A few years ago, one of my Canadian cousins visited California with his two young children during their spring break, and my daughter and I met them at Disneyland. I asked the kids what was the biggest difference they’d noticed between America and Canada.
”Warmer,” they said.
“Yes, obviously February in southern California is a lot warmer than Winnipeg,” I said, rather impatiently. “Isn’t there anything else?”
Being polite Canadian children, they looked at each other and hesitated a few moments before answering. But eventually they came out with it:
“Fatter,” they said.
And that, I’ve often thought over the years, is just one of the reasons why Canada’s single-payer system would probably be far less feasible in the United States. Canada’s population is small, homogenous, less troubled by the problematic health habits we see in our multi-ethnic poor, and filled with excessively polite middle-class citizens who are more patient about waiting in line than Americans. Still, there are reasonable arguments that it might be better, at least for many people, than the situation we have now. I really don’t know.
What I do know is that I’ve never written anything campaigning against (or, until this week, even on the general topic of) health-care reform. But a few days ago, I wrote a Los Angeles Times op-ed about how Blue Cross is giving me grief regarding some of my cancer treatments. Judging from the fevered commentary on some Lefty blogs in the wake of that piece, you’d think I was blind about socialized medicine before, but now I see.
Actually, my opinion about that whole health-insurance question remains exactly the same as it was before I was diagnosed with inoperable lung cancer almost four years ago: The government should provide a safety net, but health insurance should be unbundled from employment and people should do as much as they possibly can to take responsibility for themselves. That’s why I bought an individual Blue Cross PPO policy nine years ago, even before the COBRA coverage ran out from my former employer. I also bought private disability insurance, not because I thought I’d get sick–I was an extremely healthy neversmoker with no family history of cancer–but because it seemed prudent, which indeed it turned out to be.
The main point of my Times piece was that when an insurance company drastically raises the yearly out-of-pocket cap (mine jumped from $5,000 to $7,500 in 2004), which affects only sick members, or retroactively disallows treatments as “experimental,” which Blue Cross did with me even after two CT scans proved the treatments had been working, that’s the definition of bad faith. I also wrote:
The worried well…tend to be remarkably ignorant about medical insurance. Policy wonks keep arguing about market competition and consumer choice. But health care for the sick isn’t a market because choice disappears. You can’t shop around for generic drugs when you have cancer. Whatever chemical treatment the doctor suggests, it almost certainly will be a brand name costing several thousand dollars a month.
“Remarkably ignorant” has turned out to be something of an understatement. After reading a few of the more obtuse commenters
at Kevin Drum’s Washington Monthly
blog, I snapped in his comments:
Gosh, Kevin, but you sure do have some remarkably stupid readers for such a smart blog.
Beats me why Blue Cross would want to continue to have her as a customer. They’re not required by law to do so, are they?
Yes, of course they are. Are there really people out there who can’t figure that one out?
How is [it] that she could afford insurance in the first place? She must be extremely wealthy.
You have to be “extremely wealthy” to afford a premium of $400 a month?
I can’t help but notice that this woman is a writer for the National Review.
Just as Mitt Romney of Massachusetts is also a Republican, and we both believe in mandatory health insurance, which spreads the risk and makes it more affordable for everyone. It’s a big tent. That’s why I’m there.
I think this is an illustration of when PPO plans may be a worse option than an HMO.
So someone actually believes that the cutting edge treatments described in my op-ed would be even allowed under an HMO?
I went back to skim, and noticed some defensive, wounded attitudes about my expecting them to understand all the details of medical insurance. But really, The Washington Monthly’s is a policy blog, not some diary of a teenager’s feelings, and health care is a pretty big policy issue. It’s not unreasonable to expect commenters to be at least familiar with the basics before throwing in their two cents. (And contrary to what kindly teachers may have told you, there are indeed such things as stupid questions.)
The Washington Monthly readers seemed like geniuses compared to some Daily Kos commenters, though. Over there, they imagined I was an “extremist,” that I’m “for single-payer insurance NOW” but had argued against it before; that I’m a doctor and therefore part of the problem because I colluded with the evil insurance companies; that I wasn’t allowed (or was afraid) to write about my troubles with Blue Cross for NRO and that’s why it was in the Times; and that “conservatives never worry about the well-being of others. It just never occurs to them that they might get sick.”
Well, obviously it occurred to this one, since my op-ed made clear that I not only have individual health insurance but also private disability insurance, and both have been working pretty well for me in most instances. Rather than throwing up my hands and wailing about the terrible capitalist system, which I guess is the preferred way in Kosville, I made sure I had insurance in the first place.
I’ve always been for mandatory health insurance because it would lower costs for everyone by spreading risk among a larger pool of healthy subscribers. Libertarians don’t like the idea of being forced to pay, but we’re all forced to pay for medical care in any case, through taxes that go to emergency rooms and county hospitals that treat the uninsured. Mandatory health insurance just shifts the responsibility to individuals, making them face reality and bear at least part of the cost of their own care.
There was also a lot of Spanish Inquisition-style talk about “redemption” and whether or not as progressives they should forgive me since apparently I’ve “repudiated” my former beliefs. A couple of Kos commenters even crawled like centipedes out of their howling pit and over to my blog, where they disturbed my daughter (before she banned them) by repeatedly expressing the compassionate liberal wish that as an evil Republican I should hurry up and die already.
Regarding some of the other mistaken assumptions at Kos’s Krazy Korner, I like being in the L.A. Times for many reasons: It makes some people gnash their teeth with rage, for instance, and at least disturbs the golden retirement of others, like former Times op-ed columnist Robert Scheer. But it’s funny how those Kos commenters imagined I was afraid. I suppose that’s because their side tends to be outraged and punitive when fellow travelers stray from their party line.
One particularly silly commenter even added that she was a “two-time cancer survivor,” and therefore presumably her thoughts had special weight. That is of course a fantasy, but so is the basic idea of being a cancer survivor. You can survive a discrete event, like a mugging or the sinking of the Titanic, but cancer is a chronic condition that has to be dealt with for the rest of your life, even if only through checkups. If the cancer doesn’t kill you at first, something else will, but probably it’ll eventually be the cancer.
If pointing out unpleasant truths like that makes me an extremist, well then, I’m an extremist. But what else can you expect from a mean old Republican like me?
– Catherine Seipp is a writer in California who publishes the weblog Cathy’s World. She is an NRO contributor.