The idiocy of private health "insurance"

Dear Kaitlyn,

I just found your blog via a comment you made in Pandagon. And I read this.

I doubt very much you are an idiot. I'd say you are way ahead of the curve.

I'm very different than you in lots of ways, but we've got a lot in common too. I'm a military brat to start with, and a feminist, and I owe some of my own mental liberation to having read MAD back in the day.

Anyway, you are not the problem here. The problem is, private insurace sucks the big one. It is the essence of the evils of capitalism, distilled.

I didn't realize this until 1989, when I was already 24. I'd just moved in with Natasha (you can probably find plenty to go on about who Natasha was if you go way down to the earliest entries in this blog) and she wanted to write a play about AIDS. So, she said, let's you and I go get tested for HIV, to research that experience. So we did.

In those days, it took days or weeks for the blood sample to get processed; you had to make an appointment to come get the results back. They set it up so that no one could find out which way it went until you were in a meeting with a trained counselor--a bit nerve-wracking but good policy I think.

Since Natasha was researching the play she asked what they'd have done if either of us had tested positive. While we were discussing the options HIV-positive folks had back then one thing the counselor said was, if you've got health insurance, keep it no matter what, 'cause once you get dropped from whatever plan you had, you are screwed. No one will insure you at any bearable price. You become a human hot potato.

Now I suppose to some people this seems only reasonable, but it got me thinking about the very nature of private, for-profit, health insurance. The idea is, you pay money now, and they are betting you will never get sick and they can pocket the money, because if you do get sick it is gonna cost them way more than any one client typically can pony up over a lifetime to cover good care. So--either the fine print lets them off the hook, letting them get away with promising way more than they plan to give sick clients, or the chances of your getting sick are quite low.
Since there are dozens of rival plans competing with each other, every one has an incentive to try to persuade young, healthy fools to part with their money, and get rid of the older, sicker, more savvy folks who might want some value for what they've paid.

It might seem OK if people were in fact able to select and keep a plan when they are young and healthy, and guarantee either that that plan continues all their lives, so the company that was happy to take their money when they were young has to take care of them when old. But in real life, only very rich people have that option.

Look at me for instance. I was able to stretch CHAMPUS eligibility until I was 22, because my Dad was still on active duty and I had not actually graduated from college yet, but once I got too old for that, I had zero coverage. Could I afford to run out and sign up for some plan that would cost me hundreds of dollars a month to keep up? HAH! Once I moved in with Natasha as her full-time, live-in care provider (Natasha was disabled, if you haven't glanced at my blog yet) I worked over 60 hours a week--but at minimum wage, and with zero benefits. I was barely able to pay minimal payments on my student loans.

In 2003, I became theoretically able to sign up for union-supported health plans, but that brings me to the worst part of the story of private health "insurance in the USA. The only way that the vast majority of Americans can possibly afford to buy in is via their workplace--and as we have all learned these past 25 years or so, there ain't no guarantee anyone can keep a particular job in this country, no matter how hard they work or how loyal they are. And if your insurance is tied to your current job, it disappears the day you are downsized, laid off, or just plain fired. And all the money you paid into it vanishes into thin air as far as you are concerned. Lord help you if you have acquired "pre-existing conditions" since you last "shopped" for insurance by shopping for a job--they may have been covered at bearable rates under your old plan, but you can't keep that plan, even out of pocket if you have savings--it was a specific contract involving both you and your boss, who just got rid of you.

Or sometimes, the job just vanishes. A long time ago Molly Ivins observed that Unemployment applications in Texas didn't have any checkmark for "employer went belly-up;" her newspaper had folded, gone bankrupt, but the forms pretend that bosses are infallible and immortal--if you are out of work it has to be your fault!

But Natasha Littletree, my personal boss, actually did die, in early October 2004. I can verify--California, like Texas, has overlooked the possibility that some jobs just disappear completely. So if I had ever jumped through all the hoops necessary to sign on with Kaiser that the Sonoma County IHSS Public Authority and SEIU 250 had set up, all the money I might have paid in would have been gone.

In my current job, I have a similar theoretical right to sign on to Kaiser benefits at a price I'm told is fantastically low. Except, I don't have the money. (And one can only join up in certain time windows in the year, when the contracts are renegotiated and the phase of the moon is just so...)

And I still think that giving my money to a bunch of professional crooks is a bad investment. It may be better than getting stuck with a hospital bill, since I have no savings to pay a medical bill out of pocket, but I'm on the Republican health plan--don't get sick. And if I'm getting sick I don't want to know.

The only sensible plan is to do what every other civilized and half-civilized nation in the world does--have the ultimate insurance plan, the whole nation is the clients, everyone pays, and everyone gets served alike. No bureacracy of competing insurance bean-counters for doctors to apply to in the hope of getting paid; no contracts renegotiated every year that raise rates while adding loopholes for avoiding service. It is a simple fact that universal plans like Medicare, when not screwed up by politicians trying to privatize them, spend just cents on the dollar in administration, whereas private insurace takes a good sixth or more of their income to feed the company itself.

If I ever get into a place where I can pay my insurace premium, at this late stage in my life I'm beaten down enough to buy in, but only because I have no prospect of saving much before I'm quite old, and because I have some hope that at long last, our country might wise up and introduce universal health care once and for all. If I had been able to afford private health insurance all these years, but instead had saved the money, I daresay I might have saved up enough to cover big medical bills out of pocket.

But working class people can't do that by definition--why is another rant. The only sane thing is to hit the rich up for the bills. After all, they have no chance to get rich if there aren't healthy working people who are not in a rebellious mood, have they.

Undervaluing the work that is never done...

Over at the Pandagon place, Amanda has once again attracted a fine crop of concern trolls. Gee, and all she did was point out that making marriage into a sacred norm is a bit of a crock.

Way up here "Robert" quoted Amanda saying:

particularly since the patriarchal model has men doing so very little of the actual work that in some families Dad is mostly regarded as decoration. Seriously, I know people who had more rearing from their aunts and grandmothers.

And then he said:

This is simply a reversal of the patriarchal notion that childrearing isn’t real work. You’re assigning the work of economic support for a family a very low value.

No, no, Robert you bozo, Amanda is clearly not "assigning" that work a low value. She's pointing out that our society does that misassement. It's not subjective, it's a clearly observable fact.

The people who actually do the labor you (correctly for once) point out should be so highly valued actually don't get credited with it. Wifehood is typically a euphemism for "house slave." Of course it doesn't have to be, of course fewer and fewer women are simply accepting that, of course quite a few men are gradually and grudgingly--as always, some willingly and eagerly--taking on their share and perhaps more (for a change) of that drudgery and effort.

Not all of motherwork is a pain, of course. But even the rewarding parts are still work in that it takes serious application, however willingly applied, and that doing it means you can't simultaneously be doing something else that is valued in our screwed-up socioeconomic system.

Quite aside from the specifics of childrearing, the types of work that women do, throughout history, throughout the world, have been systematically undervalued in the patriarchial societies that have been the near-universal norm these past several millenia. Today, in the capitalist world, it is quite possible to contract to have the types of ongoing maintenance of civilization women have "traditionally" been required to do to be done on a fee-for-service basis. When we do this, we typically hire people at the lowest wages, often illegally low (and by the way, arrange for specifically childcare duties to be handled the same way). We expect people working as employees in these sectors to work long hours with minimal or nonexistent benefits. And yet, despite the cut-rate and exploitive standards set, the price tag for getting the jobs done comes out pretty high. If we paid these workers (overwhelmingly women) at rates competitive with "men's work," the price would be even higher.

For 16 years I worked as the care provider for a disabled person. I can testify how minimally I was paid. For all but 2 of those years, it was at the minimum wage. And I learned fast the pragmatic basis of the maxim "Man works from sun to sun but women's work is never done." The most draining thing about it is that you are constantly on the battlefront against entropy itself--everything is coming unraveled as fast as you can ravel it. That's the nature of keeping life going.

And I learned how absolutely essential this inglorious, scorned work is. If the housewives and servants and janitors and cooks of the world could be organized to go on universal strike, I reckon that the entire world would grind to a grimy, sticky, malnourished, sick, miserable halt in about half a week, about when the frozen snacks in the freezers run out.

And yet this work is done, continuously, for the least consideration of any category of labor, often for "free," and has been for thousands of years.

I know you've got some "economic" answer for this, dear Robert. One major reason I have zero respect for mainstream so-called "economics" is that it is precisely an ideological machine for justifying the social order we've got, as the natural and inevitable order of things, nothing more and nothing less. That's its entire content and function.

I've studied a rational, scientific approach to economics, thank you very much, and it is quite straightforward in pointing out that real economic systems are generally based on exploitation enabled by implicit, sometimes demonstrated, systematic violence. Scientific political economy is also far better at accounting for the real structure and observed details of actually existing economies than marginalist twaddle has ever been--that's my main reason, that I think that as a model, political economy based on historical materialism and the labor theory of value is reasonably true, whereas mainstream "economics" is ideological bunk.

"Women's work," especially motherwork, is not underpaid because it is cheap. It's underpaid because women are exploited systematically as an ancient and crucial part of a global system based on general exploitation. In pointing out that in fact, in the real world, men in our patriarchial society very often get full credit for being great patriarchs while actually riding free on the unpaid labor of people drastically underprivileged and arbitrarily subordinated to these very "patriarchs," Amanda is taking note of situations we've all seen examples of ourselves, and they are by no means treated as bizarre extremes. The point of this thread, to reflect on why it is that our society maintains the mystique of "marriage" as a sacred norm, comes clear if we consider that marriage as it actually evolved in our society has always involved some degree of enslavement.

Thanks for blundering directly onto the very crux of the argument that punctures your whole sanctified balloon, Robert.