Making the tough decisions
by digby
Sometimes I think that the best thing that the only way our country is going to survive is if all of our political elites are forced to live like an average American for the next two years. And by average, I don’t mean the delusional upper middle class, highly educated, well-connected professional kind of average. I mean the world of the sandwich shop owner, the garage mechanic, the office supply salesman and the corporate clerical pink collar ghetto office assistant. People who make between 30 and 60k a year and don’t have a lot of expectations that they will make much more. The middle class workers who don’t get to go on TV or have anyone but their closest families and friends ever tell them how great they are and encourage them to believe they will accomplish great things. The people who are just living their normal lives in their normal communities, doing normal, everyday, unremarkable things. In other words, most people:
If they did they would find that observations like this are totally absurd:
Seniors would enter the health care world the rest of us live in, with co-payments, deductibles and managed care. Eventually, cost control would require some tough decisions about end-of-life care and the rationing of high-tech treatments that have limited efficacy. But starting with a value of $15,000 per year, per senior—the amount government now spends on Medicare—Ryan’s vouchers should provide excellent coverage. His change would amount to a minor amendment to the social contract, not a fundamental revision of it.
That’s written by an alleged liberal, by the way, not some tea partying moron.
Most old people would be lost in “the health care world the rest of us live in” because if you are self-employed or unemployed, as retirees are, you’d have to “shop” for insurance, go through huge hoops to get insured, manage a complicated health care bureaucracy that you don’t understand, even when you are sick.(Anyone heard of elder scams? Yeah, I though so. And just because they are illegal doesn’t mean they don’t exist.) Doing all that is difficult even for people who aren’t aged, infirm and often very ill with debilitating diseases. Acting as though throwing those people into the pool is going to somehow be beneficial to the individual, much less the system as a whole, is nonsensical in the extreme.
But you wouldn’t know that if you get health insurance from your employer as most Americans do. That’s a fairly simple process. You get a job, you work a short period of time and then you are on their plan. They are not allowed to exclude you or even ask you any questions. It may require you to pay a co-pay or a piece of the premium, but the mechanics are pretty easy. You don’t have to worry about being cancelled if your payment is late because you aren’t making the payments, the employer is. You usually have no idea even how much your policy costs unless you try to go on COBRA and are then astonished as how much of your paycheck it eats up every month. (And don’t think it isn’t part of your paycheck, it certainly is.)Very often it’s unaffordable if you are unemployed and that sends you into the hell of the private insurance market, where this person wants to send frail elderly people to navigate alone. (I suppose we’ll set up some internet sites for the elderly to go to ask questions so that’s good. They’ll end up being smarter shoppers for it.)
This is why all those average Americans are terrified of losing their jobs, millions of whom have recently done so, have been exposed to the vagaries of this individual market and will endure the tortures of the damned to avoid doing again. (Good news for employers, though …)
For those of us who live the the world outside that employer covered system as this person suggests seniors should do, the idea that a sick old person of 70 could be covered for 15k a year is laughable. A good policy for a 50 year old with a health problem can cost that right now (and the health care reform isn’t going to change it.) It’s absurd on its face that sick senior citizens are going to be able to be “cost conscious.” The assumption is that they are overusing the system, when the truth is thatthey are all in the rather immediate process of dying. So let’s not kid ourselves that they are living in the same world we are as healthy adults. They aren’t. And even those with good pensions won’t be able to shoulder the high cost of senior medical care on their own. The only people who will have no worries at all under this are the upper 5%.
Cost of medical care is a problem across the board for all ages. Solving it by telling the sick elderly that they are just going to have to suck it up “and join the world the rest of us live in” isn’t going to solve it. There are ways to control costs without putting the burden on sick people. If that’s the best solution “liberals” can come up with in a rich country in which the top 1% of its citizens owns nearly half the country’s wealth, then I’m afraid our little experiment in enlightenment has been a failure and it’s back to the drawing board.
*And by the way, cavalierly throwing out obscene abstractions like the need to make “tough decisions” regarding “end of life care” is enough to make you gasp. Does this person have the vaguest idea that he’s talking about human beings here? That they may very well think they have a right to every last moment of their lives? Or at least that they should have the choice? Even Jack Kevorkian doesn’t presume to make such “tough decisions” for others.
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