Reviewing Two-Income Trap

Elizabeth Warren and her daughter Amelia wrote Two-Income Trap in 2003. It was rereleased in 2015 with a new introduction. Reading the 2015 version in the context of the 2020 election was a thought-provoking experience.

Instead of recapping the premise of the book and quoting interesting passages, I’m going to focus on what I was thinking as I finished the book. There are loads of traditional reviews of Two-Income Trap. I want to focus on what it may tell us about Elizabeth Warren and how it could predict her political actions as president.

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Abolish my Health Insurance and Raise my Taxes

Through my job with the city of Portland, I have better health insurance than many Americans. Still, I would gladly trade my adequate insurance and pay more taxes to support all Americans having access to health care.

I will use the rest of this post to demonstrate why my recent eye problems have reminded me there is no such thing as good, fair for-profit health insurance.

Billing for Nothing

When my eye started acting up, I had to go to the emergency room. I went to the emergency room at a Providence hospital. During the intake process, I was honest about my prosthetic eye, the problems I Was having with my eye, the history of issues with my eye, and what I thought was happening.

Yesterday, I mailed Providence a bill for $738. My health insurer and I paid providence roughly $3,000. Let’s see what we got for our money.

  1. Providence ran several tests, including a Cat Scan.
  2. Two unduly people checked my eye.
  3. The person who read the Cat Scan believed I had an abscess in my head that most likely required prompt surgery.
  4. I was then told Providence didn’t have anyone who could help me. I needed to see a specialist at Oregon Health Sciences University.

To recap: Providence was paid roughly $3,000 to misread a Cat Scan, misdiagnose my problem, and tell me they didn’t have anyone who could help me.

This highlights one of the big problems with America’s for-profit health care industry: they are paid for services provided. It doesn’t matter if the services are competent. It doesn’t matter if the services are needed. What matters is that services are provided and bills for those services are sent.

When I arrived at the emergency room, Providence knew they didn’t have anyone there familiar with prosthetic eyes, or even anyone who specialized in optometry. Yet, they made sure they ran their tests and had people see me so they could send their bills.

Checking the Network

When it was determined I needed a new prosthetic eye, my surgeon referred me to an ocularist (someone who makes prosthetic eyes). When I called the ocularist, I was told they needed to check with my insurer before scheduling me for a new eye. They wouldn’t schedule me until my insurer said I was in the network, determined how much they would be paid, and that I could cover the $603 that wound up being my coinsurance.

My doctor recommended a service I absolutely needed. Yet, my insurer–not my surgeon–decided whether or not I could see the recommended specialist. And don’t forget I wouldn’t have seen the specialist if I wasn’t lucky enough to be able to afford the $603 my insurer refused to pay.

Payments and Timing

The arrangement between my employer and insurer says our plans work off of a fiscal year that starts on July first. The July first date is most likely based on July first being the start of Portland’s fiscal year. But Mota, my insurer, likes the arrangement because premiums, coinsurance, and out-of-pocket limits reset and/or increase every July first.

To make this simple: I’m going to wind up paying double for the procedures on my eye than I would have paid had I first gone to the emergency room in December. This is because had the months-long process ended before the end of June, my out-of-pocket costs would have been capped at $1,800. Since everything resets on July first, I paid $1,800 for the bills incurred before the end of June. By the time I pay for the surgery I’m having in October, I will pay another $1,800.

I have no control over billing schedules. Obviously, I can’t control when my eye will need treatment. But my out-of-pocket costs aren’t related to the services I need, or how much those services cost; instead, they are based entirely on a payment schedule agreed to between my employer and my insurer.

Conclusion

The next time you believe your medical decisions and/or the costs for your medical services are determined by you and your doctor, I hope you will remember this post. In reality, our employers and the insurers they contract with control what treatments we get and how much we pay for those treatments. When you throw in a system that rewards services provided instead of caring about generated outcomes, you have a system that makes huge profits for health insurance corporations at our expense.

Reviewing Dark Money

Jane Mayer’s Dark Money is won of the most important political books I have ever read. Dark Money is a difficult, infuriating, critical read for anyone interested in learning how the ultra rich, especially the Koch brothers, have used their wealth to ensure government works for them at the expense of everyone else.

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Reviewing Where we go from Here

Bernie Sanders’s Where we go from Here is a book recapping his efforts to bring about a more progressive America in the era of Donald Trump. As someone who has supported Bernie and donated to his campaign, I was excited to read the book. Now that I have finished, I can say something really left me thinking.

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Why Sanders is Better Than Warren

I have supported Bernie Sanders since early in the 2016 campaign. I have made two contributions to his 2020 campaign.

I like Elizabeth Warren. Her focus on policy is refreshing. I agree with much of what she says.

While Warren is the only candidate besides Sanders I would enjoy voting for, there are to fundamental differences between them that give Sanders a serious edge.

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We Should Use Less Plastic

Bans of plastic straws and bags has been in the news for months. Yesterday, Donald Trump gave a speech at a developing Shell factory that will someday produce a million tons of plastic each year.

Stories of dead animals washing ashore with stomachs full of plastic have become heartbreakingly familiar. Efforts to remove a fraction of the tons of plastic polluting our oceans are getting some traction.

The political disconnect between those promoting plastic and those recognizing the damage caused by too much plastic highlights the political disconnect of the time that will someday be seen as a primary reason behind earth’s decline. Currently, it doesn’t look like too many want to stand with earth.

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Trump is a symptom

Yesterday, Joe Biden gave a speech in Burlington, Iowa where he criticized Donald Trump for failing to condemn white supremacy. Biden accused Trump of “fanning the flames.” Biden’s seminal message was that Donald trump is encouraging white supremacy. All we have to do is beat Trump, and things can return to a more normal state of affairs. Biden’s too simplistic message misses the point.

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Moscow Mitch Must Lose

There is rightly tons of focus on beating Donald Trump. Democrats will beat Donald Trump. At this point, most Republicans believe Democrats will maintain the House. Winning the presidency and holding the House won’t matter as much unless Moscow Mitch no longer leads the Senate.

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