America’s health care mess.

As an American, of course I have been following this.

I like what Bob Herbert said in the New York Times. The whole thing is revolving around this “public option” or Public Plan.

Public Plan insurance would be this thing like Medicare for people who couldn’t get any other kind of insurance. Not 65, not poor, or disabled, a vet, etc.

Since the Public Plan would be run by states and not have a profit motive, the premiums would be cheaper and the Plans would actually be competition to the private insurance industry. Private insurance rakes in a fortune—-mostly by denying you coverage when they can!

I may be back in America. Right now, I’m in Japan—covered under the Japanese system (kokumin kenko hoken). Let me tell you: here, the cost is a lot less, and part of the reason is that the “profit motive” is illegal.

You can’t set up an insurance company that is meant to suck out a profit on medical care dollars.

I don’t see why my fellow Americans feel it’s so important that private health insurance companies get to suck this money out of the health care system. Why? What’s so great about that?

I think the general public is maybe clueless to the reality. The reality is that the Blue Crosses and Blue Shields became for profit sometime in the last 20 years. Moreover, it’s really clear that people don’t understand they’re paying for uninsured people’s medical bills as a tack-on to whatever their insurers cover.

They don’t understand the shell game going on.

They just want whatever medical deal they have cut now, and not have it change in the future. Even though—sucker!— when it comes time for your big medical bill, your friendly private insurer is going to do every f***ing thing imaginable to cut you out of coverage.

There is your “death panel”. They’re even doing it to kids. Your kids.

So you have the middle class stiff. Maybe 35 years old. He’s got the coverage through his job—that he’ll lose the day his employer slaps the pink slip on his desk. He’ll be stuck paying some Crazy Cobra bill that he really won’t have the money for.

All along, he’s been paying Medicare for people at least 30 years older than he is. He’s been paying some kind of state tax to cover Medicaid for poor people. His federal tax money has been going there, too. And also to cover government and military workers.

And even if he doesn’t use his own insurance, the price is based on that tack-on of “uncompensated care”.

So he’s been paying everyone else’s medical bills all along the way. But if he gets canned and he’s hard up to pay medical coverage, he’s f***ed. As is his family if the wife didn’t have coverage for them.

This is not a great system. It’s a lousy system, where all the improvements over the years have usually just meant more money out of your pocket to give to some private insurer.

And what is the (pretend) consensus proposal out there in Washington? Create these co-ops that will insure people, but really all they are is giving extra money to the insurance industry with no strings attached.

Well ho ho! It’s the same crappy system, except we’re going to expand it by 20% to bring in all those who don’t have a formal insurance arrangement.

The blogosphere—where a lot of political opinion is jelled into some kind of form these days—is buzzing that President Obama is selling the reform movement out. Is that so? Well, there isn’t even a bill yet out of Congress.

But realistically, if the solution to the health care problem is going to be dictated once again by the medical industry (like it was in 1948 and 1994), then probably there won’t be a good solution.

I think the Obama Administration is trying to maneuver for maximum flexibility. It’s Congress as always that passes the bill, and the President signs or vetoes.

So the game, clearly, for Big Insurance is whether they can knock out the Public Plan–this option that would like a Medicare for the unlucky who are self-employed, unemployed or otherwise don’t have employer coverage. If they can do that in the Senate, then great. They either get the status quo or they get these co-ops, which will be their playthings.

If Obama receives a health insurance reform bill that has the plaything co-ops in it, he’s probably got no choice but to sign and declare “victory”. It will be punting the health care expense problem down the field to the later 2010’s, when it’s clear the whole thing will just blow up.

Obama can fight for a Public Plan in the fall negotiations—that’s probably his smartest move. But no guarantee it comes out that way.

The Senate is tricky. Small states that otherwise would be nothing get this tremendous power. Usually, the small states look for a very socialist-seeming payoff for their vote. It’s been going on since the Income Tax came in in 1913. (The small states overwhelmingly put it in.)

If the Democrats want the Public Plan, they are probably going to have to come up with all these nice federal spending projects for Montana, and North Dakota, and Nebraska and Iowa. East Coast, Illinois and California money once again being funneled into a part of the country that maybe should have just been left as one big Indian Preserve. (Except the Republicans of the 19th century needed states to balance out the power of the Democratic South).

When other expats here in Japan ask me about whether the crazy things they read about America are true, I don’t know what to say. It’s embarrassing.

For example, Canadians or British asking me if people actually believe that it’s better to have employer-provided insurance rather than have the government provide a system of medical care.

Well, I don’t know what to say. Yes, these people actually think that back home, and it’s a big issue. People get really emotional about it.

It is hard to convince others from other advanced countries that health care is such a debate in America. But I don’t know what to say.

It’s like if people keep shooting themselves in the foot because they like the feeling. And they keep it doing it. And then I am called on to justify why the people keep shooting themselves in the foot. Well? I don’t know why, they just do.

It’s so embarrassing.

The best I can come up with is an explanation of history, and how the race issue plays into things so much . But it’s a hard sell because the focus of the criticism in on how individual Americans–regardless of background—could be so stupid.

Then I maybe point out how emotional appeals are always thrown in to these debates back home.

And still, the people ask whether Americans could really be that stupid to support things against their own self-interest.

Well, you tell me. I don’t know. It seems to happen a lot.

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