Economy of Scale

As you may know by now, there was some news recently about A guy dying of a toothache because he didn’t have insurance. I hadn’t been planning to comment, because, hey, it happens. Even at my most financially destitute, I could have swing $80 for a tooth extraction, but it’s entirely possible that I’d have fallen victim to the same fate, not because I couldn’t afford health care, but because I’m stubborn and don’t seek medical assistance for anything less serious than dismemberment.
And it does seem to me like those least able to afford health care seem to want the most out of it. A few years back, I was with someone who was, I think I have mentioned, crazy. It seemed like once a week, she went to the hospital because she had some minor complaint that, had it been me, I’d have just toughed through. In fact, she left a voicemail for me a few days ago, and one of the things she was proud to report was that she’d been in a car accident a few months ago, and therefore was now getting a disability check.
Anecdotal evidence is, as we all know, the best kind. Many of my friends have absolute faith in capitalism, and overlook the fact that all of the nationalized health care systems in the world are far more efficient than the private US system. Heck, even the nationalized US system is far more efficient (Medicare is one of the most efficient medical systems on the planet. In fact, it’s one of the most efficient anythings on the planet). Anyone who tells you different is plainly and simply mistaken (or lying. Some of them are lying. Not all, but the last time I tried to be nice and pretend I believed they were all honestly mistaken, a conservative friend insisted I was being naive, and that, beyond the easily mislead sheeple, all the “real” conservatives knew these were lies, and pushed them because oppressing the proletariat is good for the rich capitalists, and, via the magic of trickle-down, therefore also good for the oppressed proles).
But anyway, you can believe that the masses should pull themselves up by their own bootstraps. You can believe that welfare is inherently paternalistic. You can believe that private charities should be responsible for taking care of the poor rather than the government (That, as it turns out, is provably false. Until fairly recently, the government didn’t get involved in taking care of the poor, it was left to private charities, mostly the churches. Poverty was a lot higher back then. Not just a little higher. Not lower.) You can claim that welfare moms are all deadbeats who pop out babies in order to keep those checks rolling in at the expense of good honest working folk (This is also false, but, hey, anecdotal evidence). You can claim that you don’t beliueve the poor are lazy and stupid and deserve what they get, but that the system rewards laziness and stupidity and therefore unless we stop giving the poor a hand, they’ll never learn to take care of themselves (That’s got some truth in it; a perpetual problem of systems like welfare and unemployment is that you lose the benefits as soon as you start to pull yourself up, rather than once you’ve finished pulling yourself up). You can claim that privitizing everything will be good for everyone. But.
Medical benefits are hard to come by and getting harder. They will continue to get harder to come by. This is not the fault of the government. This is not the fault of the poor. This will not be improved by more privitization. This will not be solved by litigation shields which allow insurers to savagely roger their customers to death without feat of being sued for it. This is not the fault of deadbeats who insist on expensive procedures when dying would be a whole lot cheaper. It’s the fault of the fact that they need to make money. And they’re failing to do so (Several major health insurers are in some bad financial places right now). They’re failing to do so for a lot of reasons. None of them can grow big enough for the economy of scale to really help them out. They all have to waste resources competing with each other. They all have huge administrative machines that are lubricated with pure money. And, of course, health insurance is an inherently losing game: they wager you’ll never get sick, or at least that you’ll die quickly and without much fuss, you wager you will. Everybody loses. Monopolies make things efficient. Competition makes things honest. You can’t have both with private industry.
You can, if you like, suppose that a government monopoly would be corrupt, evil, power-mad. Hey, why not? But everything you can say about a government monopoly, you can say about a private one. The converse is not true. Once you’ve got a government monopoly, profit is out of the equation. A private monopoly has a good reason to be corrupt and evil: it wants money. It can also be corrupt and evil for abstract cartoonish reasons like being bent on world domination. Only one of these applies to a government monopoly, and, frankly, it’s the one I find a little more believable. I’m all for capitalism in the 99% of cases where we can suffer some inefficiencies. All I’m saying is that if you’ve got to have a monopoly, I think a government-run one is a better idea.
And when it comes to health care, we need a monopoly. We need universal coverage.
I said in the beginning that I hadn’t planned to comment. Maybe you’re wondering why I did. The thing I didn’t tell you before about why January was rough for me is this: I have diabetes.
It’s a serious but very controllable disorder. So long as I keep it under control, it’s unlikely anything bad will happen as a result of it. It means that I have to watch what I eat and I have to exercise more, which would have been true regardless of this condition. It means that I have to take a pill every day, and I have to poke a tiny little hole in myself a couple of times a day to test my blood sugar. And I have to see a doctor every three months.
For the rest of my life.
My insurance covers almost everything. So I don’t have to pay most of the $300 dollars a month that my medicine costs. I don’t have to pay most of the $150 that a doctor’s visit costs. I don’t have to pay the $100 that test strips cost.
For about three years, I did not have health insurance. I managed to get away without seeing a doctor for that time, though it was pretty hard the last time I threw my back out. Actually, I pulled a muscle in my foot about a week before my coverage started, and that was a lot of fun let me tell you.
Money was tight for me during that time. In an emergency, I coulda swung $80 to have a tooth pulled.
But I couldn’t have swung several hundred bucks every month for medication.
Last night, I got the invoice from the hospital, for meeting with a diabetes educator who was very helpful in showing me how to not end up going blind, having a heart attack, losing my legs, and y’know, dying of diabetic ketoacidocis. My insurance covered it, of course. But if this had happened a year ago, when I was self-employed, living from check to check without any insurance, I could not have paid this. I could not have swung $500 in hospital bills. I could not have swung whatever they’ll charge me for my followup visits.
So, as I was saying. I have type 2 diabetes. It is a serious but very controllable disorder.
Unless you don’t have insurance, in which case it is a death sentence.
There’s your anecdotal evidence.