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Have They Ever Asked What People Like About Their Insurance?

I don't talk much about the fact that I used to live in Barcelona. It's not often relevant unless I'm playing Two Truths and a Lie. Full disclosure: I kinda forget about it. It feels like a lifetime ago. It is in the sense that I've been back in the US for almost as long as I lived there and my life here is less part of that continuum than a completely different story featuring the same central character. Still, random memories of events will spring into my head, and I think, "oh shit, that happened to me."

This week I found myself thinking about my emergency room visit while there. I cut a deep gash in my hand and started applying pressure and thinking about my self-treatment plan. My partner insisted that we go to the emergency room. I'm only just now recognizing how irrational my resistance to seeking professional treatment must have seemed to her. Our healthcare system is monstrously unique in its level of apathy, the concept of not seeking basic treatment over fear of the cost was foreign to her. We went.  I handed the receptionist my ID and medical card. I was treated quickly and released. I don't remember even filling out any paperwork. As I was leaving I slow walked past the receptionist, sure that I had missed something in translation, Catalan is a bitch. Surely, it couldn't be that simple. My partner standing by the door staring WTF at me made clear it was. As we walked home I asker her if we should expect a bill or anything. She laughed.

I thought about that experience after mulling over a Dave Weigel tweet:
A number of things struck me about the tweet. One thing to note is that it seems to be playing into the media meme that people universally love their employee based insurance rather than just enjoying it more than being uninsured. While correctly identifying that most people don't fully understand what it means to have a single payer system, based on my own experience I think his mistake is in assuming that he does. If he has actually lived anywhere with a single payer system his pet theory is suspect. I don't think many people truly understand the role that insurance plays in the healthcare system. I have a very conservative friend whose politics I forget about in the same way I forget living in Barcelona. They never come up because why bother? Occasionally he'll be unable to resist and feel compelled to comment on one of my posts on Twitter as he did recently on a post on healthcare. After a back and forth over his complaint that he didn't want the government taking over healthcare I asked, "What value do healthcare insurance companies add to the system to justify the massive profit they take for denying care?" His answer amounted to just not liking the government taking over healthcare. Many people accept insurance companies as a requisite part of our system without ever considering that question anymore than they think about the way that insurance companies make their increasing profit by denying services and payments for services recommended by medical professionals. While people scaremonger waiting times and denied services under "socialized medicine" counter to stories from Canada and Great Britain I've twice had treatment delayed by weeks by insurance companies since I returned almost 6 years ago.  In that time my insurance plan has changed 4 times.  Every year millions of Americans have to become experts at comparative insurance metrics. What's not to love about that?

Returning to the tweet another thing to note is the question in the Quinnipiac poll. It's a fair question but predicated, to some degree, on the notion that Medicare for All has significant meaning to most people. It doesn't, insurance does. The idea of having no surprise bills and knowing the cost of your medical expenses for the year, presenting your medical card and no payment at the point of service is as foreign to most as our system was to my ex. In fact when the details of the system are explained favorability is much higher,

If it were clearly explained consistently that Medicare 4 All would cover abortion, dental, vision, limit prescription drug costs and be free at point of service because it was paid for by taxes, would favorability go up even higher? At this point the fact that there's confusion around what Medicare for All means is not just due to the underlying concept being unfamiliar, there's also a deliberate attempt to confuse voters and present plans which include private insurance as interchangeable with a single payer system. As the idea of healthcare as a right has grown in popularity there have been proposals offered named Medicare Extra for All,  Medicare for America, and Medicare X all with some kind of buy in or public option that maintains the role of for profit insurance. Most of the candidates who have sponsored Medicare for All also sponsor plans that have a buy in, which speaks both to the political strength of the idea that healthcare is a right and the weakness of their support for a single payer system.

This interview with Peter Buttigieg shows both the standard framing of the question and the standard dishonest answer:

When candidates say they support universal healthcare and that they believe it's possible with for profit insurance playing a role they are saying that they are either too willfully dishonest or too ignorant to be considered for president. In order to have universal healthcare with for profit insurance and "control costs" we would need to exclude individuals or push more costs on to patients.  What they are suggesting is improvements on the ACA rather than accepting that the system is broken beyond patchwork repair. Our experience of the ACA shows that they are only advocating universal insurance, not healthcare, since millions would still be unable to actually afford to use their insurance. In a report on brief conversations with Senate Democrats Vox reporter Tara Golshan asked several about the importance of private insurance. Their responses make it clear that the role they see is not practical or financial, but political. She references an interview with Micheal Bennet in which he explains the wrong lesson he'd like us to take away from the ACA while showing the underlying deception of the mainstream discourse. "Remember when President Obama said "if you like your insurance, you can keep your insurance." I'm pretty sure that he's substituting "insurance" for "doctor" and this is always the case. The problem with the ACA was that it forced changes from health professionals with personal connections on the basis of the insurance they accepted and less that it meant interacting with another faceless behemoth. The democrats are now dishonestly using the Republican knock against the ACA, which turned out to be more true than is acknowledged, against Medicare for All. While following up on the role of private insurance I hope reporters will also ask politicians like Bennet how patients will lose their doctors if there's only one network and everyone is included.


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