November 06, 2009, 07:45 AM ET

The 'I've Got Mine' Crowd

Who are all these Americans who so love their health insurance that they’ll go to Washington to demonstrate against a government plan to offer health insurance to those who don’t have any health insurance? You know, the ones who utter such sentences as, “I love my health insurance plan,” and “Get the government bureaucrats off my back.” People who “love” their health insurance plans? How is that? Because it’s “freedom of choice,” they say. I have a name for people who dig in their “live-free-or-die” heels in order to prevent a government “takeover” of health care: the “I’ve got mine” crowd.

The news last evening reported that the “I’ve got mine” crowd cheered Representative Michelle Bachman and House GOP leader John Boehner. Boehner stood at a podium saying he would do whatever was necessary to prevent “tens of thousands” of government bureaucrats from taking over health care. Whoa, tens of thousands of government bureaucrats! That does sound bad. The mere thought of thousands of bureaucrats doing anything, let alone government bureaucrats managing health care, sends veritable chills down the spine.

Technically, I belong to the "I've got mine" crowd. I’m covered by a health-care plan, offered through my university, negotiated by my union, that’s as generous as a big fat slice of apple pie. We get everything for nothing -- or, to cover additional family members, for peanuts -- from maximum out-of-pocket payments, capped at a thoroughly reasonable amount, to dozens of therapy sessions, physical therapy sessions, acupuncture, drugs with minimum copays, unlimited doctor’s visits with $15 co-pays, etc. (Mind you, faculty everywhere, many of our students, who pay tuition that gives us our “I’ve got mine” plan, come from families that don’t have such a plan.)

But mentally, and spiritually, and in every other way, I am not a member of the “I’ve got mine” crowd. And here I’d like to ask the “I’ve got mine” crowd in Washington yesterday if they’ve ever encountered any people like me, for example (whom they probably would look at and conclude should be right in there with their “I’ve got mine” crowd) who have experienced any one of the following:

1. Calling one’s excellent health insurance company to argue with a non-government bureaucrat about what’s covered for a particular medical illness.

2. Listening to a nongovernment bureaucrat read obscure text, embedded deep in one’s health insurance plan, explaining why what looked like it was covered was actually not covered.

3. Arguing, over multiple phone sessions, with different nongovernment bureaucrats over whether or not a medical procedure, ordered by a medical doctor for a cancer patient covered under one’s particular excellent health care plan was “necessary.”

4. Resorting to begging a person in one’s employer’s human resources department to advocate on one’s behalf with a nongovernment bureaucrat at one’s health-insurance company, in order to compel said insurance company to reverse its initial decision and pay what it ought to have paid from the very start.

5. Watched as a sister who was dying of cancer (she died three weeks later), who could no longer walk on her own, and was covered by one of the “I’ve got mine” health insurance plans (different from my own particular “I’ve got mine” health insurance plan), was turned away from a hospital emergency room where she had been sent by her doctor. Why? Because hospital care in the United States has now reached the point where not even having health insurance is enough to overcome hospital emergency rooms packed to the gills with sick people who are on 12-hour waiting lists.

6. Known any person who is not a part of the “I’ve got mine” crowd who works, but lacking health insurance, has an accident and cannot afford to go to a doctor. How about a young woman who falls down the stairs, dislocates her thumb, and ends up setting it on her own? (I know this young woman; today, her thumb has healed entirely incorrectly.)

In trying to figure out how it is we arrived at a democracy with so many “I’ve got mine” sorts of people, I'm reading Alexis de Tocqueville, for starters. Toqueville predicts that American democracy would eventually atomize (that's not his word) into millions of people, all of whom believe they are relying on themselves and distrust all forms of authority.

I am also trying to figure out how it is a public good for any of the events I listed above to be taking place 00 let alone taking place on a regular basis.

I am also trying to figure out why it is a private good for me and my family that last year’s compensation for the CEO of my particular health insurance company was $3-million dollars (slim, compared to many other compensations packages for CEO's at for-profit health insurance companies).

I am also trying to figure out why it’s a good thing for our nation’s health care, considered as a whole, to have massive intermediaries who make their profit off people’s illnesses, but a bad thing for government to be the least bit involved.

Finally, I am trying to figure out how anyone could work up a passion about a system of private health insurance, and actually utter such sentences as, “I love my health insurance plan.” The only answer I've come up with is that they’re very comfortable belonging to the “I’ve got mine” crowd.

Comments

1. livefreeordie2 - November 06, 2009 at 02:20 pm

So. . .let me get this straight. You would prefer a government intermediary? I'm not sure I understand your point. My condolences on your sister, but I can tell you that it is against the law to turn anyone away from an emergency department and they aren't even allowed to ask if you have money/insurance before you're seen. In regions with more than one ED, if an ED is overflowing, they might implement what is called "diversion" so that people can be seen at less crowded facilities. Again, I'm sorry you lost your sister, but the minimum facts you present do not comport with the way things are done.

And here's the bottom line. Putting the government in charge of health care guarantees a tremendous loss of freedom. It will fundamentally change this country in a manner that most Americans don't want. Do you think health care should be considered a 'right?" If so, why would you turn it over to the government? Our Constitution protects our rights FROM the government! Here's how it works:

Once the government takes over health care, Barry's protestations notwithstanding, the amount of taxes available to pay for health care will quickly be no where near enough to cover the cost. That means they will have to reduce available services. Heck, they already do that! They have developed artificial lumbar discs for those suffering from a variety of spinal problems. Under Medicare: "Effective for services performed on or after August 14, 2007, CMS has found that LADR is not reasonable and necessary for the Medicare population over 60 years of age; therefore, LADR is non-covered for Medicare beneficiaries over 60 years of age." Do you understand that? They are making a treatment decision based on AGE! Why do you think they do that? Because of COST! What do you think will drive treatment decisions if the government is responsible for everyone's health care? Patient outcomes? Doctor's recommendations? No. . . it will be COST! Within 10 years, I doubt that a cancer patient within 2 months of passing will get into anything other than barebones hospice. As Barry said to a woman who wanted to know if her 100 year old mother would still be eligible for a pacemaker under his plan: "At least we can let doctors know and your mom know that, you know what, maybe this isn't going to help. Maybe you're better off not having the surgery but taking the painkiller." Better off? Who's better off? The patient? NO! The government - because letting you take pain pills until you die is cheaper than surgery that allows you to live longer and consequently generate more medical expenses for the government!

In the US, 85% of people already have health insurance and excellent health care. If the question is helping the uninsured, then let's do that. But you don't help anyone by destroying the system for everyone. I love my health insurance not because it can be a pain in the neck, but because when I have a pain in the neck, I get the treatment I need. . . the best treatment available in the world and I get it right away. That's why I and most other Americans love their health insurance. And talk about "I've got mine," You are aware, I hope that the Congress has exempted themselves from these changes and will continue to have Rolls Royce level benefits while the rest of us wait in line for a government hack to decide what treatment we get. You've got yours? If this passes, you won't have it for long. . .

2. punditius - November 07, 2009 at 12:35 am

The implication of using the words "I've got mine" to characterize opponents of government health care is that the people who have health care don't give a damn about the people that don't. But the actual meaning of "I've got mine" is that those of us who plan, and work, and save, and have acquired decent health care plans don't want the government screwing them up.

If the government can figure out some fiscally sound way to make health care available to the people who aren't covered without destroying things for the rest of us, most of us wouldn't object, so long as we're dealing with people who are legitimately in a hole through no fault of their own. Frankly, most such people are children. Most adults without health care lack it because they have made other choices on how to spend their money, or how to live their lives.

As for Ms. Fendrich'sister, I'll meet her with my brother, who has a debilitating and life threatening illness, has come close to dying three times in the last couple of years, lost his health care when he lost his job last summer, and still manages to pay his medical bills and get the health care he needs. And yes, I've offered to help him out and no, he says he'll handle it himself. He is against a government health care system for the same reason I am - he knows it will be worse for him than what he can patch together now.

It's called "personal responsibility," Ms. Fendrich. It's buying disability insurance when you get a job, and saving money against future needs. It's not waiting around for the government to take care of your grasshopper self.

3. umphrey - November 07, 2009 at 03:52 am

Apparently people who oppose a massive restructuring of healthcare by a notably inept administration and congress lack compassion, unlike Ms. Fendrich.

4. sherbygirl - November 07, 2009 at 10:17 am

http://online.wsj.com/article/SB10001424052748704795604574519671055918380.html

Is this really offering "affordable" care? And does this really offer choice?

I'm from Canada, the "gold-standard" of public health care. I wouldn't trade my American health care for the high taxes, massive bureaucracy, and limited services offered by the Canadian model. My brother-in-law had a ringing in his ear. Doctor thought it might be a tumor. He had to wait for two months for an MRI and then another two months to meet with a specialist to get the results. It wasn't a tumor, thank God, but we have learned that time is of the essence when dealing with health issues. He was trying to be preventative, which keeps costs down, by catching whatever he had early. Instead, the system doesn't reward him.

If he had been bleeding from his brain, he would have been seen right away. The system sends the message, if you want immediate care, you'd best be on death's door. If not, take a number. My friends in Canada keep saying, yeah, well, at least we aren't refused treatment/go bankrupt. Yes, congratulations, you all have equal opportunity to die/suffer on a wait-list. Oh, no wait, if you can pay, you can go to the front of the line, just like everywhere else. With the H1N1 vaccine, there have been 6 hour lines (outside, in the rain/cold), only to find out there aren't enough vacccines. But if you're a) a hockey player or b) a member of a private health clinic, front of the line.

Yes, I know these things go on in the States, but to hold Canada up as the gold standard is dangerous and dishonest, not to mention misleading. Reform may be necessary, but any reform at any cost is not the answer.

5. please - November 08, 2009 at 02:46 pm

@sherbygirl,

For every one of you there's one of me. Why don't we trade stories?

I moved to Canada in 2006 from the U.S. where, for my last year in that country, I had no health insurance; my employer did not give me the option and I could not afford the plan my university offered). I contracted malaria that year and one day the symptoms began to manifest themselves, whereupon I lost consciousness as my body temperature rose to 105F. My father happened to be nearby and rushed me to the local private clinic (there was no public hospital nearby) where they gave me a series of tests, couldn't determine my problem, billed me $5000 and were about to summon an ambulance had I not regained consciousness and stopped them from doing so. Why? Uninsured people like me are charged tons of money for an ambulance. I left the clinic and drove to the closest hospital instead; never mind the fact that I was in no condition to do so and that if cut I would have bled to death (my blood platelets were dangerously low). I spent the next twelve hours in an emergency room, was charged another $2000, and sent home with a diagnosis and a prescription I could not afford to fill. My health was in serious jeopardy, my credit is permanently disfigured because of this mess, but oh! Anything to avoid the boogeyman of state interference!

So yeah... maybe you would prefer to keep your American health care but you know what? You're one of the lucky ones, like Ms. Fendrich, who can afford health insurance or else gets it through an employer. Your either/or scenario is totally irrelevant to the 40 million or so people in the U.S. who have no insurance. While you would prefer to keep your private health insurance, obviously Ms. Fendrich and others are not satisfied with theirs. Would you care to explain exactly how the overly-modest plan offered by Democrats in D.C. constitutes "reform at any cost"? Troll much?

I'm not sure who "hold[s] Canada up as the gold standard" with respect to health care but I can positively contrast the experience I, my friends, and their families have with the tax-sponsored health care system here in Ontario with the one you described. What are Americans to think as they read our conflicting accounts? I have never experienced unreasonable waiting times, costs, delays, or inconveniences on my university-sponsored student health care plan (i.e. the 'basic'). My partner had a troubling-but-not-life-threatening fungal infection around her eyes, and she didn't have to "take a number" and suffer on a waiting list for treatment. She got it immediately. And when she needed additional treatment, she got that too. Promptly. The system worked as it was supposed to. She didn't have the money for private care but that does not matter--she is a human being, a citizen of Canada (as I am a legal resident), and as such she deserves treatment.

We can trade examples back and forth all day if you'd like. You can champion the American way for delivering health care and I can do the same for the Canadian system. But to present your brother-in-law's case as representative of that system is in fact "dangerous and dishonest" and "misleading", but mostly dangerous... dangerous because while you and I can fall back on state-run health insurance in Canada (if you were to lose your precious private health care), all of the people in the U.S. who have none have nothing to fall back upon. Absolutely nothing. They get sick and they hurt, maybe they lose their jobs, their houses or apartments, and maybe they die.
And it's truly astounding--a sick f***ing mess--that human beings are forced to live indignant lives as many do in a supposedly first-world country like the U.S. because an ideologue like Rep. Boehner doesn't like the looks of government intervention. And it's truly sickening that for every speech we hear from President Obama and the Congressional Democrats about the outrage they feel on behalf of the uninsured, that they do not have the political courage to offer a meaningful overhaul of the system. The people of the U.S. who do not have access to health care, and those who find their access unsatisfactory, need health care reform, NOT health insurance reform.

6. marka - November 09, 2009 at 08:51 pm

All systems 'ration' resources ... unless they are limitless (supply always exceeds and satisfies demand). Some ration by some list of priorities - in health care, Oregon had such a list, but the rational public rationing system became a victim of its own rationality -- with limited resources, it didn't cover less effective, more expensive, procedures, which became political hot potatoes - who wants to 'deny' coverage to a sick child with a relatively uncurable disease? Others 'ration' by market-forces -- those who have more resources can 'buy' more goods & services, and can jump others thru '1st class' ranking. Others ration by waiting lists -- in health care, many folks get 'better' all by themselves, so if you wait long enough, folks leave the list (and, if they don't get better, some 'leave' by getting service elsewhere, or dying ... ) That way, you don't have to serve all who initially wanted the service or good. Others ration by simply not offering the service or good -- a few years ago, the city of Portland, Oregon (half a million residents) had more MRI machines than did the entire nation of Canada. We in the US often have the newest (and often most expensive) technology available, long in advance of other systems. Which comes with a pricetag. All systems have costs, and potential benefits. With healthcare, we are buried by anecdotes, without looking at overall system benefits & costs. Hard to make rational choices when the debate & discussion is dominated by emotional responses. The real problems for health care in US are: limited health care workers -- we already have a severe primary care doctor & nurse shortage -- we import substantial numbers; limited health care facilities -- many hospitals & clinics have closed up shop, especially Emergency Rooms -- finances didn't keep up with liabilities, including 'malpractice' litigation issues. Who is going to help those outside the system now? Many practices are accepting new patients already - just try to get in when we add another few millions. Perserve incentives/disincentives - malpractice litigation dramatically increases 'defensive medicine' - many more tests & procedures than other systems use; pay-for-service reimbursement encourages lots of expensive procedures that are often unnecessary, and not used in other systems. We aren't going to reduce defensive medicine unless we reform malpractice litigation. And we aren't going to reduce cost unless we stop asking for the 'latest/greatest' - we spend lots on relatively untested yet expensive drugs & technology, simply because it is there - and Americans demand that 'everything be done'. And there are significant 'lifestyle' issues that the 'health care' system can't really address, because we really have a 'sick care' system. Diet - with obesity the most obvious; and exercise - ditto, drive large numbers in our system, and individuals have to take some responsibility for that, rather than rely upon 'health care' to take care of it. Finally, I have no faith that a government bureaucracy is going to be any better than a private one -- if anything, it will be worse. Medicare/medicaid continues to suck up more & more resources, despite many attempts at reform, and it will only get worse, not better, with an aging population and continuing demand for 'everything that can be done.'

7. dank48 - November 12, 2009 at 08:37 am

Tocqueville was right.

8. dank48 - November 12, 2009 at 09:16 am

Actually, if Congress were interested in reforming health care, rather than in posing and preening and as usual running for re-election before their chairs get warm, it would be pretty simple. Congress could simply make the health-care program Congress enjoys available to all Americans. What's good enough for our Representatives and Senators is good enough for the rest of us.

I think about half the problems of this country come from the legislative habit of exempting the legislature from laws imposed on everyone else. Congress should have to live by the same rules as the rest of us--remember that quaint old concept, rule of law? But the mind-set is obvious: once one has been annointed, it's good-bye commoner status and hello aristocracy, however temporary.

As it is, the country has Senators and Representatives the way houses have mice and cockroaches.