• Your experience is not everyone else’s

    This is one of my all time favorite Doonesbury strips, from October 1982:

    In case you can’t read it, a cleaning lady is talking to Jane Fonda. Ms. Fonda tells the other woman that she looks worn down and that she should exercise more. The cleaning lady replies that she doesn’t have time for such things. Ms. Fonda than lectures her on the fact that no one is busier than her, as a “wife, movie star, activist, and entrepreneur”, and that if she can find time to exercise, then anyone can.

    The cleaning lady responds with one of the most insightful retorts I have ever read. She says, “you’re as busy as you want to be. I’m as busy as I got to be. I hate to break it to you, but there’s a big difference.”

    I bring this up because there’s been a resurgence this week on the blog of people who are lecturing others (and the public) that if they can save enough for their health care, and be “responsible”, then so should everyone else. What they are forgetting, though, is that their life experience is not everyone else’s. It’s great that they can save as much as they like. Not everyone can.

    If you make $50,000 a year, and you’re pretty healthy, then it may be completely reasonable to save enough so that if you have to go to an emergency room, then you have the $1000 available. Doing so seems responsible. But you have got to realize that you’re making an above-median income. More than a quarter of households make less than $25,000 a year. The world looks very different to them.

    Moreover, many people aren’t healthy. Health care for them is expensive:

    If you’re in the top 10% of spenders, then your medical costs are more than $26,000 in a year. If you’re in the top 30% of spenders, then your costs are more than $12,000 a year. There are lots of people who make below median incomes and are in the top 30% of expensively sick people. They are not you. Don’t assume they are.

    If you’re doing reasonably well, and your life is stable, then it’s likely you’re saving and spending as much as you “like” to. That’s very different than spending as much as you “got” to. Try to remember that the next time you’re lecturing someone you don’t know on how you’re doing a better job than they are.

    @aaronecarroll

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    • My wife and I are two reasonably healthy adults. We both worked and saved to buy a reasonable home. We both continued to work until late in my wife’s first pregnancy, when her water broke at 31 weeks. Between the time I was 34 and 39, we had two premature children, both of whom had to be lifeflighted from our rural location to a NICU. In total they spent more than 3 months in NICU. One of them has subsequently had two major spinal surgeries, in addition to a host of other smaller problems. In total, my insurer has spent more than one million dollars on care for their total 27 years of life. Both are now extremely bright and capable individuals who will make wonderful and productive citizens.

      Change any one minor circumstance, say have me working for a small employer who does not offer health coverage. Other than being born a Romney, how was I supposed to save money for that care?

      P.S. In a health system without appropriate regulations, neither of them would be able to get health insurance for almost any of their future health conditions, because insurers can point to so many events in their first years of life that make those “pre-existing”.

    • No need to publish this comment. Just wanted to let you know to change *than in the first paragraph to *then

      “and that if she can find time to exercise, *then anyone can”

    • I love that you posted this. This gets at some pretty fundamental issues in the larger health care debate. But I would add that for those that believe that they are “doing a better job” its not just about working hard, its about making better decisions. And that is what they really mean – they have made better decisions over the course of their life and that is the basis for their success. Others who are not in the same position must not have made good decisions – whether it was to get an education, take care of themselves, or be in dysfunctional relationships, etc. So the cleaning lady should have made better decisions somewhere along the way that would have put her in a better position. And ultimately this mentality leads to the ant vs. grasshopper mentality wherein ultimately since I made better decisions than you, than I should not feel responsible to make your life easier. Taking responsibility means living with the consequences, even if that means starving when winter comes.

      I think we have to do a better job of articulating the dynamics of health disparities and social determinates of health. Otherwise we end up looking like all we want to do is subsidize peoples bad decisions and alleviate their responsibility for their own actions.

    • IMO, the inside-the-Beltway Very Serious People are some of the worst offenders in this realm. They’re more than ready to cut spending on ‘entitlements’ that they will never have to rely on, or Social Security payments they will never have to rely on. But they are largely blind to the fact that their class experience and interest is not shared by most Americans. (Yes, Simpson and Bowles, I’m talking about you and anyone else who cites your class-biased policy prescriptions.)

      The Doonesbury strip is a great illustration, thanks for the post.

    • Some people just assume their experience is the whole of reality. It’s a failure of empathetic imagination, really, and not just applicable towards health care. Public policies should be structured to affect the world based on how it actually works, not on the personal anecdotes of those who would be just fine without it.

    • “Why don’t they just go out and get a job?” my fiend asked me in response to a comment I had made about cuts to the State Medicaid program.

      I responded that 52% of Medicaid beneficiaries in our state are low-income children.15% are disabled non-elderly adults (many with severe mental illness) and another 15% are low income seniors (including institutionalized elderly with dementia). The remainder are pregnant moms, medically needy adults with medical costs so great that paying for them pushes them below 100% Federal Povery Level, and single parents with low income children, many of whom also suffer from disabilities and have applied for SSI/SSP.

      “Which one of these do you think should go out and get a job?”, I replied.

    • It is to late to sign up, but for those interested in good reading lists, the ones under reading assignments for Emannuel’s course is excellent. Very good list of primers. ( I think this is Kosher to post, but if not, don’t.)

      https://class.coursera.org/healthpolicy-2012-001/class/index

      Steve

    • That is why I am a big proponent of being concrete. Don’t say we need to help the poor get coverage say we need to help families earning less than $20,000/year get coverage. It is useless to say in a discussion I cannot afford health insurance without saying why home much you earn of what a preexisting condition makes your insurance cost. Beggars cannot be choosers. Those who foots the bill should decide how much of your own money and effort should go into before “we” pay.

      Some people can live on very low income. It leaves a lot for health insurance.

      It is also why I like my health care compromise.

      • That is why I am a big proponent of being concrete.

        Don’t say we need to help the poor get coverage say we need to help families earning less than $20,000/year get coverage. It is useless to say I cannot afford health insurance without saying why. You need to say how much you earn and/or what a preexisting condition makes your insurance cost. Beggars cannot be choosers. Those who foot the bill should decide how much of your own money and effort should go into paying your medical bills before “we” pay.

        BTW: Some people can live on a small amount of money. It leaves a lot left to pay for health care.

        This is also why I like my health care compromise.