Awkward

Recently one of our family heirlooms made it out of a dusty drawer and onto the web. Back when I was in high school our family had a professional portrait session that produced some less-than-flattering results. I submitted one of the shots to the delightful Awkward Family Photos site. It was posted, and our inadvertent family treasure was available to be admired and mocked by the great multitudes.

I assumed this was the end of the awkward saga, until a few weeks ago when I was informed that Awkward Family Photos (AFP) was making a book. Would we like to be in their very special, very Awkward Family Photo album? Yes! We would. Well, some of us would. My dad, as it turned out, would not. Much arm-twisting ensued. We teamed up, worked in shifts, and pulled in in-laws for support. He suggested that flaunting our moment of awkwardness was undignified. We responded by unloading with every tale of his indignities we could recall.

Really, what's the big deal? What's the worst that could happen? We prevailed. Release forms were signed. I assumed this was the end of the awkward saga.

Last Wednesday I received this email...

from afp <awkwardfamilyphotos@gmail.com>
to Ben Swainbank <bswainbank@gmail.com>
date Wed, Aug 26, 2009 at 3:01 PM
subject awkward family

Hey Ben,

I wanted to let you know that the Rachael Ray Show is doing a segment on awkward family photos next week and the producers of the show love your family photo. They're interested in talking to you about the picture and possibly having you appear on the segment with Mike and I and I wanted to see if this is something you would be interested in. If not, we totally understand but just wanted to reach out to you.If you are interested, I'll put you in contact with the producer. Let me know what you
think.
Thanks!
Doug

My national television debut! I had visions of airplanes, and wardrobe assistants, and green rooms. It did occur to me that my claim to fame was looking particularly dorky in a particularly dorky old photo. Whatever. I could work with it. "Well, Rachael, actually it's a good thing I was posed behind the couch. If I hadn't been, you would be able to see that my pants were way to short."

I never did hear from the producer. I won't be Rachael Ray this week. If you see my dad, just tell him I turned them down. It's more dignified.

Premiums Part II: This Time It's Personal

We hear a lot about how expensive the American health care system is. The true costs are obscured for a lot of Americans. Our employer or the government picks up the tab. There may be a problem, but it's not our problem.

Unhappily, this is not the case for me.

It's not that anyone in my family is sick, or that we don't have insurance. We're healthy. We're insured. However, neither Christine's nor my employer pay for our health insurance. We get to purchase our own. We get to pay the premiums. We notice when they go up.

Five years ago, when yet another tech start-up that employed me went belly-up, I did a brief stint as a consultant. I purchased a $1000 deductible plan from Anthem BCBS for a reasonable rate. We kept the plan and over the years the cost bumped up each spring. In the spring of 2008 our premiums were a mostly-reasonable $765 per month. In April we got a premium hike of over 20%. Anthem assured me this was not a mistake. This April they went up again to $1191 per month.

After a 55% jump in two years, I wanted out. It's not hard to think of ways I would rather spend $1200 every month.

As I shopped around for other health insurance options I had an unpleasant discovery. One of my children has a "pre-existing condition". Nobody would sell us a family policy. Nobody would insure my son. This came as a shock. I had assumed "pre-existing conditions" only applied to people who were, you know, sick. AIDS? Diabetes? It has to be something expensive and potentially lethal, right? We had none of that. The kids are never at the doctors and never miss school. I was looking to spend lots of money on an insurance policy that I had no expectation we would really need. Nobody was willing to sell me one.

Because my son was already insured with Anthem, they couldn't reject him altogether. Three of us got our own "family plan" with a $5000 annual deductible from Celtic. My son stayed on his own plan with Anthem. Total cost $657 per month. Cheaper, but with our deductible, we'll pay all our own bills, and insurance covers next to nothing.

This has been an educational experience for me. It is the lens through which I now view health care reform. Shopping for insurance has made clear to me the limitations of relying on for-profit companies to provide health insurance, and the extent of the monopoly power insurers have. No family wants to risk going without insurance. Insurers can raise rates without fear. To the extent that they compete, they compete to get customers who won't require health care. They are very conservative about guessing who those customers will be. For-profit health insurance companies don't make their money by healing the sick. They make their money by avoiding anyone who might get sick.

We hear about the high cost of health care for individuals and small business. The thought of paying $1200 a month in premiums brought that home for me, because I was writing the checks. This situation isn't very different for people who get insurance from their employer. The average employer-sponsored plan for a family of four cost nearly $13,000 a year -- not much less than I was paying.
The rising cost of health insurance is everyone's problem. The for-profit companies we have rely on are part of that problem.

Premium Health Care

President Obama was asked a good question at one of his town hall meetings last week. The question went to the heart of the confusion about the public option. Obama's answer missed the point.

The question was something like "If there's a public option, and I get my health insurance from my employer, can I just quit my company plan and jump on the public option?" The unspoken follow-ups are: "If lots of people do this, won't it cost a ton of money? Wouldn't that require a huge tax increase to pay for it? Wouldn't that be a government take over of health care - exactly what people are so up in arms about?"

Obama went on about how the CBO says his plan will cost less than $100 billion per year, how they will get some savings from efficiency, how they won't raise taxes on the middle class. All true. But beside the point.

The real reason you probably won't want to jump off your employer-provided plan, and onto the government one, is that doing so will cost you a lot of money. The public option is not an entitlement. It won't be given away or paid for in tax dollars. They will charge their subscribers premiums, just like any health insurance provider. This is why it won't require huge tax increases. This is why, unless your employer offers the government plan (and maybe even if it does), it may not be such a great deal.

Having a non-profit, member funded, health plan that anyone can buy into, may still be a great option for those who choose it. Some people don't want to have to pay for a government-run, public health care system with their tax dollars. Those people are in luck. They won't have to.

The Slippery Slope

"Government takeover of health care" is constant refrain from health care reform opponents these days. It is an article of faith that the "public option" in the various bills will lead to the end of the private system and everyone will end up getting their health insurance from the government. Once there's a public option that anyone can join, via the power of the slippery slope, it'll only be matter of time before the takeover is complete.

That reform opponents would have this fear and make this claim is not too surprising. More interestingly, the left, and reform supporters seem to have same expectation. They would really prefer a single payer plan. Obama isn't pushing for one. But through the public option and via the slippery slope we'll get there. Somehow.

Both sides are wrong about the power of the slippery slope. If we've learned anything about the current and historical efforts to reform health care, we have learned that it's not easy to change anything. The status quo is one big boulder. The slope may be slippery, but it's steep and goes uphill.

There is relatively little debate about the text and the implications of the bills themselves. Despite the hopes and fears of of the left and the right, the bills themselves are what's important. That's what we're going to get. And this is good thing...