Tuesday, January 17, 2023

"How Can Anyone Survive in America???"

If your only impression of America came from the Internet, you might think it was a dystopian hellscape.

UPDATE: I wrote THREE TIMES in this entry, "I am not defending our system, just explaining it" but some readers seem to think the opposite - that I am promoting "The American Way" as better than the rest of the world!  That is not the case.  Read!  The point is, the "memes" bandied about online make the system seem worse than it is.  For example, today is posted online a bill for a kidney transplant - about a quarter-million dollars. That's how much they cost in any country - you just may never see the bill.  The patient's responsibility? Four-hundred dollars. That part is never followed-up in a "meme" which is why we should not get our information from them.

People do quite well in America. You have to be astute and on your toes, however, as our system is admittedly harsh and unforgiving on those who don't pay attention or those who intentionally flaunt the rules.  Can things be made better?  Let's hope so. The patchwork setup that is our health care system makes government bureaucracy look efficient in comparison.  And the gun thing.... crazy.

But if America was really that bad, you'd see an outflow of migrants from our country, not into it.  It isn't a horrible dystopian nightmare.  No, that's Russia.

Please read before flaming, though.  Let me repeat it again, three more times:

I am not defending our system, just explaining it.

I am not defending our system, just explaining it.

I am not defending our system, just explaining it.

* * *

I read online some folks in Europe asking, "How can anyone in America survive?  Medical bills in the hundreds of thousands of dollars! Student loan debt of a hundred grand or more!  No unions!  Minimum wage jobs!  Everyone getting shot on a daily basis!  No public transportation to speak of!  People starving in the streets!  Drugs!  Homelessness!  Surely this is a dystopian hellscape!"

Well, it may seem that way if all you saw were movies and television or memes on the Internet.  People like to post pictures of medical bills in the hundreds of thousands of dollars - but never post the actual amount due to them.  Granted, our medical system is weird.  A friend of mine has recently moved from Canada and I have tried to help them navigate our medical system. They are on the ACA (Obamacare) and should be all set.  But the crazy world of deductibles, out-of-pocket limits, and "co-pays" are quite confusing to them, particularly when you come from a system where you never see a bill at all (but there is a bill, somewhere, you just don't pay it).

UPDATE: Rob Ford, the Queen of Canada and Trump wanna-be is apparently trying to privatize hospitals in Ontario!  So weird.

Bear in mind I am not defending our system, just explaining it and pointing out that it isn't quite as bad as trolls on the Internet make it out to be.

Our Obamacare plan costs us $125 a month, and it has a max out-of-pocket every year of about $3500.  These are not big numbers. And for routine things, they are often covered almost entirely, but understanding medical billing not only requires an advanced degree in mathematics, but metaphysics as well.  I went to the doctor to have a mole removed.  They tested it and it was not cancerous.  I get three bills from the  doctors and a "statement of benefits" from the insurance company.  I owe the doctor's office a $25 "co-pay" for a standard office visit.  Another practitioner bills me $185 for the procedure, but the insurance company knocks this down to $45, of which I owe $18 for some reason.  Finally, the "lab" sends a separate bill for testing, which again, was a couple of hundred dollars, but insurance limited part of the claim and paid part and sent the balance due of $35 to me.

It is weird and trying to figure it all out will drive you nuts.  It pays to have even a high-deductible plan, as the insurance company crams down the prices on services.  So a colonoscopy "retails" for $3500 but if you have insurance, the doctor charges only $1500 (the rate they negotiated with the insurance company) and I owe a few hundred of that for some reason.  And yes, I get three bills - from the hospital, the doctor, and the anesthesiologist.

Yes, it is a crazy system, and it does require that you sign up for insurance.  Some people don't - often for stupid reasons.  "I ain't signing up for no Obumma-care!" one Tweets, "I'm waiting for TRUMP-care!" - and they get it, too, a grifter-plan that costs more than Obamacare (ACA) and covers Nothing.  Yes, you are free in America - free to be as dumb as a bag of doorknobs.  The sad part is, some people mean well but are just dumb, and they get exploited mercilessly in this country.  And yea, we should protect people who are vulnerable like that - and we do, to some extent.

Do these $100,000 medical bills exist?  Yes and No.  A friend of mine just had a heart procedure and it saved his life and cost $100,000 which the hospital said Medicare would pay for.  He gets a heart-stopping letter (no pun intended) from Medicare, saying, "Nah, we ain't payin' it!" because - get this - the doctor didn't perform two tests first to see if the procedure was necessary.  He may have performed these tests, the problem is, he didn't code them properly on the patient sheet.  They even listed the codes he should have used in the letter they sent!  So the hospital just needs to re-submit the paperwork with these two codes and no problem, right?  Except that the hospital probably won't figure that out.

The medicare people tell my friend not to worry about payment as it was the hospital's fault they said medicare would pay for it, so the hospital has to eat it.  And you wonder why medical care is so pricey these days.  You wonder why they have ridiculous rules like this.  Who has a heart procedure just for funsies?  Well, besides me, that is.

Real horror stories occur when people go to the ER and a physician sees them - a physician who is not "in network" as he is a visiting doctor filling in during this era of labor shortage.  Since he is "out of network" his charges are not subject to the pre-negotiated rates and the health insurance company might not cover all or any of his charges.  This results in nightmarish bills and confused patients.  When you are in a coma, having a heart attack, or having a stroke, you don't think to ask, "Say, are you in-network or not?"

It is a pretty stupid system.   In many cases, after a lot of negotiation, these bills are whittled down.  The deep dark secret of medical billing is that hospitals don't expect most of these bills to be paid.  That's why you NEVER put a medical bill on a credit card or take out a second mortgage or use a HELOC to pay one.  Once you do, it is ordinary debt and subject to ordinary debt standards of collection.  But medical debt?   Most hospitals will negotiate this down dramatically.  They may slash it (particularly if you go through the bill and note any discrepancies - and there are usually a lot of them) and then offer an interest-free payment plan - $5 a month for life (just kidding, but a friend of mine paid a hospital $10 a month for years, to pay for his first daughter's birth expenses).

Hospitals know that if the patient is poor, they can declare bankruptcy easily and have most of the debt wiped out.  Better to collect $10 a month than nothing.

Again, I am not defending this practice - why should it be a burden to the patient (who is going through enough as it is) to decipher endless bills that make little or no sense, navigate the bizarre world of medical billing and coding, and then negotiate with a hospital?

In other instances, people get humongous bills simply because they have no insurance at all and thus are charged "full retail" prices for all services and the bill ratchets up quickly.  Again, it is scandalous that someone with no insurance is charged the highest rates, while the wealthier person who has insurance  gets discounted rates.  Usually, such folks declare bankruptcy and the hospital gets little or nothing.  The costs are passed on to the rest of us.

And insurance is expensive.  Before Obamacare, when I was in my 40's, I paid $500 a month or so for a $10,000-deductible policy for me and Mark.  As we got older, the price went up as the risks were greater and the cost of medical care continued to escalate.   Obamacare saved the day, but if I had to pay the full premium it would cost $1500 a month (read that again, slowly) instead of $125.   It is the reason I retired - if I continued to work, I would have to spend $18,000 a year on health insurance, as the subsidy would disappear.

Like I said, I am not defending this system, just explaining it.

Rarely, though, are people forced to pay these extreme bills.   There are outliers, of course, and the news media likes to hype these.  Ambulance rides are a particular problem as the insurance company might pay a flat fee of $1000 per ride, but for some reason, the ambulance company charges $3000 - and you have to pay the rest.  Air Ambulances ("Life Flight") is even worse - $14,000 or more per ride and the insurance company may leave you on the hook for ten grand of that.  Worse yet, if you are out cold, a medical technician decides if you need a life flight.  He often decides you do - after attending a free "life flight" seminar in the Bahamas, courtesy of the company.  Conflict of interest?  Nah!

So why don't we have single-payer, national health, socialized medicine - or whatever you want to call it? Good question.  Many (including myself) have noted how much it would cost in terms of the Federal budget.  It could expand the Federal budget by 50% or more.  But that argument fails to consider that we are already paying that amount, as a country, to insurance companies, hospitals, doctors, laboratories, ambulance companies, and the rest of the "medical-industrial complex" (one of the largest, if not the largest, industry in the United States).

So if Comrade Sanders' idea of "Medicare for All" was instituted, it would expand the government budget, but at the same time, zero-out the amount paid by companies for medical plans, the amount paid by individuals for insurance policies, the amount paid by Obamacare for subsidies, and the amounts written-off by hospitals every year.   The costs would be the same (if not less, as the Medicare system is very aggressive about cramming down prices) just paid by different entities.

Incidentally, "Medicare for all" would not mean an end to private health insurance.  One big decision  you have to make when you qualify for Medicare (age 65 right now) is what supplemental insurance plans to get.  Part B, Part D, Part Z or Part-T!   It is very complicated and again, we are asking the bag-of-doorknobs set to navigate this.  So Medicare-for-all would still require supplemental insurance and my elderly friends (who are 10 years older than me) are paying hundreds per month (sometimes over $1000 a month) for these supplemental plans.  Kind of sad, ain't it?

But that is the rub - under medicare-for-all it would be harder for doctors, particularly specialists, to charge outrageous amounts and make tons of money, as medicare has strongly negotiated the prices of services and some medicines.  So, as you might imagine, the AMA lobbies heavily against this.  Obamacare was the shot across the bow.  Medicare-for-all might come about, if Democrats can regain power and get a working majority in both houses.   This might not happen for a long time.  It still would not be "socialized medicine" like in many European countries.

But what about Student Loan debt?  "In my country, college is free - or at least inexpensive!" our Euro friends say.  That may be true, but many of the "crippling student loan debt" stories are indeed outliers. Depending on which source you read, the average student loan debt is closer to $35,000 than $350,000.   It is only those who pursue advanced degrees that end up with hundreds of thousands of dollars in debt - and that is because they charged their living expenses as well as tuition, to student loans.  It is also because they chose an expensive "name brand" university, rather than a State school (in-State, please!).  In addition, if they are "middle class" they might not qualify for much aid or scholarships.

And if they got a useless advanced degree, there is no way they can ever pay it back.  Whose fault is that?  (One way to tell if someone has a useless degree is if they post online that they have a "Masters" degree but cannot find a job that they think they deserve.  They never say Masters in what.)

There are alternatives.  I worked my way through college - all 14 years of it - and I would have it no other way.  I learned far more by doing this, as I actually worked in my field (as well as others - Planned Parenthood?) and got a lot more experience than simply figuring out how to pass tests and write essays.  Anyone can do this, to some extent - few choose to.   Many young people today feel that working some "job" while in college is beneath them.  They graduate with a useless degree, tons of debt, and mediocre grades and find out they are qualified only for the shitty jobs they deemed beneath them while they were students.  These are the agitators who are pissed off.  College was a great fun time for them, and now they graduate and everything sucks.  But whose fault is that?

There is some evidence that the latest generation is figuring this out - after 20 years of news stories about how expensive and useless many college degrees are, as well as the horrors of student loan debts (which, unlike medical debts, survive bankruptcy) many of "Generation Z" are giving college a "pass" or at least figuring out other ways of approaching it.  People will do that, if things get bad enough.  Sadly, many an 18-year-old will trade his entire life for four years of partyingWe shouldn't ask 18-year-olds to make decisions like that.  Then again, that's how you staff an army - with 18-year-olds.

But yea, the student loan thing sucks, and it should be fixed. I am not sure "free college" or total loan forgiveness is the answer, however.   But the "meme" that every college grad is hundreds of thousands of dollars in debt is a false narrative and one perpetrated by people who want to run us down (i.e., the Russian "Internet Research Agency" otherwise known as Putin's Troll Farm).  Student Loan debt, unlike medical debt, is voluntarily taken on.  Sadly, it is taken on by hormonal teenagers, who end up in a world of woe as a result.

Note also that in terms of poor choices, getting private student loans (which often have higher interest rates) is another poor choice some students make because, hey, free money - right?  And of course, those same private loan companies will offer to refinance your student loans over 30 years or more, at a higher interest rate, but a lower monthly payment.  It is a bad choice, but many bite on it as they think it will be more affordable.  But in most cases, they bite on it so they have more money to spend now - and not on bread and water, either!

As for jobs and unions, it is correct that the union movement has been severely set back since about 1980.  Hardly anyone belongs to a union anymore, but that seems to be changing.  This time around, though, they are unionizing service workers and low-wage workers, not the "cushy" high-pay jobs in auto plants or the like.   Minimum wage hasn't risen in ages (until recently, in some States) but no one has paid minimum wage in ages either (in most urban areas) as you can't attract help at that rate. With the "labor shortage" workers do have more options right now - and that is driving employers nuts!  No doubt, the next GOP administration will "tear down the wall!" (with Pink Floyd played at MAGA rallies) to let in immigrants, and once again create a labor surplus.  Their corporate handlers will demand it.

But a huge chunk of Americans are not working the drive-through at McDonald's - they have decent, middle-class jobs in the trades or technology or even in some office environment.  We hear a lot about the poor and destitute, but fly over America some time and see how many millions of middle-class homes there are, and how many fancy cars, SUVs, and pickup trucks clog the highways.  Yes, those are other "problems" we have to deal with, but the point is, we are a wealthy nation.

Guns?  It is crazy - and heartbreaking.  But it isn't like getting shot at is a daily occurrence, unless you live in a real gang-ridden ghetto (why are you living there, again?  There are other options - no, really). Sadly, this seems like a problem that will get a lot worse before it gets better - if in fact some kind of "civil war" doesn't break out - which some assholes are already trying to start by shooting up drag shows or power transformers (I guess some dunderhead thought "transformers" had something to do with "trans").

Similarly, our "homeless problem" is an issue, but affects a very tiny minority of the population.  These are NOT people "down on their luck" but mostly mentally ill people and/or people with drug or alcohol problems. Yes, they need help - many refuse it.   The real "down on their luck" people are not sitting on a street corner begging for money for their drug habit (no matter what their cardboard sign says!). And in fact, many of these "sainted homeless" are rather dangerous - not just annoying.  They will physically assault you (or each other) and lately, the game seems to be attacking and even killing Asian people by stabbing or beating them or pushing them in front of subway trains.

The real problem with homelessness is that we have stifled debate about it by claiming the homeless are sainted innocents and somehow better than us - we money-grubbing middle-class people who have to go to work every day, after sweeping up the broken glass from our car window and taping plastic over it.  California has a severe homeless "crises" only because they subscribe to this nonsense - and it acts as a bug-light, attracting more homeless as they know the pickings are good - whether through begging or through thievery.

Speaking of which, our crime problem.  Another thing America is tagged with is having "the highest incarceration rate [even greater then] [other than] China!   And maybe that is true.  But on the other hand, our country is pretty large and we have a lot of "freedom" in this country - to do good or do evil.  And a lot of people choose the latter, as it seems more attractive and fun.  Yes, being a drug addict isn't the horror show they depict in the movies.  Being high all the time is fun - that's why people do it!  Sure, you end up in some horrible places, but since you are wasted all the time, you tend not to notice the grunge.

We also are a diverse population.  It is a lot easier to have cohesive social values in a country where everyone is of the same mindset, the same race and creed, and speaks the same language and follows the same customs.  Yes, Germany is very clean - Germans stick together and work toward a common good.  Sweden is the same way - when everyone is Swedish, well, there ain't a lot of racism or discrimination.  We are seeing today, a huge push-back in many European countries where "migrants" are settling - and not fitting in.  They often end up in ghettos where no one speaks the local language, no one has any job skills, and they do not practice the native cultures.   France has had to deal with this for decades - with a huge Arab (Algerian) population in high-rise ghettos which ring the city.  Riots are commonplace and despite generations being born in France, they have yet to assimilate.

There was a recent story in the papers about a lady in Switzerland who was denied citizenship.  The Swiss (who are my ancestors - I can claim 1/16th heritage, I guess, which is to say, nothing) are pretty strict about everything (they are all crazy, quite frankly, but in a mostly harmless way).  To become a citizen you have to meet a lot of standards - speak one of the languages (preferably Swiss German), know and practice the local customs, know the history, and not piss off your neighbors.  Apparently, this lady was protesting the large cow-bells the Swiss put on their cows (more cowbell!) which is a tradition of theirs.   She was approved for citizenship, but one of the final tests was to have the local citizens vote on it - and not surprisingly, they told her to get bent.  The Swiss, it seems, want to preserve their mono-culture (or cultures) and not let it get diluted.

We, on the other hand, absorb other cultures like a Borg Cube.  The end result can be wonderful or awful.  Many minority groups have trouble assimilating after generations - and are still subject to discrimination.  Some recent immigrants show no signs of wanting to assimilate. This does create issues - but issues we talk about, endlessly.  In some other countries, this sort of thing is swept under the rug.

But what about our prison system?  To be sure, there are many in the system for often trivial drug charges, and most of these folks are black.  A white teenager can have his Dad hire a lawyer to get him out of jail.  A black teen takes a plea bargain, or at best, goes to "drug court" where he pleads guilty, provided he survives probation and endless drug tests.  In our small down, a young white girl was busted for drugs and went to "drug court" and of course, failed out of that program.   NPR did a story about it, and not only did she get out of jail, the judge was forced to resignThat happy ending doesn't happen a lot to young black kids.

But again, a lot of this requires action on the part of the victim.  You have to set out to be a gang-banger, it doesn't "just happen" to you.  The television tells stories of young kids who are "forced" to join a gang. I question this, as a gang has to be cohesive and why would they want to have a member who has to be forced into it?  The Mafia never had this problem - people have to want to join, and even then, only a select few make the cut.

Similarly, I have little sympathy for a teen who drives around in a car with blue headlights and expired tags, with drugs in the glovebox and a gun under the seat.  I mean, you've given them probable cause to pull you over, and if you just left all that other shit at home, all you'd get is a ticket.   Maybe there are some people who need to be in jail.  Folks never consider that.

And I guess that is the main thing about living in America - and the point of this blog.  In America, you are bound by the decisions you make, the actions you take, the contracts you sign, the crimes you commit.  This is the part no one talks about.  Yes, things can be pretty draconian in the USA - so you have to act and choose carefully.  If you do the right things, you can end up fabulously wealthy or at least pretty well-off.  You choose poorly, you end up in a world of woe.

When you scratch a "world of woe" story from the USA, usually there are poor choices involved.  And if the story is in the New York Times, those poor choices are glossed over or minimized. Yes, in addition the Russian Internet Research Agency, the largest source of "ain't it awful in America" stories come from left-leaning press.  It gives liberalism a bad name!  So stop it, please!

The good news is, it ain't all that hard to make the good choices, as evidenced by the staggering number of middle-class and wealthy people in this country. You don't even have to make very good choices consistently, just not make the real shitty ones.   And I say this as having tried both sides of the equation - drinking and doing drugs and dropping out of school, and then giving that up, going back to school and ending up a millionaire within a decade.

And yes, some folks have an "unfair" advantage in life.  Mine was my parents buying an Encyclopedia - as well as other books.  They valued education and beat that into me (often literally) and told us that we were expected to do well - be above-average - as one needed to try hard to succeed in life.  And this impetus came from their upbringing in a time in America (the 1930's) when the shit was even more real and "succeeding" wasn't an option but a mandate.  Succeed or starve - that was a real possibility for their generation.

Not so much today.  No, there are no starving masses in America.  Those "homeless" people you see out by the expressway?  They have a SNAP card that allows them to buy food, and medicaid to pay for health care.  And if they wanted to get a job (which pays less than begging) there are programs available and places to stay.  But the begging gig can be a lot more lucrative.

We have TANF, Social Security, SSI, SS Disability, Medicare, Medicaid, so-called "Obamaphones" and "Obamacare" and so on and so forth. In fact, you can live pretty well with a part-time job and government handouts. Our social safety net may have a few holes in it, but it is damn hard to starve in America, unless you have an eating disorder.  Funny thing, that is never talked about in those anti-American "memes" you see online.

Is life better in other countries?   Perhaps, I don't know as I have only visited a half-dozen or so (which is about six more than most Americans).  Oddly enough, many people from countries with National Health Care, free (or subsidized) college, luxury (by US Standards) prisons, gun control laws, low crime rates, strong unions, and better social safety nets, end up coming to America.   This always puzzles me, as we are told what a socialist paradise [fill in the blank European country] is.  Why would anyone leave that for the vile, evil USA?

That is a good question, and I often ask that of them.  Usually the answer is, opportunity.

Yes, we have opportunity - for those who strive for it.  For those who don't, we have consequences.

Maybe that is good, maybe that is bad.  Maybe that is part of our greatness - or our weakness.  I don't know.  I can only observe.

But no, things aren't quite as bad as the Internet memes and social media postings make it out to be.  And quite frankly, why is anyone getting their information from memes and social media in the first place?