[A few edits were done 3/31/12, to paragraphs preceded by **. The original versions weren't unintelligible before being corrected, but they are clearer now.]
I had written a fairly heartfelt, relatively succinct “position statement” on the individual-mandate provision of the Obamacare law that recently had arguments for challenges heard before the U.S. Supreme Court. I held off posting this statement on this blog because, in part, seemingly nearly everybody was making such statements, and I probably had little more original to say than many others. In short, I am against the individual mandate, but I also would tend to be practical about it. If it is upheld, and I (like many others in my position) would have to pay a penalty on my federal tax return for failure to buy my own insurance, I would have contingency plans for how to deal with that. Among them would be finding ways to have business expenses and such to report on my 1040, to offset the penalty to the extent possible.
I had written a fairly heartfelt, relatively succinct “position statement” on the individual-mandate provision of the Obamacare law that recently had arguments for challenges heard before the U.S. Supreme Court. I held off posting this statement on this blog because, in part, seemingly nearly everybody was making such statements, and I probably had little more original to say than many others. In short, I am against the individual mandate, but I also would tend to be practical about it. If it is upheld, and I (like many others in my position) would have to pay a penalty on my federal tax return for failure to buy my own insurance, I would have contingency plans for how to deal with that. Among them would be finding ways to have business expenses and such to report on my 1040, to offset the penalty to the extent possible.
But one way I can contribute to the debate, if a marginal one, would also be fun: to have a little periodic feature on this blog (generally similar to “Movie break”) called “Anecdotal Evidenz,” the second word spelled Germanic-ly just for fun (and to save on character space). This would be to relate little stories—many from my own experience—to support the following simple notion: If every Shmoe who is not covered by some kind of group insurance in this country should step up to the plate and pay out of his own pocket for insurance, in order to help the financial integrity of an insurance system that aims to cover everybody, do we really have a rational, integrity-redolent health-care system in this country that would inspire (and give a kind of moral/emotional reward for) that kind of socially responsible effort? If I break my ass to pay for health insurance, am I assured that I am helping a large system that is, generally speaking, sensible in its every part, including toward me (and you)? Or are there many anecdotes to show us that the “system” has a lot more problems with it—more numerous and often of huge consequence—than just several million citizens who, putatively ignominiously, decline to get insured?
Let’s look at those anecdotes and see if we can answer the last question yes.
Anecdote 1 (1984): Health insurance at my first post-college job
This is a story I’ve told numerous times over the years, from a sort of forgiving, retrospective bemusement. But it’s funny how the story lends itself to more acerbic analysis as I pose it in this blog series, with an eye to casting skepticism on the apparently not-rare viewpoint that says just a few big tweaks, like getting everybody insurance even if it means compelling them to pay for it, will make the American health-care system “closer to perfect” rather than the jerry-rigged, hypocritical, at times laughable mishmash it really is.
When I started a “permanent” version of my job as a weekend building manager at the Marvin Center, the big student union at my college that was run by a paid staff, it was not much different from the assistant-manager job I’d had as a student for about two years. Short sum: I had a student job at the Marvin Center—a paid job, within the university (not work-study)—from October 1980 to May 1981, September 1981 to May 1982, and from September 1982 through about early May 1984. The portions of this to December 1981 were in the Marvin Center’s game room, a limited facility on one floor; the rest (for about two years) was as an assistant manager (often there were two of us per night we worked, along with a non-student staffer) of the whole building, which spanned about six floors. When I applied for and was made the permanent assistant building manager for Friday, Saturday, and Sunday nights, this was a slightly glorified version of what I’d done as a student—and developed skills and responsibilities in—since January 1982.
The permanent job was 30 hours a week—admittedly part-time, but I think this suited me fine, not only because it followed a busy several years as a student with a double major and with paid work almost all through the school year, but (in terms of longer-term rationale) I was considering taking post-graduate courses, and the Marvin Center job wasn’t meant to be a career thing anyway…and (in terms of ad hoc developments), I would take a second job, outside the university, with the Tennessee Valley Authority’s Washington, D.C., office for about two months in 1985.
George Washington University, my college, had (as far as I recall) a very good health insurance plan. I forget now whether it was an HMO; I don’t think it was a preferred-provider plan; but it was oriented primarily to GW as a large employer. It might have included fee-for-service provisions along with HMO qualities; I can’t remember. And I think it was offered by a large health-insurance company like Blue Cross-Blue Shield. In any event, it was generally a good plan, and it did cover treatments from facilities that were outside what I think the plan suggested you use.
**But if you were part-time, whatever number of hours you worked, you were classified as “20 hours a week” and, per a logic that apparently felt that if 20 hours a week compared to a 40-hour full-timer meant half the work, you paid for half your insurance. So even though my regular schedule was 30 hours a week—and the overall university even had some employees who were classified as full-timers who worked 35 hours a week—I had to pay for half my insurance as if I was a 20-hour worker. So, for a few months early in my tenure as permanent staffer, that’s what I did.
This, by the way, was the first regular health insurance—actually, the first of any kind—I ever had. I never had health insurance when growing up, and never had it during my student years in college. The same was true for my mother and sister. You could do that in those days. (And whenever I had health expenses, I paid out of pocket, basically.)
In those days, I was in my twenties, and generally healthy. One regular health expense I did have was for megavitamins, which I did not consider elective—and which generally still had credibility in the early 1980s, but which after the death of one of this therapy’s main proponents, Carl C. Pfeiffer, M.D., Ph.D., in 1988, would fall into increasing ill repute, to where it is regarded as quackery today (rightly so, for reasons I won’t detail here, but which I have written about elsewhere). I had been getting megavitamins, usually as a yearly matter (you bought everything you would take for a year in one annual visit), since 1979. When I went to my regular appointment with the megavitamin facility I saw in summer 1984, I had a bill for $200+, which was fairly typical. I submitted the bill to the GW health insurance program.
It covered all of $4 of it. About 2 percent.
I thought, if my main health expense that I could foresee as a regular matter was hardly going to be covered by GW’s insurance plan, why should I be paying for half of my premium a month? So I dropped my coverage soon after the megavitamins billing.
**Meanwhile—here is more of a kicker—my sister, who graduated from college in 1985—in Washington, D.C., but from American University—was working (as a sort of low-level producing functionary) for a small media firm run by woman with a strong personality (it produced syndicated radio shows). And since my sister was full-time there, she got a full health insurance benefit, paid for 100 percent by the employer. What was the plan my sister’s deal was offered from? The GW health insurance plan.
See, apparently GW’s employer-dedicated plan not only served the massive GW workforce, but also was shopped (presumably by some sales dorks within the administration of the plan) to outside, smaller companies, whose money (when they signed up) paid for premiums that would be only too welcome to the administrators of the GW plan. (And if I’m not mistaken, my sister’s individual plan had more features than mine had, but I could be wrong on this.)
Of course, as far as my own health-insurance situation was concerned, this would be the first of many, many experiences I would have of an employer doling out a work deal for you that seemed quite good for you in some respects—the nature of the job, the hours, etc.—but the health insurance benefit was more like, as the old story has it, the feather held out by the Indian chief, who ostensibly is seeing, with a show of wisdom, if his young disciple can snatch it from his hand, while the chief is always making sure the disciple doesn’t get it.
This was hardly the worst story I would experience (or hear about) of an employer’s health-insurance offer being less than it should be, even by standards of simple fairness related to your situation. The worst horror story in my life involved a medical-media publisher I worked at in 1993-94.
But this is one good example of how, with all the talk about pooling risk (then or now), the high-minded principles that are “espoused” and the realities seen on the ground have diverged quite a bit at least as far back as about 30 years ago. And this was with a massive employer like GW. GW’s health plan could suck in premiums from companies outside itself to beef up its revenues, but its own employees could not always rely on fair practices for whether they qualified for insurance paid for entirely by the employer.
