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You are here: Home / Anderson On Health Insurance / The wonk’s lament

The wonk’s lament

by David Anderson|  July 8, 20178:44 am| 46 Comments

This post is in: Anderson On Health Insurance, Open Threads

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One of my favorite people to follow on Twitter had the Wonk’s lament:

And now I have summarized my last decade of research in far fewer than 140 characters https://t.co/ERBpjfFsb7

— Sarah Gollust (@sarahgollust) July 5, 2017

D58826 in comments earlier this week expresses the wonk’s lament from the other side:

At the end of the day most non-policy wonks view healthcare and heath ins. as ‘when it hurts make it better’ and ‘don’t let my child die’ and I don’t care what it costs.

I realize at the policy level all the things David talks about are important but most people look at it like they look at the ‘in case of emergency break glass’ fire extinguisher. They aren’t really into the details.

And that is true. The job of a wonk who gives a damn is to take the complex, the confusing and the nuanced and make sure that when needed, the fire extinguisher works right and it works well. Everything else is a detail. So we geek out about corner cases, we write monographs and op-eds and journal articles. We talk to our fellow wonks. We convince John to give the keys to his blog to some random health insurance plumber who won’t shut up about health policy for almost four years running.

And if we do our job well, it should be expressable to the interested, lay public, as 140 characters and it should lead to better lives and better outcomes.

Open thread….

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Reader Interactions

46Comments

  1. 1.

    OzarkHillbilly

    July 8, 2017 at 8:59 am

    Well, at least we appreciate you.

  2. 2.

    Steeplejack

    July 8, 2017 at 9:00 am

    Your posts have been very informative. I don’t often find anything to comment about, but they have been very useful in discussions with acquaintances and the occasional smiting of wingnuts.

  3. 3.

    Bradley Flansbaum

    July 8, 2017 at 9:10 am

    I don’t know beans about energy. But would an analogous example to above be, “when I turn my light switch on, all I care about is the glow” or “what is my bill this month?” Not for me. But I sure as heck don’t follow energy policy, blogs, or legislation.

    But do I care? Yup. But it has to be handled in the manner just like you describe above. Make me take my eyes off Health Affairs. Make me interested in fracking and why it matters to me–and you got me for life.

  4. 4.

    Julia Grey

    July 8, 2017 at 9:10 am

    Yes, please don’t take my lack of comments as signifying disinterest!

  5. 5.

    Baud

    July 8, 2017 at 9:22 am

    most non-policy wonks view healthcare and heath ins. as ‘when it hurts make it better’ and ‘don’t let my child die’ and I don’t care what it costs.

    If that were all it was, then it wouldn’t be a problem. Too many people prioritize denying benefits to the “undeserving” over a universal good.

  6. 6.

    kindness

    July 8, 2017 at 9:24 am

    It’s a tough issue. You can’t make people care about details. I get it though. We have finite capacity for stuff in our everyday/long term head. I think mankind has always had issues with portions of society being left in the dark about details and issues. I’m not sure that the intentional ignorance has been forgiven or practically celebrated in prior societies though. It is the application of Real World to everyday principles of being, and that isn’t one of our finest achievements. I think previously societies generally trusted those that did know more about particular subjects. With Fox & the puke funnel though you have a whole segment that celebrates the not knowing and not wanting to.

  7. 7.

    BC in Illinois

    July 8, 2017 at 9:25 am

    I appreciate what you do. I need people who know about health policy. It’s great to find some to trust, sometimes understand. Some things can’t be expressed in 140 char

  8. 8.

    p.a.

    July 8, 2017 at 9:25 am

    Trumpcare: In emergency break glass. Take shard: slash wrist.

  9. 9.

    SiubhanDuinne

    July 8, 2017 at 9:35 am

    @BC in Illinois:

    ??????????????

  10. 10.

    Ohio Mom

    July 8, 2017 at 9:39 am

    I am only half-joking when I say that I don’t want to learn anything new at this stage of my life — it seems that most of the time, I am studying up on something because there is a problem that needs solving.

    It might be a newly acquired medical condition or something wrong with the house. We will need a new roof soon and so I am going to have to learn all about shingles and whatever else, else I’ll have no way of even beginning to know which salesman to half-trust. The thought of thinking about roofing glazes my eyes over.

    Because my kid has a disability, I’ve had to learn about the Medicaid and SSI systems, and the list goes on. It is tedious and anxiety-producing.

    It is a relief to me to know that Dave Anderson is on the health coverage case. Finally, something I don’t have to goggle! I am appreciative!

  11. 11.

    Barbara

    July 8, 2017 at 9:42 am

    I have in the weeds health policy FB friends, and they got into this in the weeds policy discussion about how to prove ACA benefits of the kind public health people like to think about. I intruded and said that for me, all of this could be rolled up in one metric: my brother could not buy insurance at any price prior to 2014 and now he can. What I object to most about these discussions is that they only take place for poor people. Is anyone debating at this point in time whether group insurance has measurable impact on the health of insured populations? Sure, debate what levels of subsidies are good or necessary, and maybe at what point they are even counterproductive, but I can’t stand the idea that we should engage in special analysis as to whether it’s “worth it” to finance health care for poor people. This is one of the things that comes from having such a fragmented way of providing health care. We get to demean other people over things we take for granted for ourselves. Policy people should at least acknowledge that fragmentation and double standard where they can.

  12. 12.

    Cheryl Rofer

    July 8, 2017 at 9:45 am

    David – you do a good job at this and I’m grateful.

  13. 13.

    Yoda Dog

    July 8, 2017 at 9:45 am

    @Steeplejack: I would like to cosign this sentiment and add a huge thank you for all your work here, David.

  14. 14.

    OzarkHillbilly

    July 8, 2017 at 9:49 am

    @Ohio Mom:

    I am going to have to learn all about shingles and whatever else,

    Get a standing seem metal roof if one is allowed where you live. If not, get architectural shingles. Properly installed it’s a 40 year roof, more if your roof is steeply pitched.

    Either one costs more, but it’s the last roof you’ll ever put on your house and they are good selling points if you ever move.

  15. 15.

    hovercraft

    July 8, 2017 at 9:49 am

    “We convince John to give the keys to his blog to some random health insurance plumber who won’t shut up about health policy for almost four years running.”

    I rarely comment on your informative posts, but they provide important information about the bullshit being spouted by the assholes pissing on us and telling us it’s raining. I for one am grateful for your contributions, so please geek on.

  16. 16.

    FlyingToaster

    July 8, 2017 at 9:58 am

    @Barbara: That is the odd discussion: insurance for poor people versus insurance for contract workers.

    I had junk insurance (good if I was hit by a bus, worthless otherwise) for a few years back in the 90s. When one year they decided to raise premiums by 50%, without adding a single benefit, I dropped it and went bare until HerrDoktor & I bought the house.

    Under the ACA, they would have had to cover contraception and an annual physical, which is nearly all I needed (didn’t cover eyeglasses, but hey, neither did some of our employer’s insurance).

    You should check if Kaiser has studies out — or in the works — on employer provided insurance. I remember reading something about this in the past 6 months, but I have no idea where.

  17. 17.

    Gelfling 545

    July 8, 2017 at 10:00 am

    I can’t begin to count the times I’ve quoted you to the few idiots I know (I don’t encourage idiots as a rule but some you get by blood). Although unlike the person currently squatting in the WH, I always understood that healthcare is complicated, in dome ways, I had no idea. Thank you for btinging us this information.

  18. 18.

    Nicole

    July 8, 2017 at 10:04 am

    I can only chime in and echo how very, very grateful I am for your health industry posts. As someone who was flung unceremoniously from the kingdom of the well into the kingdom of the sick last year (thanks, genes!), and is now dealing with a $22,000 bill that is most likely a screw-up on the insurance company’s end, but it still taking months to sort out and frightens me every time another threatening bill from the hospital comes in, I have learned very well the panic a bad health diagnosis can produce and quickly you say, “Whatever you think is best” to a doctor. I have shared sooooo many of your posts to my FB page, hoping to help my newly middle-aged cohort, many of whom have not yet had a serious health crisis, understand why this is so important, and so very complicated.

    And last week a friend of mine went to the hospital because he couldn’t move his bowels and found out it was because a tumor was completely blocking them. He went from healthy to stage 4 colon cancer in one visit to the ER. His wife has started a GoFundMe to help cover their family’s food and living costs because they are now down to one part-time wage. Ugh. I think tying health care into being healthy enough to work is one of the cruelest things this nation does to our population.

  19. 19.

    rikyrah

    July 8, 2017 at 10:08 am

    Mayhew, you explain things well. I can either spread the word myself, or refer people to your excellent posts. Thank you ??

  20. 20.

    Jeanne

    July 8, 2017 at 10:12 am

    I just want to pile on to how helpful your posts are to explaining the ACA nuances and what a disaster trumpcare will be. Although I don’t comment I love all the wonky details. Thanks so much.

  21. 21.

    burnspbesq

    July 8, 2017 at 10:16 am

    Dave, you earn your Cameron season tickets here every day.

  22. 22.

    Dr. Ronnie James, D.O.

    July 8, 2017 at 10:19 am

    …and every so often, you get a President and Congress that actually listens to wonks. And you get to pass a bill that’s like wonk Christmas, Thanksgiving and your 21st birthday all rolled into one. And it gets to be the law of (most of) the land for 7 years and counting. And it works! :D

  23. 23.

    Ohio Mom

    July 8, 2017 at 10:26 am

    @OzarkHillbilly: Thanks for that info!

    We have a ricky-ticky 1970s ranch with a problematic basement in a near-in suburban sub-division. I’m not sure this house deserves that good a roof.

    One of the main reasons people move to this neighborhood is the school system. They put up with a fair amount of house flaws to do so.

    The big question for us is, how much longer are we going to stay here, once our kid is finished with school?Would we be better off moving somewhere nearer a bus line, considering our kid may not learn to drive? (we actually live about a mile from a bus stop, pretty good for a suburb). Or would it be more economical to stay put? We thought a ranch might be appealing to other oldsters but a lot of high-end ranches are going up very nearby.

    Hmmm, maybe roofing materials aren’t the biggest issue here. This was a useful exercise.

  24. 24.

    Villago Delenda Est

    July 8, 2017 at 10:34 am

    I dunno, Dave. That Mayhew guy seemed to know his stuff, too.

  25. 25.

    MomSense

    July 8, 2017 at 10:39 am

    The Republicans are totally messing with my life right now. I had an interview with an organization in Boston and I think it went well because they went over their benefits with me. Now I’m pissed. It’s the same money I make now but the insurance is soooo much worse than my cost sharing ObamaCare Silver. The narrow network plan is 225 per pay period for a plan with a $6,000 deductible.

    Right now I pay under $400 for a plan with a $1,500 deductible and the cost sharing means I won’t even pay that much.

    The question is what level of insecurity and threat can I risk to stay where I am? Fuck Ryan, and McConnell and all the rest. They are as bad as cancer.

    ETA To clarify that is 225 per week compared with 400 per month now.

  26. 26.

    Mandarama

    July 8, 2017 at 10:41 am

    Both of my parents died young, in rural Mississippi, with no health insurance. In both cases the fallout was as you’d expect. As a result, years later I lobbied SO hard for the ACA. I don’t utilize it myself, but I’ve taken comfort every day in the idea that other people might not have to suffer the grief my siblings and I carry. I read your posts religiously and try very hard to understand details that I can use as I call Congress and argue with all of my red state neighbors and relatives. Thank you.

    The only thing is, I still can’t think of you as anything but Mayhew.

    Also, I live in Tennessee (not far enough away from MS) so I have *really* been following your recent posts. Much appreciated.

  27. 27.

    MomSense

    July 8, 2017 at 10:51 am

    @Mandarama:

    (((((Mandarama)))))). Thank you.

  28. 28.

    zhena gogolia

    July 8, 2017 at 10:52 am

    @Barbara:

    My GP has a similar attitude. He says patients who used to not be able to get mammograms, or a CT scan when they have abdominal pain, now can with ACA. Case closed.

  29. 29.

    frosty

    July 8, 2017 at 10:57 am

    @FlyingToaster: I had vision/glasses insurance from my employer, but it didn’t pay much for out-of-network providers, like Lenscrafters and Pearle. Turned out the amount I was paying was more than I got back from insurance, so I dropped it. It averaged out to a couple hundred a year for three of us.

    The in-network providers were all tiny optician shops. I preferred to go somewhere where I had a better selection to choose from.

    If I have a medical problem with my eyes, those docs are covered under the regular insurance plan.

  30. 30.

    Kelly

    July 8, 2017 at 11:13 am

    An old friend of mine was laid off last week. At 62 job hunting will be challenging. He’s done well and could afford to just retire if only Obamacare was secure and maybe getting a few improving tweaks.

  31. 31.

    Karen

    July 8, 2017 at 11:17 am

    I turn 65 next month, I have been swamped with mailings from insurance companies we should have a something that helps rather than gets rich off those over 65; the worst part is that couldn’t afford most of those plans

  32. 32.

    john fremont

    July 8, 2017 at 11:21 am

    @Steeplejack: Well said!

  33. 33.

    Alternative Fax, a hip hop artist from Idaho

    July 8, 2017 at 11:51 am

    Thanks for informative posts; they’re among the few places I keep my mouth shut because I *admit* I don’t know enough to make an informed comment. This stuff is complex (who knew?) and I learn a lot.

    While your insurance discussions are every bit as informative as his were, I do wish that Mayhew dude would come back with his “You be the Referee” posts.

  34. 34.

    Bg

    July 8, 2017 at 12:02 pm

    David, I understand about half of what you write but that’s way more than I knew before I started reading your stuff. It makes me not sound like an idiot when I make my daily calls to my Senators and Rep. Thank you

  35. 35.

    Hal

    July 8, 2017 at 12:08 pm

    I’m finding some of the “imagine if this was Chelsea Clinton” comparisons I’m seeing on social media annoying. Chelsea Clinton has a Phd in International Relations and a MPH. Not to mention her mother and father have a wee bit more political experience than Trump. If she did have some role in the Hilary Clinton Administration she would at least be qualified.

  36. 36.

    Shalimar

    July 8, 2017 at 12:15 pm

    @Hal: I think of them more as “imagine the hate machine outrage if this was Chelsea Clinton” comparisons. No one is accusing the Clintons of being that inept politically.

    As for all of the healthcare posts, I read every one even though I have absolutely nothing I can add to the discussion.

  37. 37.

    randy khan

    July 8, 2017 at 12:26 pm

    And if we do our job well, it should be expressable to the interested, lay public, as 140 characters and it should lead to better lives and better outcomes.

    There’s a great story about Richard Feynman that I saw on Daring Fireball last month (a very good Apple-centric tech blog, for those who don’t know it), taken from Feynman’s Lost Lecture, by David Goodstein, that gets to the same idea:

    Feynman was a truly great teacher. He prided himself on being able to devise ways to explain even the most profound ideas to beginning students. Once, I said to him, “Dick, explain to me, so that I can understand it, why spin one-half particles obey Fermi-Dirac statistics.” Sizing up his audience perfectly, Feynman said, “I’ll prepare a freshman lecture on it.” But he came back a few days later to say, “I couldn’t do it. I couldn’t reduce it to the freshman level. That means we don’t really understand it.”

  38. 38.

    scav

    July 8, 2017 at 12:26 pm

    Je n’ai fait celle-ci plus longue que parce que je n’ai pas eu le loisir de la faire plus courte.

    And, more than mere time is required to produce distillate of any quality. Understandable prose on complicated processes that nevertheless conveys the nuances — that’s a skill.
    Producing bathtub gin out of platitudous sound-bites is banal.

  39. 39.

    StringOnAStick

    July 8, 2017 at 12:29 pm

    My husband wants to quit and become a contractor on his 60th birthday next year so he can work 3 days a week and we can do more travel and outdoor activities. All of that is predicated on being able to buy insurance through the exchanges, especially now that he was diagnosed with a life long chronic disease. I can’t get insurance through my job because I don’t work enough hours and I can’t work enough hours to get it because of carpal tunnel syndrome and basic arthritis so common to my profession (dental hygiene). He’s still determined to do it, but I’m hope that by the time January rolls around that he’s considered the issues a bit more; he’s still mentally processing his diagnosis and feels fine. Actually, I hoping even more that by then the bastards in the WH and the rest of the R-Treason party have been brought very low by Mueller and the IC because I think it will take that to stop their plans to kill the ACA.

    Many thinks to David/Richard, without your posts I wouldn’t know how the ACA works, the tricks they are trying to pull to kill it, but most of all what a lifeline it is for so many people.

  40. 40.

    randy khan

    July 8, 2017 at 12:29 pm

    @Shalimar:

    I think of them more as “imagine the hate machine outrage if this was Chelsea Clinton” comparisons. No one is accusing the Clintons of being that inept politically.

    I’m with you. It wouldn’t be about her qualifications to do the job at all, just the appearance issue. (And, just because the gratuitous swipe is entirely justified, she’s more accomplished than anybody in the Trump clan, not to mention more qualified for a role in government.)

    I would be curious to know who the other G-20 leaders had sitting in for them when they did one on ones. I would guess high-level foreign ministry types.

  41. 41.

    Victor Matheson

    July 8, 2017 at 12:42 pm

    I am currently in Greece. It is my observation that they simply treat every ailment with uzzo.

    I am sure that treatment course has a scientific basis so I am imbibing as a preventative measuring just to be sure.

  42. 42.

    FlyingToaster (Tablet)

    July 8, 2017 at 1:13 pm

    @frosty: Our current employer-provided plan includes glasses — free annual exam, first x dollars on specs every other year. I’m still paying for prescription sunglasses and weird contacts, but that’s about half what I used to pay.

    High tech attracts a lot of people with glasses, so I’m thrilled.

  43. 43.

    Mandarama

    July 8, 2017 at 1:42 pm

    @MomSense: Thank YOU. I love BJ snarling jackals and aspire to be one, but that was a much-needed internet hug. The assault on the ACA and the complete capitulation to Cheeto Benito that surrounds me has me pretty depressed.

  44. 44.

    Geeno

    July 8, 2017 at 3:05 pm

    If not a lot of people comment on these threads, it’s because their particular questions were answered in the post.
    I don’t usually comment on these insurance threads, because I have nothing intelligent to add.
    I read and am enlightened. Perhaps I should comment to say thanks.

  45. 45.

    Hurling Dervish

    July 8, 2017 at 4:29 pm

    You can definitely take my lack of comments to mean lack of interest. God, what a tedious poster. And so incessant! Even when things get urgent, you latch onto the deep underbrush instead of a tree, let alone a forest. You routinely throw around terms law people don’t know, rarely take the time to teach the concepts. Drags the whole blog down. Please try twitter for awhile.

  46. 46.

    MomSense

    July 8, 2017 at 5:17 pm

    @Mandarama:

    It’s really tough to see our country take such a dive. Got plenty more hugs for you!!

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