so now I'm going to have to go back into the hospital next month for two days for radioactive iodine treatment. Not to mention the medical care for my son (who has two very expensive medications he takes for seizures...even with the insurance we pay $130/mo), and we probably would have paid about $150K last year out-of-pocket for medical care without insurance.

The problem though, with self-insuring, is that it can sometimes be tough to get insurance. If you don't live in an area that has Kaiser, you might be out of luck as fewer and fewer doctors are participating in HMO plans. There was an article in the LA Times a few weeks ago (which I'm now having trouble finding to link to) about people being turned down for coverage from Blue Cross and other health insurance companies for "pre-existing conditions" such as childhood asthma.

Posted by: deja pseu at February 19, 2007 8:37 AM

Deja, so sorry to hear about the thyroid cancer and the need for treatment. I hope it isn't too terrible to go through.

Posted by: Amy Alkon at February 19, 2007 8:41 AM

Amy - How do you figure you're gonna pay for my care? The government doesn't automatically pay for all uninsureds. You have to actually apply for that stuff. I've got good credit, I can go into debt for it. I've always been amazed that people will go $50,000 in debt for an Escalade, but not to fix a broken leg.

In MA, they passed a law requiring everyone to purchase health insurance. This is nothing more than a tax on youth. Single young men with good health are being told to forfeit thousands of dollars a year to underwrite the bad health choices of other people.

Crid - Off Chance is precisely that. The likelihood of something happening to me is minimal. I don't go to the doctor all that often, and the last time I went (last year) for a sinus infection he yelled at me for not having been in for a physical in the past 17 years. I don't see a need to give him $200 to tell me what I already know - there's nothing wrong with me.

But there are people with employer-provided HMO coverage that go to the doctor every year (sometimes more than once) just to be told that they are fine. And for that, my insurance that I never use costs just as much as theirs.

Thank you, no.

Posted by: brian at February 19, 2007 8:48 AM

Silliness. You don't go to the doctor until the day you do. And on that day, your creditors are not going to want to know that you thought it would be "cheaper to just go into debt for the whole bag," as if the value came from somewhere other than their wallets.

Posted by: Crid at February 19, 2007 8:56 AM

"I don't have insurance because I cannot justify giving some company $300 a month on the off chance that something happens to me."

"But, you can justify the chance that the rest of us will have to pay thousands upon thousands for your care?"

This is somewhat of a "false dilemma". The estate of the injured can be attached for recovery of medical expenses, and you'd have to show that the injury suffered on his part was beyond his ability to pay. In short, you are comparing coverage for the average malady to the occurrence of the greatest calamity.

Paying more than 8 bucks a day for your health care insurance should be a call to examine where the money goes. Defending yourself against that cost is not a matter of denying other people any risks - which is the logical extension of a system people somehow believe is a solution.

Think of it this way. You know health insurance is not a magic bullet against anything. Like other insurance (theoretically), it is a money pool the many pay into so that the few who are ill can be treated. There are huge expenses in the administration, and then in the administration of terminal and non-responsive cases, where treatment options start to include "quality of life" arguments. Terri Schiavo cost a lot of other people because of political grandstanding. This will not change if health care is nationalized. All that will happen then is that a Federal agency will be standing in line for payment, along with all those others who magically appear on your medical bills today.

I see a market here, for the Medical VISA® Card. People are accustomed to paying credit card bills. You would have a credit limit of $15K, and beyond that, sir, well, you have to stand in line down there at the neighborhood clinic...

Even if there were no changes in treatment delays or practices, the presence of a credit-card bill would knock most of the "somebody else is paying, I'll have the works, please" mentality.

Think of it. Rather than lengthy paperwork between you and an insurance provider and between the doctor, the hospital, the labs(s) and the insurance company, you talk to the doctor, and you pay her.

That'll never work.

Posted by: Radwaste at February 19, 2007 9:00 AM

Rad - by staying out of the insurance system, that's what I do now. Fee for service. Whoda thunk it?

And you miss the point of nationalized health coverage, which is to create a larger dependent underclass at the expense of the productive classes.

Whenever someone expresses how much better things would be if only we had government-managed single-payer insurance, I have only three words for them: Department of Motor Vehicles.

Posted by: brian at February 19, 2007 9:21 AM

Deja, so sorry to hear about the thyroid cancer and the need for treatment. I hope it isn't too terrible to go through.

Thanks Amy, the treatment itself is just more inconvenient than anything. Two days in isolation in the hospital, and limited contact with other living things for a couple of days after I get home. But no pain, no nausea or anything like that. It's the two weeks of prep that's going to be icky. I have to go off my thyroid hormone and maintain an extremely restricted iodine-free diet (no dairy...AT ALL...aarrrggghh!). But, it's a one time shot and I'm done, and it ain't chemo, thank goodness. According to my doc, if you have to get cancer this is the one to get, as it's extremely curable.

Posted by: deja pseu at February 19, 2007 9:28 AM

underwrite the bad health choices of other people.

News flash...even people who make "good" health choices get sick, sometimes seriously or are involved in life-threatening accidents. This is one of those arguments that just drives me up the wall. Sure there are steps you can take to reduce the odds, but it's not as much in your control as you think it is.

Posted by: deja pseu at February 19, 2007 9:38 AM

> (no dairy...AT ALL...aarrrggghh!)

Fuggit Lord, just take me now.

> it's not as much in your control
> as you think it is.

Pinsky talks about this on the radio: Strapping young bucks and withered old men both complain in his office: "But I've never been sick before!" His reply: "Now, you're sick."


Posted by: Crid at February 19, 2007 9:45 AM

Fuggit Lord, just take me now.

Heh, that was pretty much my reaction when I read the booklet. But I figure I'll make up for it plenty on our trip to Paris in May....

Posted by: deja pseu at February 19, 2007 9:51 AM

Yeah - you're lucky it isn't chemo. Glad for you it's not.

As for people saying they're too healthy for health insurance -- see Crid's Pinsky comment above.

Posted by: Amy Alkon at February 19, 2007 10:03 AM

Because of all of you, I'm now getting health insurance.

Posted by: PurplePen at February 19, 2007 10:05 AM

BTW DB, heartfelt boredom is what we're here for... Let 'er rip.

Posted by: Crid at February 19, 2007 10:09 AM

Yay, Purple.

Check out Kaiser if it's where you are. It's what I found to be the most cost-effective comprehensive care. I don't love it, but I found a very good primary care physician, which makes all the difference. (I searched doctor reviews on the Internet, then requested the doctor nearest me with some pretty stellar reviews.) I can even e-mail her with problems, which can save an unnecessary appointment, or after my appointment, with questions.

Posted by: Amy Alkon at February 19, 2007 10:23 AM

Thanks Amy, will check out my options. Your story on doctor reviews reminded me that one time I had to go to a poor mans clinic in a bad part of town. The doctor told me I prolly had some sort of throat infection and pumped me with antibiotics. Didnt cure anything. So when I had the money I went to a rich mans clinic and in 5 min the doctor said "Oh you have allergies". Patched me right up. Been with that doc eversince. As an adult I now realize the allergy symptoms were obvious but me mum was uneducated in those regards. On a side note im a hispanic woman and we never refer to ourselves as chicanas want to get to get looked down upon or laughed at by mexican immigrants.

Posted by: PurplePen at February 19, 2007 11:20 AM

It's all very nice to brag about how responsible and self-supporting you have been all your life, but consider the case of somebody who loses his job benefits because he loses his job. About a third of all such people will be denied the opportunity to buy insurance at any price, due to any of dozens and dozens of preexisting conditions. This has nothing to do with virtue or responsibility, and everything to do with luck, genetics, and age. I'm fine with a system that taxes people for minimal coverage, provided that it actually makes that coverage possible. The system right now is the worst of all worlds.

Posted by: Fred at February 19, 2007 11:30 AM

When you lose your benefits, you can go on Cobra and start paying as I do for your health care. Your health care doesn't end -- your boss isn't just picking up the cost of it anymore.

I don't think health care should come with employment. The president, thankfully, has taken some of the tax unfairness out of that for people like me who buy their own health insurance.

Posted by: Amy Alkon at February 19, 2007 12:14 PM

Some people. The few times my wife and I have had to go to the emergency room, we've usually been shuffled to near the end of the line. It's called triage. The two times we rated higher then many others were my appendicitis attack, and the food poisoning I suffered through in Chicago.

As for the "organ donor" riding the motorcycle, it's definitely the over-lawyering more then the motorcycle. One only need look at all the various self-mutilating stupidity people do, and sue for, to know it's not motorcycle riders in general that are to blame. Spill hot coffee on your lap, sue. Take a look at any power tool, and the various warnings, and you just have to shake your head wonder what idiot caused the warning to be there in the first place.

Posted by: Keith_Indy at February 19, 2007 12:14 PM

Yeah, back when I had just gotten out of school and was working for something less than peanuts -- and uninsured -- I started getting panic attacks out of the blue. The first few times I thought it was a heart attack, and so I ended up in the emergency room. After tests, the bill eventually came to about 2k. I was in Riverside County at the time, and qualified for their indigent health program, which would've taken care of the bill, but ended paying out of pocket to maintain some sort of libertarian sense of honor. Got Kaiser after that, and kept them for years. They were very good, by my experience. Plus, they own their own toys so they'll give you that echocardiogram just for kicks.

Posted by: Paul Hrissikopoulos at February 19, 2007 1:25 PM

you can go on Cobra

It's my understanding though that there's an 18 month limit on COBRA. You can't just keep it indefinitely.

Posted by: deja pseu at February 19, 2007 1:48 PM

Accenture has temporary health insurance for people between jobs as well, I skipped Cobra, too much paperwork.

Posted by: Shinobi at February 19, 2007 2:05 PM

After Cobra runs out, you pay in full yourself - which is how it should be in general. Workplace health insurance (which sucks more for a family of five than a single person) is financially unequitable -- especially to those who are self-employeed...although, as I mention, that's changing, thanks to the president.

Posted by: Amy Alkon at February 19, 2007 3:33 PM

The existing problem has been forty years in the making. Between government, the insurance companies, and the for-profit medical business, all heavily populated with lawyers, we now have a paradigm with major flaws. Not the least of which is spending vast sums on people at the end of their lives.

I was born in a hospital that was a charitable foundation, as were most before the government got involved. Now it's impossible to find such an animal. Count the doctors you know who no longer practice because the business of medicine has killed their love for it. It's all a big disfunctional mess. Thank your congressman.

Posted by: Casca at February 19, 2007 3:41 PM

It would be very educational to research what other countries have tried and what the results have been. There is no perfect solution, every system is open to abuse.

When you do have government paid health insurance, everybody gets the cheapest possible option, and if you want something better, you have to argue and fight for it. It seems that if you get for-profit health insurance, they disquailify you for anything expensive or for any pre-existing condition.

Posted by: Chris at February 19, 2007 3:47 PM

"When you do have government paid health insurance, everybody gets the cheapest possible option, and if you want something better, you have to argue and fight for it. It seems that if you get for-profit health insurance, they disquailify you for anything expensive or for any pre-existing condition."

So, you could whip out your medical VISA® card and pay your own way. Simple for doctors to collect, and returns billing issues to the purchaser, where it belongs.

The hardest thing to keep in mind is that extremely expensive things happen routinely for which no closure can be obtained. A co-worker had twins which spent two months in intensive care. There was no clue in family history that this would happen. The costs are real.

There are a lot of times we are tempted to disregard really difficult choices, but just as it is with "safety" - actually an abstract concept - we have to notice what the financial picture is with individual as well as industry issues. Until that happens, nobody's going to solve this.

Posted by: Radwaste at February 19, 2007 4:27 PM

After Cobra runs out, you pay in full yourself

Actually, with COBRA you do pay the full premium. Once COBRA runs out, you usually do not have the option to continue on the same insurance plan. Better hope you don't have any "pre-existing conditions" that can get you turned down for insurance. From what I've read, this is becoming more of a problem for those seeking to get individual insurance.

Posted by: deja pseu at February 19, 2007 4:32 PM

Cobra works close to what you describe, but with a HUGE catch. An insurance company does in fact have to continue your coverage, but Cobra rates tend to start high and only get higher because after those 18 months the company has the right to reassess your rates based on little things such as medical history. If you have the misfortune of having been diagnosed with cancer as I was (despite good eating and exercise habits my entire life), you are for all intents and purposes uninsurable if you lose your job -- unless you can afford $1200 or more a month for coverage once Cobra runs out. I'm now self-employed and essentially work to pay for medical coverage and not very good coverage at that. The year I was the sickest, including monthly premiums, co-pays, deductibles, I spent about $20,000 on health care because the latest treatments are either considered experimental (mostly a way for insurers to avoid paying) or the best drugs are too new to have generics (and so the insurer doesn't pay but a pittance). I don't know what the answer is. I do know that when you're hoarding half of the eight little name-brand pills that keep you from wanting to die after chemo so you can avoid the $200 co-pay on the next round (that's right, $200 for EIGHT pills), you know something in the system needs fixing.

Posted by: AAA at February 19, 2007 4:39 PM

Some states have their own medical insurance plans for residents considered 'high risk' and cannot get coverage from regular insurance companies.

Posted by: Joe at February 19, 2007 4:50 PM

> they'll give you that echocardiogram
> just for kicks.

We've heard of worse ways to anchor a weekend in Riverside.

Posted by: Crid at February 19, 2007 5:13 PM

OK, this is scary. Amy and I are agreeing that the one and only conservative thing the GWB has done in his entire presidency is good.

Take away the tax incentive for everyone to get the catch-all programs, and perhaps my ideal program will come available. There's ones out there now that are close, and I almost bit. but somewhere between $60/mo with a 20% coinsure and no preventative coverage, and $100 a month with no coinsure and preventative coverage, is what I want.

Why that shouldn't be doable for $80 is beyond me. Unless it's because the market isn't quite there yet.

Make it financially unpalatable for companies to do health insurance as a pre-tax bennie, and I think a lot of healthy young men will opt for the same coverage I want - cover the stupid shit that nobody plans for, and let me deal with the preventative care.

Posted by: brian at February 19, 2007 6:42 PM

Sorry Amy, but not everybody is a perfect specimen in excellent health, even at the young age of 40. After your 18 months of Cobra, you are on your own. Kaiser can agree to continue you or not as it sees fit, or raise your premium to $1100 a month, or just refuse you entirely. California does have a very expensive, low benefit option that you can get on by putting your name on a waiting list. Under the current system, you might conceivably find yourself without insurance, get into an auto accident, and find yourself with a couple of hundred thousand dollars in bills.

I'm fine with the idea that people should be responsible by providing for their own medical expenses by paying a reasonable monthly premium. Where your argument falls down is in the assumption that any such thing exists for everyone who would like to take advantage of it. There are some people who are effectively uninsurable under the current system of non-group policy underwriting. The Los Angeles Times ran an article pointing out that about a third of applicants get turned down entirely.

Posted by: Fred at February 19, 2007 11:54 PM

Why am I still awake? Must be the six chocolate chip cookies I ate. Anyway, I could be wrong here, but I am under the impression that if you have had no gap in coverage here in California, you must be offered coverage.

As for plans for an adult male at 80/month... That'll be the day. I am a healthy, non-smoking, no family history of ANY kind of illness, girl in my 20's with no plans to reproduce and crazy vigilent reproductive habits, and I can't get coverage that's any good for less than $150/month. Currently, I have a 'save-your-ass' plan that gets me nearly a 70 percent discount on care, so that if I do need it, I won't be completely buried in debt. But the second I hit 35, I'm going straight for the full ride coverage. 2 months before my stepdad got cancer at the age of 46, I told them they should have more complete coverage 'just in case'. Now, over 50k in debt with medical bills, they're kicking themselves. I think people have an exceptionally naïve notion of their own invincibility. Everybody ages, and when something nasty sneaks up on you and you CAN'T get insurance, it won't be just the one time you'll be paying for it. It will be years and years (maybe for the rest of your life even) of medical bills that could make you lose your home and any hope of retirement.

Posted by: christina at February 20, 2007 1:02 AM

I just looked up a Kaiser quote -- and for a person 20-24, it's as low as $58 a month for a high deductible health savings acccount plan:

Plan Features (Mouseover for details)
Deductible: $2,700 / Individual or $5,450 / family
Annual Out-of-Pocket Maximum:
$5,250 per individual, $10,500 for family
Prescription Drugs: $10 Generic / $30 Brand Name
Non-Preventive Care Office Visits: $30 After Deductible

Now, I don't know about pre-existing conditions, but make a big difference by getting into Kaiser in your 20s, rather than applying first in your 40s, Fred.

Try your cost here. I could take my own coverage, at 42, down to $202 with a $50 copayment plan instead of my current $25 plan.

Posted by: Amy Alkon at February 20, 2007 4:05 AM


As for plans for an adult male at 80/month... That'll be the day. I am a healthy, non-smoking, no family history of ANY kind of illness, girl in my 20's with no plans to reproduce and crazy vigilent reproductive habits, and I can't get coverage that's any good for less than $150/month.

Christina - the reason I should be able to buy insurance for half what you do is, quite bluntly obvious: you have a vagina, and all the extra maintenance that goes along with it. I don't care how "vigilant" you are with your reproductive habits, you have an infinitely higher risk of pregnancy than I do. You've also got all kinds of other maintenance issues that I as a man just don't have. And I see no reason why I should be forced to pay more to underwrite the upkeep on a vagina I don't get any benefit from.

Amy - HSAs have a hidden expense that's not in the bottom line price - the amount you have to put into the HSA. Which drives the monthly amount back up to HMO territory. I don't need "Health Maintenance", I need "Oh, Shit!" care.

Insurance is a bet, in this case, I bet some company that I won't get sick. What we have now is not a bet, it is a cost aggregation and spreading scheme. And those only work when they are not voluntary. And that is the reason why there is no momentum to take away the employer-based tax incentives to offer HMO-style coverage to all employees.

Because the moment you make it easy for people like me to opt out of the HMO system is the moment life gets much more expensive for all you vagina owners. Sorry to be that blunt about it, but there it is.

Posted by: brian at February 20, 2007 5:06 AM

If you go to the link, there are very affordable plans without HSAs. Even "Oh, Shit!" care.

Vagina owners?

Heard of prostate cancer and a host of other ills that are non-sex-specific?

Posted by: Amy Alkon at February 20, 2007 5:12 AM

Amy - I've already looked at what's available in my state. For my money, paying 70 bucks a month for something that is only going to offset 80% of what the insurance company thinks a service ought to cost is more of a gamble than just paying my own way.

Given that there is no family history of either heart disease or cancer, I'm not worried about my odds there. And if I were to get prostate cancer? Big deal. I die.

Posted by: brian at February 20, 2007 5:44 AM

And if I were to get prostate cancer?

The rest of us end up paying for you. And that is a big deal to me, and should be to you.

Don't be complaining about taxes and/or calling yourself a conservative and then expect the rest of us to pick up the cost of your medical care. You don't plan on offing yourself if you get sick, do you?

Posted by: Amy Alkon at February 20, 2007 5:51 AM

Amy -

You keep coming back to The rest of us end up paying for you. And that is a big deal to me, and should be to you.


How do you end up paying for me? I die, my parents and/or brothers sell off my assets and put me in the ground.

The hospitals aren't going to treat me if I don't show up. And if I do show up, I pay cash.

Why is that so hard to understand?

Posted by: brian at February 20, 2007 6:23 AM

If you have "assets," you can afford insurance.

Posted by: Crid at February 20, 2007 6:30 AM

Crid - how do you think I got the assets? By not spending $300 a month on insurance!

Whether you agree with it or not, by not having insurance sine I went into business for myself (6 years ago) I've saved, what, 21,600 dollars?

Which is a hell of a gamble, but it's paid off. How much better off would I be if instead of paying for health insurance for eight years at my previous job I'd pocketed the money instead?

Posted by: brian at February 20, 2007 6:40 AM

If you're injured in a car accident, nobody's going to check to see if you have insurance and then leave you lying bleeding if you don't. Do you really think your family will sell off your house to pay your medical costs, or let the rest of us pay your medical costs, and sell your house when you die and keep the money?

Posted by: Amy Alkon at February 20, 2007 6:42 AM

Actually, my family won't get a say in the matter. I die, my assets go to probate.

If I go to the hospital and they fix me, just because I don't have insurance doesn't mean they write it off. There's this thing called "debt". My brother hurt his hand, and got put back together. Paid it off over time.

You've created a false choice - insurance or burden. It is possible to self-insure. It just happens to be imprudent for people who have things that tend to break a lot like children.

Posted by: brian at February 20, 2007 6:56 AM

That's like saying, in 2007, that Intel was a good investment in 1980. It's a little late for anyone to be impressed by your keen eye. I

Posted by: Crid at February 20, 2007 7:41 AM

NY continues to mandate that none of these low cost plans that insure against catastrophic illness are available here.

My wife, daughter, and I are insured under her and my plans. We also have a Healthcare Reimbursement Account. The paperwork to coordinate benefits and actually get the bills paid is a real pain. I'm going to drop the HCRA and just keep the money. I'm tired of fighting Aetna for my money and the tax savings, honestly, doesn't come close to making up for the aggravation.

Posted by: markD at February 20, 2007 8:16 AM

Hi - I am a transplanted American now living in a country with hybrid socialized/private health care (Israel). This is the result of Israel's concerted plan to open up this area to competition while insuring that everyone has basic coverage.

This means that (virtually) everyone is covered by several large HMO-like orgnanizations for a basic basket of healthcare services, underwritten by the government.

Additional coverage is available for more exotic/expensive things - for a monthly premium.

And doctors and clinics (including those HMO-like behemoths) are promoting a lot of cutting-edge stuff on a private basis, which introduces competition into the system (and introduces good, modern medical advances into the market, too - and gives doctors incentive to become expert). So for example laser eye surgery for vision correction is widely available, for a reasonable fee.

And to contain costs, you now have to pay SOMETHING out of pocket to the doctor each time
you visit, and SOMETHING for perscriptions. But it's subsidized and nowhere near the real cost.

At every turn, the government tried to split the income stream between partial subsidy and what-the-market-will bear.

And it seems to be working very well - nothing like British or Canadian medicine, with its long waiting lists for relatively common procedures. Despite some grumbling and the annual media circus when experimental but unproven treatments and drugs are not included in updated basket of basic coverage.

I am a small-government Reagan-conservative booster of free-market reforms here in Israel - you're asking for trouble if you talk to me about having a "right" to health care - but the American system where people can't get basic coverage if they lose their jobs is inhumane and outrageous. And as some have pointed out, voluntary insurance just doesn't work in this case.

It's possible for government to get managed health care right. It's possible to guarantee universal basic coverage while putting a whole lot of free-market goodness into the sytem.

Kinda like replacing government-administered Social Security with mandatory investment in private retirement instruments (which is another idea now taking hold in Israel, although it started elsewhere).

Posted by: Ben-David at February 20, 2007 10:03 AM

I hate how hard you have to fight for good medical care when using a HMO. I understand the cost analysis part of it, I'm not paying premium so I'm not going to get premium, but I had to wait 9 months to get 2 tumors taken out when I was 19. By the time they were removed I could barely walk because of pain and the tumors had grown very large (one the size of a cantaloupe, the other the size of a golf ball).

On the other hand, I still remember the panic I had when I didn't have insurance and cut my wrist on a piece of glass while doing the dishes. My first thoughts weren't about my safety, but about there was no way I could afford this and was there anyway I could patch myself up by myself. Luckily I was able to do ok since no major artery was cut. I've always had health insurance since then.

As another warning to you who don't have health insurance, I've had a friend join the navy just to get the signing bonus to pay off her medical bills. She got a cold and it didn't go away. Can you imagine in this day and age winding up in the hospital because of a cold when you're in general young and healthy? Well it happens. It became an infection that required three days of IVed antibiotics. So, she joined the navy, for probably one of the worst reasons aside from getting back at your parents.

What am I saying? Insurance is expensive and clunky, it needs to be reworked, but it's what we have and it's way better than having nothing. I do think that it would be nice to have a cheap, widely available “oh shit” coverage. You’re getting headaches all the time, or you’re having dizzy spells? You pay for the doctor and tests. Your house explodes and you have burns over a lot of your body? Oh shit insurance. No one wants themselves or their family to make major medical decisions based off of what they can pay for out of pocket.

Posted by: Stacy at February 20, 2007 10:04 AM

Even if it were true that my vagina makes me higher risk, despite testicles and prostates and all those ugly parts that tend to get ill too, you ride a motorcycle, Brian. You ride a motorcycle without a damned helmet, while under the influence of testosterone. Just being male puts you at greater risk of accident according to the car insurance people, and I think that would transfer into health insurance if it were calculated
like that.

Also, you don't take into account what might happen were you not able to make your own decisions, a la Schivo. Would your family really sell your assets rather than take advantage of the 'free' money?

How can anyone really say that they'd go home to die if they got cancer? I bet things look a little different from the other end of the barrel.

Posted by: christina at February 20, 2007 10:07 AM

Also, I'm not quite sure what vaginas you've been running with, but mine only requires a looksee under the hood once a year, just like your bits are supposed to get. Btw, who pays for your yearly std testing?

Posted by: christina at February 20, 2007 10:18 AM

Same with mine, Christina. Not a problem vagina! Those of us with health insurance GET yearly STD testing -- and pap smears. Imagine how dumb it is to not have preventive care -- which Kaiser, in some studies I came upon this morning, found to be much cheaper than waiting until disaster strikes -- and then to find out way too late that you have cervical cancer.

Posted by: Amy Alkon at February 20, 2007 11:16 AM

Christina -

What STD testing?

Did you miss the part where my doctor yelled at me for not getting a physical for the last 17 years? And the only reason I went for that is they wouldn't let me into college without it.

Posted by: brian at February 20, 2007 2:10 PM

No, I did not miss that part. I was just hoping your invincibility complex did not extend to social diseases that could wreck someone else's life as well as your own.

Unless of course you have been utterly celibate, in which case, I'm very sorry for bringing up such a depressing topic.

Posted by: Christina at February 20, 2007 2:31 PM

Christina - I can say with absolute certainty that I have no STDs. And no children.

Why you would think it a depressing topic is beyond me. It's not like I have any control over who's attracted to me.

And why would you need a yearly STD test, unless you are promiscuous, or you suspect your partner of being such?

Posted by: brian at February 20, 2007 2:57 PM

I have no children...none that I know of.

Posted by: Amy Alkon at February 20, 2007 4:11 PM

Hey Amy - I just heard that your beloved Rose Cafe is banning strollers, which is sure to keep moms who don't want to park their $800 Bugaboos outside away.

Posted by: AAA at February 20, 2007 4:26 PM

Really? Who'd you hear this from? And who'd they hear it from?

Posted by: Amy Alkon at February 20, 2007 4:38 PM

It's a hot topic of conversation on a West Side mom's board I belong to. Apparently the cafe owner told the original poster. Don't get too excited, though. They're not banning the babies themselves, just their mode of transportation. I guess the strollers were getting in the wait staff's way or maybe it has something to do with fire codes. I'm a mom but I'm all for it. I used to put my girl in a sling and she'd sleep the entire meal away.

Posted by: AAA at February 20, 2007 5:38 PM

Got a link?

Posted by: Amy Alkon at February 20, 2007 6:24 PM

It's a private board; you have to join via the founder to gain access and it takes a couple days. But no one's outraged or anything. More disappointed.

Posted by: AAA at February 20, 2007 6:26 PM

Can you post a quote from the board, or does that violate their rules?

Posted by: Amy Alkon at February 20, 2007 6:54 PM

On the vagina cost thing: yes, pregnancies are a medical expense not directly borne by men. But, on the flip side, men take worse care of themselves and take more risks than women do, on average. Far more. Given that most American women who do have children only have one or two these days, and given that men are more likely to get heart disease (still the #1 killer) and less likely to get preventative care for a whole host of me, men aren't incredibly cheap to insure compared to women.

I personally have a few chronic health conditions - nothing that qualifies as a disability, or that you'd be able to tell looking at me, but they still would likely be excluded if I ever went without insurance. I've paid Cobra - I didn't like it, but I did it. In return, my migraine meds are covered, thank Freya.

For those saying they don't want to pay for health insurance because they're healthy...well, you're a part of the vicious cycle that keeps costs high. Probably the best insurance I have had, or that I will ever have, was at a previous job where almost all of the (large) workforce was young or young-ish; the company itself was fairly young, and the types of jobs it had tended to skew younger, with not a lot of 60somethings. Insurance there covered EVERYTHING...well, not LASIK, but everything else, including infertility treatments. Were they insane? Nope, they had a healthy enough risk pool that they could offer special benefits that would be enough to attract, and keep, certain workers who would otherwise go elsewhere, but who wouldn't necessarily end up using the benefits in full.

"I do think that it would be nice to have a cheap, widely available “oh shit” coverage. You’re getting headaches all the time, or you’re having dizzy spells? You pay for the doctor and tests. Your house explodes and you have burns over a lot of your body? Oh shit insurance."

In other words, you'd like the option of having health insurance work like car insurance? I am ALL for that. What we have now is the equivalent of getting oil changes for $1 and transmission flushes for $30, but being mostly or totally on the hook for major crash damage or replacing totaled vehicles. Not good.

Posted by: marion at February 20, 2007 7:28 PM

If you're signing up for Kaiser, a pregnancy currently in progress is considering a pre-existing condition, rendering you temporarily ineligible.

I will have no children.

And my health insurance, with a pretty good HMO, is for both preventive and catastrophic care.

Posted by: Amy Alkon at February 20, 2007 8:10 PM

Marion - you nailed it. It's the $1 oil changes that drive the costs through the roof. If preventive care is as inexpensive as Amy points out (and I can tell you that a physical is about $200, which is cheap for a once-a-year cost) then there's really no need to wrap that up in a blanket policy.

Posted by: brian at February 20, 2007 8:11 PM

Again, you don't know when something catastrophic is going to happen to you -- for example, a terrible car accident or other accident with serious complications.

Posted by: Amy Alkon at February 20, 2007 8:15 PM

I wrote a big comment, but it was eaten by cyberspace. Here's a condensed version:
Std's happen to everyone. According to the CDC, 1 in 5 have herpes. According to Planned Parenthood, 1 of 4 people currently have an std. Many people don't know they have anything. Condoms break, tear, and most of all, don't cover all your bits and pieces. There is no such thing as safe sex.

Aside from all that,
I find the idea of being celibate extremely depressing.

Posted by: christina at February 20, 2007 8:21 PM

I looked in the junk folder and it wasn't there. I'm sorry cyberspace at it, but at least it wasn't my software!

Posted by: Amy Alkon at February 20, 2007 8:48 PM

Christina - what you find depressing I find an acceptable risk management strategy.

There is no way anyone can reasonably accuse me of paternity, I have no STDs (and no risk of them either) and therefore have no need of enhanced medical care to deal with them. I am at zero risk of losing all my stuff in a divorce, all the acrimony that goes with intimate relations never occurs in my life. And by refusing to even initiate anything with members of the opposite sex, false accusations of rape are not plausible.

That's an awful lot of bad stuff I never have to contend with.

Posted by: brian at February 20, 2007 9:01 PM

Hey, no issues with that here. You do what works for you and since that happens to coincide with not spreading disease, I'm happy about it. That wasn't exactly clear in your previous posts, but I guess that means I didn't need to whip out my handy-dandy statistics. I find it interesting.

But you still may have an accident, get a serious illness, etc., especially riding a motorcycle.

Posted by: Christina at February 20, 2007 10:29 PM

And by refusing to even initiate anything with members of the opposite sex, false accusations of rape are not plausible.

If you also refuse to leave the house, you'll never be hit by a car (unless one crashes through your living room).

Posted by: Amy Alkon at February 21, 2007 7:52 AM

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