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Dutch Treat(ment)
The health care plan I've been proposing is the one where health insurance is untied from employment, where everyone buys their own, and where everyone has to buy insurance of some kind, just as we do for driving cars.

In other words, you don't get to say, "Oh, fuck it. If I get in an accident somebody else -- or the state -- will pick up the tab." But, that's essentially what people a good many people who don't have health insurance have been saying.

I'm still wondering if the girlfriend Ben Ehrenreich wrote about, Ofelia Cuevas (another photo here, the girl with the long hair who's standing, according to a caption), had to pay anything for the "emergency" care she got (after they apparently hospital-shopped) and she came back from New Mexico and got in line behind the gunshot victims at county USC -- or if the rest of us picked up the tab. If we did...doesn't it seem right that she would pay us back? I mean, what ethical person would want to suck off of other people instead of paying their own way?

Here's the story, from a previous blog item, "Playing Health Care Like Lotto":

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?

This sort of thing would no longer happen if the U.S. opted a plan like that in The Netherlands. From an article in the W$J, Gautam Naik writes:

The Dutch system features two key rules: All adults must buy insurance, and all insurers must offer a policy to anyone who applies, no matter how old or how sick. Those who can't afford to pay the premiums get help from the state, financed by taxes on the well-off.

The system hinges on competition among insurers. They are expected to cut premiums, persuade consumers to live healthier lives, and push hospitals to provide better and lower-cost care.

Some are already taking unusual steps. The insurance company Menzis has opened three of its own primary-care centers to serve the patients it insures, and plans to open dozens more in a move to lower costs. Rival UVIT offers discount vouchers to customers who buy low-cholesterol versions of yogurt, butter and milk.

To prevent insurers from seeking only young, healthy customers, the government compensates insurers for taking on higher-risk patients. Insurers get a "risk-equalization" payment for covering the elderly and those with certain conditions such as diabetes.

Results have been good:

Since a new system took effect here last year, cost growth is projected to fall this year to about 3% after inflation from 4.5% in 2006. Waiting lists are shrinking, and private health insurers are coming up with innovative ways to care for the sick.

Oh, P.S. Where the Ben/Ofelia thing really got fun is over on mere Ehrenreich's blog, where I didn't quite fit in with the socialists in the comments section. Here's one of my comments (the italicized part is my copy-in of a previous commenter's remark):

I believe he said the girl friend didn't have either the money or the insurance (several thousand dollars?) to cover the medical care involved. Not much of a mystery there.

Why didn't they? Even at my most struggling as a freelance writer, when I was so down and out I was forced to take a job for $5/hr for an all-girl moving company, and when I couldn't afford a bed (I slept in a sleeping bag on a door propped up on two milk crates) I had health insurance. Why? Because I would be horrified at the thought that somebody else would have to pay for me. A pity more people don't feel that way.

An HMO or high-deductible health insurance can be had for not a terrible amount of money. In my 20s, I paid $100-something a month -- maybe $130? -- for Kaiser Permanente HMO. At 42, it costs me $258.

If you're dirt poor, that's one thing. If you decide to gamble the money you could be paying for health insurance on, say, new shoes...well, that's another thing entirely.

Ms. Ehrenreich, as long as you're "blowing the whistle on medical larceny," how about blowing the whistle on those who use the emergency room for apparent non-emergencies and use the rest of us to fund their health care instead of paying for it themselves?

Posted by: Amy Alkon | February 19, 2007 at 02:56 AM

Here's another:

I didn't "introduce the problem," Ben Ehrenreich did by doing an op-ed in the LA Times about it. Furthermore, his premeditated attempt to get non-emergency care at the overburdened county USC emergency room is disgusting. According to his op-ed, her circumstances: "She was between jobs and between health insurance plans."

Again, when I was "between jobs," I didn't gamble that I wouldn't have a medical condition, nor did I expect others to pay my way. I worked really bad jobs out of a sense of personal reasponsibility and paid my health insurance, as I do now. See the bit about my $5/hr job as a mover above.

"We couldn't afford the thousands of dollars the surgery would have cost at a private hospital." Translation: "We'd rather not pay the price of her gamble that she could go without paying for health insurance, so we're going to sneakily make other taxpayers pay instead by going to an emergency room for trauma patients with a pre-existing condition."

I'm guessing Ehrenreich didn't mention the girl's name in the paper because he doesn't want them to send her a bill, which they should. How is what they did not theft?

What's most disgusting is that his own mother apparently thinks nothing of this. The day I brag to my parents that I've gotten my significant other free medical care "on the dole"...well, I'd be hearing about it for decades, and not approvingly.

Posted by: Amy Alkon | February 19, 2007 at 07:53 AM

And another:

"You've got the money, you just chose to spend it on something else."

Exactly. Kaiser Permanente is very affordable.

Many people just choose to gamble, then expect others to pay for them. Like you, my health insurance is what I've always paid first.

Posted by: Amy Alkon | February 20, 2007 at 05:17 AM


"And believe me, this young woman has not been "choosing" to spend her money on things other than health insurance -- what a privileged perspective!"

Why doesn't she get a job? Maybe she can't get a great job -- maybe not in "Ethnic Studies," if she is who I think she is -- but there certainly are jobs for those who can work. See above, when I wanted to work as a writer, but was forced to take a job as a mover.

Again, it's a personal responsibility thing.

FYI, Anarcissie's not taking the facts into account. Here's a little more info: I made $5/hr when I was in my 20s, and it was an anomaly, and I'm now in my 40s, so it was about 20 years ago. During that time, I worked my worst job ever -- dressing up as a chicken and handing out flyers to hostile NYC pedestrians.

Furthermore, I didn't have a bed at that time -- I slept on a door propped up on two milk crates with a sleeping bag on top. I rode my bike to get around to save money on transportation, and ate beans a lot. But, I paid my health insurance, and I'd never expect anyone else to pick up after me.

So, why can't this girl work? Or is she just too cool to take a job as a barista? I believe Starbucks pays health insurance for their employees who work over 20 hours a week.

Posted by: Amy Alkon | February 21, 2007 at 08:08 AM

More bulldog-on-a-bone-ing from me at the Barbara Ehrenreich link. And yes, in case you're wondering, I e-mailed both Cuevas and Ehrenreich in hopes of finding out whether the taxpayers indeed paid for her care, but neither ever e-mailed me back.

Posted by aalkon at September 16, 2007 11:11 AM


One of the aspects that tends to be overlooked is that it's exactly that system of socialized medicine and someone else picking up the tab that drives up treatment costs. Even the Dutch system (which is probably a progress, compared to the rest of Europe) will meet its limits if only the insurances compete, and hospitals and doctors do not.

According to Michael S. Rozeff the hospital bill for his birth in 1941 was less than $75, about $1000 in today's money, and his mother stayed in hospital for ten days. A sum most people probably could afford even without insurance.

Posted by: Theodor at September 16, 2007 5:42 AM

Serious question Amy:

Anthem is now offering a high-deductible plan in the $100-150/mo range. Are they still a decent company to do business with? I had Anthem about 10 years ago when I worked for a company that bundled health insurance in the compensation, and I don't recall having any problems with them.

Now that the market has responded and started offering something that us young, healthy, unburdened men want, it's probably worthwhile to get some.

Posted by: brian at September 16, 2007 6:02 AM

This seems like a battle between the responsible and the irresponsible.

How did the irresponsible get so much power?

Posted by: doombuggy at September 16, 2007 6:15 AM

> the hospital bill for his birth
> in 1941 was less than $75

Well, when your child is born next month, would you pay that price for the 1941 standard of care? Obviously when you pay a hospital bill nowadays, you're paying for the capacity to treat a lot of exotic conditions and problems that aren't that likely to show up... Weird cancers and freaky test results that would have been complete headscratchers for a doctor in the mid 20th century. But would you want to take the risk? 1941 tools, techniques, and medications?

Meanwhile, Europe isn't paradise: From Bruce Bawer's blog:

Norwegians boast of their system's "total coverage" – but total coverage doesn't mean guaranteed care, or care on demand. Far from it. Even the media here, which generally push the official line that Norway's system is far superior to its U.S. counterpart, run occasional stories about Norwegian children who've been turned down for life-saving medications, who've had to fly to the U.S. to get the care they needed, or who've died while waiting for treatment. In America 20% of women with breast cancer die from it; in Norway, owing to the long queues for treatment, the figure is 27%. Fewer than one out of five American men with prostate cancer die of it; in Norway, one out of three die.

Yes, America's health-care system has serious problems. But so do Canada's and Europe's. What's different is that Americans are keenly aware of their system's problems, are arguing vigorously about those problems, and are trying to decide how best to fix them. In Norway, by contrast, the people have been taught from earliest childhood to be grateful for the wonderful health-care system their social-democratic government has given them. (A patient who had to wait four months for a knee operation told Aftenposten: "I don't think it was long to wait.")

Posted by: Crid at September 16, 2007 7:00 AM

Crid, the tech trickle-down has been present throughout history. A proper cost comparison would correct for that, and show instead the added modern factor of malpractice insurance in Litigiousville, USA.

I hope everybody saw 20/20 last week. Stossel & Co. found a bunch of clinics and doctors opening direct-pay services, cutting out the very real cost of paying an assortment of insurance companies and regulators to second-guess their care and literally bury them in paperwork. This is exactly what should be happening.

I got an MRI a couple of years ago. On the bill detail was two eye exams for foreign material - $50 per eye. The exam consisted of asking me a question: have you ever had an eye operation to have something removed? Then I noticed the radiologist was in Bradenton, FL; I'm 510 miles away.

BCBS thinks this is perfectly fine.

That's why medicine is such a mess. It's the result of many people claiming their health is somebody else's business. That itself is self-fulfilling.

Posted by: Radwaste at September 16, 2007 7:39 AM

I've discussed this issue w/ more liberal minded friends. The general consensus of such people is that health care is a right, not a privilage. In other words - health care isn't dirty cheap and is therefore more of a cost burden on the poor. The wealthy can afford the best health care and then some.

This pisses liberals off - the idea that rich people get taken care of while poor people are left to die in the street. Their solution is, obviously, equal health care coverage for everyone through taxation.

This line of thinking tends to piss me off and it's tough not to allow the debate to escalate - people shouldn't be in the street left to die... but ultimately, if a person is able to work s/he should go get a job (one w/ health care if possible) or purchase it on his/her own. There is no reason health care should be provided by the state any more than car insurance should. I'll grant that our health is more important than driving around, but caring for oneself should be up to the individual. Not a babysitter, oops I mean the government.

In MA there is an affordable BCBS plan that the state helped develop after making health coverage a law in our commonwealth. It's cheap and if you don't have coverage the penalties are costlier than just paying for insurance. This is a fair solution I think...

Posted by: Gretchen at September 16, 2007 9:23 AM

Amy - "what ethical person would want to suck off of other people instead of paying their own way?"

Insurance is the way the healthy pay for the sick. Or what do you think your $258 per month is paying for?

(I'm not advocating not insuring, just pointing out a fact.)

Posted by: Norman at September 16, 2007 10:38 AM

TO: Amy Alkon, et al.
RE: The Medicine Industry

I've a very poor opinion of ALL parties in this arena. That includes the so-called 'regular people'.

However the main target of my ire is the people who have turned doing good into a money-making activity.

I see it every day. And, from a special perspective and additional understanding. The point is this....

...medicine has become an 'industry' as opposed to a 'profession'.

I look out the window of my office and see the epitome of that across the way, in the form of a hospital, that was once operated by the Episcopalian church. Today, its CEO says his reason d'etre is to improve the corporations bottom line.

That speaks volumes....


P.S. Extra credit question.....

....How much does a liter of physiological saline cost?

Posted by: Chuck Pelto at September 16, 2007 4:41 PM

Then I noticed the radiologist was in Bradenton, FL; I'm 510 miles away.

I don't see why this is a problem. I have a friend who has a business where they have radiologists around the world working for them. This means, if you get hit by a bus, and need an expert to read your films or MRIs, you can, because that person will be working regular hours in some other part of the world.

Norman, I realize I pay for other people, and I think this should be minimized. I'm 43 and take very good care of myself. If you smoke and eat your way to diabetes, well, you should pay for that. It's like the helmet thing above -- per a Spanish proverb Nathaniel Branden once quoted me: "Take what you need, but pay for it."

Chuck, don't kid yourself. Everything has become an "industry." To romanticize the country doctor vis a vis the scientific discoveries made possible by the funding of the much-maligned "big pharma" is just silly. I just wish big pharma had come through with something for Cathy Seipp in time.

Posted by: Amy Alkon at September 16, 2007 6:22 PM

I too wish that "big pharma" had come through with something for Cathy, though I'm very grateful that the industry has managed to come through with drugs that have helped/save others. As for the paying for other people...well, I figure that most of us don't die before we get old, and there's always the chance that a person who takes good care of him/herself will be in a major car accident/be diagnosed with cancer/etc. It would be hard to put rules in place that would minimize the coverage of not-taking-good-enough-care-of-yourself ailments while still allowing for the coverage of other serious ailments...and, y'know, with our luck we'd get someone making the decisions who truly believed that if cancer patients were just more positive about things, they wouldn't need medication.

Amy, you are correct about Starbucks. 20 hours a week gives you health insurance, and there are no obstacles making working those 20 hours per week difficult. I have had several friends and relatives who benefited from that policy while living the starving young person life in NYC and other big, expensive cities. (Of course, baristas also get free food, and the type of food available at Starbucks doesn't tend to be cardiologist-approved...)

Posted by: marion at September 16, 2007 7:13 PM

if your helmet-less motorcycle rider has paid for his own health insurance, why would you care?

even if he didn't, why would you? if he wrecks his bike without a helmet on, chances are he's probably dead. the cheapest patient is a dead one.

Posted by: jody at September 16, 2007 8:11 PM

A doctor of slight acquaintance years ago used to talk about (former) motorcyclists in the "Honda" ward, and say that that there were worse things than death.

> If you smoke and eat your
> way to diabetes

Well, yeah, but it will be a no fun line to draw, A favorite line from Hitchens is "This ends badly." I remember when Seipp announced her illness on her blog and noted that she'd never smoked. All these bad fates are going to show up in the population anyway... And a very special bad fate has been set aside for each of us.

Amy's right about the "industry" thing. All those impersonal forces and self-interested institutions have made this a great time to be alive.

Posted by: Crid at September 16, 2007 8:29 PM

the cheapest patient is a dead one.

I'd venture that a good many in moto accidents are the kind that are kept alive as giant turnips for years on end.

Posted by: Amy Alkon at September 16, 2007 11:01 PM

Regarding Cathy, to borrow from Mr. Hobbes, for some, life is far too nasty, far too brutish, and far too short.

Posted by: Amy Alkon at September 16, 2007 11:02 PM

Amy - "I realize I pay for other people..."

So far, you have done (and long may you continue to do so!). But the point of insurance is that if you ever do need treatment the insurer will pay for it, in excess of the premiums you have paid. In other words, other people who don't need treatment will pay for yours.

The point of insurance is to even out the uneven chances that life deals. There must be winners and losers in this scheme, or we would not need insurance.

You may be right right in saying that we should each pay our own insurance, but the purpose of that is that we don't each pay for our own medical bills. There's a hint of inconsistency in your position.

Posted by: Norman at September 17, 2007 12:49 AM

when people crash their motorcycles without a helmet on, brain damage isn't the problem, it's that their brains are on the outside of their body, or at least there's nothing to keep all the blood from draining out in minutes. happened to a fellow down the street from where i lived; he was dead before the ambulance got there.

now if there was some sort of protective device to prevent your body from the immediate effects of an impact, like crumple zones and seat belts, but your brain rattled around inside your skull, you might end up with some brain damage. this is what happened to my best friend's kid sister a few years ago, who spent 2 months on life support in a coma before they gave up.

Posted by: jody at September 17, 2007 5:52 AM

You may be right right in saying that we should each pay our own insurance, but the purpose of that is that we don't each pay for our own medical bills. There's a hint of inconsistency in your position.

Norman, having insurance of some kind is paying your own way. In paying my way, I choose to be part of a medical collective -- a wise choice, I think, for somebody like me. I have catastrophic care if I need it, but inexpensive maintenance care. In fact, in writing this blog item, I realized I can probably cut my costs by having a lower monthly fee and higher price for doctor visits, since I rarely make them.

No system is perfect, and frankly, I'm unhappy with socialism in general, but something has to be done about our broken system and the Dutch system sounds better than ours and closer to the plan I'd invent if I could.

Posted by: Amy Alkon at September 17, 2007 7:24 AM

This converstaion brings up a question that has been in my mind for some time. If we have $150 for health insurance each month, do we need health insurance at all? If, when I started work I had put the same amount I pay for health insurance monthly into a savings account I would currently have $6,450, not including interest (or that time I had Mono.) And this is after only about 3 and a half years in the working world. It seems to me that 6k should be enough to handle an emergency. Perhaps a more serious illness would require a loan of some sort? (Sort of like a student loan, but a med loan?)

It seems to me that if clinics made an effort to bring costs down (goodbye malpractice, goodbye malpractice insurance) that it should be completely possible for people to save for their health. (Special tax free accounts could be created, like a 529.)

It is hard for me to imagine why my mother's health insurance costs 15,000 a year. I have to wonder what the actual bills are that the insurance costs that much.

Posted by: Shinobi at September 17, 2007 8:12 AM

Oh yeah, I thought this was funny:

Posted by: shinobi at September 17, 2007 8:13 AM

Shinobi, you can't get a loan without collateral, and you don't know when you will get seriously ill. Cathy Seipp was very prudent in her eating and exercise habits, and never smoked, yet she got lung cancer (the kind smokers get). LYT got appendicitis and had over $10,000 in hospital bills. You can get insurance from Kaiser for $150, I think. You probably just have high deductible for that price.

Posted by: Amy Alkon at September 17, 2007 8:18 AM

TCS link is very funny.

PS Cathy probably lived longer and with less angst about Maia and maintaining financially because she not only had very good insurance (the responsible thing to do if you have a child depending on you -- she had Blue Cross), she also had disability insurance through Lloyd's of London (I believe).

Posted by: Amy Alkon at September 17, 2007 8:20 AM

TO: Amy Alkon
RE: Oh. Cripes!

Don't get me started on THIS!

Talk about a mess. And talk about miscreants. The medical industry epitomizes them their worst.

All they are, today, is a scheme to divest families of their accumulated savings.

Seriously.... much do you think a quart of salt water, with a few odds and ends ingredients, in a clean plastic bag should cost, anyway?

If you said several hundred dollars, you're close to what my hospital charged.

These cretins are worse than the US Air Force when it was 'called down' for paying several hundred dollars for a hammer, back in the 80s.

At least the Air Force got to use the hammer more than ONCE!



Posted by: Chuck Pelto at September 17, 2007 5:08 PM

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