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Paranoia is a Pre-Existing Condition (Updated)

Fact #1: I am self-employed American.

Fact #2: I have a severe, chronic medical problem.

These two facts don't mix nicely.

As a self-employed worker, I don't receive the benefits that usually accrue to salaried professionals doing similar work: employer-contribution 401K; paid vacations; and, in particular, employer-provided health insurance. I knew going in that this would be the case and decided that the other, non-material benefits of working for myself outweighed the material drawbacks. For the most part, I can provide the equivalent benefits to myself -- a retirement savings account and money set aside for vacation time.

But not health insurance.

Because I have a "pre-existing condition," I can't get insured. I've tried. The coverage I have, through COBRA, will run out soon -- and at that point, I could be in trouble*.

I bring this up not to elicit suggestions or sympathy, but to identify myself as someone with a personal stake in the current health insurance reform process underway in the United States -- and someone who would clearly benefit from that reform's success. I'm following the debates closely, and am thoroughly depressed by what's been going on (which probably qualifies as another pre-existing condition). Opponents of reform have successfully triggered a level of political and social paranoia in a significant subset of the American public that hasn't been seen in years, possibly decades.

Two friends of mine living outside the US -- one an American ex-pat, the other a UK citizen -- both wrote lengthy and smart pieces about the American health insurance reform debate. Their arguments sum up my feelings very nicely, and I want to encourage you to read them both.

Adam Greenfield offers "On Systems, and What They Do," examining the healthcare and insurance process in the US from a systems-thinking perspective, and uses it as a jumping off point to talk about how we make data-driven decisions -- and how easily they can be disrupted.

The collectivites arrayed against the “Obamacare” bogeyman construct the body politic as a zero- or even a negative-sum game. They’ve identified a loophole, a vulnerability in the operating system of American democracy for which as yet there’s no patch. And because their victory conditions don’t require the affirmative production of a workable solution, the challenge before them is much (infinitely!) easier: all they have to do is drive a wedge through that vulnerability and they’ve won. The foreshortened, truncated, mutilated human lives that will result are collateral damage, an acceptable side effect. And the damage to the health and functioning of the republic? That’s a feature, baby.

Charlie Stross, in "Merciless," looks at the US healthcare debate by asking the question, what happened to mercy? It's a quality that seems sorely lacking the US today, and this fact is excruciatingly visible in the arguments around healthcare.

The subjects vary — crime and penal policy, healthcare, don't get me started on foreign policy — but there is an ideological approach in America that is distinguished by one common characteristic: words and deeds utterly lacking in the quality of mercy.

There is a cancer in the collective American soul — a mercy deficit that has in recent years grown as alarmingly as the budget deficit. Nor is it as simple as a left/right thing: no political party has a monopoly on merciless behaviour. Rather, a creeping draconian absolutism has cast its penumbra across the entire arena of public discourse, tainting every debate, poisoning and hardening attitudes across the board.

Calls for revenge on a sick and dying man are part and parcel of the pathology, as are shrieks of outrage against the mere idea of subsidizing healthcare for the indigent or unlucky, or rough talk about "every now and again ... pick[ing] up a crappy little country and throwing it against the wall just to prove we are serious".

It's sad, and frustrating, and shameful. And, for me, it's not theoretical. As I watch this debate happen, I am ever-conscious that when politicians and pundits talk about the mass of people without insurance, they're talking about where I could be in a few months.

I have options; I'm "lucky." I could give up being self-employed and try to find a full-time job, with benefits (emphasis on the try: this is difficult for someone with an eclectic background in good times, but would be near-impossible right now). I could push my wife to leave school and have her try to get a job with benefits. But to the extent that entrepreneurialism and self-improvement through education are supposed to be core to the American ideal, it's more than a little frustrating to have to set them aside simply to be able to continue to walk.

[*UPDATE: I'll be in less trouble than I feared, as I should be able to get a HIPAA policy. It's a grim prospect, though: the rate will be about double what I was paying under COBRA (where I'm paying both employee and employer costs for insurance), and the rules are such that, once I get a HIPAA policy, I can never change it, even if rates go up.]


The US Social Security and Medicare systems are already bankrupt to the tune of trillions of dollars.

Before considering spending more trillions of non-existent dollars on Health Care the present mess should be fixed first.

I am very pessimistic about the future of the US economy.

Yeah, the health care debate is starting to piss even me off, and I'm a Swede, so it doesn't even effect me.

BillK, you're either misinformed or lying.

It will be decades before the Social Security trust fund is depleted, and even then benefits will still able to be played . . . just at a much reduced rate. And that could be fixed with numerous small tweaks to increase revenue (e.g., lifting the cap) or reduce benefits (tie increases to inflation rather than cost of living). The entire health industry could benefit from cost/benefit analysis and an emphasis of preventative care.

Medicare will be in sore shape much earlier. The administration is looking into ways to curtail growth (and no, not through "death panels").

* * *

I am disgusted beyond words (well, "nauseous" and "dismayed" come to mind) by the tenor of the health care debate. Death panels! Socialism! Government takeover government takeover government takeover rationing longlines!

The armies of Duhness are afoot, and they're spewing talking points written up by insurance industry lobbyists.

One thought I've had is that for all the Americans who aren't right-wing-nuts, there's a tendency to value multiculturalism, and respect people's different ideas.

However when you have a group whose only goal is to destroy everything that is not them, multiculturalism is the wrong response. I'm wondering what the right way to deal with the crazy is. You can't just say "You're insane" because they'll take that will just feed into their martyr complex.

Perhaps the LA City council had the right idea, recently someone showed up in KKK garb and refused to take it off. Not having any other solution, the council members left until they no longer had quorum and the meeting was canceled.


The Social Security Fund doesn't exist. It has all already been spent by Government on other expenses. All that is left are IOUs. The Government has relied on the fact that to-date Social Security revenue income from payroll taxes has been greater than Social Security payouts. But that is changing rapidly due to the recession and the ageing population. The Social Security future liabilities will only be paid if payroll taxes are sufficient to support the payouts to the ageing boomers. And they won't be. Just print a few more trillions for the national debt.

it is as though having the nihilists out of office is in some ways more dangerous than when they were the elected majority.

Once you exhaust your COBRA coverage you will be eligible for an individual HIPAA guaranteed issue policy -check with your state department of insurance b/c you usually only have a short time frame to enroll once COBRA is exhausted. Some states limit the amount that insurers can charge for these policies

Jamais -- We are in the same boat (self-employed / pre-existing condition) -- and you do have another option because you live in California. It's the Major Risk Medical Insurance program -- which I have now, and which I wrote about here in case you're interested.

The bad news is that so far, MRMIP has sucked -- and I've had to spend a lot of time on the phone fighting with Kaiser. That said, it seems like a lot of people who have "regular" health insurance also spend a lot of time fighting on the phone with their insurance providers, provided they have "preexisting conditions" or other issues that force one to actually use one's insurance, which the insurance companies don't want you to do. I still spend about $500 on health care a month.

I also found The Atlantic's cover article "How American Health Care Killed My Father" interesting -- The article isn't actually a sob story re: the writer's father, but more of an examination of deeper Qs., i.e. why we use health INSURANCE for routine things like checkups when we wouldn't use, say, auto insurance when we need an oil change.... Not exactly practical in terms of where the health care overhaul debate is not, but still interesting to think about....

OECD data:
Total spending on health care, per person, 2007:
United States: $7290
Great Britain: $2992
Japan: $2581 (for the year 2006)

Since we're already spending about twice as much for health care that isn't as good (on standard metrics) as Great Britain or Japan (or France or Germany or the Netherlands or....), I really have to wonder if all of us in the USA have been overcharged for years. If we weren't overcharged I do believe that we could easily supply healthcare to everybody in this country who needs it.

PS: An IOU from the government is sometimes known as a government bond and can pay interest.

Well, sure we've been overpaying for inferior health care for years. We spend upwards of 20% of our healthcare dollars on administrative crap, including the bureaucrats who turn down tests and procedures, marketing and advertising, CEO salaries, and all of the health insurance industry's Washington lobbyists. In a nation with a single payer system such as Canada, they spend less than 5% on administrative costs.

Corollary to gmoke's post:


Japan: Ranked 3rd, overall life expectancy 82.12 years.
Canada: 8th, 81.23
France: 9th, 80.98
Sweden: 10th, 80.86
UK: 25th, 79.01.
Then we get down to:

US: ranked *50th*, 78.11.

Now, if you could count Puerto Rico, we're only 42nd. Too bad about that statehood thing.

Look at that chart. We're literally down in the third world - check out our neighbors on the chart. We spend 3x what Japan does per-capita and yet we are beaten out by:

Most of the Caribbean


This is such a weird debate to see from the outside. In Australia everyone has basic health coverage via the government & tax system (no "death panels"). We also have the option to take private health insurance to fast track treatment rather than wait for public treatment. I visited the emergency room last year as a walk-in off the street & was treated overnight in emergency ward with lots of tests & received no bill to pay. When I wanted to have non emergency surgery I did not want to wait the 6 months for the public hospital so I chose to use my private health insurance to get it done immediately. I have some chronic conditions that are fully convered by the government health insurance too. Sure we pay for it out of our tax dollars, but it does seem more equitable. We also have choice. I'm not sure what the problem is with this kind of system?

"All that is left are IOUs."

You know those little green pieces of paper in your wallet?

Those are just IOUs too. Backed by the full faith and credit of the United States of America, and nothing else.

Still less real is the money you have "in the bank" - guess what? They don't actually have it any more! They loaned it out to other people! All they have are a bunch of numbers in a computer!

So, it turns out that YOU are also broke, bankrupt, bereft of funds, financially fucked, in precisely the same way you accuse the government of being.

Back on planet earth again: the healthcare bill, even without the public option, will essentially solve your problem, Jamais. And a good thing too.

Coverage for small companies is almost as difficult, and gives them an enormous incentive to hire young, healthy workers over old people or those with chronic conditions that do not affect their work - which means they do not hire the best person for the job. That is a guaranteed productivity killer.

In reference to anon | August 25, 2009 1:29 PM, I was in the exact same situation when I had testicular cancer. Once the 18 months finished (I got a final full $4K checkup the last week on that policy), I was offered a guaranteed issue. It was 3x the cost, and with a $4K/yr deductible, whereas my old plan was 100% coverage (no deductible.) I found out that because I was instantaneously unemployed (easy for a self-employed person to be in), I was eligible to get free care at the state public hospital.

It would be nice if the system were set up to force folks like me to pay into the system (e.g., via higher income taxes or a VAT tax, etc.) rather than freeload, but the current system offers no choice.

Yes, the whole "IOU" thing is pretty laughable. Our entire economy is based on IOU's.

I also have to say that this recent attention to the national debt, while welcome (at last!) and very apropos, is rather humorous *at best*. Just remember this: whenever any GOP politician complains about the debt going to $10T that they were perfectly happy with GOP administrations running it up from $0.5T to $9T.


*Nobody* borrows and spends like the GOP.

There is no such thing as a HIPAA policy- though HIPPA does play a role in getting coverage. As long as you had coverage for the preceeding 12 months and no break in coverage over 60 days, HIPPA requires insurers to cover you. And you can change plans-- you just can't exceed the 60 day break- I have 2 chronically ill children, both with liver transplants in the past 2 years and am self employed-- Ive changed plans and carriers twice in the past 4 years (once with a kid on the transplant list) it was no problem. Nothing excluded, no waiting period-- YOu need to learn more about your rights under HIPAA berfore you err and lose the gaurantees it offers.

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