Reprinted from Therinth, a burn ward RN.
Having spent the past twelve hours hanging out with a bipolar person in their full blown manic state, i’d like to make a few comments. And i’m making this post public, unlike most of them here.
(Perhaps them being manic wore off on me some, because i can’t get to sleep without saying some of these things.)
I watched the first 30 mins of the first episode of House for this season. Let me list the ways this show is wrong: House attacks another pt, and is still bunked with that pt, and not moved to the violent psych ward with people who are manic with a side of stabby. They give House haldol. Haldol by mouth is like the unicorn. NO ONE HAS EVER SEEN IT. If someone’s fighting you, you think you’re going to stick your finger in their mouth to give them a pill where they can bite you, and/or spit out the pills, or cheek them? No. Haldol is an IV/IM drug. House’s manic buddy, who helps him out, is mildly plausible as a character, until he starts…helping House out. Rhyming, yes, too much energy, yes. Annoying? Hell yes. Responsible enough to help someone else follow through on a plot? Oh hell no.
And also, the time he’s cuffed, no one is in the room with him, that’s UNLIKELY, given restraint laws these days, and when he’s in solitary…for reals? That room is *that* white? No fucking way. Not a single stain of shit, piss or blood? Unnnnnnnnnnlikely, my friends.
House is usually enjoyable enough that i can suspend my disbelief. But if i’m going to keep watching, the next hour had better have him have his ass back in the hospital, where i can merely smirk at the thought of doctors hanging IV meds.
So, while i’m babysitting this patient, stopping him from picking off all of his dressings with continual reorintation and redirection, what plays in the background? That new medical show, Three Rivers.
Gah. I didn’t pay attention to the whole thing. I didn’t have to. What i heard was enough. The part where someone who doesn’t have insurance (and isn’t even an American?) needs a transplant. The doctor smugly tells some secondary character that, “You’ll find a way…” implying that somewhere there’s a loophole big enough to drive that truck through. I’m sure by the end of the episode it happened — someone reached up their rectum, and found a quarter of a million dollars that they didn’t know was there to fund the operation.
I hazard a guess that this is what is wrong with America’s interpretation of their current healthcare system. Perhaps, not having recently been ill, or having always been well monied, you’ve never pondered what typical medical care is like, or how much it all might cost, were you without insurance. You think it’s all like it looks on TV. And even if the worst does come to pass, and you’ve blown through one liver and need a new one, well, surely someone will break some rules for you, too.
No.
You lose your job, find out you need coverage for cancer-car-wreck-diabetes-your baby-can’t-breathe the next day?
You’re fucked. (Unless you pay into Cobra’s outrageous system. And when that runs out? Still fucked.)
You never had a job with health insurance?
Way fucked.
While i’m so very damn proud of my profession, i believe we cannot continue to go honorably on. Not when the real deal is that people are denied care every day because of situations they cannot control. Even if they could control them — they shouldn’t be denied.
There’s no Dr House or Grey’s Anatomy blowhard who is going to come down from on high to save you on your worst day, no matter how much TV you have viewed.
You’re one job away from losing it all, or going bankrupt to pay for it. Not only you, but your children, your parents, your neighbors. (All you people who are getting by on Medicare, get off my fucking lawn unless you see the irony in the care that you receive.)
We need a public option. We needed it yesterday. We sure as hell need it tomorrow.
Please, if there’s anyone you can talk to about this, do so. Get the word out. We are all in this together, honest to fucking god, as humans on this planet, as Americans, as people who at the very least should have the wisdom and self preservation to hope their nannies and dishwashers won’t have untreated TB.
Word, Mandolin. My husband says these kinds of things damn near every day when he gets back from the ICU.
Absolutely. I *have* health insurance and I keep my cell on vibrate these days to dodge the creditors who want me to pay more than the 15 to 20/bucks a month I am able to pay on all I owe to various hospitals, clinics, dentists, specialists, etc around town — that 20% my insurance doesn’t cover; or the this-and-that it doesn’t cover; or the $500 per person deductible, every year, not covered….I could go on. This doesn’t count what doesn’t get covered on prescription drugs.
None of us are even sick! This is just for day-to-day random crap! Dentist visits! Eyeglasses! (Not covered!) The kid gets strep! Someone sprains an ankle! The kid needs braces! Mr. delagar needs a root canal! We end up nearly 3000 dollars in debt.
Gah!
The part where someone who doesn’t have insurance (and isn’t even an American?) needs a transplant. The doctor smugly tells some secondary character that, “You’ll find a way…” implying that somewhere there’s a loophole big enough to drive that truck through.
To be fair, there is at least one loophole that I know of. A non-American with no insurance (and no money…at least not enough for a transplant) can get a bone marrow transplant through the NIH. IF they agree to be part of a study which the NIH is running, IF they qualify for that study, IF they have enough money to get there and live on while they get treated…
So how do I know this? I’m working on getting a patient into this program. Let’s just say that it’s taking more than one 50 minute episode to get it done.
I think a couple of fades or a nice montage or even a subtitle, “n days later,” would handle that.
MONTAGE! With either “Taking Care of Business” or “Under Pressure” playing.
Oh hell, Mandolin. Anyone who takes anything they see on a dramatic TV series seriously is out of touch with reality, regardless of whether it’s legal, medical, or anything else. I’m not saying this to invalidate what you’ve said, but only to point out that you are giving us a specific case of a more general phenomenon.
True. But then, Medicare grossly underpays providers, requiring people like me to pay higher amounts in private insurance premiums and doctor fees to subsidize them. In fact, it underpays providers to the point that many providers (such as my 84-year old mother’s doctor) refuse to take Medicare patients. It is also spending money so much faster than it comes in that the CBO projects it’ll be out of money completely in 2016. The more people learn about Medicare the more holding it up as an example of what we can expect from the health care bills in Congress scares people off. It’s a great argument for killing them and keeping the present system.
I have a friend who lived as a child with his family in Germany for a while. They didn’t have much money. He commented that in the U.S. a given procedure would have cost his family tens of thousands of dollars, but in Germany it was free. Well, guess what – it wasn’t free. It just cost someone other than you. Which is great for you, but not so great for someone else.
I don’t think too many people are doing that. What I see way more often are people posting that signs reading “No government run health care! Leave Medicare alone!” are too stupid to be taken seriously in a debate about pizza toppings, much less a national health care system.
—Myca
Repetition of first line of post: this is reprinted from Therinth, the blog of a burn ward nurse. I do not possess the constitution to work in health care; I faint at the sight of blood.
Medicare grossly underpays providers (requiring people like me to pay higher amounts in private insurance premims and doctor fees to subsidize them)
I’m really not sure how true this is. How do doctors in geriatric specialties survive if they need to be cross-subsidized by private insurance (which presumably few of their elderly patients have, most being solely on Medicare)? Doctors in those specialties make pretty good money, from what I’ve observed (and had pay my way through college). Why do people keep saying that a practice can’t survive on Medicare? If this is actually true, why do doctors take Medicare patients at all? It’s not like doctors feel obligated to take any patient with any kind of insurance; many doctors refuse to take Medicaid patients.
It’s unfortunate that a large percentage of viewers do, then. Perhaps we need to mandate responsible portrayals of these fields. Or at least giant flashing neon letters spelling out “THIS DOES NOT HAPPEN IN REAL LIFE,” superimposed on all unrealistic portrayals.
I’m not sure if it’s on-topic here (and I can’t read the post to find out because I’m allergic to spoilers). But I did post a quote about the alleged medicare underpayment issue in the open thread.
Well, guess what – it wasn’t free. It just cost someone other than you. Which is great for you, but not so great for someone else.
Speaking from both sides of that argument – an Australian taxpayer who is also a cancer survivor – it’s pretty much painless for that “someone else” because that “someone else” is ALSO entitled to exactly the same treatment. And, short of a totally injury-free and illness-free life after which I’m suddenly killed by a bus, I’m going to need it. And if not me, my friends and relatives.
That’s a totally selfish version of universal healthcare, and far from the only reason I (and my entire country) support it. But since you’re taking that tack, there you go.
Not to mention that the whole point of insurance pools is that everyone pays in a little, so that when bad luck strikes one person, there are more resources available than if she had only been saving up the little bit each month against this eventuality. It goes back to the Hayek point I’ve quoted here before about the proper function of government:
A good point made by another Hayek-quoting blogger:
The reason intellectual conservatives oppose transfer payments like welfare is that they destroy incentives to work, and may encourage attitudes of entitlement which undermine the moral strength of the country.
But universal health care does no such thing. Being provided security against the risk of cancer doesn’t make us less likely to avoid getting cancer. It doesn’t create incentives to be less healthy (more wasteful perhaps, but in the interest of health not pecuniary gain). Catastrophic disease could befall any individual at any time, nearly any of whom could not possibly prepare for it with only his or her personal wealth. Pooling the risk among everyone is of course the most efficient and humane solution, whether done through a public option, all through private insurers, or a competition between the two (this is why mandates are necessary).
What happened to Robert’s comments?
This is a thread of Mandolin’s, and Robert isn’t allowed to post to Mandolin’s threads. So I’ve moved Robert and PG’s exchange to an open thread. Sorry for any confusion.
Not to mention that the whole point of insurance pools is that everyone pays in a little, so that when bad luck strikes one person, there are more resources available than if she had only been saving up the little bit each month against this eventuality.
Well, there’s also the issue of the people who created the pool and put up the investment to get it started and make the payments even if miscalculations were made or an unlikely risk occurs and payouts exceed payments or even assets. Insurance pools don’t get created out of thin air. They’re started by people looking to make money. They exist to give them profits commensurate to the risk they take and the effort they put in.
But, be that as it may, there’s also the issue that in insurance pools up to this point, the people involved have made decisions on the risks they face and acted accordingly on a voluntary basis. What’s being proposed here is that people must participate in an insurance pool whether they want to or not. That’s different.
But universal health care does no such thing. Being provided security against the risk of cancer doesn’t make us less likely to avoid getting cancer. It doesn’t create incentives to be less healthy (more wasteful perhaps, but in the interest of health not pecuniary gain).
For things like cancer where it’s harder to make an evaluation of individual risk, that’s got some validity. But that doesn’t describe the full set of risks that threaten people’s health. There are plenty of other things that ARE evaluable by the individual. A cop or a masonry worker can forsee that they are more likely to have physical injuries than a white-collar worker. You know that if you smoke or have high-blood pressure or a dangerous job you stand greater risks, and you can make choices like changing your job, changing your diet or quitting smoking you can change those risks. People CAN make choices that endanger or preserve their health.
Speaking from both sides of that argument – an Australian taxpayer who is also a cancer survivor – it’s pretty much painless for that “someone else” because that “someone else” is ALSO entitled to exactly the same treatment.
But what if that someone else has gone to a great deal of effort to get educated, get a good paying job (or start up a business) so that they can afford to buy that insurance privately? Or, has the same income as you but has chosen on their own to forgo such insurance? On what basis do you justify taking money from them to pay for your insurance? Just because something is also available to everyone else doesn’t justify in and of itself taking money from everyone else for you. They may not want it, so why should they then pay for it for you?
Oh, Amp, I think we already disposed of “TV lies to you”. We’re working on the second half of the posting.
So a set of hospitals getting by on Medicare payments was found? Good for them. Not too many, though, eh? What I read there doesn’t look like there was a lot of in-depth analysis of the rather large number of factors that likely affect medical costs in a given hospital. I’d like to see a critical examination of this study.
I won’t say that there’s no lessons to be learned, though. I don’t at all shoot down the idea that we have to control costs. In fact, that’s one of my major criticism of this whole effort; I don’t see ENOUGH effort in it to control costs.
Christ, I have to wonder … did we see this kind of apocalyptic freak-out around drivers being required to buy car insurance?
WHAT IF I DRIVE REALLY GOOD AND I DON’T NEED INSURANCE HUH? HUH? WHAT THEN?!
Damn, dude. Sometimes, the government makes you do some shit for public safety. It’s just how things go. Like … this is the creeping intrusion of the government into private life that makes you guys freak out? Not warrantless wiretapping or detention without charges or police brutality or criminalization of sodomy or any of that shit?
This?
I am mystified.
—Myca
A cop or a masonry worker can forsee that they are more likely to have physical injuries than a white-collar worker.
RonF,
I don’t understand your point. The question is moral hazard. Are you suggesting that if we have affordable coverage available to everyone, it will create an incentive to work in needed professions that nonetheless carry higher risk of injury, and that would be a bad thing?
Random comment about House: My mom is a doctor, and can’t stand the show. At the beginning of one episode, upon hearing the patient of the week’s list of symptoms, said that she would give the person a particular drug. After the characters in the show go through the usual mess trying to figure out what the patient was suffering from, they end up curing his condition with exactly the same drug my mother said that she’d use.
But what if that someone else has gone to a great deal of effort to get educated, get a good paying job (or start up a business) so that they can afford to buy that insurance privately?
Well, then they can buy private insurance so that they can queue-jump, have a greater choice of doctors and hospitals, and have some allied services like massage subsidised. There’s no ban on private insurance in addition to universal cover. And what idiot doesn’t want healthcare? No politician in a universal healthcare country would dare mess with the idea of everyone having care – see, for example, comments by the Conservative leader in Britain (yes, the Conservative leader) on the NHS.
I don’t think it works to just say “tv lies” if the tv image is the only one people have. It’s very hard to find errors when you don’t have specific knowledge.
As for that particular episode of House, I bow to your superior knowledge about Haldol, but I’d be surprised if that sort of gross neglect of patients doesn’t happen some of the time.
Yeah, the House psychiatric episode was pretty damned weak.
My wife loves House, but after watching a few episodes I’m not particularly entertained by it. The medical sub-plots seem way too contrived and exist pretty much only to support the exposition of the relationships among House and the other characters in the show.
I do not possess the constitution to work in health care; I faint at the sight of blood.
So? You just need a low goo field. Try psychiatry. Or radiology. I don’t recommend neurology since you do have to deal with sticking needles in people’s spines and dealing with the goo that comes out.
@RonF – I don’t think anybody watches it for the medical mysteries. The show is basically about enjoying Hugh Laurie’s incredible performance. Everything else is window dressing… which is why this new season is on very shaky ground – now that House is getting help, there is more drama and less of his hilarious evil cynicism on the show.
After the characters in the show go through the usual mess trying to figure out what the patient was suffering from, they end up curing his condition with exactly the same drug my mother said that she’d use.
They got the diagnosis and drug right? That’s not half bad for a TV show. I’m still amazed at how many medical TV shows make really silly mistakes like defibrillating for asystole. Heck, I saw one in which they were planning to use morphine to treat asystole. I nearly fell off the treadmill giggling at that one. (I only watch TV while exercising so falling off of equipment from giggling too hard at mistakes in medical shows is a real hazard for me…Makes me wonder if the lawyer shows and cop shows make just as silly of mistakes in their areas. I kind of assume so but don’t have enough knowledge in those fields to catch them as often.)
House is just Ben Casey in the world of today. If you like one, you probably like the other.
@Dianne – defibrillators and flatlines are shiny technology drama that must be used at every single possible opportunity. Chest compressions and arrhythmia are dull.
Chest compressions and arrhythmia are dull.
They could show them giving the epi down the ET tube and follow it up with a rhythm check in which the patient is back in V fib and needs cardioversion.
The other difference between TV and real life being that the vast majority of codes in real life don’t result in a live patient, muchless one that is able to breath independently and talk within hours of the code. Ironically, this makes TV codes LESS exciting than real ones: you don’t get the feeling of awe that always follows a successful code in real life.
@Dianne,
that, definitely. I don’t think most people realize that those techniques are a 1-in-a-million chance, because in TV land, 1-in-a-million chances happen every time.
“I bow to your superior knowledge about Haldol, but I’d be surprised if that sort of gross neglect of patients doesn’t happen some of the time.”
Again, I’m not the author of the post, but you don’t give a by-mouth drug to a hysterical patient *for your own benefit, not for the patient’s.* You risk being bitten.
*
Ron, you have an oversimplified view of how people intake media. People may be extremely capable of realizing miracle cures are obvious fiction without having the same sense about background details that seem innocuous. Doctors hanging their own IV bags is a great example, and one that creates an illusion of doctors having more time to concentrate on their patients than they really do.
ETA: It’s like how commercials work. No one (or very few people) report believing in commercial claims, but the mere exposure to the product name improves your subconscious preference for it (in the same way that humans have a more pleasant feeling about anyone whose face they’ve seen before, even if it was for microseconds that could not have registered consciously). One absorbs a lot of narrative messaging on the subconscious level, and it’s not necessarily the text of any given show, so much as its unspoken assumptions and details.
All the medical professionals I know say Scrubs gets it closest to right.
Scrubs is totally my favorite medical show.
I can tell you that every time a therapist is pictured on one of the lawyer/cop shows, weakly asserting confidentiality before spilling their guts about their current/former clients, I want to smash something. You can’t even ACKNOWLEDGE SOMEONE IS IN TREATMENT unless there is a serious allegation of child abuse, or the client is an *immediate* danger to themselves or someone else. None of this “oh, she’s been arrested? Well, I’ve been worrying about her…” crap.
Nevermind the content and process of therapy sessions as represented on TV.
From everything I’ve heard from lawyers, yes. Most of the lawyers I know get a little angry when you mention the title “Law and Order.”
My sister agrees that “Scrubs” is the most realistic medical show, but I thought that was just because she’s also in training and the low man on the totem pole. She dislikes “House” especially because she thinks they use too many expensive tests and procedures.
“Law & Order” is actually a great bar exam study tool. You watch for all the Fourth Amendment violations. I’ve never seen a show (or movie) about law that seemed realistic, either, although “Adam’s Rib” is my favorite. I think it’s the only litigation movie I’ve seen where you sympathize with both sides, instead of feeling that one is clearly right and the other clearly wrong.
RonF: Holy farging frack! Germany has more than 82 million people, and you worry about the plight of “tens of thousands” having to chip in the equivalent of a dollar each? If so few people need health care through no fault of their own, then clearly you won’t even notice paying for it.
How many people in this country have gold- or even electroplated health insurance now? Most business owners take what they can get, for themselves and their employees, and so do most working people.
The point people have been making, over and over again, is that there isn’t really such a thing as healthcare insurance on the market. There’s no real way to purchase a guarantee, because insurance companies have made an industry principle of qualifying eligibility and reimbursement way beyond efficacy. There’s no compact here, no payout.
That aside, why should I subsidize that lifestyle? I’ve gone to a lot of trouble in the course of my working life, too. I don’t want to give another dime to any private insurance company. Their product is ridiculously expensive and inadequate even aside from the fact that any serious illness will bankrupt me, no thanks to their services, full stop.
So why should I be forced to choose between supporting a few happy constituents and going without medical care? Especially since neither option actually protects me or them from the catastrophic effect of illness? How is this any different in principle from a tax, except for the part where I would actually see a benefit in return for all that money?
How many people in this country have gold- or even electroplated health insurance now?
Apparently enough of them that Obama could make hay last year on McCain’s suggestion that the tax exemption for the fanciest health insurance be eliminated … and now apparently adopt that suggestion and get massive pushback from unions.
How is this any different in principle from a tax, except for the part where I would actually see a benefit in return for all that money?
At the point that we have single-payer, we’re no longer really using insurance; instead, we will have made health care into a public good, like roads or primary and secondary schools. There will still be some private (just as we still have toll roads and private schools) for people who want the extra fast and fancy, but we’ll have turned our focus from the catastrophic and improbable to the more mundane and universal. If I am paying into the system not just to obtain the $50,000 heart disease treatment, but also to obtain my monthly prescriptions and get my yearly physical, then it’s on the scale of a public good. And the sensible way to pay for public goods — even ones you might not be using personally, e.g. if you live in NY and never drive anywhere, or if you don’t have kids — is through taxes.
I think a lot of people *think* they have really good insurance, just because they’ve never really had to use it. My mom & her husband have genuine gold-plated health insurance that’s eventually gonna bankrupt the school district they retired from (though not because of them – they very thriftily chose the Mayo clinic for their main clinic because of bad experiences at the much more expensive local hospital.).
I used to have pretty good insurance, but the company went bankrupt. My last job had really TERRIBLE insurance, basically a high-deductible HSA plan that also had very high copays – in some cases the copays were actually higher than the cash cost of a doctor visit for routine care, for us. But the people I worked with thought it was GREAT because they knew so many people with no coverage at all – it was a pink-collar job, so lots of women were working there for benefits for their families, while their husbands had no-benefit jobs like owning small companies, that paid better.
(Now i don’t have my own insurance, but my domestic partner works for an international company that offers domestic partner insurance, so I’m covered. And hoo boy is that expensive, what with the extra taxes and all – i’m not surprised people are unhappy at the thought of paying taxes on their insurance benefits.)
I’m genuinely curious – what is this alleged “gold-plated insurance” that I occasionally hear referenced in the health care debate? I’ve been on a lot of insurance plans from a lot of different places. My parents were part of one of the earliest HMOs from my childhood. I bought an individual HMO plan for some years in grad school. I’ve been on plans from four different universities now, either as a student or an employee. I’ve been insured by a small not-for-profit, and by the infamous Whole Foods (oh, how I could go on about the omissions in Mackey’s “worker-centric” plan!). And I’ve spent time without insurance. And I’ve *billed* insurance regularly for my services as a clinician.
At any rate, I really don’t know what to picture when I hear about “excessive” insurance policies. Are there policies that routinely cover liposuction and nose jobs? Policies that approve every treatment immediately and routinely? Policies that cover spa treatments? Policies where you always get a private room in the hospital and your food is catered by Alice Waters?
Is a policy with a $20 co-pay for visits and meds “excessive”? With a $30 co-pay? With a $10 co-pay?
I just have no idea what these policies are like that are under discussion. I feel like there’s some kind of dog whistle or code word being used that I don’t understand, so if someone with knowledge could translate, I’d appreciate it.
(First person to argue that SF civil employees’ coverage for gender reassignment procedures is “gold-plated” gets a fail at life for being both transphobic, and too dumb to read a little research. Seriously: if that’s what this is code for, then assume I’m officially disgusted. But I don’t think that’s what this aspect of the debate centers on, and would like to know what is actually at issue here.)
Elusis,
I have good insurance: copay for office visit is $25; for urgent care clinic is $50; for ER is $100; for Tier 1 drugs (generics) is $10, for Tier 2 is $30, for Tier 3 is $50. My husband has “gold-plated”: he doesn’t have any co-pay for office visits nor most prescription drugs. If you’re in an HMO, you’re inherently not getting “gold-plated” because that generally means you’re expected to choose your provider from a limited set, to get a referral from your primary care physicians before you can go to a specialist, etc. Traditional Medicare + prescription coverage is pretty gold-plated because it’s fee-for-service and you can go to the doctor you want. If my husband’s ear is bothering him and he wants to pick an ENT specialist out of the phone book and go to that guy, he can do it and his insurance will cover it.
Gold-plated insurance isn’t fiscally sound for the overall system because people should be going to their primary-care physician first, instead of popping up at specialists’ offices based on a guess at what ails them. If your primary-care physician doesn’t understand what’s wrong with you but won’t give you a referral, then your plan ought to allow for you to go to a specialist on your own initiative and have that reimbursed if it turns out that there was a real problem that your primary-care person was wrongly dismissing. But I think there does need to be a bit of a gate-keeping function, whether through co-pays or primary-care physicians, on the use of medical services, or some people will use more than they need.
The Japanese health care system is interesting for comparison, because on the one hand the culture is more hypochondriac than ours; people go to the doctor for a lot of things that Americans would just handle at home, like cuts. But on the other hand there’s still a paternalistic tendency in the medical profession, so that if the doctor says “You’re fine” or “There’s nothing to be done,” people generally accept that as true, instead of going home to research cures on the Internet and harassing the doctor about the drugs they’ve seen advertised on TV. So people feel like they’re getting a lot of medical attention and feel gratified by that, but they’re not actually getting all of the possible medications and procedures and so on that would be offered in the U.S. I’ve heard that Japanese doctors will sometimes even give patients what are basically placebos (vitamin pills etc.) to get them to stop worrying.
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Thanks for the info PG. I’m still not sure, though, what this gold-plated thing means, other than, apparently, Medicare (which by gum the government had better keep its hands off of!) So does “no copay” mean “gold-plated”? Does “no preferred provider list” mean “gold-plated”?
Is that really all that’s being referred to – lack of copays? Or os there some other dog whistle that this phrase is meant to invoke? (For example, I have to wonder if “gold plated” means “any coverage for contraception/pregnancy”.)
Does anybody know if there’s data out there that shows how many Americans are covered by “gold-plated” insurance versus plain ol insurance?
For example, I have to wonder if “gold plated” means “any coverage for contraception/pregnancy”
I have never heard it used that way. I don’t think merely meeting a state’s minimum requirements (and I think New York and a few other states already mandate that insurance sold in the state cover contraception/ pregnancy) would be “gold plated.” Even Medicaid covers that stuff, and Medicaid is so crappy in terms of reimbursement rates that the real problem is finding a provider willing to accept it. (Medicaid famously cannot use federal funds to cover an abortion, but some states use their own funds to cover that.)
I don’t think there is a specific definition of “gold plated,” but it’s meant to signify a combination of freedom, choice, and low cost at the time of service.
I guess I’m still left trying to figure out who would actually come under this “tax Cadillac benefits” idea. It makes me nervous, which could just be the paranoid PTSD of the last eight years combined with the crazy unacknowledged racism tied up in the whole health care debate, but could also be because it’s clear some people have their sights set on something in particular, and I have no idea who or what it really is.
Elusis,
Probably the easiest way to figure out which benefits to tax would be to look at how much the policy costs the employer and tax the cost that goes over a certain line. Remember, compensation (which includes health insurance) paid to employees is a deductible business expense, so the more that employers can say they’re paying in compensation, the less they’re paying in business taxes. If my husband’s policy at BigLawX costs the firm $25k a year, then the government can look at the average cost for an insurance policy for someone in my husband’s category (by whatever factors insurance companies are allowed to consider in pricing a policy: age, smoker status, etc.) and tax the employer on what it’s paying for his policy beyond that average cost.
ETA: Slate has a decent Explainer on this.
Thanks PG. I’ll take a look.
Something that struck me today – is “cadillac benefits” code for “union members”?
Elusis,
I first heard the “Cadillac” metaphor for great health care when I was taking bioethics classes at college, and no one ever seemed to be thinking of union members when they said it (the shitty health care metaphor was the “Yugo”). I can’t say for sure what people in other contexts might have in mind, though. And of course lots of people (like my husband) have “Cadillac” level insurance in non-union jobs, simply as part of an overall good compensation package and because the partners of the firm like having a form of compensation that works to cross-subsidize the partners (middle-aged stressed-out not-working-out partners and counsel get a lot more use out of awesome health insurance than a bunch of 20- and 30-something junior associates do).
“Gold-plated” insurance is any insurance that costs over a certain dollar amount (I dunno exactly what). Even if, in reality, it sucks and your employer is horribly overpaying for it.