A lot of people are talking about the various “mandatory” plans floating about various congressional and gubernatorial offices right now. Ahnold’s, Wyden’s, etc. It’s all the Rage, for young politicians: it’s an issue that is still unmade in the national media (what is to come, not what is) and if you’re enterprising you can ride this political wave for a generation or more. If as a consumer, you’ve ever had problems with Phase One of the plan to keep people separated from their dollars and their health, you know what I mean. You’re never more ready for activism than when you’re reviewing your year-end out of pocket for health care. But get ready to feel the need to go all Che on some ass: Phase Two is a little more “humane” in that everyone gets to pay some people to do nothing, while getting nothing. Or worse.

Right now, we’ve reached a point, after going on 40 some years, where we’ve decided we don’t think the old or the poor should just die when they can’t afford good care. Actually, just the old- it’s the anger of the upper-middle class that’s really driving the grassroots scream for reform. Biff and Muffy can’t stand the idea that they’re spending 3K on Grandma’s private care and being told to pay even more for subpar converage. Those of us down here on the botton have experienced quite a different reality for some time.

Economics make my ears bleed, and I don’t understand the desire to make money off the ill. That aside, I’d guess that a system into which everyone pays and benefits equally is cheaper than dozens of competing for-profit plans administered by a dozen competing bureuracracies, each of whom must swim the oceans of commerce ever seeking maximal profit. I also don’t see why the rich bitch so; we can keep upscale for profit chi-chi health centers for the rich, so long as they’re willing to pay for them on their own. Hell, the price of a nose job might even fall.

I do know something of “you must have insurance, it’s the Law.” If you’re struggling, it’s a nightmare. Imagine losing certain essential rights, like the one to work or afford food, if you didn’t spend some portion of your income on “insurance.” But imagine there are no truly affordable options for your budget; every one represents a significant drain on your limited income. Imagine that you also receive no real benefit from this plan; you pay for essentials like visits and medication in significant portion to your budget just the same. And the out of pocket, if you get really sick, will max out the last of your credit line, just to keep up. Chances are, when you’re poor, if you get sick for an extended period, you’ll lose your job or be demoted [don’t start with me about “regulation” and “protections;” right to work, baby]. You’ll lose the very benefits you took the job to get. And unless you qualify, and quickly, government programs won’t keep you out of unmanagable debt. But don’t worry, the new BK bill makes it sure your children will have no chance of going to college, should you be able to afford having any.

Anyway, if you’re poor you say, “I’ll take it.” Because that’s the Law, and the surest way to fuck up your life when you’re poor is to risk crossing the Law. So most don’t, and find themselves, because of this wonderful “madate,” a little poorer and more harried than before, when they just took risks and only went to the ER when they absolutely had to and paid out of pocket, praying those bills didn’t exceed a couple of thousand.

Under plans like these, we now pay thousands per quarter, for less, and more risk. Poor folks like me didn’t thank the folks who made this extra hurdle to jump over. It takes very little, the “smallest” economic personal crisis, to upset this balance. Many play games, shuffling papers to keep the hospital, clinic, insurance company, employer, and bill collector a step away. Did I mention how much harder, and more horrifying this all is if you have kids, or dependents? Or that often, the wait between effective treatments is the length of the “go no-go” timeframe with respect to preventative or restorative care for life-threatening illness? People can’t afford to be treated, and so they die. Now, that group includes boomers and the upper middle class.

This isn’t going to just go away. People (Republicans and bean counters) won’t get their way, and the poor saps “costing us our money” aren’t going to go quietly into your profit margin. Few have the will to stomach large numbers of family members and friends dropping needlessly like flies and keep silent. What they will do, what they will demand, I cannot say. I feel a little sorry for our thick-headed politicians, they’ve had rock-sure top quality insurance for too long.

Experiencing the “bad apples” in our health care system can scar you. For life. You really don’t want to hear about “3 to 5 years from now,” or “a new selection of plans” with “great” savings and customer service. You want that check you write for $865/mo to go to a college savings account, or a car payment, or just putting food on the table. You’d like to see fewer receipts and credit card slips for expensive co-pays. You’d like to stop reading about preening peacocks in Lalaland. You’re tired of hearing about $100 billion dollar windfalls for the elite few, and death as a result of denial of “experimental” treatment for that little girl on the plastic jar in the gas station, begging you for a quarter to help pay for an operation.

Anyway, a lot of what we do down here on the bottom is a direct precursor to the games that will played everywhere soon. Except for an elite, most people will learn to enjoy the alternatives like nutritional therapy, self-medication, black market drugs, grey market drugs, mobile, low-service, for-profit corporate “health stations,” the Internets, pill-trading, creditor juggling, Chinese traditional medicine, Mexico and prayer. You can kiss excellent service, clean and shiny waiting rooms, free doughnut and coffee, and smiling, fresh-faced specialists goodbye. We used to have those things too, back when neighborhood doctors could afford to help with babies and make housecalls. Anyone else remember those days? I wonder: has anyone enumerated all the ways one must have the skillz of an accountant, postal worker, master forge artist, carney barker and Zen monk just to keep up with the paper avalanche that is “staying insured?” I swear, I should manage multi-billion dollar pyramid-scheme trading houses, the shuffling tricks I’ve learned.

Well, I’m sure some great plan will pass and everything will be better and I’ll be able to retire in comfort and security, my mind at peace in the knowledge that no health crisis will ever cause me to lost my home or savings. Insurance companies are our friends, right? They only want to make a manly, All-American profit off a jobs-providing, junket sponsoring political landscape, right? No one has ever had a problem with their insurer, right? That’s unpossible!
So I put my faith and trust in some good politician to pick the right bunch of companies to make what should be a government program more complicated and less efficient. That I _must_ pay for.

I think the descent, as found at various moments in history, goes something like this: Decent experiment with limited democracy; period of pseudo-imperialism and extensive wealth; period of corruption and civic indolence; period of economic and civic dissipation; period of oppression and militarization; period of insurgent countermeasures, period of sustained violence. We’re somewhere between “economic dissipation” and “oppression/militarization.” We’re being oppressed “for our own good/health,” so that we won’t complain too loudly about the economic conditions in which we find the standards established during our democratic period disappearing.

The bottom line for Dems is that they shouldn’t miss this freight train. This is clearly a “get on board” moment, and I suppose these early steps are to be expected. It’s clear the Democrats will have to be taught that there is tremendous support for sweeping and truly progressive health care reform. But to elites everywhere I’ll remind: it can cost you a little now, or a lot later. Once people get a taste for health care beyond capitalist “choice,” they tend to go all the way to that….socialist stuff! If you want to keep your claws in, cut back on the internal waste and fraud and start offering real plans people can afford. I won’t hold my breath.

UPDATE: Ian has an in-depth report. The money quote:

It’s partially funded by a 4% payroll tax on companies that don’t provide healthcare for it’s own employees. Everyone must have insurance and must buy it. Those below the Federal Poverty Level (FPL) will be given insurance, those earning 101% to 250% of the FPL will be given a subsidy for it. (The FPL for one person is $9,800. The FPL for a family of 5 is $23,400.(PDF))
A 4% tax on employers is too little - even Walmart pays 7% of payroll, and their health care sucks rocks.

So I am paying for my employer to save 3% at my expense by shuffling me off to some insurance company designed plan that is almost 50% less well funded. I am also trying to nativgate some maze of predatory companies offering marginal plans to the poor, I have to do it without the help of my employer and out of my already strained monthly budget. Who here thinks fair plans will be offered for ~10K/yr? And how it rankles to know this isn’t a “benefit,” but a double cost? First you pay for less efficient corporate for-profit programs that offer less, and that money comes out of both my pocketbook and from the programs that the government has previously offered, at no/t (much) cost? No, this is just bullshit, and won’t last.