Language check: do you have health insurance, or health care, or neither?

(and, what assumptions are inside those terms?)

In America, access to health care is usually described in terms of having “health insurance”. At the doctor’s office or pharmacy you’re likely to be asked for your “insurance card”, and the crisis in access to medical care is generally discussed in terms of the [fifty million or so] “uninsured Americans”.   However, insurance (meaning, private insurance) is just one of the various ways that health care is provisioned in the U.S., as in other countries.  (See Wikipedia overview of world health-care systems and types).  We also have publicly funded Medicare, care provided directly by employers, direct fee-for-service, indigent care, etc.

So, why do we usually say “insurance” instead of, say, “health care”?  Isn’t care what we’re actually interested in, not the way it happens to be paid for?  But my main point is, might the implications of the term “insurance” implicitly shape how people think about health care in this country, when this is the term that’s constantly used?

It’s true that in technical discussions, there is a concept of “social health insurance” which cover everyone, e.g. Medicare.  However, for most people, the term “health insurance” probably associates with other forms of insurance they’re likely to have,  such as car or home insurance.  What are the characteristics of “insurance”, inferred from these ordinary examples?:

  1. insurance is individual — an insurance policy is a contract between me and a private company.  Me having this policy implies nothing about whether my neighbor has one, or what its terms might be.
  2. insurance offsets future, unpredictable losses — not routine expenses.
  3. insurance is underwritten / actuarial:  policy issuers decide whether to grant a policy, and they set prices and policies based on their assessment of the customer’s risk level.

Now consider the implications for one’s implicit model of how health care works, based on these characteristics:

  1. [health insurance] is individual: access to health care is something that I, individually, negotiate or purchase.  It is not something I have in common with my neighbor, community, or even family member, necessarily.   It is a private asset, not a public good, and there is no community or societal norm describing what, if anything, I should have.
  2. [health insurance] offsets future, unpredictable losses:   health care will be covered for me primarily in the case of a future, unexpected, unlikely occurrence such as an injury or new illness.  Any condition existing at the time the insurance contract is signed will *not* be covered — so, if you are pregnant, have a blood disease, already take a medication for some illness, have a permanent genetic condition, this will not be covered.   Preventive care may not be covered, because it is not unanticipated.
  3. [health insurance] is underwritten / actuarial:  you have no right to health care — you will get it only if a health insurer decides it can cover you profitably.  If you have any existing illness, you most likely will not be “insurable”.  If you do get care, the price you pay for it will reflect your age, location, health history, gender, and any other risk factor the insurer chooses to consider (except for some legally prohibited ones).  If you are unlucky enough to have, say, a congenital condition, or live in a high-health-risk community, or be advanced in years, you may pay far higher premiums to get coverage.

So, by implication “health insurance” connotes a private, atomized, incomplete, non-preventive, discriminatory system that disclaims any notion of social equity or a human right to health, and excludes or financially punishes those with the greatest needs.

I’m just saying.

New Orleans, mostly without people

New Orleans, once again depopulated — this time thanks to my photo-taking habits, not natural disaster.  Like the Talking Heads album, this is mostly songs about buildings and food.   I was in the Big Easy for the American Library Association annual event.
Slideshow: click on “Show info” at upper right for notes.

Facebook and the Case of the Missing “Dislike” Button

I am puzzled by Facebook’s comparative lack of way to filter and organize your FB experience, specifically the central News Feed feature.  It essentially uses opaque, automatic methods to construct a quite filtered News Feed for you, out of many sources.  There are just a few, on/off user controls such as choosing to block particular apps or completely defriend people.   In the past they tried things like Lists (groups), and  “less of this” controls, but these features are either dead or largely unused.

The non-uptake of those past features may suggest that users generally don’t want or can’t be bothered to do “filtering” and such management tasks.  (much like how, as the software-design maxim says, at least 95% of people never change any default settings).

On other hand, perhaps FB just didn’t figure out the right way to give users filtering powers, and so it’s failing to serve many people who are tired of the unfilterable mess, or who don’t even consider using the service for that reason.  (long before FB reaches its goal of signing up everyone on earth, they’ll have to convince some billions of skeptical middle-adopters, i.e. most people, that it’s not just an unending stream of trivial tidbits which they don’t have time or interest for).

Personally, I think that better, user-controlled filtering can and must be achieved.  You often hear that Facebook “got it right”, i.e. social networking, after Friendster, Myspace, etc. failed.  But to me that shows a limited imagination, or historical sense.  I believe Facebook’s grand social experiment, fascinating as it been, has hardly mapped or mastered the potentials of social networking.  Google’s grand entrance into the space, Google+, will put a spotlight on that.

In fact, it seems to me this is a gaping wide opportunity for a competitor such as Google+.  Consider, there is a FB group, “Facebook, give us a ‘dislike’ button”, that’s existed for years and currently has 495,290 members.   (  A half million users both annoyed and geeky enough to protest for a filtering feature!

It seems an obvious feature, yet various theories abound as to why Facebook won’t ever do it.   Some think that networking is inherently positive, i.e. is always link *building* rather than narrowing.  Others say the big FB would never allow such a capacity for public, negative feedback to afflict the corporations and brands upon which its monetization ambitions depend.

As to whether “Dislike” could get adopted by a mass user base, one problem is that although it the term is an obvious inversion of the existing “Like”, the meaning is ambiguous.   If a wall post reports that, e.g. New Jersey has voted to limit public employee’s collective bargaining, does a “Dislike” vote mean that you don’t like what New Jersey did, or that you think the FB user’s post was uninteresting / inappropriate?  Some people understand “Dislike” to mean comiseration with the post, some disapproval of the post.

Personally, I would suggest not only a “dislike” button (anonymous), but a user-set option to allow anonymous commenting.  (anonymous limited to those in your friend network).   Therefore, those users who wish to improve their Facebook posting manners, and learn what their friends actually find uninteresting or in poor taste etc., could do so.  This could be a quite socially educational, even *genteel* influence upon the chaos that Facebook can be today — a curious mixture of interesting, diverting, salacious, braggardly, irrelevant, tiresome, proselytizing, and oblivious (e.g. auto-posting your every pointless and contextless Tweet remark, or location check-in).

Facebook experience today.. a party to which not quite the right people showed up, with a few too many shouters and drunks, just not quite bad enough to leave?  yet.

Really un-public libraries: Ramses’ tomb

The library said to be the greatest of all ancient Egypt was that of Ramses II — the Ozymandias of Shelley’s poem. It was built and assembled as part of his burial complex, and may not have long outlasted his death. (Lerner, 2009; Quibell, 1896). It was not built for the living, let along for the public. Just an example of how most libraries, throughout human history, have been quite different than the present-day public library model.
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