If this is an emergency, hang up and call 911

Years ago, an American car company made a decision that reflected a way of thinking about people. It wasn't the fault of the car company, they were a product of their environment and people who taught business classes and wrote books and gave whatever sufficed for Ted Talks in the days of digital pagers all suggested it was smart. So the car company listened and one morning America awoke to find the humble Chevrolet Cavalier had been reborn as the Cadillac Cimarron. The car represented the idea of "brand identity" or something, which seemed to stress the importance of what we called things more than how we built them. Upon waking up to this new offering from a once iconic American company, America hit the collective snooze button and contemplated the idea that much water had passed under the bridge since WWII and perhaps it was finally time to welcome a Japanese car in the driveway after all.

My mom worked for the state of New York as a college professor. She was proud of her health insurance, which was called the "Empire Plan", a name in itself that shouted greatness and excelsior and a lush Albert Bierstadt painting of the land of my youth. Her doctor once told her she had "Cadillac insurance" and she loved the idea of a policy as stately as the Fleetwood model, two tons of American metal and a big block V8, and all of the comfort and security we felt when that big door closed.  But I grew up in those days and can testify that those old Cadillacs started to rattle soon after the first payment and they got stuck in the snow and had the stopping distance and handling of a barge. They were not the Cadillac of Cadillacs and certainly the little Cimarron was not the anything of anything, it was just a cheap car with some vinyl glued to the roof. 

So life has this way of coming around full circle.  And that's a little annoying to us because we want to see ourselves as individuals riding our own trail, sort of a Remington in a Bierstadt. But here I am, a new policy holder in the Empire Plan and the clock on the phone says I have been on hold for 27 minutes and despite the music being better than most I'm starting to have a buyers remorse. As I sit on hold, I'm going through the company website to better understand how this uniquely American system of paying for medical services works. The way the plan works, apparently, it to break our healthcare into separate pieces and subcontract each component out to a whole separate company with a whole separate phone system with different music and their very own web site and presumably their own office somewhere in Elmira or Omaha where the music lives and the people swarm around meeting my healthcare needs. Or not. I can't think of a good metaphor for this design, calling it an octopus isn't really fair to the whole cephalopoda family so maybe we better stick with General Motors in 1990 and leave it.

When my call rings through, finally, to Omaha, I'm able to speak with a specialist for another uniquely American invention, the "pre authorization". I remember years ago, people screaming about socialized medicine and how healthcare decisions were supposed to be between me and my doctor, like our world was an episode of Marcus freaking Welby MD on the television set. If only it were thus. My healthcare, and yours too, is dictated by the two parties in the back office making and taking these "preauth" (that's the cool way to say it) calls all day long. The purpose of these calls is to determine which tests, procedures, medications, doctors, clinics, solutions can be brought to bear on a problem and how much it will ultimately cost the patient. The patient who is already shelling out well north of a thousand dollars a month. For insurance. For protection. For, as they say, peace of mind. And the news I get when the hold music stops is not engendering any peace. The kind woman from Omaha suggests I see a specialist "in plan" and that specialist has an office out on Long Island which is, yes, in the Empire state, but is 8 hours away and the people speak a different dialect and have a culture so different it represents international travel. So I shrug and give up pay the out of network costs if its for my family or skip the care if it's for myself and the house wins again and I lose.

And we accept this. That across our land, people will spend the day seeking permission to use their insurance to get better. We accept a rubbish medical records system because people have been told to fear government control and centralization of medical information and payment as socialized medicine. They were told it would lead to death panels. They were told they would lose the Cadillac they worked so hard to afford we would all have to drive some lousy Trabant from a failed eastern bloc nation. But then riddle me this, when Americans have to decide on insulin vs. rent, or skip car insurance to pay for the MRI claim the insurance company rejected or wake up in an out of town hospital knowing a car accident just ruined a families' financial survival. When our health, our families and our livelihood is determined by the woman in Omaha, don't we have a death panel? Right here, right now. And yet we cling to our failed model and call it the best in the world. 

My mom's plan probably was a bit of a Cadillac. Her generation saw our system as American Greatness and for a woman born a month before the 1929 stock market crash, who lived her youth watching the family wealth evaporate and a nation enveloped in the dust clouds and bread lines of the 1930's, it must have seemed grand. Now, so many years later we have something that is but a cheap plastic reminder of American greatness. We can ask for better and there is no shame or fear in asking. Good government and value for our taxes and insurance premiums is not socialism, its what we all work for as Americans. Its how we provide for the people we love. It is a right. For all of us, every last one of us. The weakest, the smallest, the sickest. No one is left behind in the water, we all rise together.