Gold-Plated Idiocy

So part of President Bush's brilliant solution to America's health-care crisis is to tax those fat cats out there whose "gold-plated" health insurance premiums are above a certain yearly cap: $15,000 per year for families, $7,500 per year for individuals.

These $15k/$7.5k caps include the employer's contribution. So, curious, I went to the employer's benefits website to compare the total costs of the various health plans available to us. Our current plan comes under the $15k cap, but all of the married-couple plans are within a few thousand dollars of $15k. Once we add a daughter to our family, all of the plans worth having (everything but the Kaiser HMO and the oops-I-just-sawed-off-a-limb catastrophic plan) jump above the cap. I pity my single colleagues, for the cheapest plan they can buy right now costs $9,240 per year. Oops!

And I've never seen my insurance premiums go down, so it's just another year or two before any of our choices is above the cap, and we're stuck paying higher taxes for less-but-more expensive medical care. (I'm sure that the cap amounts aren't indexed to inflation or the average cost of insurance, so this is going to turn out just like the AMT — a gigantic tax trap intended for the "gold-plated" that ends up grinding the middle class.)

And while I can hear the shrieks of horror coming from economists at conservative think tanks already, raising taxes on our health insurance isn't going to change our utilization of that health insurance one iota. Why? Because we already only go to the doctor when we need to. The current Republican bogeyman — the modern version of Ronald Reagan's Cadillac-driving welfare queen — seems to be someone with "gold-plated" insurance who goes to the emergency room as a regular recreational activity. Who the hell does that? We've been to the emergency room, waiting for hours for Shelby to be seen, serenaded by the sounds of a drug-crazed arrestee who's been strapped to a gurney and is shrieking insensate nonsense at the police and the ER nurses. Going to the emergency room is not fun. Even visiting our regular doctor with an appointment can involve forty-five minutes of sitting and waiting as he takes in all of the people he's overbooked ahead of me (and let's not even talk about what happens when you visit the urgent-care clinic).

If I'm getting "gold-plated" service, I shouldn't have to argue with my insurance company for months about whether a paramedic call followed by ambulance transportation was actually an emergency, rather than some kind of expensive and exotic taxi ride. (One means the insurance company pays $25.50, one means they pay $300 — guess which one they chose.) I shouldn't have to call the insurance company multiple times to correct a series of 'clerical errors' that mysteriously always break in the insurance company's favor (these 'errors' seem to start cropping up every year once we hit our out-of-pocket limit — but I'm sure there's no connection). But yet some idiot Republican speechwriter chooses to characterize the medical care we receive as if we're making weekly trips to a concierge clinic on the Upper East Side — and the media pretty much uncritically laps up the whole "gold-plated" theme.

Also not helping are the sensible liberals who react to this proposal with credulity — this is actually a quite progressive change to the tax code! It would make an excellent incremental first step to single-payer universal health care! No it wouldn't. This isn't an incremental first step toward anything. Give Bush what he wants, and he'll shaft the middle class with a tax hike, give the insurance companies a big shiny gift, and then stop right there. And he'll probably find a way to hang the whole mess around your neck, too.