Those who oppose covering them are effectively saying “I got mine, get your own you lazy bastard.”

The insurance companies like the current business model because it allows them to make more money by denying coverage even for people who have been paying for years. Effectively they’re saying “We got ours, get yours somewhere else you stupid bastard.”

What’s lacking from both sides is empathy. They just don’t care about anyone but themselves. There’s a psychological term for people like that – sociopath.  Sociopaths are interested only in their personal needs and desires, without concern for the effects of their behavior on others.

If an adult family member got a severe illness (like cancer) and couldn’t afford to pay the bills, wouldn’t you do everything in your power to help him/her out? You’d spend your own money to help out, wouldn’t you? You wouldn’t say “Tough luck. You’re an adult, deal with it. If it bankrupts you, too bad. If you die, that was inevitable anyway.”

Of course you wouldn’t (assuming you aren’t a sociopath).

This country is your family. Caring for them is the honorable thing to do.

The big debate these days is whether the federal government should be in the business of providing health insurance. Ultimately that’s what the debate is about.

Your answer to this question depends on whether you’re a Liberal or Conservative. Liberals say “yes”. Conservatives say “no”.

What’s funny (to me anyway) is that Conservatives often cite capitalist motives as the reason why the government should stay out of the health insurance business. They say that certain care will be denied because it will cost too much. (They fail to mention that private insurance companies already do this.)

But that’s what capitalist motive is, right? Cut costs to increase profit?

The other fear tactic is that the government will have to raise taxes considerably to pay for this. But that’s a capitalist motive too. Raise prices to increase profit.

The real problem for Conservatives is that they believe that any government program that shows any caring for citizens is evil. To that end they will do anything they can to prevent any social program from coming into existence. Furthermore, they will do anything they can to cut funding for existing social programs to help ensure their demise while simultaneously claiming “see, the government can’t run this properly!”

Lakoff has what appears to be an explanation for this mindset. Conservatives have a strict father model of government. Liberals have a nuturant parent model. Rather than explain those models here, please see the linked Wikipedia articles instead.

People on both sides want to live as independently as possible. It is my belief, however, that Liberals understand that society has grown to the point where we are all interdependent. Conservatives have not yet acknowledged this.

As interdependents it is our duty to support each other when necessary. Conservatives do support each other through contributions to church or charity. But since they choose the church or charity they choose specifically who they support which generally means supporting their own kind.

Liberals believe in supporting people even if they don’t necessarily agree with them.

A Liberal would gladly pay additional taxes to help provide government run health care that took care of a Conservative. The reverse is generally not true. But a Conservative would gladly contribute to a charity that helped provide health care to someone in their own community who needed that help.

I believe that slowly but surely more and more people are moving towards the Liberal view of how things should work. This scares Conservatives who are becoming the dying breed. But obsolescence is a part of capitalism to which Conservatives put all their faith in. They should be happy to see it working even if it inevitably means their demise.

Single-payer means exactly that: one payer. The problem we have now is that there are too many insurance companies with too many plans and too many ways you can or can’t be covered. This means that if you and I each visit the same doctor for the same procedure and all the same billing codes are used but we have different insurance then we pay different amounts. Not only that, but the doctor probably collects different amounts from the different insurance company.

Additionally, because of so many insurance companies not all doctors accept all insurance. This means that although there may be 20 doctors in your town that can treat you, if only 3 of them are covered by your insurance then you have a choice of 3, not 20.

Aside: I’ve run in to this personally with dental care. There are about 25 dentists in the town I live in. But only ONE of them takes the insurance I have. And since they fired me I now have ZERO dentists I can use in my town and now have to drive to a town 15 miles away for dental work.

Now instead consider if we had only one insurance company. Now doctors have a choice – to accept this insurance or not. They only have to learn how to deal with one system (instead of hundreds) which means they’ll learn how that system works and have fewer errors. It also means that all patients would pay the same when they visit the doctor (this could mean $0, but I’m not getting into minutia here). And, the doctor would get paid the same amount for a procedure every single time.

In our hypothetical town with 20 doctors chances are that most, if not all, of them would accept this insurance. So now instead of having 3 doctors to choose from you have 19 or 20. Doctors would now have to compete on service to get new business. Yes, that’s right, single payer would increase competition.

Now let’s talk about the other side of the coin: everyone-in.  In my vision (remember, this is MY vision. Don’t blame anyone else for it.) every single person who resides in the U.S. and anyone who is a U.S. citizen regardless of where they live would pay insurnace premiums into this system. It would be a tax (yes, that’s an “evil” word, but taxes are the price we pay for civilization so get over it).  This tax would be progressive where those earn a little would pay a little, and those who earn a lot would pay a lot.

As I mentioned before I’m not getting into minutia so I don’t know what those tax rates would be. But let’s assume for a moment that they were 10% of your income. Sounds high, doesn’t it? It’s not. Let me show you why.

Right now the median income in the U.S. is about $50,000 for a family of four. 10% of that is $5,000.  But the average (sorry, I couldn’t find a median) cost for health insurance for a family of four for a year is $12,700.  I imagine health insurance costs vary far less than incomes so comparing a median to an average isn’t going to significantly skew the numbers.

Another advantage of everyone-in is that everyone is paying into the system so there’s more money available to pay out when people need it. Also, your premiums don’t change if your health does. Just because you got lung cancer from smoking for 25 years doesn’t mean you’ll be charged more. You’ve been paying in for 25 years so now you get the benefit of using what you paid for.

Closer to home, you won’t lose your coverage if you lose your job and can’t afford the premiums. No income means no premiums, but it doesn’t mean no coverage. So lose your job. Or quit your job and start your own business. You’ll still have health insurance.

Since the only way an everyone-in system could be enforced is if it’s run by the government then that’s what we’d end up with. However, I would prefer if that entity was completely self-funded. Whatever money it collects it uses to fund its own operations. It has to ask permission from Congress to raise rates (taxes). And the money it does collect cannot be used for any other purpose. I would even like a restriction on loans – that no loans be allowed either.

I’ve tried to think of some objections that might come up. Here’s what I’ve got at this time:

1. Employees will take pay cuts to pay for this.
Probably not. Most large employers are already paying for a large chunk of health insurance for their employees. Mine pays about 62% of the cost. Even if the cost was exactly the same ($12,700 per year for a family of four) since it’s a percentage of income rather than a fixed dollar amount, and would be considered a tax, wages will adjust, but then so would prices that are a result of the wages. The net effect would be pretty close to zero. The major impact would be loss of jobs for the CEOs of insurance companies. The staff could go work for the single-payer system and would probably be happier since they’d be helping people instead of focusing on denying claims.

2. This will ration healthcare.
Healthcare is already rationed. As my example above illustrated I only have a choice of 3 doctors here in my town. I can’t go to any of the other 17 unless I want to pay 5 times more for a visit. That’s rationing. Single-payer will open up more options for healthcare, not reduce them. This is not about doctors working for the government. It’s about doctors working for themselves and getting payments from the single-payer insurance.

3. It’s socialism!
Yes. And so what? There are some services that belong in the public realm. I happen to believe that health insurance (not health care!) is one of those areas. Again, my vision is not about doctors working for the government. It’s about doctors working for the patient and simply getting paid by a single entity.

4. You’ll kill off an industry
Not necessarily. It will kill off the large-scale insurance companies. But those who are working for them could go to work for the government entity. The notable exceptions are the CEOs who would be crying because they wouldn’t be getting $100 million paychecks. I feel for them as much as you do.

5. The government is inefficient and would waste our money
The administrative overhead for a typical government entity is 5-10%. For the typical insurance company it’s about 30%. Who is more efficient? I suppose if your goal is to make money for stockholders then the private company is certainly more efficient at doing that. But personally I’d rather take that 20% difference and put it back into providing healthcare instead of lining the pockets of shareholders. Also, my vision has the entity as self-funded and does not have unlimited taxing power. It would take an act of Congress to increase funding rates.

6. Doctors will spend more time fighting for payment
Really? How much time do they spend now? Most doctors spend 4 hours per day filing claims and fighting to get paid. Remember, right now it’s the goal of the insurance companies NOT to pay claims. Under single-payer that’s no longer the goal. The current system also has different payouts for the same procedure depending on coverage. Single-payer means a single payout amount for a procedure. The chance of an incorrect payout is drastically reduced.

7. Fraud will increase
In every system there is a certain amount of fraud. Our current system actually encourages it because insurance companies don’t want to pay claims. So doctors will occasionally inflate claims in order to be fairly paid for their services. This happens today already. Insurance companies have people on their staff to help detect fraud and put a stop to it.  With a single-payer system there would also be a fraud detection unit. I would think that it would be easier to detect fraud since doctors can only do so many procedures a day/week/year. If a doctor claimed excessive procedures done then since everything goes through one entity it would be easier to spot. Currently a doctor can file claims with dozens of insurance companies who may not have the entire picture. Personally I think fraud would go down, not up.

8. I don’t want to be forced to do anything
To me this sounds like fear of change. But let’s take it at face value. The only thing you’d be forced to do is pay into the single-payer system. You’re most likely already paying insurance premiums. If so, then the only thing changing is who you’re paying. You’ll have a choice of more doctors. You know you’ll have coverage even if you’re out of work. You know you’ll have coverage even if you get really sick. You know you’ll have coverage if you have a child with Down’s syndrome. So what’s really being forced on you is less risk, more choice, and likely lower cost. Is that a problem?

On June 3 my wife and I went in for an initial visit and supposedly for a cleaning. Instead of a cleaning though they took a bunch of x-rays (18 pics each!) and just poked around our mouths. Then they told both of us that we needed a full deep cleaning across all teeth. (Periodontic scaling). When we went to the front desk to schedule follow up appointments we were told that our once-a-year deductable was $50.00 each but that our treatments would come to a total of $38.40 each. These are treatments that would normally run over $2000. While skeptical that we actually needed the deep cleaning we went ahead and scheduled for them.

A couple weeks later I went in for my first cleaning. When it was all done and I went up front to pay the person there told me it would be $254.00 for that day’s work. Needless to say I was shocked as I was expecting to pay just under $20 that day.

The person explained that they had gotten my insurance info wrong and that the estimate was quoted for PPO and not the DMO that we actually have. I did my best to be polite but ended up asking if they had “pulled the quotes out of their ass”.  At that point the person understandably got mad. She quickly decided that it would be best just to bill me. And I quickly decided that it would be best if I calmed down before addressing this further.

So about an hour later I came back with the original estimates in hand. It turned out that the person I was talking to earlier was the office manager. I apologized for the comment then calmly proceeded to make my case. It turned out that the $254 that was due for the day was the correct amount due. (I had checked with my insurance company before coming back).  It was the original estimate that was wrong. However, they also were not supposed to charge us the deductables ($50 each).

What got my goat was that the office manager then proceeded to blame ME for the mistake because I hadn’t put the insurance information on the new patient form. Never mind that they had a copy of my card and the card clearly has all the information on it. Of course that also puts them at fault for a bad estimate because if they didn’t know my insurance information then they were effectively pulling numbers out of thin air.

But somehow by the time my appointment rolled around they figured out what my insurance actually covered, so they had the correct information the whole time.

Anyway, I asked her to give me new estimates for all of our upcoming procedures. She told me she could have it for me in time for my appointment the next day. Fine.

I came in the next day about 30 minutes before my scheduled time sneezing and coughing (turned out it’s bronchitis – I still have it). She saw me walk in and we started our conversation. She gave me the new estimates as well as a new amount due of $154 due to the incorrect charging of a deductable. I paid that by check but put “to be disputed” in the memo field.

I also asked to cancel my appointment for that day because I was coughing and sneezing and felt that having them poke around in my mouth with sharp instruments probably wasn’t a good idea, plus I didn’t want to get the hygenist sick. The office manager waived the $25 cancellation fee typically charged for cancelling with less than 24 hours notice. I thanked her and told her that I appreciated that.

She also asked if I was planning on cancelling any other appointments. I told her that I wasn’t sure. She warned me that if I cancelled less than 24 hours in advance that I would be charged the $25 fee. This is fine since that’s their policy.

So today I check the mail after being laid up sick for the past 5 days. There’s a letter from the dentist dated the same day that I went in the office saying that they no longer want my business. (Interestingly though, the postmark on the envelope is 2 days after the date on the letter.)

Here’s the dilemma. We were already strongly considering changing dentists so I’m not really concerned that we’ve been fired. What I’m wondering is if I should go after the dentist for misleading billing practices.

The other concern is whether or not the deep cleaning procedure was even necessary. That’s something I hope to find out soon from whatever new dentist I end up with. If it wasn’t necessary then does that push it further along to where I should go after the dentist for performing unecessary procedures?

I’m not a vengeful person. My concern is more for others who may not stand up for what’s best for them. And if that happens then this dentist will continue to mislead their patients.

What are your thoughts?

This dentist’s practice had four or five chairs in a single room with just some short walls between them. This meant that anything anyone said could be heard by everyone else in the room. So my wife got to hear everything about my diagnosis and I everything about hers.  We also got to hear the diagnosis of someone else who neither of us knew. And they got to hear ours as well.

Is that wrong or what?

From the office’s perspective they’re legally covered and can’t be sued for disclosing things that are overheard by others. This is because it’s only the patient who can waive the doctor-patient privilege. As soon as we accepted treatment in that room which we knew was not private we waived that privilege.

Needless to say we’re now looking for another new dentist.