I could probably afford better insurance if I wasn't paying for theirs.

September 30, 2009 10:53 AM

What kind of health insurance would you have as a federal government employee? The Office of Personnel Management would like to help you decide among the gazillion plan choices you have. Perhaps you are a Congress member? Then head on down to the Attending Physician of the United States, "It's one of the, quote, benefits of being in Congress," Kagen said. "They have physicians and nurses that will see you on the spot, on the beck and call." (link to single page print version).

from the article quoting Kagen...

"But while [Rep Steve] Kagen touted in campaign advertisements and news interviews that he had no insurance coverage, he openly admitted he used OAP services. In January, for example, he paid more than $4,000 out of pocket for outpatient arthroscopic knee surgery. After the procedure, he said, he used the attending physician's office and staff to assist him with physical therapy."

Wikipedia on the Office of Attending Physician

A NYT editorial on why we can't all have the same health care as Congress - and how we could possibly all have better care.

Congress’s health plan pays for routine expenses like office visits and vaccinations, for example, which is like auto insurance covering oil changes or new windshield wipers. As a result, the premiums are steep — upwards of $13,000 a year for a family (69 percent of which is paid by the government). To provide the 50 million Americans who are now uninsured with such a plan would require scary tax increases.

posted by sio42 (42 comments total)

"It could probably be shown by facts and figures that there is no distinctly native American criminal class except Congress." --Mark Twain
posted by chavenet at 11:05 AM on September 30, 2009 [5 favorites]

Services offered by the Office of the Attending Physician include physicals and routine examinations, on-site X-rays and lab work, physical therapy and referrals to medical specialists from military hospitals and private medical practices.

So, the same services offered at my employee medical clinic?

The difference, I guess, is the fact that I have to go off-site to see a specialist.
posted by muddgirl at 11:09 AM on September 30, 2009

Members of Congress interviewed for this story say they believe the model of ready primary care services offered by the OAP should be expanded nationwide, though few discussed the logistics of how those services could be offered.

Yeah, they "believe" that, just like they "believe" that universal health coverage is something that should not decided on the basis of the magic money that most of these worthless sleazes get from the health care industry, big pharma, and other special interests.
posted by blucevalo at 11:10 AM on September 30, 2009

Then why of why don't a number of Democrats introduced a bill that states that either there is to be a public option or there must be a health coverage that is exactly the same as that given members of congress, no less than that...and let congress vote on that and let the American people see an up or down vote, by name.
posted by Postroad at 11:18 AM on September 30, 2009 [3 favorites]

...pays for routine expenses like office visits and vaccinations, for example, which is like auto insurance covering oil changes or new windshield wipers.

Apparently the writer hasn't seen a bill for some vaccinations lately. For instance, our doc charges $200 per round to administer the HPV vaccination. My insurance, of course, does not cover this. It's an out-of-pocket expense. Hardly comparable to getting new wipers. Hardly routine.

Oh, and that $13,000/year premium comes out to, roughly, $1084/month. That's not that much higher than what many families are paying for worse coverage. So, hell, they're getting a great deal.

I find it troubling that a common thread through all of the healthcare debates seems to be circling around the unspoken idea of just how bad can we make everyone's coverage. This comes in the form of stories about the other guy's "Cadillac" coverage. The underlying message being that they need to suffer some pain and have their benefits cut. This just seems odd. Where's the argument that says we need to improve the coverage on those without the Cadillac plans?
posted by Thorzdad at 11:20 AM on September 30, 2009

upwards of $13,000 a year for a family (69 percent of which is paid by the government).

How much of this actually goes to care, as opposed to administrative costs and insurance company profits?
posted by dilettante at 11:24 AM on September 30, 2009

When I get hired somewhere again, I'll have a dog in this fight again. Right now, I have to worry about getting food on my table and out from under four months of past rent.

Health care debate? No debate. No job, no food, no coverage and Congress can suck it.
posted by Lipstick Thespian at 11:28 AM on September 30, 2009 [6 favorites]

"..of the people, by the people, for the people..."

Well, some of them, anyway.
posted by entropicamericana at 11:30 AM on September 30, 2009 [1 favorite]

Congress’s health plan pays for routine expenses like office visits and vaccinations, for example, which is like auto insurance covering oil changes or new windshield wipers. As a result, the premiums are steep — upwards of $13,000 a year for a family (69 percent of which is paid by the government).

People aren't cars! Comparing auto insurance to health insurance is silly.

Other countries manage to provide coverage for so-called "routine" expenses like office visits and vaccinations for much less than $13,000 per year (for example, in Canada, for about 1/5 of that). Extrapolating from what some sort of fancy-pants health insurance costs for members of Congress to what health insurance would cost for 50 million people is just dumb.
posted by ssg at 11:36 AM on September 30, 2009

Or for example in Belgium, where my daughter just got her vaccinations topped up last week during a school visit to the health-center (they go see a doctor during school time every couple of years). She'll get the HPV vaccine for free this way too.
posted by LVdB at 11:44 AM on September 30, 2009 [1 favorite]

Other countries manage to provide coverage for so-called "routine" expenses like office visits and vaccinations for much less than $13,000 per year...

Yes, but those countries aren't trying to protect private corporation profits. That's really the core of the argument here, after all. If you want healthcare, you will have to pay higher taxes because your elected representatives will never, ever, ever do anything that might cut into corporate profits. Hell, the only plans that stand any chance of passing guarantee increased business to the insurers.
posted by Thorzdad at 11:48 AM on September 30, 2009 [17 favorites]

Wow, the USA has some of the worst (and most expensive) healthcare in the Western world, and you want to INCREASE prices and REDUCE coverage?

It's a mad, mad, mad, mad, mad world!
posted by blue_beetle at 11:48 AM on September 30, 2009 [3 favorites]

People aren't cars!

I am! Vroom, vroom!
posted by infinitywaltz at 11:51 AM on September 30, 2009 [10 favorites]

This comes in the form of stories about the other guy's "Cadillac" coverage. The underlying message being that they need to suffer some pain and have their benefits cut. This just seems odd. Where's the argument that says we need to improve the coverage on those without the Cadillac plans?

I think the key here is the people we're talking about are the ones making health care policy, but chances are, it's probably been years if ever since they had to come to grips with the issues that people who don't have cadillac plans tangle with. I don't particularly want cadillac plans to go away, but I do want the people making the relevant policy decisions to have more than a research or ideological understanding of the issues.

For that reason, I think it'd be a good stunt and a good faith gesture for members of congress who want real change to renounce participation by themselves and their legislative staff not just in government plans, but in group plans of any kind. It'd also be good real research. By virtue of their status and connections, they still wouldn't experience the problems with the market that a lot of us do, but maybe it'd give a broad idea.
posted by weston at 11:51 AM on September 30, 2009 [5 favorites]

"he paid more than $4,000 out of pocket for outpatient arthroscopic knee surgery."

For comparison: I had similar surgery for a torn meniscus a few years ago. Yes, the surgery itself was about $4000, but with all the other expenses (MRI, P.E., office visits, knee-brace, etc.) the total was over $12,000, which even with my good, state-funded insurance cost me about $3000 out of pocket.
posted by coolguymichael at 12:06 PM on September 30, 2009

Hey, it's good to be king.
posted by emjaybee at 12:25 PM on September 30, 2009

LVdB: But over here, you'd have the rabid anti-socialism and anti-vaccination crowds screaming bloody murder at the thought of a "government doctor" jabbing your kid with needles while she is at school (yes I know you get a choice and nothing is done without your consent, but that doesn't seem to stop the shouting). It's obviously far more preferable for the parent to miss work, the child to miss school, both to hop in the minivan to go to the doctor's, have a good portion of the bill spent on insurance administration expenses, refuse to give your kid the shot as the result of continued FUD, and miss yet more work and school when said child gets the measles (or worse). But hey, you avoided socialism, so it was all worthwhile.
posted by zachlipton at 12:50 PM on September 30, 2009 [1 favorite]

…pays for routine expenses like office visits and vaccinations…which is like auto insurance covering oil changes or new windshield wipers

No, it really is not. What a stupid claim to make.
posted by five fresh fish at 12:51 PM on September 30, 2009

No domestic partner benefits though!!!
(My partner works for the Congressional Budget Office. Insurance is great--but...)
posted by mkuhnell at 12:52 PM on September 30, 2009

Ways that comparing car insurance to health insurance is stupid:

1) Preventative car care only slightly reduces the risk distributed in a pool of drivers. Car insurance doesn't cover prevention, because it doesn't cover wear and tear. Car insurance covers unforeseeable accidents. Health insurance covers that too, but the cost incurred by the risk pool has more to do with chronic, long term sickness which is more preventable.

2) Mandated car insurance coverage is not analogous to mandated health insurance coverage. I can choose not to drive or own a car, and thus avoid the risk of collision. I cannot choose not to have a body, and I will always be at risk of damage to it.

3) Information asymmetry in an auto-shop is no where near as severe as in a doctors office. Mechanics have a standard book value that defines how long typical jobs should take, and prices are derived from those well studied values. Mechanics regularly give quotes, and if they stray from them significantly, there are market repercussions. Healthcare providers often cannot even answer how much a given procedure will cost before consulting with payers, and determining which price they want to use for the customers situation.

4) The supply of M.D.s is more controlled than the supply of auto mechanics. There is no corollary to the AMA and Medical Boards.


Hivemind dogpile! Please feel free to add more!
posted by butterstick at 12:54 PM on September 30, 2009 [2 favorites]

As a non-Congress, low-end, but unapologetic federal employee, here's how it works on this end: We do have a wide range of choices for health insurance, as shown in the first link. Each plan has a different cost and different coverage. We have an "open season" during the year when we can change our insurance.

Each plan has its own pros and cons. The empoyee portion of the plan is deducted from my pay each pay period.

On my current plan, I pay* about $360 a month toward the premium. Some plans cost less, and some cost more.


(*Yes, I know I pay this out of salary that is ultimately paid by you, the taxpayer. But I'm worth it.)
posted by The Deej at 1:05 PM on September 30, 2009 [1 favorite]

If you think that's sweet, wait until you see their Felony Forgiveness program.
posted by clockzero at 1:37 PM on September 30, 2009

Sad afct: some of our older folks who are not yet eligible for Medicare, are moving to Mexico, waiting two years there, and then using their health care system until they're eligible for Medicare. In other words, Mexico has better health care than we do! MEXICO! If that keeps going on, Mexico may have to do something drastic...like build a wall to keep us out. They can use cheap American immigrants to do the work, then boot 'em back into the U.S. to die of neglect when the wall is complete.
posted by jamstigator at 1:48 PM on September 30, 2009 [2 favorites]

'afct' = 'fact'
posted by jamstigator at 1:48 PM on September 30, 2009

Most obviously, the difference between car insurance and health insurance is that with cars, there is the concept of "totaled," where if the margin of diminishing returns has exceeded the cost of repairing the car, it can be replaced with a new car.

We get one body, we don't get to total it out when it gets too expensive and replace it with a new model. Which is why preventative and maintenance care is so very important, and why people are worth saving even when their bodies suffer chronic illness or disability.
posted by Bueller at 1:57 PM on September 30, 2009

There are quite a few nice parts of Mexico, and I'm sure the dollar goes a long way.
posted by smackfu at 1:58 PM on September 30, 2009

>> …pays for routine expenses like office visits and vaccinations…which is like auto insurance covering oil changes or new windshield wipers

> No, it really is not. What a stupid claim to make

Yes, it really is. And what a "stupid" -- that is, baseless and unexplained -- retort for you to reply summarily like you did.

At the heart of the matter is the fact that "insurance" is an inappropriate model for healthcare in modern society. Insurance - home insurance, car insurance, life insurance, travel insurance, whatever, any kind of insurance that is actually insurance - is about risk spreading. A big bulk of health care costs are covered by cost spreading. There's no risk that you'll need vaccinations, or yearly checkups, or an average of n number of prescription medications, or dental care. There's no risk that you'll have befallen upon you the unexpected tragedy of needing a physical for your kid so he can play soccer.

At the heart of the matter is the fact that non-tragic medical care, routine medical care, preventive medical care, the kind of medical care that we pretty much all agree everyone should have, is quotidian and not a risk to insure against.

And of course, once you realize that this all boils down to cost-spreading -- not risk-spreading! -- it becomes face-palm obvious that we should use an existing cost-spreading infrastructure to implement it, in order to avoid wasteful duplication of overhead. It should be a nation-wide infrastructure, with the ability to fund things with gross income, and preferably a repeat player with Big Pharma in order to have cost-reduction leverage...

I wonder what that sort of existing infrastructure might look like... :-|
posted by jock@law at 2:00 PM on September 30, 2009 [2 favorites]

I wonder if having everyone covered by health insurance will change the fact that more than 75% of people who are bankrupted by medical bills are insured?
posted by mullingitover at 2:14 PM on September 30, 2009 [1 favorite]

Um, that was a good rant, jock@law, but I think you and five fresh fish actually agree.
posted by Faint of Butt at 2:21 PM on September 30, 2009

Just throwing this out for perspective. Two Fl. 70+ yr olds pay a combined $6450 for Medicare and Fl. BC/BS supplemental insurance. Or $537 a month. So all you soon to retire folk who think your medical expenses will magically disappear with your enrollment in Medicare.........and this doesn't work (for all practical purposes) for over seas travel coverage. That is extra.
A lot.
posted by notreally at 2:26 PM on September 30, 2009

Just throwing this out for perspective. Two Fl. 70+ yr olds pay a combined $6450 for Medicare and Fl. BC/BS supplemental insurance.

That's $268.50 per person per month, which is a damned sight better than most people can get. I figured my insurance up earlier, and with the employer's contribution it's $342 per month.
posted by dilettante at 3:45 PM on September 30, 2009

Two Fl. 70+ yr olds pay a combined $6450 for Medicare and Fl. BC/BS supplemental insurance. Or $537 a month.

As of two years ago, my BC COBRA premium was $300/mo at a minimum (least expensive plan, most expensive was pushing $500). I was 35 and rated in a location where the general population would likely have been rated at above average health levels.

You're apparently telling me that two people over twice my age pay less per person than I did for combined Medicare and supplemental BC/BS care.
posted by weston at 3:50 PM on September 30, 2009

upwards of $13,000 a year for a family (69 percent of which is paid by the government).

By "the government" actually means taxpayers. Like me. I'm helping to pay for 69% of their insurance. And meanwhile, they want to protect me from having the same kind of insurance?
posted by Houstonian at 4:20 PM on September 30, 2009 [1 favorite]

I saw this on ABC's morning show. At the end, Diane Sawyer quipped how she'd been visiting the capitol for 30 years and had no idea it existed. I worked at the capitol for six months and walked by it countless times, and even went once to get something for allergies going crazy (fast, nice, service!). I don't have a clue how she missed it.
posted by Atreides at 5:16 PM on September 30, 2009

upwards of $13,000 a year for a family (69 percent of which is paid by the government).

So they don't pay the $13000, but only 31% of it? Or $13000 is the 31% and the government pays the rest?
posted by Obscure Reference at 7:04 PM on September 30, 2009

The $13,000 is the total, and they pay part and the government (their employer) pays the rest.
posted by dilettante at 7:21 PM on September 30, 2009

My significant other pays around $550/month. She's in her 50s and does have osteoprosis. And that's her only realistic choice, as that's the plan offered by her former employer (she's a retired teacher). That's the group rate, but being retired she has to pay for all of it, no employer contribution. And they just raised her copays 50% and added a donut hole for her this year. She could say 'kiss my ass' and go look for an individual plan, but that'd cost even more, guaranteed. So she has this (Cigna) plan which reams her pretty hard, or she could go out on her own and get reamed even harder, and that's the extent of her choices. Medicare will be cheaper, if she can afford to live that long.

Incidentally, in the time it took to reach the above paragraph (more or less), someone WITH INSURANCE died or went bankrupt from lack of medical care.
posted by jamstigator at 7:40 PM on September 30, 2009

Er, 'read', not 'reach'. I musta smoked too much pot today or something, because I suck today.
posted by jamstigator at 7:43 PM on September 30, 2009

You're apparently telling me that two people over twice my age pay less per person than I did for combined Medicare and supplemental BC/BS care.

Yes. That's true. But these two people (us) paid $10,000 a year for BC/BS (including a comprehensive dental plan) prior to turning 65. When Medicare kicks in there is a false belief by many that gov't will be taking care of all their health care costs/needs. In our case we are about $3,000 better off now. But our annual costs are still in the range of $7,000 +.
By the way. I/we did not have the option to forego medicare and continue with our private BC/BS private policy. Something we would have preferred because of the comprehensive nature of the private policy we had to give up.
posted by notreally at 7:54 PM on September 30, 2009

Revealed: millions spent by lobby firms fighting Obama health reforms
posted by Artw at 2:19 PM on October 1, 2009

This makes me think how in the UK, our politicians all make a point of using the NHS (except, perhaps, when they are trying to make a different point)
posted by marmaduke_yaverland at 2:42 PM on October 1, 2009

From Artw's link: "There are six registered healthcare lobbyists for every member of Congress"
posted by dilettante at 2:53 PM on October 1, 2009