John McCain’s health care plan is rubbish. So says everyone. Most of the summaries I’ve seen have focused on the fact that twenty million will likely lose their employer-cushioned coverage, and that the individual market is horrible to those who have been ill, or for those who are obese.
The plan is rubbish, for all the reasons cited. But it’s rubbish for more reasons. It’s rubbish because it’s made of rubbish.
The individual market is horrible to those have been ill, but when it’s stated like that, it sounds like something only the sick or chronically ill will have to worry about.* And most of the people writing about it are either young, and eminently insurable on account of being young, or have comfortable employer-based insurance. I don’t think they get quite how much the individual market sucks for a normal person.
So let’s play pretend, because let’s be clear: this is a bad idea for everyone.
John McCain is elected, and the health care coverage of twenty million people gets dropped. Two of those people, Jack and Jill, are a couple in their fifties. Jack and Jill are in excellent health and middle class. Absolutely no chronic conditions. Great CON. Neither of them smoke. And we’ll assume that they’re also of normal weight.
Let’s play on eHealthInsurance.com. Jill is 52 and Jack is 56. For $400 a month, they can get coverage. This is not nice coverage. This is coverage that tends to have a multi-thousand dollar deductible, no prescription coverage, no doctor’s visits coverage. If they want an HMO-style plan with co-pays and prescription coverage, call it $1100. (And of course, their risk is evaluated individually.)
But let’s make it a little more realistic. Jill is overweight. Not obese, mind you. Let’s say she has a BMI of 27. This varies a bit by company, but add 25% onto her premium. Jack smokes. He’s been trying to quit, but he picked up this habit back in the 60s and it’s been hard to kick. Jack is probably now uninsurable. (Were he younger, figure another 25%)
Actually, they probably both are. In their fifties, they’re bad risks. When they had employer-based coverage, this wasn’t a big deal, because their own personal risk wasn’t evaluated. It is now.
And we’ve spotted them perfect health and perfect health histories, mind you. According to this study, the average American adult fills nine prescriptions a year. Someone in her fifties: 13. So surely it’s not insane to think that someone in her fifties might be on one or two medications.
Now, we can assume that the market will change a little bit, and that Jack and Jill might have a tax credit to play with. That isn’t going to make them younger, or a better risk. This plan is cruel to boomers.
So who in this country is this plan supposed to benefit?
21 comments
September 17, 2008 at 6:43 am
Vance
As far as I can tell, no one. That is, it seems like a fairly rare instance of straightforward Norquistism — the government shouldn’t be trying to solve this problem, so let’s stop — garnished with tax credits so there’s still something to call a “health plan”.
September 17, 2008 at 6:44 am
Rich Puchalsky
I am self-employed at my own small business, just like all those libertarians — wait, no, every libertarian I’ve met is in a big company. Anyways, being self-employed, and supporting a family, I have to pay for family health insurance. Through the cheapest HMO I can find, it’s about $1000/month — my family is reasonably healthy. That’s more than the monthly mortgage payment on my house.
Republicans do not support small business, and never have.
September 17, 2008 at 6:46 am
Rich Puchalsky
Actually, Vance, I haven’t bothered to read anything about the details of McCain’s plan, but if it gets big business out of their legacy health care obligations, it’s a huge benefit to them.
September 17, 2008 at 6:50 am
dana
Exactly, Rich. I feel ya. How the hell did it get to be the conservative position to spend a house’s worth of money on *insurance*. Not care, mind you, just insurance?
Vance, the thing is, this is more than just Norquistism; this is actively making the problem worse by undermining the only part of the health care coverage system that is almost functional.
September 17, 2008 at 6:52 am
Vance
Right, good point — I don’t know about that either. (Of course if that happens there will be blood.)
And of course in principle, that sort of reduction in government outlay is supposed to benefit us all.
September 17, 2008 at 8:22 am
bitchphd
The thing that continues to get me about McCain’s “plan” is the risibility of proposing a $5k tax credit for insurance costs. NO ONE’s insurance costs just $5k/year.
It’s like . . . it’s like McCain has no fucking clue.
September 17, 2008 at 8:52 am
karmadrome
It’s possible that McCain has no clue, but there is little doubt that the people who put together the plan for him know exactly what they’re doing
McCain enjoys comparing himself to Teddy Roosevelt when he’s wearing his populist mask, but the reality is that he is a part of exactly what Roosevelt sought to avoid: The instruments of regulation have become corrupted by the very industries they were designed to regulate.
When business and its surrogates take over the instruments of regulation, you get the McCain health care plan. Anyone who tells you that Republicans don’t believe in “class struggle” and “redistribution of wealth” haven’t been paying attention, have they?
September 17, 2008 at 9:25 am
chris y
And most of the people writing about it are either young, and eminently insurable on account of being young, or have comfortable employer-based insurance.
And no parents?
Rich, I can’t think of an actually or potentially governing party anywhere in the world that supports small businesses, can you? Small business owners are treated as patsies by the far right from Poland to Portland. As a corporate serf, I have to agree that it breaks my heart.
September 17, 2008 at 9:29 am
teofilo
At one point, before she had the job that she has now, my mom was shopping around for individual health insurance. She filled out the forms for Blue Cross giving her health history to get a quote, and mentioned that she had had temporary high blood pressure when she was pregnant, which is not an uncommon condition. Otherwise, her health history was extremely good. The quote she ended up getting was so astronomically expensive that there was no way she could afford it, so she didn’t get the insurance. (She now has a job with very good insurance through Blue Cross, and she has no compunctions about charging as much as possible to it.)
September 17, 2008 at 9:35 am
dana
And no parents?
Indeed.
The quote she ended up getting was so astronomically expensive that there was no way she could afford it, so she didn’t get the insurance.
This is another good point; sometimes people will be coverable, but at a rate that is too high to be a live option. Do these count as “just choosing not to have health care coverage” under the McCain plan?
What’s especially dumb about this is that as I understand it, it’s not the treatment gestational high blood pressure or the BMI of 27 that incurs most health care expenses in any case; leaving the problems untreated leads to worse health care outcomes.
September 17, 2008 at 9:43 am
Josh Carrollhach
McCain will likely be remembered by historians as a weak man… a weak, old man to boot. What integrity he had (and this is a subject for debate) has gone by the board as he enthusiastically embraces whatever sand his handlers blow in his direction. I wonder if it is his unbridled ambition or just his propensity to fuck things up that is at fault, but I don’t care.
By the way, I wonder if anyone might care to address his role in fire aboard the USS Forrestal that killed 134 sailors. I’ve read accounts that hold him responsible for “wet-starting” his jet and triggering a Zuni missile mounted on the F-4 behind him. I haven’t read any clear accounts, but there is some ambiguity about it.
September 17, 2008 at 10:06 am
Adam Roberts
People over here in the UK like to kvetch about the NHS; waiting times and such. It’s salutary, speaking personally, to be reminded of what life would be like without it.
September 17, 2008 at 10:09 am
Vance
No kidding, Adam. I lived for a couple of years in Italy. The health service there has its issues (underfunding, inequality, some corruption) but coming from the US, I was astonished what a difference it makes for people to be able to regard health care as a right.
September 17, 2008 at 10:12 am
PorJ
This is all well and good, but where’s today’s “This Day in History”? Do you take requests? The NFL was founded on this date in 1920 in a Hupmobile (? – !) showroom in Canton, OH.
September 17, 2008 at 10:14 am
Josh Carrollhach
In France the doctor comes to you. In the US, if a doctor made a house call he’d likely spend most of his time reviving whomever was supposed to pay the bill!
While the government often louses things up, at least its core philosophy is public service. The private sector’s only duty is to its shareholders. Why on earth would anyone assume that private enterprise would do anything other than try to wring out every short term penny?
Remember, while the dead don’t pay their premiums, they also file no claims (or something like that).
September 17, 2008 at 10:26 am
ari
PorJ, I invite you to write it up. Let me know if you’d like to. Otherwise, you’ll need to get your requests in with a bit more lead time.
September 17, 2008 at 3:38 pm
urbino
Not care, mind you, just insurance?
This calls attention to the thing about the larger health care debate in this country that drives me batshit. Even among the Dems, the debate is almost entirely about insurance — how many people don’t have it, how to get it to them, whether to force them to buy it, etc. (With McCain you get the further question of whether too many people have it.)
Nobody wants health insurance. Fuck insurance. We want health care. Health care is what too many people don’t have, and health care is what we need to figure out how to provide. We don’t need insurance for it, we need assurance of it.
It’s like insurance has so tightly attached itself to care, nobody can think about getting to the latter without going through the former.
September 17, 2008 at 4:38 pm
bitchphd
Agreed. Check out HR 676–yes, the site says “insurance” but it’s actually a single-payer, universal care plan.
September 17, 2008 at 5:17 pm
Josh Carrollhach
“Care” is right, Urbino. Western medicine, I believe, has been in a decline since the 50′s as far as care goes.
The reliance on technology and pharmacology sidesteps the skill for which 19th century physicians were so well paid: the reassurance that the body would heal itself (often with the aid of harmless nostrums such as chalk balls and/or prodigious use of laxatives and emetics for effect). Too often a hospital visit entails n interminable wait that leads to a micro-visit with an exhausted, overworked doctor who can only remember your name because it’s on a chart. And don’t get me started on the way interns are hazed, overworked and exhausted (the reason being, if you ask the doctors, that “we all went through it.”).
All the hospital parking spots are taken by pharmo reps, too. They breeze in, address the nurses and receptionists by name and dole out game tickets, pens, ball caps…
I said don’t get me started!
September 19, 2008 at 11:30 pm
Notional Slurry » links for 2008-09-19
[...] I have grown sick of shadows, so I’m going to get a torch. « The Edge of the American West "John McCain’s health care plan is rubbish. So says everyone. Most of the summaries I’ve seen have focused on the fact that twenty million will likely lose their employer-cushioned coverage, and that the individual market is horrible to those who have been ill, or for those who are obese. [...]
October 20, 2008 at 12:04 pm
To cure the plague on both your houses costs $500. « The Edge of the American West
[...] of McCain’s health care plan that reviews the history of employer-based medical coverage. I’ve already said what I think the problems with McCain’s plan are, viz., that the $5000 tax credit isn’t even close to the cost of [...]