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Survival Rates

November 15, 2010

“The American Health Care System,” as we think of it, encompasses doctors, hospitals, insurance companies, and government assistance and intervention, in the form of Medicare, Medicaid, and the few regulations we have to prevent the “magic of the market” from sawing us in half.  What this concept fails to encompass are our own cognitively dissonant beliefs about the system – we all laugh at the crazy dumb person who waves a sign that says “Government out of my Medicare!” and yet, this perfectly describes the strange mix of “bootstrappy” self-reliance that rejects the helping hand of the gummymint yet puts blind religious faith in the infallibility of an equally monolithic and self-perpetuating system. 

A great many Americans don’t see “national health care” as something that helps to create a more equal and therefore more stable culture, but they also fail to see that “socialized medicine” can be a powerful tool in the arsenal of both Capitalism and Democracy.  As Tony Judt noted in Postwar, the reason “socialized medicine” and the rest of the safety net came about in Europe after WWII was to prevent a recurrence of the catastrophic economic disparities that drove the rise of Fascism.  In most cases, Judt noted, it was the middle class more than “the poor” who actually benefited from socialized medicine, since it enabled them to stop worrying about losing everything to a serious health crisis and go about the business of entrepreneurship that turned Germany into an economic tiger in the 1950s.  As for me, I like my current work, I’m happy in my job, but it weighs on me that I can never permanently leave Nevada without losing the only private, state-sponsored health insurance policy I will ever get.  “Private” insurance is feudal in nature, it chains anyone with any medium-to-serious health problems to “the land” where we have coverage, because we will be denied that coverage anywhere else.  Only if we can find equal coverage through an employer elsewhere can we be mobile.  Obama’s tragically lame effort at creating “risk pools” didn’t help me, or anyone, really – it only allows those who have been uninsured for six months to join.  Look, buddy, if you’re uninsured for six months it’s probably because you don’t have a job, and therefore no money, or you have the kind of underpaying job that doesn’t offer insurance, so how are you supposed to come up with the cash to pay a health insurance premium?  Besides, the kind of person who needs to get into a risk pool who goes uninsured for six months is probably halfway on their way to dead because they haven’t had their meds that whole time.

Truly “socialized” medicine would unchain many people from the yoke of insurance and worries about illness and its costs, and allow a level of entrepreneurship unseen since the birth of Silicon Valley.  Full many a great business idea is born to blush unseen, and waste its sweetness on the desert air, because the one risk its inventor cannot afford to take is for himself or his family to be uninsured.

Yet to many Americans, having health insurance or not is seen as a private decision, and going without it is a “risk” they have an almost religious belief they should be allowed to take, like buying a lottery ticket only in reverse – they’re betting they won’t get a multimillion dollar hospital bill in exchange for the hundreds of dollars it saves them a month for taking that risk.  They are betting that something bad will happen, but not too bad – a broken arm, or some such, which they could manage to cover out of pocket with the money saved on premiums.  The irony is, should they come down with cancer or have a heart attack, it will not only bankrupt them, but the excess costs they don’t and can’t pay will then be “socialized” anyway, passed on in the form of higher rates to those of us who do pay for insurance, passed on to other “private payers” in the form of higher fees.  I’ve never heard of any underfunded and uninsured libertarian who ever got cancer and said said, no, Doc, just put me in the grave, I don’t want to be a drain on the Producers.  Everyone who “goes cowboy” and rejects the social responsibility of being insured, and then becomes critically ill, is like a Goldman Sachs of one, capitalizing their gains and socializing their losses.

People want to be able to choose their doctor, because we all know all too well that there are good doctors, and there are very bad doctors.  Nobody wants the gummymint assigning you to the bad one.  Probably only a transparent, well-constructed socialized system would ever solve that problem – good doctors, I have found from personal experience, cover for bad doctors, especially within their own practice when a malpractice suit would internally socialize their losses.  If we had a publicly available outcomes table for all doctors, giving the survival rates and satisfaction surveys of their patients, then and only then would we be “free to choose” since only then would we have the information we need.  But doctors consistently attack any private sector efforts at transparency.

I think about these things a lot, because for many years I had to fight doctors to survive.  I have had a few good ones, and I’ve fired many bad ones.  Mom has recently had to go to war with doctors as well, and I always marvel that so many of the people who insist on keeping the health care system we have today fail to see that simply “choosing” a doctor and then sitting back and letting them do all the decision-making, or lack thereof, or letting their staff blow you off into the next year for a critical follow-up, can be tantamount to suicide.  Our current system is about as Darwinian as it can get – the fittest, those who fight for the care the system is either too unwilling or just too apathetic to provide, survive – we find a way to get insurance and get a good doctor.  We the Living refuse the pills for cholesterol or bone loss that end up causing organs to fail or jawbones to disintegrate.  Doctors merrily roll along, writing as many prescriptions for anything as will get them to a “conference” in Tahiti; hospitals charge $140 per Tylenol; and we pronounce all this better than the awful specter of “socialized medicine.”  Yes, socialized medicine done wrong means shabby hospitals and inferior doctors because the best and brightest go into finance instead of medicine, means no choice between the good and the bad – but done right, it means high standards imposed universally.  It means bad doctors get fired and removed from the profession; it means bad drugs never make it to market.  It means we have a transparent system that truly leaves us free to choose what’s best for us.

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