Our Health Insurance Is Fucked Up
You don't need me to tell you this, but I will.
It is foolish, useless, and extremely popular to be in the vibe-assessment business. As a skill or even a party trick, it is very valuable, for instance, to sense when you are walking into a bar that you should immediately leave. As a way of assessing broader social or political trends, it is much harder to trust, and therefore has much less public utility. It is entirely too easy to conflate your mood with something much bigger and broader—and I suspect a significant plurality of political columnists are assessing public policy and horserace riffraff through a thin veneer of Serious Analysis draped over their deeper and not-so-latent sexual pathologies. To be so fully immersed in the narrow and sterile discourse of online politics and pop culture is to assume the posture of the one who knows exactly what’s going on, which, in practice, makes you a blathering and insufferable idiot. This is the advice I would give to the people covering politics and culture at the nation’s biggest and most important outlets, but this week’s edition of This Is A Newsletter is proof that vibes are indeed very real and that everyone who survives my mad man assessments should understand that my opinions ultimately do not matter.
After a momentous change in the presidential race, my mood was anxious and a little gloomy. But the absence of Joe Biden’s whispering ghost combined with the relentless torrent of BRAT memes and Coconut Tree remixes have shifted my vibes to be more giddy, goofy, and as close to joyous as I’ve been about national politics in a while. I’m not ready to declare it A New Day In America or whatever, because there is still a massive gap in how boomers and millennials access health insurance. Most Americans no longer have the luxury of staying at the same job for their whole career and having the same healthcare plan; we’re either laid off or have to job-hop to climb the corporate ladder or our current employer changes plans, which tosses us around different insurance coverages. Once we have a doctor we somewhat enjoy visiting, they could someday be out of network, which is a phrase that should only be reserved for when you move too far from the Wi-Fi. It should not be a corporate euphemism that essentially means, “If you pee in this cup, we’ll charge you $5,000.”
America missed the boat on universal healthcare in the late 1940s when Great Britain established the NHS and the post-war labor pact was at its apex. Most of the major social democratic overhauls in the West happened in the immediate aftermath of World War II, and everything since then has either included piecemeal reforms or defensive actions against governments going to war against their own social safety nets at the behest of the ruling class’s demand for endless profit. Bill Clinton’s flubbed attempt in the 90s was an already-doomed Hail Mary, while Obamacare and Bernie’s pitch for Medicare-for-All were epiphenomenal.
Private healthcare was allowed to metastasize for 80 years and is now a $2 trillion cancerous tumor eating away at all of us. Healthcare accounts for over 17% of the national GDP, and employs about half a million people—which doesn’t even include pharmaceuticals and med tech, who also have a significant stake in retaining the current for-profit system. These entrenched interests force the average American to pay double what citizens of countries pay in taxes for single-payer healthcare, and there is no discernible evidence that the average American receives better service, or the nation experiences better overall health outcomes for the hefty price tag. There is very little disincentive towards raising costs or providing better care when almost no one even has a choice of where they purchase health insurance.
The way all this plays out in our quotidian realities is monstrous and evil, but hidden beneath the absurdities of a byzantine and broken system. We’ll log on to some fancy boondoggle app called DCTR, which is the kind of cheesy Silicon Valley startup that would advertise in the subway: “We just thought it was time healthcare got a little more rizz.” By some divine miracle of our alleged interventionist god, you will find a doctor who’s in network, and the earliest day they can see you is February 21, 2026. When you finally reach that appointment, leaving the office turns into an agonizing suspense-filled dread, because you’ll speak to the receptionist to see if you owe them anything, and they’ll say, “You can leave, you’re probably good.” You don’t love the probably they slipped in there.
Three months will pass, and you will receive a strange letter from your insurance company that will say:
“Hello, cherished customer. We’re excited that you’re taking your personal health seriously by going to your routine preventative checkup. However, according to the audio recordings of your visit that we picked up by bugging the front office, we have ascertained that you brought up a concern about a sore knee, which, according to your plan, now qualifies this a specialty visit and is no longer covered. Afterwards, you did use a Kleenex at the front desk to blow your nose, so we will have to ding you your first-born child.”
You’ll call your insurance provider to inquire about this astronomical cost, and while you’re on the phone, the topic of actually having your first-born child comes up, so you ask about how much that will run you. Your provider will respond, “Oh—so you’re not gonna like that either…”
I just spent 30 hours in hospital for a minor operation. Not counting the various tests and pre-op examinations in the lead up to the operation, I saw 15 medical professionals during my visit. Specialist surgeon, anesthesiologist, two med student observers, OR nurse, three recovery room nurses, three post op care nurses, two night nurses, specialist who signed my discharge, discharge nurse who walked me through follow up appointments and gave me some necessary supplies (catheter bags) to take home.
Total cost was about US$ 50.
That was spent on a housecoat I didn’t need and taking a taxi to and from hospital.
I’m grateful to live in Canada. People like to complain about our system but you’ll get no complaints from me.
And telemedicine? We've reduced healthcare to a 'snapchat.' The next time my doctor's office suggests scheduling an online appointment, I'll tell them they are out of my network (wifi) and that the doctor will actually have to see me in the flesh.