The Sick and the Well, Part II: Perspective

By Christian Probasco, 3-14-09

I carried a quarter-sized kidney stone inside me for about a year because the trucking company I was driving for only offered pretend insurance. When I learned how much it was going to cost me to have the stone zapped with sound waves and how little of the expense my company would pay, I put the operation off. Then a study came out showing a lithotripsy could damage the pancreas and help precipitate diabetes. I already suffer from boughts of reactive hypoglycemia and have been told by doctors my condition is “pre-diabetic.” I wasn’t interested in further damaging my pancreas, and I delayed the operation even longer. 

So last year I found myself in the emergency room in shock, sans insurance. The doctors ended up performing two operations on me that put me about twelve grand in the hole.

I’m sure some of you have had similar experiences dealing with medical expenses. You know the drill. No insurance? The receptionists and nurses stare at you as if you were growing another head. What to do? How to bill? Where do they keep the paperwork for such occurrences?

I needed to discuss some test results with a urologist who was following the lithotripsy machine’s migration through central Utah. His receptionist figured out which hospital he would be operating out of that evening and told me to meet him at the emergency room there. When I got there, the nurse told me she would have to “check me in” before she would page him. And then the hospital would sequester me in one of the emergency stalls until he came calling and bill me for recording my blood pressure, my temperature, weight, height, posture, general complexion and so on, and bill me again for every minute I sat there breathing the hospital’s oxygen and kept real patients with life-threatening conditions waiting in the lobby. A real boon for the hospital, which was only serving as a meeting place, and a real hazard to those who need urgent medical care.

The medical system is chock full of such nonsensical policies and it would surprise me if they weren’t contributing to the deaths of thousands of patients. The nurse I had to deal with that night, and many others I’ve come across, acted as though she couldn’t care less whether her charges—vomiting toddlers, bleeding teenagers, sick mothers and migrants who could only point where it hurt—lived or died.

I wrote a story a few months back about options for fixing our medical system and how, at that time, neither presidential candidate was offering solutions palatable to anybody but special interests within the medical establishment. I was driving a truck at the time and I remember some radio personality, maybe Limbaugh or Hannity, bloviating about our “gold standard” medical system. I still can’t figure how anybody could use that terminology to describe our system. 

Obama has promised to “make health insurance affordable and accessible to all.” by “investing in health information technology, prevention and care coordination.” And he will promote public health by requiring “coverage of preventive services, including cancer screenings, (and increasing) state and local preparedness for terrorist attacks and natural disasters.”

Maybe I’m not alone in wondering just how many people show up at the hospital each year suffering from “terrorist attacks and natural disasters.” A few, I suppose, but is that really a major input for medical costs in the United States? And how much money will we save through cancer screenings or other non-mandatory preventative medicine? Or does Obama want to make his prescriptions for preventative medicine mandatory?

To be fair, there’s more to Obama’s plan but it’s a mixed bag. There are a few free-market fixes, such as “(allowing) the importation of safe medicines from other developed countries” and “taking on” (!) “drug companies that block cheaper generic medicines from the market” (with the U.S. military, maybe?) and “(creating) a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees” and “(reforming) the insurance market to increase competition by taking on” (again) “anticompetitive activity that drives up prices without improving quality of care.”

But then there’s other stuff like, “Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees” and “Make employer contributions more fair by requiring large employers…to make a meaningful contribution to the cost of quality health coverage…” and “Ensure everyone who needs it will receive a tax credit for their premiums” and requiring “hospitals to collect and report health care costs and quality data” and reducing “the costs of catastrophic illnesses for employers and their employees.”

Now, how is Obama going to pull this off without raising taxes significantly, or raising costs for businesses to do business, and thus raising the price of goods and/or services, eh?

We are a nation divided into two camps on how to approach difficult problems like affordable health: raising living standards and what I call the “Wal-Mart” approach.

Raising living standards involves forming unions. Unions are how the United States got its middle class and they’re the only reason we aren’t expected to work 12 hour days (some people still do, though. Ask a truck driver). But they don’t seem to be terribly popular right now. And forming Unions doesn’t address the issue of skyrocketing medical costs .

On the other hand, the “Wal-Mart” approach doesn’t sound like a great way to provide quality medical care, does it? Bear with me. Wal-Mart’s strength comes from dropping prices to the point where they can tap into the pockets of the lowest economic tiers of society. The markets that will always be there.  They do that by buying in bulk, leveraging their buying power, keeping their delivery system in perfect trim, and slashing their own profits and the profits of their suppliers to the bone. If you’ve ever shopped there, you know that most of the products aren’t terribly bad.  They’re not great either, but they’ll do. The toaster you buy there will last a few years. The food is mostly the same brands you’d find in your local grocery store, but less expensive. The clothing is generally durable, if not particularly fashionable.

In fact, shoppers usually get better quality than they have a right to expect, chiefly because much of the merchandise is manufactured in China, where labor is cheap and the dollar still goes a long way (they like it like that). But that’s neither here nor there. Wal-Mart’s business philosophy caters to the lowest common denominator. Schlubs such as myself who are just getting by. Working mothers. Service employees. Even the unemployed. The economic class just below blue-collar workers, though you can catch the lower echelons of that strata shopping there as well.

Obviously, there are a few aspects of the model that need tweaking, like the way Wal-Mart sticks it to their employees. Really sticks it to them. And their community-bullying tactics. I could go on. The attributes I’m focusing on are the company’s relentless march towards efficient delivery of inexpensive goods to the near-destitute. That model could be applied to health care and the results wouldn’t be any worse than what you’re seeing now. I would wager they would be better, because they would give the underclass access to medical care at reasonable prices.

Doctors, nurses and physician’s assistants would probably not get wealthy from such a system, however. And it would help solve the healthcare crisis rather than putting more of the system under government control, where medical care would inevitably become even more expensive. Politicians and Washington bureaucrats would have to fight their normal inclination to strangle new markets. Baby boomers, who are already guaranteed healthcare, which their children, grandchildren and great-grandchildren will pay for, would have less to gain from it than those future generations.

Wal-Mart and a few other stores like CVS and Walgreens are getting into the retail clinic business . Their model is sort-of what I’m talking about. If you want an even better example of affordable health care, take a look at the clinics which offer LASIK surgery. For a measly few thousand bucks, you can get a well-experienced technician to correct your vision by shooting a LASER into your EYEBALLS--safely. Compare this with the $12k it cost me to have a rock zapped from my pancreas without even opening me up. If laser eye surgery wasn’t elective, it would probably cost you about $50k to get your eyes permanently fixed. But it is elective, meaning most people have to pay for it out of their own pockets, and so there’s been a race to the bottom to see who can safely provide the surgery at the lowest price.

The American Medical Association, by the way, one of this nation’s 800-pound gorillas of campaign donations and lobbying, which relies on massive government regulations to increase the costs of health care and keep doctor’s salaries high, wants retail clinics to be regulated and investigated out of existence. There’s a surprise.

So why is this a particularly Western issue? As I’ve written before, Westerners, individually, are more temperamentally inclined than Easterners, Californians or even Southerners to want to pay their own way—as opposed to having the government (i.e. other people) or their employer’s insurance company pick up the tab. Pulling your own weight is, or was, part of the Western tradition. And if more people adopted this tradition, and doctors, hospitals, drug companies, insurance companies and medical manufacturers competed for their money, there wouldn’t be a health care crisis, because most health care operations would have to become affordable.

But then, if there wasn’t a crisis, why would we need politicians?