Saturday, March 13, 2010

John Stossel's "Sick in America"

Thanks to Papa Mike's Blog

I have to admit to a bit of a bias here in that John Stossel resembles my friend Hossein. So I'm inclined to like him. The fact that when he opens his mouth, sense comes out, just seals the deal. I'll look at one segment in each post, since there's so much to reflect on.

My comments:

I agree that things are screwy. And it especially leaps out at me because I was out of the country for five years. I returned and found that an uninsured office visit at the clinic I used to visit went up in price from $35 to $65. That pretty much put it out of my uninsured reach. I'm also annoyed by how long it takes to get an appointment -- you almost have to schedule your illness around when the doctor will be free. When I was in Korea, I got used to just strolling into the doctor's office (even a specialist's office) and being seen within 15 minutes, even without an appointment.

But there are trade offs. My friend had minor outpatient surgery when we were in Korea. Another friend was hospitalized. Both the outpatient surgery suite and the inpatient hospital room reminded me of the inspection reports I'd read on seedy abortion mills. Filthy, overcrowded, with patients crammed into every available space, and they relied upon family and friends to bring food since the hospital had no dietary services. I had to bring my friend breakfast in the morning, and leave a lunch for her, then drop off another meal on my way home from work. Otherwise she'd have had nothing to eat. Many people just ordered the ubiquitous Korean delivery food, and left the dirty dishes piled up outside the rooms for the delivery drivers to pick up later. American medical facilities are MUCH cleaner.

I could go on. I just want to say that I agree there are things that need to be fixed.

I get tired of people blaming doctors and insurance company employees for wanting to make a living. Who among us -- except the nuns of the Missionaries of Charity -- does what they do in life for free, with no regard for bringing home a paycheck? We need paychecks to provide for ourselves. Wanting to make a living isn't evil. And when you consider the investment a doctor makes in her education and setting up her practice, I do not begrudge her a nice car and a nice house once she has her loans paid off. She worked very hard -- much longer hours and harder work than I or most other people would be willing to do -- and deserves to prosper. And a clerk or secretary or HR director or branch manager of an insurance company is just as entitled to a decent paycheck as a clerk or secretary or HR director or branch manager in any other workplace. Just because you need something doesn't obligate other people to live in destitution so that they can provide it for you purely out of the goodness of their hearts.

All those social workers that the Left so admires -- GET PAID. They're "making money off troubled people." Welfare case workers are "making money off poor people." Firefighters are "making money off people whose houses are burning down." Cops are "making money off people who've been robbed or assaulted." The minute you yourself are willing to forgo an income so that you can do nothing but let others avail themselves of your skills for free, THEN you can complain that doctors "make money off sick people." Their job is to take care of sick people. If they don't get paid, they CAN'T do it, much less won't. Even the selfless Doctors Without Borders only have the free time and money to underwrite their journeys to provide free medical care to the destitute is BECAUSE THEY MAKE GOOD MONEY IN WEALTHY COUNTRIES. That's called basic economics. Get used to it and stop resenting it.

I gotta agree with Michael Moore about lobbyists -- and not just medical or insurance lobbyists -- owning politicians. Robert A. Heinlein defined an honest politician as "one who stays bought." The answer to government corruption, though, is hardly MORE government! The answer to the problem of politicians being for sale isn't to put more control of our lives into their hands!

And Stossel gets to the point: Health care is FUBAR and expensive because everybody is spending other people's money. As P.J. O'Rourke paraphrased Milton Friedman's reflections on "perverse incentives":

1. You spend your money on yourself. You're motivated to get the thing you want most at the best price. This is the way middle-aged men haggle with Porsche dealers.

2. You spend your money on other people. You still want a bargain, but you're less interested in pleasing the recipient of your largesse. This is why children get underwear at Christmas.

3. You spend other people's money on yourself. You get what you want but price no longer matters. The second wives who ride around with the middle-aged men in the Porsches do this kind of spending at Neiman Marcus.

4. You spend other people's money on other people. And in this case, who gives a sh*t?

And, as O'Rourke said, "When the legislature controls what is bought and sold the first thing that is bought and sold is legislators."

Stossel notes that GM spends more on health insurance than on steel. Hm.... Wonder why cars are so freaking expensive and why Detroit is going down the toilet? And linking health care to your employer might have been feasible when people spent an entire lifetime working for the same employer. Now it's not unusual for people to remain only a few years with one employer before changing jobs. You might just as sensibly link your health care to how long you keep your vacuum cleaner.

I want to know more about Vicki, who had the foresight to get her own insurance when she changed jobs. Did the "temporary insurance policy" make it plain that they'd not let you renew if you were diagnosed with cancer? Was it a purely temporary thing, where even the healthy wouldn't be permitted to renew?

And if her insurance hadn't been tied to her job, she'd have never wound up in that "temporary insurance" quagmire in the first place.

What about being allowed to form voluntary risk pools based on things in your life unlikely to change? Why can't Lutherans, or bridge players, or vegans, or Hispanic women, or fans of Oprah Winfrey be allowed to form insurance pools? And once you're in a pool, you can remain in forever even if your Lutheran, bridge playing, or vegan status changes, as long as you maintain your premiums. Sort of the way you can join a credit union while you work for the school district, and you can stay a member even if you go to work for Starbucks?

I'm a bit confused as to why Vicki rejected the insurance, at $25,000, too expensive. I'm taking that to be $25,000 a year. But her $300 a day pills add up to $109,500. She'd save money. Or am I not understanding this?

I know what it feels like to be treated like a nobody because you don't have insurance. I remember crying in the parking lot after being turned away by a hospital's midwifes' practice because I was uninsured. Fortunately for me, one of the midwives chased me down in the parking lot, brought me back inside, and told the billing department that they WOULD work out a payment plan for us.

Being uninsured can really suck.

While we're transitioning out of employer-linked insurance, we'll need a stopgap for people like Vicki who get caught in between. But that said, I think there's a lot to be said for practicing frugality with medical care instead of, as the well-insured often do, just swooping in and getting all manner of things. My daughter knows people on Medicaid who go in every three months for HIV tests -- even though they have not changed partners -- because they perceive the test as "free". They're not paying for it. I am, out of my taxes. They don't need HIV testing unless they've changed sexual partners or have cause to suspect that their partner cheated. But four times a year the taxpayers are buying "free" HIV tests for these people. Stossel's point -- if you see it as free, you help yourself. Even a $5 co-pay on those "free" HIV tests would probably limit them to when the person actually has a reason to think they might have been exposed to HIV, rather than as a freebie that they take advantage of simply because it's there.

No comments: