The insurance mess

I haven’t had employer-provided health care in over ten years, which means I’ve been paying for individual or small group insurance for myself and now my family every month. Every year my premiums increase by 30%, so I’ve changed providers going from crappier to crappier policies until now we’ve got the cheapest I can find. This “cheap” policy is costing over $1300 a month and is an HMO, so it only covers in-network providers. Because it’s not a very good insurance company, very few providers take it. For my OB/GYN I just pay out-of-pocket for my appointments.

Two things now: my pediatrician referred my son to an ear-nose-throat specialist to check his hearing. None of his referrals take our insurance, so I called the company, used their website to pick a random doctor, called the doctor and was told they didn’t take it, was transferred to another doctor, was transferred again and finally ended up with a fax line picking up my call after fifteen minutes on the phone. After two hours calling various people, I gave up and am now going to pay out-of-pocket for the referred doctor for Ollie tomorrow.

Some time last week I think I stepped on a piece of glass. There’s something in my heel and I’ve soaked it and squeezed and tweezed but whatever it is, I can’t get it. It’s been throbbing for a week. My primary care physician can’t see me for two weeks. Their urgent care center takes my insurance but I have to make them my PCP to have the visit covered. Another local urgent care facility doesn’t take my insurance. So basically if I want to address this before May 24 and not pay out-of-pocket, I need to go to the ER and it’s a $50 copay.

I wouldn’t even mind going to the ER except my local hospital closed and the ERs are across or uptown. Why did my local hospital, a level 1 trauma center serving an area with over 800,000 people, close? It went bankrupt. There was a New York Times article around the time of its closing stating that its ER was a dumping ground for people with no insurance because they wouldn’t turn anyone away. I don’t know if this is true. I don’t know why they went bankrupt and suddenly closed. But it’s insane that an area as dense as the lower west side of Manhattan has no hospital and that politics and money are keeping residents from critical health care services.

I probably won’t go to the ER because it’s not an emergency, and I don’t think it’s an appropriate use of those services. But my insurance and the system are conspiring to send me there. I’m not sure how that keeps health care costs down, to pay for an ER visit over less extreme types of care. I guess ultimately the insurance company saves money because I’ll just walk around with glass in my foot for two more weeks. And pay out-of-pocket for care in addition to paying thousands of dollars a year for insurance.

I’d hoped health care reform would somehow solve this, but it’s clear to me that it won’t. The system is broken and even people who talk about fixing it don’t seem to realize just how broken it is.

Investigating the Bush presidency

Carl Bernstein (who forever is linked to Dustin Hoffman in my mind) has an essay on the Vanity Fair site calling for, Senate Hearings on Bush, Now.

After Nixon's resignation, it was often said that the system had worked. Confronted by an aberrant president, the checks and balances on the executive by the legislative and judicial branches of government, and by a free press, had functioned as the founders had envisioned.

The system has thus far failed during the presidency of George W. Bush—at incalculable cost in human lives, to the American political system, to undertaking an intelligent and effective war against terror, and to the standing of the United States in parts of the world where it previously had been held in the highest regard.

There was understandable reluctance in the Congress to begin a serious investigation of the Nixon presidency. Then there came a time when it was unavoidable. That time in the Bush presidency has arrived.

He makes a pretty compelling case, and I hope Congress wakes up one of these days and decides to take some action.

Placing Sept 11 in historical context

Over the weekend there was an interesting op-ed in the New York Times by Joseph J. Ellis, Finding a Place for 9/11 in American History. First he questions the threat of September 11 to national security, "in the grand sweep of American history" and finds, "it does not make the top tier of the list." And as such, he questions whether the broad changes to domestic and foreign made in its name are justified. Second, he examines when such changes have been made (e.g. 1789's Alien and Sedition Acts and the internment of Japanese-Americans during WWII) and finds:

In retrospect, none of these domestic responses to perceived national security threats looks justifiable. Every history textbook I know describes them as lamentable, excessive, even embarrassing.

It's ridiculous that in the effort to "win" the war on terror, we're scraping the constitutional protections that make America the great country that it is. And as Professor Ellis writes, history will likely show that once again, we've overreacted.

American Experience on John Adams

I caught the premier of American Experience's John & Abigail Adams the other night and really enjoyed it, though the program's tagline ("Meet the original power couple") is discouraging. President Adams was a very interesting fellow, and I've been intrigued by him since I read Founding Brothers: The Revolutionary Generation by Joseph Ellis a few years ago.

An examination of Adams is especially timely now with so many issues arising with regard to executive power in the US. John Adams wrote the constitution for the Commonwealth of Massachusetts, which established three branches of government. It was largely the basis for the Federal Constitution when it was later drafted. He believed the separation of powers in government was critical to maintain democracy, and that left unchecked (esp. by the judiciary), the executive branch could move towards despotism.

I highly recommend watching the program if you've got two free hours. It's not just informative but also entertaining, and has catapulted John Adams to the top of my list of favorite founding fathers.

Examining thirty-three years of Roe

Usually I can't read any article about abortion because no matter what side it supports or stance it takes, I get angry about something. But today, on the thirty-third anniversary of Roe v. Wade, there's an op-ed in the New York Times, Three Decades After Roe, a War We Can All Support that frames the debate in a way I can get behind. The premise: everyone acknowledges abortions are bad and that we'd like to reduce the number of abortions, the real issue is how to do that.

The problem with using restrictions to reduce the number of abortions isn't that the restrictions are judgmental. It's that they're crude. They leap too easily from judgment to legislation and criminalization. They drag police officers, prosecutors and politicians into personal tragedies. Most people don't want such intrusion. But you lose them up front by refusing to concede that there's anything wrong with abortion. You have to offer them anti-abortion results (fewer abortions) without anti-abortion laws.

The pro-choice path to those results is simple. Help every woman when she doesn't want an abortion: before she's pregnant. That means abstinence for those who can practice it, and contraception for everybody else. Nearly half of the unintended pregnancies in this country result in abortions, and at least half of our unintended pregnancies are attributable to women who didn't use contraception.

It seems like a fitting time to reexamine this issue and discuss better ways to address it. For too long both sides have been polarized and unable to even discuss the topic of abortion in any reasonable manner.

The last abortion clinic

Yesterday I watched Frontline's The Last Abortion Clinic. Unlike some other abortion-related news reports or documentaries that pick a side or person to profile, this program examined the abortion debate from the context of the 1992 Supreme Court decision in Planned Parenthood of Southeastern Pennsylvania v. Casey. Casey changed the standard of review for laws regulating abortion from the Roe v. Wade trimester framework (abortions legal in the first trimester and the ability of states to regulate in subsequent trimesters) to an "undue burden" standard. The majority wrote, "An undue burden exists, and therefore a law is invalid, if its purpose or effect is to place substantial obstacles in the path of a woman seeking an abortion before the fetus attains viability."

Since Casey, states have enacted more than 200 regulations limiting access to abortion (parental notification, twenty-four hour waiting periods, etc.), testing the limits of "undue burden." This documentary looks at abortion in Mississippi and its neighboring communities, and the effects of the regulations. It was astounding how much has changed since Roe and Casey. There is now only one abortion clinic left in the entire state of Mississippi.

You can watch the entire report online at the website, and I highly recommend it, regardless of what side of the debate you're on. The site also has lots of ancillary information that is excellent, including an examination of the six major Supreme Court decisions on abortion and a map of abortion regulations by state.

Rehashing the same stale file sharing argument

Over on Dangerousmeta I saw a link to this Op-Ed by Daniel Henninger from the Wall Street Journal,Can Justice Scalia Solve the Riddles Of the Internet? Without profit even the digital world will break down. Having recently read the excellent profile of Justice Scalia in The New Yorker (which frustratingly doesn't appear to be online), I was curious to read the article. I was disappointed to discover it rehashed the same old fallacious arguments about people "stealing" music online, and worse, that it got mired in questions of morals.

One would expect the article, beginning with its subtitle, "Without profit even the digital world will break down," to espouse a pro free-market stance (it is the Wall Street Journal, after all), but one only has to read half of the piece before Mr. Henninger begins to crow for old business models to be locked in place by the government if "the people" (Pirates, I'm looking in your direction…) won't follow the old rules:

[T]here will always be another wave of digitized aliens hacking through the copyright walls. There has to be a better way.

There is. It's called right and wrong.

It may seem quaintly old school to suggest that people should stop downloading culture without paying simply because it's the right thing to do. But that may be the best option available.

For starters, if "the people" don't solve this problem themselves, Congress will, and you won't like the solution–unless you enjoy the tax code.

Why it's up to "the people" to solve a problem that's surely not theirs I don't know. Worse, the presumably pro free market writer Mr. Henninger, (who is the deputy editor of The Wall Street Journal's editorial page) threatens/encourages/suggests government intervention rather than identify the real source of the problem: the media companies themselves. Instead he hints that downloaders may just well be a bunch of Commie freeloaders!

I would push this even further; it requires a moral or at least philosophical commitment to the legitimacy of profit. Absent that, there's no hope.

If only Mr. Henninger, the RIAA, and those enamored of their old business models predicated on tangible media would stop litigating for the past, they would see there's a whole lot of hope out there.

According to this Pew Internet & American Life Project March 2005 Data Memo (warning: pdf):

Current file downloaders are now more likely to say they use online music services like iTunes than they are to report using p2p services. The percentage of music downloaders who have tried paid services has grown from 24% in 2004 to 43% in our most recent survey.

There are two things happening with online file sharing:

1. It's the market's way of saying not that it doesn't see profit, per se, as legitimate but that the prices charged, for example, by BMG for Shakira's CD don't reflect its perceived value.

2. People are willing to pay when there's a means available for them to do so that embraces what's great about the digitization of media (easy access, portability, recommendations/sharing with friends and family, etc.).

Just because large companies chose to ignore this technology rather than embrace it doesn't mean the market should as well. The market is actually working as it should, and consumer demand is driving the development of stores like iTunes. The people/market aren't wrong, it's the companies who'd rather litigate instead of catching up, or leading.

What if big media companies — instead of pouring millions into lawsuits like Metro-Goldwyn-Mayer v. Grokster — invested money to:

1. Digitize all the content in their catalogs, and offer it for sale through iTunes or some other online music store of choice. During the 2003 Eldred v. Ashcroft case, the Supreme Court found that 98 percent of all copyrighted works are not commercially available. Digitize all that, and suddenly there's a whole lot more to sell.

2. Continue to explore and expand ancillary revenue streams from all the album extras like concerts and merchandise. I seem to recall from a New Yorker article that this is where a lot of the money comes from anyway, and a large amount isn't from CD sales.

3. Embrace the web — not just to create a distribution mechanism for the digital bits, but also for the fans. Create lively sites for each artist, populate them with real consistent content, create conversation space for aficionados (what fans have already done with sites like green plastic radiohead, a fan site for the band Radiohead) and build the traffic. Make money off of the ad revenue.

How hard is it to adapt and evolve one's business model to the changing time? I think that's what irks me the most about all this — taking it to the courts to ensure that because something once was, it should (be legislated to) always be. All this "copyright" is just code for "profit."

P.S. What about a bumper sticker that says, "Your failed business model is not my problem"?

P.P.S. In retrospect, this is such a stupid article, I can't believe I wasted any time responding to it, when I could be enjoying the glories of Paris!

Saving the already-saved Social Security system

I received some feedback via email regarding my post, No smoking gun in Iraq from January 13th. One reader wrote:

Gee, I remember back in 1998 the Clintons and just about every Democrat in Congress were screaming that the budget "surplus" should only be used to "save Social Security." If you believe Social Security needed saving back then and doesn’t now then you must believe it has already been saved. Well, who saved it? Clinton didn’t do anything, so the only answer can be George W. Bush. So following the logic of the Democratic talking points that Social Security is not in crisis (which you have clearing bought into for whatever reason) to be consistent historically you must be willing to admit that someone saved Social Security already and you should be able to tell us who that was. Further you must be able to tell us what transpired in the last six years in the Social Security budget to take it from needing to be "saved" to no longer being in crisis. Are you willing to blog on that a bit?

I could blog on that for a bit (and address the issue of conflating talk of long-term Social Security reform with "crisis" and an immediate push towards privatization), but it's a lot easier to point everyone to someone who can do a much better job of it than I: Hendrik Hertzberg at The New Yorker. In this week's Talk of The Town, Unsocial Insecurity Mr. Hertzberg writes:

"This is one of my charges, is to explain to Congress as clearly as I can: the crisis is now," Bush proclaimed at an "economic summit" a month ago. He does indeed have some 'splaining to do. This year, the Social Security system–the payroll tax, which brings money in, and the pension program, which sends money out–will bring in about $180 billion more than it sends out. It will go on bringing in more than it sends out until 2028, at which point it will begin to draw on the $3.5 trillion surplus it will by then have accumulated. The surplus runs out in 2042, right around the time George W. Bush turns ninety-six. After that, even if nothing has changed, the system's income will continue to cover seventy-three per cent of its outgo.

That's using the Social Security Administration's economic and demographic assumptions, which are habitually pessimistic. Using the assumptions of the nonpartisan Congressional Budget Office, the surplus runs out in 2052. And if one uses the economic growth assumptions that Bush's own budget office uses when it calculates the effects of his own tax cuts, the surplus runs out in–er, maybe never.

I do support some kind of Social Security reform, if only to ensure that the surplus never runs out. But I question the language of "crisis" and the rush to privatization — a solution that Hertzberg points out that even White House officials and The Comptroller General of the United States, David M. Walker, say does nothing to eliminate the long-term gap and maintain the solvency of the fund.

No smoking gun in Iraq

In fact, there was no gun at all! In news that I'm sure surprised no one, the US announced the search for weapons of mass destruction in Iraq — the justification for our pre-emptive invasion of that country — ended after two fruitless years. The New York Times opines in its editorial Bulletin: No W.M.D. Found:

The search for weapons of mass destruction in Iraq may have been one of the greatest nonevents of the early 21st century, right up there with the failure of the world's computers to crash at the end of the last millennium. That Y2K scare at least brought us an updated Internet. Fear of the nonexistent W.M.D. brought us a war.

No matter how the Administration spins it, the ends do not justify the means. Lies, scare mongering, and faulty intelligence have no place in a democracy, regardless of whether a democratic Iraq is the ultimate outcome of the war.

This tactic has been so successful for President Bush that you can see it being applied once again, now to Social Security and its current 'crisis' (though projections show benefits will be solvent until 2042, see Democrat disputes Social Security 'crisis'). Americans, I beg of you, in the words of Chuck D: Don't believe the hype!

Supporting the US troops abroad

Over the Christmas holiday I discovered anysoldier.com and was surprised I hadn't stumbled across it sooner.

Sergeant Brian Horn from LaPlata, Maryland, an Army Infantry Soldier with the 173rd Airborne Brigade was in the Kirkuk area of Iraq when he started the idea of AnySoldier to help care for his soldiers. He agreed to distribute packages that came to him with "Attn: Any Soldier" in his address to the soldiers who were not getting mail. Brian is no longer in Iraq but Any Soldier Inc. continues with your support.

Any Soldier Inc. started in August 2003 as a simple family effort to help the soldiers in one Army unit, thus our name. However, due to overwhelming requests, on 1 January 2004 our effort was expanded to include any member, of any of the Armed Services, in harms way.

We now have 981 Contacts (872 Army, 8 Navy, 42 Air Force, and 59 Marine) helping approx 43,570 soldiers!

There's a list of contacts, including recent emails, and a list of suggested items to send. You can even purchase care packages that have already been assembled with soldiers' needs in mind. I spent a long time just reading the emails from soldiers, it gives you a better sense of what it's like over there than reading most news articles. So if you received some money for Christmas and you're not sure how to spend it, consider getting something for Any Soldier and making a soldier's day.