Health Care Wha?
by lbej
Americans are funny about government. I understand that we were once a people into frontiering and mountaineering and engineering and all sorts of eerings, but now we’re mostly into the sitting and the staring and the eating. In the past we didn’t need so many things taken care of for us but now we do. Civilization is also very complicated now. You could treat your own bear-inflicted wound in 1810, but you’re not very well going to give yourself a heart bypass in 2010. The health care debate has been bothering me, because I think it’s silly. I hear something to the effect of “I want to make my own decisions about health care.” Really? Do you really? Then it’s a good thing you have all that medical training and oh yes the finance and statistics knowledge that helps you to weigh costs against benefits. It’s also a good thing that 300 million people can make uncoordinated, arbitrary and contrary decisions about health care and force the consequences into a single system that then doesn’t fail catastrophically. Otherwise you’d need people with actual knowledge to administer the system.
So the first choice is do you want an orderly system that works most of the time or a chaotic system that never works? You choose the first option or you go sit in the corner and put on the dunce hat. The next choice is do you want the system run for your benefit or the benefit of the shareholders of medical companies? If you are one of the shareholders, maybe you pick choice number two. If not, you really should pick number one, otherwise you’re being silly.
So now we have the problem of government. Nobody likes it. This is because it does many things and invariably each person will resent one of those things to the neglect of the other things it does that aren’t so terrible. That’s fine, you don’t have to like the government. The awesome thing is that you get to vote to change it. If you don’t think elections matter, how do you explain the enormous amount of money corporations and unions and other groups spend financing them? The alternative is that corporate boards and corporate executives make the decisions. They will do what they’re supposed to do, which is preserve and enhance revenue streams and control costs. This does not make corporations bad. Let me repeat that they are doing what they are supposed to do, what they are created to do: make money for the shareholders. People are being deliberately naive and or disingenuous if they argue that corporations should do something different. If a manager has to make a decision and one choice helps you and another helps the company, which choice will she make? Which choice should she make? You’re not being honest if you say she should help you. I understand that a stark choice like that isn’t always necessary, and that doing right by customers is often good for business, but it’s not so important when you have a monopoly and an inelastic demand curve.
I think of health care like national defense. We need it and we can’t provide it for ourselves. It’s expensive and you don’t use it all the time, so you’d like it if you could just pay for the little bit you need at the moment you need it. Also you’d like to pay a little bit even if you need a lot. But if you don’t pay for it now it won’t be there when you do need it. And you can’t deny it to others if you want it for yourself, not unless you plan to start turning critically ill people away when they show up in the ER. Maybe you want to do that, but please say so if that’s the case. So it’s a public good in economic parlance (free riders can’t be entirely eliminated). The issue is not whether the government should provide health care or not. Of course it should not. Look at the people you know who work for the government–do you want those people giving you a colonoscopy? Private companies and individuals should provide health care, just as they provide the products and services that are necessary for national defense. The difference is that in the case of national defense, elected officials tell the private companies what the people need, whereas in the case of health care, boards of directors are making those decisions. Yes, I know shareholders vote for corporate directors, but are you a shareholder, you personally? If so, fine. But probably you aren’t. You have to pay for that right to vote, which we call a poll tax.
The point is I want the government to make health care decisions so I can vote yay or nay without owning stock in every company from which I might ever require medical services. If you don’t want that, I think you should explain to everyone what you do want.
Dream of the Dragon 
I guess I want that. Really I want a lot of conflicting things. I want someone to help me feel better when I’m sick, no matter what. And I don’t want it to cost any money, ideally. But if it has to cost money, I want it to be cheap. However, I don’t want every doctor’s office to be roach infested and the doctor to be as bitter as that old guy at Burger King who hates everybody including himself. YET, I don’t like the fact that in the current system, getting my teeth cleaned by a good doctor can cost around $200 or more without a great copay. Just so the doctor can continue being incredibly rich, and telling me I need certain procedures done that aren’t necessary just so he can make more money ripping my mouth apart. SO, if the government can make decisions about how to equalize the health system, that would be cool. I think I deserve the same healthcare as Gwyneth Paltrow, even though I have less than 1% of her income.
That said, there’s nothing really wrong with the free clinic, except that I wish it wasn’t always so crowded. And I’ve never experienced it being actually free.
Oh man I did not mean dentistry. Dentistry is the biggest racket in the world. I just had to get a crown and it cost $944. It’s porcelain, but I’m pretty sure I don’t have the equivalent of a place setting or four in my mouth. I can’t understand at all why teeth are such a big thing. If wooden teeth were good enough for George Washington, wooden teeth are good enough for me. I have to go back to the dentist next week to have two cavities filled despite the fact that my teeth feel fine. One of these days dentistry is going to break wide open just like asbestos and cigarettes.
Word on the street is that once the reforms kick in it will be increasingly hard for Republicans to demonize it. All that closing the doughnut hole, covering pre-existing conditions, sliding scale of government subsidy on costs, blah blah blah. But now it’s all just expensive in the eyes of many Americans not yet feeling the benefits, and when the economy is weak every spending plan is the work of the devil. Except for war. You’re right about paralleling health care and national defense – both are essential, costly, and unpredictable. And it’s rare that the majority really reaps the benefits.
I think that on this front people will come around. But again, corporations and monopolies will throw millions and millions at politicians to protect their bottom line. The politicians will spout populist nonsense and everyone will get dumber and sicker while someone gets richer.
The essential problem is that you’re rational and deliberate, while most people want to be told what to think – assuming the mandate is simple and catchy. Phil Collins thought he was living in the Land of Confusion, but I swear it’s way dumber now. And more inexcusably so.
Also, I think corporations are generally evil. It’s true that they act according to their own rules of generating profit. But I don’t believe that the accumulation of wealth, certainly on that level, is ever necessary. In fact, it’s misguided and damaging to all but a select few. I’m very biased against corporate greed, and absolutely in favor of the government taxing that upper 1% into oblivion. How rich does anyone really need to be?
I agree about large established corporations. There could not be two forces with interests so naturally opposed as big business and small business. Small business thrives on change, big business resists it because it is disruptive. I know of what I speak on this topic. The aspect of big companies that is missing from small ones, and the part that makes them so opposed to change of any kind, is middle management. I have worked for it, and I have been it, and that didn’t work out for me. But middle management is the problem. Executives are grossly overpaid, but they do take risks and shake things up from time to time. Middle managers absolutely do not, ever.
Any reason they have to call it a doughnut hole? I honestly think the Republicans hate the idea because they have the best health coverage in the world. To me, and people like my mom who do have pre-existing conditions and therefore are not insurable because the premiums are like Paris Hilton’s yearly shopping bill, it’s a no brainer. I’m a bit spoiled in Australia but it’s just common courtesy to say, hey citizens, if you break your left leg, you don’t have to sell the right leg on the black market, it’s okay. See a doctor.
HA. Just realized that the post was initiated by lbej.
You should have recognized my double smartness compared to that other guy.
You’ve done it now.