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My Terrorist StateApril 09, 2006 My state's attempt at reforming access to health insurance isn't keeping me awake at night, but that's not to say it isn't scary. "Massachusetts Sets Health Plan for Nearly All" read the New York Times headline on Wednesday. Wow, I thought. Maybe I'll be able to afford health insurance again, and maybe that insurance will be something I can actually use? I read on. Under this plan, the state would subsidize insurance for people who make up to three times the poverty level. For single people this 3X figure is said to be around $30,000 a year, a number that sticks in my mind because my annual gross income hovers thereabouts. Maybe I'd qualify for some subsidy, especially if they're talking about net or even taxable income; maybe not. If not, and even if -- they plan to penalize people who can afford health insurance but don't buy it. And of course they get to say what we can afford. That's the scary part. Their idea of "poverty level" is so low that I marvel at anyone who can manage on twice that amount. Could our elected officials and policy wonks and academic experts manage on it? While we're at it, how many of them have to pay out of pocket for their health insurance, and how many of them are self-employed or employed by very small businesses, and how many of them have gone looking for coverage lately? And there's the rub: these people are inventing plans for them, which is to say us. They have no idea what our lives are like. They have no idea that they have no idea, or maybe they just don't care. Evidently they haven't even read Barbara Ehrenreich's Nickel and Dimed. Needless to say, ignorance doesn't stop some of them from pontificating about freeloaders and moochers, or any of them from presuming to tell us what we can afford -- from presuming, in other words, to tell us what our priorities should be. The big reason that I'm not lying awake at night is that with every passing day it becomes more clear that plenty of people have problems with Massachusetts's much-tooted [sic] plan, and some of those people have significant expertise and maybe even clout in the field. One of them, Marcia Angell, a former editor of the New England Journal of Medicine, noted: "If you don't fundamentally change the system, you run into the following dilemma: Anything you do to increase access and coverage inevitably increases cost. And anything you do to contain costs inevitably reduces access and coverage." Some good-sized rocks remain in the path of the steamroller. Whew. Other people have noticed that the steamroller isn't posing much threat to the insurance companies, who might, just might, have a teeny tiny bit to do with the soaring cost of health care and the fact that so many of us have limited access to it. I'm not the only one who wonders if the health-care mess can be cleaned up state by state, as long as the insurance companies can veto any state's plan by threatening to go elsewhere. Forget about state sovereignty for a moment: why doesn't Homeland Security go after these people? Start with the state legislators and, of course, Governor Rich Guy. No, they aren't flying planes into tall buildings, but you don't have to kill thousands of people to qualify as a terrorist. The essence of terrorism lies less in what people do than in who does it to whom. It's not terrorism if we are doing it to them. In that case, we're in control, so we're not afraid. Terrorism is committed against us by the uncontrollable them. Whether it's terrorism or not depends on which side you're on. Fellow named John McDonough was quoted in today's Boston Globe. He used to be a state legislator. Now he's running an advocacy group called Health Care for All. Sez he: "Let's not be afraid to experiment and try new things! It's so much better than constantly engaging in the stupid ideological back-and-forth. Let's embrace a real genuine bona fide amalgam of right and left approaches and learn from them. It's exciting, it's thrilling, it's great!" Sure, if you're the experimenter. To us lab animals, it doesn't look so good.
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