The bentley/chevrolet analogy is terrific.

You have delivered a stance that I only wish the 'powers that be' had/would broadcast.

That said, I sadly have come to believe that the majority of those who 'have' believe they are not responsible for the 'have nots' and/or consider themselves and theirs to be insulated from any fallout - no matter financial or other. They are wrong on both counts IMHO.

The society and world I aspire for all is the one your post promotes.

Greatly appreciate.

Rec'd.

Liz II, I love what you wrote, and I would agree that it would be nice if we could come up with some really really good reasons why we want/need it, but I'm pretty sure, if they existed, we'd be talking about them already.

IMHO the only reason I can come up with either on my own or in scouring the internet it is the "right thing to do." And, if I may be so bold, that is what your piece boils down to, just much more eloquently said.

As I see it, ignorance of reality is at the bottom of this aversion to health care/health care insurance for all. Those who have insurance think that they have it because a) they earned it b) they deserve it, and that the "others" didn't and don't.

They have somehow been able to paint all those who are uninsured or under insured as being responsible for their own fate. "Well, if they wanted insurance they should have worked harder and gotten a better job." They pay no attention to the fact that 1400 people a day lose their insurance because they either lost their job, their employer quit offering it due to skyrocketing costs, or lost it because they got sick. Some of them will never get it, unless it happens to them. For many, where they stand depends on where they sit. I doubt that many who object to "health insurance for all" are living without it and are in need of medical care they can't afford.

They either don't know or don't care that 62% of the personal bankruptcies in this country are as a result of crushing medical bills. Or that many of those who are losing their homes because of those bills, ARE insured, and that it is the co-pays and uncovered portions of the bills that are bankrupting them.

Some would rather see people who they see as "worthy" go w/o it because if they get it, so will all those scumbags that don't deserve it.

And then there is the "keep the government out of my health care" crowd. Of course, many of them (or their parents) are on Medicare and aren't rebelling against it, so go figure.

These people need to be educated, but they don't want to be. They are comfortable in their little worlds, either not seeing, or looking away from, the truth that is so obvious if they just paid attention.

How we got to be a country that is so willing to sit by and watch so many suffer is beyond me. I hate to think we were always that way, but in truth we probably have been. I don't know why it has taken me so long to see it. How is it even possible to watch an innocent child die, an elderly person suffer, a mother or father become incapacitated, or a family thrown out into the street, when all it would take is a little realignment of our priorities to prevent it? The whole thing disgusts me.

*****But then again (lightbulb moment) as more and more people become uninsured, and our hospitals are overrun with people who can't get treatment anywhere else (which WE pay for), and more and more people are not seeking care until treating them becomes an economic nightmare (which WE pay for), is there an argument to be made that it is less expensive for us, in the long run, to treat these people before they are so sick, than to wait until they are at the emergency room? That it is in our economic best interest to make sure that people can get preventative care now, so we don't HAVE to pay for their debilitating illnesses later?

How I explain it: I believe that the government will be more accountable to me than United Healthcare every will. I worry less about the government rationing care than I do about for profit insurers rationing care and not even owning up to it. I believe, mostly, in choice. The choice of a public option if I want it or a private option if the for profit or not-for-profit sectors can offer more generous coverage at a better price.

while it doesn't do a lot the "why", I felt that member markg8 did an exemplary job with one of the main "hows" today in a comment on another thread:

September 1, 2009 11:20 AM

If you employer has under $250,000 in payroll he or she isn't required to pay a tax or offer insurance to employees. Between $250,000 and $500,000 there is sliding scale tax from 3%? to 8% for employers who don;t offer insurance. Above $500,000 in payroll it's a flat 8% is they don't offer insurance.

That money goes into a pool that subsidizes small business and individuals with tax credits to buy insurance ($53 billion), making it desirable and a net cost winner for small businesses the self employed to buy insurance.

On top of that with the new regs outlawing their worst practices all health insurance will be better and cheaper. Better because it's real insurance and cheaper because they'll actually be competing against each and won't have any need for hundreds of thousands insurance industry bureaucrats who specialize in denial of care sleight of hand.

Much has already been said, but here are a few other points to think about.

It's fine to bring up the topic of people in need, but that can't be the main point. The large majority of Americans are reasonably satisfied with their health insurance and wary of change. It's important to convince them that what is satisfactory now won't remain that way. You can tell them:

If you're very rich, there's no need to worry. Health insurance premiums are growing much faster than inflation and won't be affordable in a few years for most people, but if you're wealthy, you will still be able to afford them.

There's still a problem, though. If you get sick, the insurance companies can rescind your policy if they find even a slight irregularity - e.g., you forgot to mention that you had acne as a teenager. Don't worry, though. They probably won't bother to do that unless you get a really serious illness that's very expensive to treat.

Don't worry about that either, though. They probably won't find anything, so you're OK as long as you don't change jobs or lose your job. If you do, you might not be able to get good coverage at a new job.

But of course, you might. So as long as you don't run up too high a medical bill, the insurer will pay it. After you reach the limit, you're on your own, but if you're lucky, that will never happen.

Here's what reform will do:

First, no insurer will ever by able to turn you down. Never! You can lose a job, switch jobs - it doesn't matter. You'll always be able to obtain coverage.

It will always be good coverage, because the reforms guarantee everyone that essential medical services will be covered. No skimpy policies with huge deductibles or copays that are the more affordable policies today.

It doesn't matter whether you're sick, or have a pre-existing condition, they won't be able to charge you extra for that, so the insurance will always be affordable.

I hope you never get sick enough to run up a huge medical bill, but if you do, the insurer will have to pay it. No more annual limits or lifetime limits on coverage.

If you have great insurance now, and are lucky enough that you can still afford it a few years from now, you can keep it. Otherwise, if you find yourself uninsured, you'll be offered much more choice than is now available. You'll be able to choose from multiple private insurance plans, and also from a public plan that will be affordable enough to prevent the private plans from overcharging you (sort of like Medicare for younger people).

Even if you're as rich as Bill Gates, you might want to think about family members, friends, or neighbors who are middle income working people. I'm sure you care about them, so even if you're a billionaire with fabulous health coverage and guaranteed job security for a lifetime, they'd appreciate it if you support the kind of reforms they need.

Please.

I am a big fan of the civil rights argument and approach. Logical arguments only go so far... The discussion must be spiritual in nature to move the hearts of our fellows. Healty care needs to be reframed as an intrinsic right. That also means you have the right to opt out and be a drag on the system. But the option must always exist to cover anyone regardless of condition or cost.

I’m definitely going to have to get that Lakoff book. One thing you can’t dispute is that the right has run circles around the left (and shoved us off into the ditch) when it comes to “framing” an argument. They really have made those who want health care reform look like the greedy, uncaring ones! Fascinating (also disgusting).

Anyway, looking back over the comments (and ignoring a few side-arguments), I think themes are starting to emerge, probably the most important being the ones identified by one_wilson and financial considerations. I'm just jotting down notes here, as much as anything but wanted to summarize what I think are some very good ideas before this post disappears.

Reasons why we need health care reform [with suggestions of how to explain]

PATRIOTISM/NATIONAL IDENTITY

** Americans take care of each other.
[use the Katrina images - the ‘moral imperative’ examples of cube3u]

** Americans solve problems in ways that benefit all our citizens
[give examples of hard-working, rock-ribbed Republicans that have lost their home or filed for bankruptcy in order to pay medical bills]

** Americans don’t tolerate solutions that leave some citizens in dire circumstances
[both of the above]

** Americans don’t tolerate unfairness
[[contrast lives of two families: equal background, equal “worthiness,” one talking about how good their health care is and the other spelling out the physical and financial horrors they deal with on a daily basis — use hip replacement example]]

**Americans face facts and don’t hide their head in the sand and they have no tolerance for things that don’t work.
[[Facts showing that the current health care system is simply not working - details below]]

NATIONAL PROSPERITY/PRODUCTIVITY

**America values its hard-working, law-abiding middle class
[[Stilli’s excellent point: interview with very rich covered by private ins and very poor covered by Medicare, and then working joe-schmoe who is either not covered or poorly covered. (As a note to that, public school teachers - good job, right? – may get health coverage, but in many systems that doesn’t mean a “family” plan and they have to pay $300 - $500 - more/month to get coverage for their spouse and children.)]]

** Americans solve problems now - they don’t wait for the situation to become so intolerable that everyone is suffering.
[[Facts and figures about percentage who were able to afford coverage and adequately covered 20 years ago, 10 years ago, now. Emphasize as someone said that it’s a dynamic situation and the situation today is just a snapshot – it’s already gotten worse and will get worse still unless something is done]]

** A nation prospers when its workers are healthy and are performing the work they do best, not taking inappropriate jobs just to get health coverage or living with constant anxiety that they won't be able to survive an illness or injury
[[Interviews with people who have stayed in a job or gone to a job they didn’t want just to get coverage; interviews with non-insured who have untreated physical problems that limit their ability to work.]]

**Our inefficient, costly health care system is destroying our ability to compete in the world market.
[[Info from jsfox’s post]]

**Our current system is putting us at risk of public health disasters that would certainly affect everyone in the country
[[Info on inefficiency of emergency room treatment, possible impact of no regular monitoring, inefficiency when people don't have regular providers who can quickly get them vaccines or treatment when needed]]

**Our current health care “system” is woefully inefficient and costly
[[Info from Dan K’s post]]

**Our current health care system is being operated with profit, not health, as the primary concern and goal.
[[How can you justify denying coverage to someone who has a pre-existing condition unless you are more concerned with making money than you are with keeping people healthy? Think about it. Those with pre-existing conditions are the ones *most* in need of regular, continuing care. – Also, you can be, and will be, stripped of coverage or have your coverage limited if you get sick, so current coverage is only very good for those who are very healthy.]]

FINANCIAL WELL-BEING/SECURITY

** While some can afford good health care today, NO ONE will be able to afford it in a few years.
[[Show % of income devoted to health care costs over the years – list of things that used to be covered by health care insurance that isn’t covered now - co-pays, etc. Info from Fred Moolton’s post.]]

** No one is safe from catastrophe under the current system.
[[Even if you have a gold-star plan, you may suddenly have to help your child, your sibling, your parent, your neighbor if they suffer catastrophic illness or injury. amike’s story says that so poignantly]]

**Bankruptcies and home foreclosures, many of which are caused by our health care mess, hurt everyone, particularly businesses and investors
[[# of people forced into bankruptcy by medical costs; impact of bankruptcies and foreclosures on creditors and other home owners, i.e, on the ‘haves’]]

**Taxpayers pay more for health care services given to the indigent now than they would under any of the proposed reforms.
[[Info on how much emergency room coverage costs vs having regular medical care - remind people that no one can be denied necessary services even now.]]

*The present system is unfair to employers, with some carrying a large part of the health care burden while others make no contribution at all.
[[Info from markg8 by way of artappraiser. As I understand it, an employer that chooses not to provide or contribute to health coverage may lose a competitive edge in attracting employees, but that’s it - that's the end of their involvement. And a small employer has to pay more proportionally than a large employer, rather than less as this system would provide.]]

Well, I certainly feel better prepared now to go into the break room and casually make mention of health care ..... Wish me luck.

I'm sorry Liz, but your argument, to me, still sounds too much like "I feel sad when others are sick". While that may be true, and I happen to agree with you, I don't think you really 'get' it.

You said:
"I'll never lose my home in order to pay medical bills, but my self-employed .. and uninsured .. neighbor might well have to make that choice.)"

You're wrong. Dead wrong.

You're thinking of this problem as something that primarily affects "other people" - people who are self-employed, or don't have health insurance. But the threat to you is just as real.

Think you're covered with great insurance? What happens if you get a serious condition? What's your lifetime maximum limit on benefits? You can max out a million dollar lifetime limit in months. What would you do if you insurance company decides to not cover $50, or $100K in expenses on some procedure? Do you have a spare $100,000 laying around? You have no recourse, no laws protecting you.

And heaven forbid that you get fired / laid off. What then? You've got a pre-existing condition. You think that's going to make you an attractive candidate to employers? Good luck getting coverage on the individual market. The consumer protections for this are practically nonexistent.

*THIS* is the problem with healthcare today.

------------------
HEALTHCARE TODAY IS LIKE RUSSIAN ROULETTE
------------------

You need absolutely everything to go right.

If you have a good job at big company, and they provide good health insurance, and you qualify, and you don't have to wait six months to get covered, and you don't get a serious condition, or your spouse, or your kids, and the insurance company doesn't deny your claims, and you don't need to go "out of network" for care, and they don't rescind your policy, and you don't get fired, ...

Then it's great! But you need a very long chain of fortuitous circumstances for everything to be good. If any one of those things goes south, you're screwed.

Having insurance, even having great insurance, doesn't protect you. It's a false sense of security.

A few personal examples:
1) My mother had non-cancerous tumor in her spine a few years ago. She had insurance and got approval for the doctor, the hospital, and the procedure. *After* the tumor was removed, the insurance company changed their minds and stuck her with a $50,000 bill. She spent years paying it off.

2) A few months ago mom had a heart-attack scare. My father works in the cardiac unit of a local hospital. Mom had some troubling symptoms, so dad told her to come to the ER to get checked. After a full day of scans and tests, they sent her home with a clean bill of health. Unfortunately, the insurance company decided to screw her. She doesn't work, and is covered under my father's policy. Apparently, a few months prior to this, the insurance company decided that they didn't have "proof on file" that she with lives my father. So they dropped her coverage. No notice, no letter, no nothing. When she asked the insurance company how she was supposed to know this, they said "you should have noticed that the deduction amount changed from your paycheck when you went from family coverage to single coverage".

So, she is now stuck with a $12,000 bill from that one-day trip to the ER.

3) A coworker has two teenage sons. One developed a nervous-system disorder called Guillain-Barre Syndrome, and racked up $250,000 in expenses in _ONE_MONTH_. The other was just found to have a brain tumor. How long do you think our $1 million dollar lifetime max coverage is going to last?

4) Another coworker has a one year old toddler that choked on a piece of canned fruit. She collapsed, had a stroke, and has been in hospitalized for months - in and out of a coma, with a breathing tube for life support. They have exhausted their lifetime benefits of one million dollars, and have been desperately holding bake sales and fundraisers to try and raise money for their helpless, one year old child. They are teetering on the edge of medical bankruptcy.

AND THEY HAVE INSURANCE. GOOD INSURANCE.

Every one of the stories above is from someone who is covered (or thought they were covered) under a good insurance plan.

*This* is why I want reform. I don't want it just because I think it's 'right', or because I hate to see the poor suffering uninsured people around me.

I want reform to protect *me and my family*. I look around me and I see friends, family, coworkers, being devastated by events that are completely outside of their control.

That's the part that is most horrible about all of this. There is _nothing_ that I, as an individual, can do to protect myself from these situations. I have an insurance plan, I contribute the maximum to my HSA, and ... and... I pray that nothing bad happens.

What else can I do? There aren't any other preventative steps I can take. There's no 'super-insurance' policy I can buy to protect me from ... insurance companies. If I get stuck with a $50k bill, or dropped, I'm hosed. No recourse.

No amount of deregulation, free-market competition, bigger HSA, more tax breaks, tort reform, sell-across-state lines B.S. is ever going to provide me that protection. The *only* way to protect me is via legislation.

Legislation that provides strong consumer protection like: no rescision, no pre-existing condition exclusions, real limits on out-of-pocket expenses (not just in-network, covered procedures), caps on premiums, etc.

I do agree that health care _should_ be a right for everyone. I've lived in both Europe and the US, so I have some perspective on both system.

But if you want a stronger argument for reform - this is it. Do it to protect yourself. Forget altruism, or moral high-ground, do it for you.

HEALTHCARE TODAY IS RUSSIAN ROULETTE
STOP SPINNING THE CHAMBER AND DEMAND REAL REFORM!

Come to think of it, that would make a good pro-reform commercial. Imagine a game-show theme with a wheel-of-fortune spinner and an announcer.

"Welcome! To! The! Healthcare Game!"

[crowd cheers]

Host: "Welcome everyone! I'll be your host today for another exciting game. Let's bring up our first contestant"

[A man walks up on stage and takes the microphone]

Host: "So, what's your name?"
Man 1: "Bob, from Kansas City."

Host: "Welcome, Bob from Kansas City! So, who are you playing for today?"
Man 1: [points to audience, nervously] "Uh.. my wife Jenna, and two daughters Elle and Jasmine"

[family waves from the audience]

Host: "Ok, Bob. Well, let's ... play.. The Healthcare game!"
[crowd cheers]
[Man spins the wheel]
[Wheel slows down and comes to a stop]

Host: "Oooh no! Sorry Bob! Looks like you have prostate cancer! Looks like your company is going to 'no longer need your services', because you are way too expensive to insure now! Yep, and now that you're unemployed, you'll quickly spend through all your savings and have to file for medical bankruptcy!"

[Camera pans to audience - the girls are crying, and mother is in shock]

Host: "Thanks for playing Bob! Next contestant!"
[Bob slinks off stage]

Host: "Next up is Jill... come on up!"
[Jill walks onto stage]

Host: "Hi Jill, who are you playing for today?
[Jill takes the microphone nervously]
Jill: "Uh.. I'm playing for my husband Mike, and my two year old son, Jimmy."

[Mike and Jimmy wave from the audience]
Host: "Ok Jill, give it a whirl!"

[Jill spins]

Host: "Oooh - lookie here! You need a $100,000 surgery! But don't you worry, because insurance is going to pick up the _whole_ tab! Oh, and you get another free spin. Go ahead, give it another go, Jill!"

[Jill jumps up and down, then spins again]
Host: "Ah.. sorry Jill.. looks like the insurance company decided after-the-fact to not cover the surgery after all! Psych! Well, what's a $100,000 among friends? Sorry little Jimmy, looks like no college for you!"

[Jill slinks off stage]

[Third contestant starts to run off the stage.
Host runs over and puts his arm around him]

Host: "Whoa, whoa, whoa! Hold up there, speed racer! You haven't had a chance to play your turn yet!"

Man : "But.. but.. I don't want to play."
Host: "Ah, you see, that's the beauty of The Health Care Game!"

[Host looks into the camera with a big smile]
Host: "Everyone has to play. Everyone, every month. You don't get a choice. Good luck!"

[Scene freezes]
Voice over: Stop playing games with your healthcare. Demand real healthcare reform now.

Good (although horrific) points, mazda_c. Chilling, chilling examples and in a way it's a wonder there aren't more like that in all our lives.

I actually probably am okay because I work for a HUGE government employer with excellent coverage/no ceiling, am close to retirement age, and get to automatically keep my excellent insurance after retirement at quite low/reasonable cost. ------- However, the point about what do I do if the provider, excellent tho it may be, decides not to pay for a specific procedure is well-taken and I'd be as helpless as you say in that case. -------- And even if *my* medical bills are unlikely to take me under, I'm totally vulnerable if my child, or sibling, or neice or nephew or good friend should be blind-sided by illness and no/poor coverage.

So, okay, I'll try to remember how vulnerable I truly am when I write up that letter. Gee, what fun.... thanks for reminding me .... ;-)

(And stilli, I WISH I was one of those who could pick up a pen and solve big problems!! It always amazes me that such people exist.)