John McIntyre, whom James Wolcott calls "the Dave Brubeck of the art and craft of copy editing," writes on language, editing, journalism, and other manifestations of human frailty. Comments welcome. Identifying his errors relieves him of the burden of omniscience. Write to, befriend at Facebook, or follow at Twitter: @johnemcintyre. Back 2009-2012 at the original site, and now at

Thursday, August 6, 2009

To your health

Even though my health insurance will expire in another couple of months, I have a steely resolve to no longer read, watch, or listen to* any advertisement about health care legislation.

You already know, or should, what they are saying. Proponents of whatever version of President Obama’s proposal turns out to be will offer assurances that everyone will be covered; that, no, you won’t have to pay more; and that, no, never, absolutely not will taxes have to increase. Opponents will continue to scream Socialism! — as they did about Medicare, and Social Security, the forty-hour work week ... **

One would imagine that people can see the realities:

You don’t want your medical care to be determined by some faceless government bureaucrat? For reasons I don’t quite comprehend, you have warm, affectionate feelings for Aetna? For CIGNA? For United Healthcare? You think your insurance company is going to come to your hospital room with a nice little potted plant and sit at your bedside and hold your hand and say, “There, there”? As if it makes a difference whether the cubicle where the faceless bureaucrat sits is in a government building or at an insurance company?

You don’t want rationed care? You’ve already got rationed care. Perhaps you can’t afford medical insurance. Or perhaps you can but have been shut out because you have a pre-existing condition that the insurance company doesn’t like the look of. Either way, you’ll wind up in the emergency room, driving up the costs for everyone.

You understand — right? — that powerful forces are arrayed here. The physicians, the hospitals, the drug companies, and the insurance companies all have an interest in getting hold of the enormous sums we pay for medical care, and they are all jockeying for influence as legislation creeps through Congress. They are understandably looking out for their interests, but not necessarily for yours. (Yeah, they say they have your interests at heart. They say things.) Those interests will be taken into account in the legislation, because politics is all about balancing interests.

But I’d like to think that somewhere in the House or Senate there are a few members thinking about people like the middle-aged man sitting in his basement in Baltimore who has enjoyed reasonably good health for fifty-eight years but who is apprehensive about what will happen to him and how he will be able to afford treatment.

The advertising campaigns are likelier to stir you up than to inform you. So instead of heeding them, perhaps you could go to some calmer, more reputable sources in print or online and lay hold of some dispassionately related facts. And maybe you could also look up your representative’s and your senators’ mailing addresses or e-mail addresses and remind them pointedly that your interests are also supposed to be taken into account.

*It just feels good every time I split an infinitive, a smack in the face of a usage superstition.

**Speaking of screaming, I don’t know whether the people who are shouting down their elected representatives at town hall meetings are members of some secretive scheme or merely hysterical citizens, and I don’t care. Denying people an opportunity to speak is profoundly un-American. It is equally un-American when university students and faculty shut out or shout down a speaker whose views conflict with prevailing campus orthodoxy. If you despise a speaker’s views, you protest — that is assuredly American — but you do not silence him.


  1. "So instead of heeding them, perhaps you could go to some calmer, more reputable sources in print or online and lay hold of some dispassionately related facts."

    I'm having trouble finding some. Any suggestions?

    Here's what I want our health care to look like:

    We get to choose our own doctors.

    All treatments (even massage therapy) will be covered (except maybe elective surgery that is purely cosmetic--i.e., not reconstructive after an accident; non-surgical cosmetic treatments, such as acne medications would be covered because they will help the patient's mental health).

    No drugs will be "preferred" over others. The bureaucrats need to understand that supposedly "equivalent" agents are NOT equivalent in every patient. By "preferring" one drug over another, they are essentially preferring one patient over another (who might have bad reactions to some of the filler ingredients or in whom the preferred agent is not as effective, etc.) And, again, ALL agents will be covered.

    Patients will not be required to travel to and wait forever in their doctor's offices on different days in order to have more than one test/procedure performed (as Medicare and my private insurer both currently require them to). This policy (their paying for one test or only the cheaper of any two tests performed in a single day) is an insane waste of everyone's time and money (and all the wasted gas doesn't help the environment either). Sick people often have trouble making the trip even once, requiring them to go twice just because the doctor wants two tests done is definitely not in the patient's or anyone else's interest.

    Patients must not be required to take cheaper drugs before more expensive ones, although doctors can be encouraged to try the cheaper ones first, the decision should be up to the doctor and patient. My main reason for wanting this is that my insurer's records of what I have tried in the past are not accurate: 1) their records don't go back as far as my body and its medical history do (and sometimes the cheaper ones they want me to try first have not only been ineffective, but had bad side effects), and 2) often medications that I've already tried never get into the insurer's records in the first place because my doctor gave them to me as free samples.

    Recently, a doctor prescribed me a new gut-specific antibiotic that my insurer refused to cover. They said that I first must try four other older cheaper antibiotics. I had taken all four of these antibiotics in the last few years for other conditions, after accidents, surgery, etc. (thus, to their limited minds, I had not taken them yet), and not once did the condition I was prescribed the new one for abate (i.e., so I know they would be ineffective for it if I tried them again), AND each time I took those cheaper (non-gut-specific) antibiotics, I developed another condition from taking them (which I then had to take another medication for). I called to ask them why they would want to pay for eight prescriptions (four antibiotics plus the four antifungals I would need because I was taking them) before they would pay for the single drug that the doctor said would work in me. They forwarded my complaint, and of course they still denied it. I had to pay about $400 for 10 days worth of the new drug out of my own pocket. It worked, but the insurer should have been intelligent enough to have covered it in the first place. Think of the cost of all the multiple return visits to the doctor I would have been required to make had I done what they wanted me to do (on top of the cost of the eight prescriptions).

    I could write much more, but as usual, I've written too much as it is.

    P.S. It's great that the democrats allow the right-wingers to come and yell at them. If I recall correctly, Bush strictly limited access to any of his "town hall" meetings, so that only people who loved him even got in.

  2. Kaiser Family Foundation has good, substantive coverage of health care reform efforts.

  3. I have never understood why people - usually staunch defenders of capitalism - don't understand that insurance companies are *for-profit* organizations. They are answerable to their *shareholders* not their policy holders. They make money by NOT spending it - which means by NOT paying out. It's really that simple.

    The government man will get paid whether he spends or not. The insurance guy gets bonuses for denying your claims.

  4. Who doesn't understand that insurance companies are for-profit companies? Doesn't everybody? That's the problem with them.

    In one of Carl Hiaasen's books (I think, "Skin Tight"), there's a good part where the guy whose job it is to deny all claims gets his comeuppance.

  5. Patricia the TerseAugust 7, 2009 at 1:13 AM

    It's none of any government's bloody business how often I see my doctor, what he puts on my chart, what medications I take, how much I weigh,what legal products I consume or how often I eat Haagen-Daaz Coffee Ice Cream. If I have a question about my health, I call the doctor. If I have a question about my insurance policy, I call the company and yes, I can talk to a real person who lives in New York State, not Sri Lanka. Under a government plan, I can see myself trying to make some low-level clod in Albany or Washington understand what the purpose of a drug is. And I look forward to the day when said clod has all my personal information in front of him: the possibilities for mischief are legion. No, thank you. Medical personnel take oaths before they are turned loose to practice, and insurance companies do have strict rules about how their employees do their jobs. I doubt the bureaucrats and their masters are under any such restraints: they work for a political system, not a medical one. There are changes that can be made in the way some things are done - beginning with changes in the entitlements called 'malpractice suits" by trial lawyers.To allow Congress - any Congress - to determine anything as important as decisions Americans make about our health is a dreadful risk. Congress has demonstrated that it is incapable of ordering lunch.

  6. Patrick K. LackeyAugust 7, 2009 at 2:45 PM

    Medical insurance has become for almost everybody what the draft used to be for young men: a distorting factor in every life-altering decision.

    The economy (bow when you hear the word) is burdened when the dispersion of talent is distorted by the inavailability of health care.

    Prose style is burdened when a writer's subject is health care, though Mr. McIntyre has managed to write on the subject in English.

    Incidentally, too little has been written about the euthanasia provision in Republicans' health care plan. It requires that the elderly report to an offing center when they no longer can prove they have the means for adequate medical care and general self-support. The offing centers would be operated by private contractors with reassuring names like Precious Step or For Our Children. Each patient would be sold a stick of gum to ease the final moments. Cheap gum would suffice since the flavor needn't last long.

  7. Nobody on the right is allowed to dissent. Only people on the left. End of story. Welcome to Obama's America. And Keith Olbermann's. You can have it.

  8. As Bruce Dern, in his role as the corporate space freighter botanist in Douglas Trumbull's 1972 sci-fi classic "Silent Running," said to the ship's three half-pint robots, Huey, Dewey, and Louie, during a shipboard poker game: "We're not playing for Three-in-One Oil here."

    The stakes are high. The players are anted up.
    Now Congress has to deal the tickets.

  9. Soylent green is people! lovin' it.

  10. Re: "Nobody on the right is allowed to dissent."

    Let me suggest that you might read the post. Dissenting is everyone's right, and I do not say and have not said that anyone's dissent should be silenced. What I object to is falsification of facts and shouting people down. You want to support those?

    As to Mr. Olbermann, he is a tedious windbag, and I do not listen to him.

  11. Reading some of the desires for health care restructuring (reform is too benign a word) I am reminded of working with the Air Force on the development of aircraft communications equipment: What they wanted boiled down to Zero Weight; Zero Size; Zero Power use; and Added Lift for the aircraft. You want Zero Restriction on doctors, tests, and referrals; Zero Requirements on drugs and therapies; Zero Limits on use of the Medical System; and Zero Out-Of-Pocket Cost to you. Oh, and No New Taxes (read my lips).

    I would be interested in knowing what the various factions mean when they talk about a "Public Option." Is that like the VA Hospitals - you go there and are seen by government employees in a government facility? Is it like the Federal Employees Health Benefits plan, of which I am still a beneficiary, where most of the private insurers "bid" for you money by providing Federally-mandated minimums plus whatever they wish to offer? Is it like the military TRICARE program, where private health insurers bid on contracts to provide services to military family members in a large area (like The Northeast)? All are "Public Options," all are funded completely or in part by The Government, but only one eliminates the private insurers entirely.

    Retired in Elkridge

  12. These are exactly, RiE, the questions to which one would want to hear answers, instead of the shouting of a mob.

  13. This is interesting. My question is, are CATS covered under family health care plan?