In which Luis Lang appears to call for Single Payer, and other interview insights

UPDATE 5/19/15: SEE IMPORTANT UPDATE TO THE LUIS LANG SAGA!!

I know I said I was done writing about Luis Lang, the guy in South Carolina who's going blind and is uninsured due to a combination of his own decisions and the SC administration. However, my colleague Harold Pollack over at healthinsurance.org just posted a lengthy interview with the guy to get his take on things. Since I'm one of those who tore him to shreds, it behooves me to let him say his piece.

Read Pollack's piece for the full interview, but here's my main thoughts in response:

• Lang notes that in addition to his new medical bills, he also already has a bunch of existing hospital bills and zero income since December due to his medical problems, so he owes money to family/friends/neighbors due to his car being reposessed. Quite frankly, Lang and his wife appear to be in the exact same situation as millions of other people across the country. The difference, of course, is that most of those other folks weren't foolish enough to deliberately avoid any sort of health insurance until they got into a jam. It's one thing to not be able to afford coverage or to be denied it due to a pre-existing condition, but the Langs specifically stated that they went out of their way to avoid doing so until it was literally too late.

• Lang confirms that he and his wife don't have any children, which answers one of the questions I had. In other words, no 3rd mouth to feed, no school, clothing, pediatrician or college expenses.

• He further confirms that his wife hasn't worked. Until now I figured this might be because she was taking care of the kids, but apparently not since they don't have any. Is she physically able to do so? Has she tried, but the economy sucks so there's nothing available in the area?? I have no idea. I assume that if she was disabled or whatever that one of these interviews with Lang would have mentioned it, but it never comes up.

• Lang notes that being self-employed means that his income is (was) highly variable from month to month. I agree with this; both my wife and I are self-employed, so we do understand that it can be feast or famine from month to month.

• Lang notes that he can't refinance his house since there's no equity and he can't get a loan now because he has no income. Fair enough.

• He doesn't have anything to say about selling the house and he & his wife moving to, say, a small apartment (which many people do) or, more extreme, selling and moving to a state with Medicaid expansion. Perhaps they're underwater on their mortgage, which sounds likely given their other financial woes, and which would be ironic given that his income was coming from maintaining foreclosed properties.

• He then accuses the Charlotte Observer of being "biased to the left" for not telling the whole story about his medical history, claming that his doctor (who had been treating him at a generously sliding scale rate) stopped offering the discount "because of the Affordable Care Act". When pressed on this point, Lang claims that due to the ACA:

"...all the other insurance companies cut back on what they were paying doctors so he could no longer afford to give me discounts because what he would make on other payments that other insurance companies would pay full payment, he would use it help other people who didn’t and basically what he was charging me was the same thing like if I had Medicare. So if I had Medicaid, he would have only gotten paid $80 for the visit and that’s the only thing he was asking me to pay."

Um...wait, what? I've read that 3 times now and for the life of me I can't figure out what the heck he's saying here. It sounds like what he's saying is that his doctor claims to be getting reimbursed less for other patients from the insurance companies since the ACA went into effect, therefore he can no longer afford to give Lang a massive discount.

That may or may not be true, but that's the doctor's choice; it's not like there's a provision in the law which forbids doctors from offering discounted rates, which is what Lang implied originally.

I even asked Pollack what he thought Lang meant here; his response?

@charles_gaba Dunno, to tell you the truth.

— Harold Pollack (@haroldpollack) May 16, 2015

Great. Anyhoo...

• Lang next claims that he doesn't oppose the ACA, but doesn't like the way it was done (join the party, pal!)

• Pollack points out that pretty much none of his gripes have anything to do with the law itself, but rather with his own ignorance about it or with his home state--entirely GOP-controlled across the board--denying the very type of services which he needs right now. This leads to Lang grudgingly saying:

It’s not that I’m only blaming the federal government. I blame both the state and federal as far as … for certain things.

Ah. That's mighty big of him.

• Lang then revisits the "highly variable income" point, noting that when your income bounces around a lot, it's difficult to know whether you're gonna come out ahead or behind the following spring when it's time to file your taxes; you may end up having to pay back some or all of the tax credits.

Well, you know what, Mr. Lank? You're absolutely correct about this...so what??? The only reason you would have to pay some of it back would be if your income ends up being significantly higher than you thought it would be. That's a GOOD THING. It means you have more money than you thought you would. And whatever amount you might have to pay back would still be a lot less than the increase in income.

In fact, I went ahead and plugged in Mr. & Mrs. Lang's info into HealthCare.Gov. He says that he's 49 and his wife is 55. He's also a smoker (dunno if she is; I'll assume not). They live in Lancaster County, SC.

On a $40,000 income, for instance, they'd qualify for $616.90 per month in federal tax credits, or $7,400 per year.

If he did end up with $50,000 in taxable income, that credit would drop to $489.63 per month, or about $5,900 for the year.

In other words, if Lang did take in $10K more than he was expecting to, he'd have to pay back about $1,500 in federal subsidies...but he'd still end up $8,500 ahead.

For someone who claimed that he had insurance because he was so "proud" to pay his own way, he sure seems to have a fuzzy grasp of economic logic.

• Pollack then tries to explain to Lang that without the ACA, he'd have been completely uninsurable regardless of any enrollment deadlines, because of his pre-existing conditions (smoking, diabetes, etc). Lang's response is...well, frankly, to ignore the question and blame everything on "the politicians" of both parties. He also claims that he was jussssst about to enroll in insurance after all (I guess his "pride" finally ran out?) when gosh, whaddya know, his medical problems beat him to the punch.

• Pollack asks what Lang thinks we should do, and he actually gives something resembling a reasonable response: "get rid of wasteful spending" like companies basically committing Medicare fraud by selling supplies to Medicare recipients dirt cheap and then billing the government for the full amount. He seems to feel that getting rid of that sort of waste would save enough money to create a "non-political healthcare system".

Of course one of the biggest attacks on the ACA during the 2012 Presidential campaign was the utterly BS lie claiming that the law "robbed Medicare of $700 billion"...when in fact here's what the ACA actually does:

Neither Obama nor his health care law literally cut a dollar amount from the Medicare program’s budget.

Rather, the health care law instituted a number of changes to try to bring down future health care costs in the program. At the time the law was passed, those reductions amounted to $500 billion over the next 10 years.

What kind of spending reductions are we talking about? They were mainly aimed at insurance companies and hospitals, not beneficiaries. The law makes significant reductions to Medicare Advantage, a subset of Medicare plans run by private insurers. Medicare Advantage was started under President George W. Bush, and the idea was that competition among the private insurers would reduce costs. But in recent years the plans have actually cost more than traditional Medicare. So the health care law scales back the payments to private insurers.

Hospitals, too, will be paid less if they have too many re-admissions, or if they fail to meet other new benchmarks for patient care.

Obama and fellow Democrats say the intention is to protect beneficiaries' coverage while forcing health care providers to become more efficient.

Boy, that sure as hell sounds a lot like "getting rid of wasteful spending" like over-reimbursing private companies for Medicare expenses!!

Annnnyway...

At this point they move to the GoFundMe account, which is currently up to over $20,000 from 1,100 donors, I might add...and judging from the comments, it appears that it's still almost entirely self-described liberals/progressives who are footing his bill.

• Lang gripes about people saying nasty things about him...as they donate $5 apiece to save his butt.

• He flat-out states that he hasn't given the slightest thought to any of the hundreds of comments (whether nasty or polite) which suggest that maybe it would be a good idea for him to, you know, stop blaming everyone else for his own problems, particularly the very administration which bent over backwards to help people like him, only to have him squander every opportunity they gave him.

• He claims that he "never intended it to become political" and that he actually blames the "ACA donut hole" (ironically, the ACA actually closes the so-called Medicare donut hole; I assume he's referring to the Medicaid Gap which, even more ironically, only exists because of the GOP's refusal to expand Medicaid in states like his).

I should note at this point that there's one specific part of the original Charlotte Observer article which made it "political":

He identified himself as a Republican and blamed the completely-Democratically passed law for his problems, which would've been bad enough...but then his wife went and made an unbelievably selfish, arrogant and, frankly, rude statement. That was what set people off more than anything else, I suspect.

Then Lang says something which I had to re-read to believe it. Check this out:

"what I think should have been done is the Affordable Healthcare and Medicaid should have been combined in one. So that way, the states … take it out of the state’s hand. The money would not go to the states. It would all be in one fund so that conservative or liberal states could not play games and that way it would be mandatory and it would be fair for everybody."

Hmmm...

• Take healthcare money out of the state's hands.
• Place money for healthcare all in one fund.
• Make it mandatory.
• Make it fair for everyone.
• Don't let anyone game the system.

Gee, that sounds an awful lot like...dare I say it? Single Payer Healthcare.

In closing, Lang continues to give backhanded compliments to the 1,000+ progressives who have stepped up to the plate (sure they're saving my eyesight, but they're saying mean things while doing so!!) while simultaneously whining about how he's received (literal) radio silence from anyone on "his side" (conservatives) aside from a single local radio station.

I think Pollack did a pretty good job overall, although I do wish he had pressed Lang to actually answer some of the questions that he avoided, such as why the hell his wife hasn't been working (part time at least) if their situation has really been this dire for so long, especially as they have no kids. Speaking of his wife, I'd be fascinated to hear her try to defend her "put him at the front of the line" quip.

In short, aside from inadvertantly advocating for Single Payer Healthcare (!), Mr. Lang...

• Blames his doctor for not giving him any more discounts (while claiming that he's not blaming him)
• Blames "the government" for not cutting enough waste (while simultaneously complaining about them cutting the waste which allowed him to receive the discounts from his doctor)
• Blames liberals/progressives for "saying mean things" (while simultaneously taking the money which they, and only they, are providing to get him out of this scrape)
• Blames conservatives who he thought were "on his side" for not bailing him out (even though the entire mindset of conservatism is supposedly that everyone is on their own and that handouts are evil)

Not once throughout the interview do I ever hear Mr. Lang take any of the blame for his own situation himself.

In conclusion,  the only thing I heard here which helps his case whatsoever is that yes, refinancing his house probably isn't a viable option. So, you know, there's that.

Read the whole interview here.