Burning stupid: health care edition

There are some conversations I am finding more and more difficult to have, or even to tolerate, because the loudest arguments are often really flamingly stupid. Health care is one of those.

I think the US ought to determine which country has the best most-bang-for-the-buck system, and replicate it. Now, this may not come down to an easy choice, deciding how to balance our bang for our buck. But we're not even seriously looking at how other places have done it, and I've got a problem with that. I can tell you right off it is not going to be our current system, and it is going to be a single payer universal system. It's just the numbers, folks. Per capita, Americans pay more and get worse care than any other developed nation. Wanting it to be otherwise isn't going to change that. And the "not invented here" crap? A health care system is NOT the place for it.

Now, I am not at all saying that every position in opposition to mine is stupid. Not at all. There are plenty of intelligent arguments against my position. For just one example, adopting one of these established systems will almost certainly destroy the health insurance industry as it exists today. Personally, I think this is ultimately a good thing, but with the economy in the awful state it's in, now may not be a good time for it.

(Something I got to point out to the "Capitalism is God" people, though. Capitalism worshipers claim that capitalism is always the most efficient way to allocate resources. If that were true, replacing a capitalistic system with a socialistic system would not destroy jobs, it would create them. The most efficient system would be using the smallest amount of resources. If changing requires less resources, the the original system was not using the smallest amount of resources, and thus is not the most efficient.)

There are lots of blindingly stupid arguments against universal health care, though. Some of them, I wonder if the people saying them have ever read typical private insurance terms. For instance:

Stupid 1: In a socialized system, you will be told what doctors you can see and what procedures you can have.

Um... Four words. "Out of network provider." Three more: "procedure not covered." My insurance company already tells me what doctors I can see and what treatments I can get. I eagerly await the day every doctor and every hospital in the nation is "in network". If I get in a serious car accident on my way to visit my mother, I am screwed. Actually, I'm kind of screwed just in town, because I'm only allowed to use one of the three hospitals. The Catholic hospital. Women, if you want to be treated like a wrapper for a uterus, the local Catholic hospital is the place for it -- and I speak from experience here. Under nationalized healthcare, my health options will hopefully determined by my choices, not by someone else's religious beliefs.

Stupid 2: Ungodly long waiting times await you, unlike in the US.

Oh dear. I just spit my beverage all over the monitor. It didn't splash on you, did it?

I read an article a while back that said that when you equalize for population density, wait times in countries with socialized medicine are the same or shorter than in the US. Unfortunately, I've lost that link.

However, I can tell you this. It takes a minimum of 2 weeks to get an appointment with my PCP, and it's usually 3 or 4. When I needed to have a diagnostic ultrasound, I had to wait an entire month for the procedure, and then another month for the follow-up appointment so that my doctor could tell me what it said. (And I had to go to the Catholic hospital for it, where I was treated like a walking uterus. Not fun.) It took like 3 months to get an official diagnosis, when I knew what was wrong with me the day I called for the first appointment. It was the only one of the 3 most likely possibilities that matched my age group, weight, and symptoms.

When I last went to make an appointment with my gyno, mine had left the practice. If I wanted to come under the head doctor, I would have had to wait 9 months for an appointment. Because I agreed to go under the newest member, I "only" had to wait 5 weeks.

Where do people get this "short wait times in America" idea? Yes, we have prompt care clinics where you can get in same-day. They have those in other countries, too.

Also, anyone else note how the comparison is always to either Canada's system or Britain's NHS? I am not dissing either system, because they are far better than the American alternative. But neither of these is considered the best in world, either. Ironically, America's to blame for some of that. Canada's was shorted funding due to NAFTA, and from my perspective a lot of Britain's problems are coming from taking an Americanized viewpoint towards health care. But that's MHO.

Stupid 3: A universal health care system is impossible. It couldn't possibly work.

Don't tell me that something can't be done when every other developed nation in the world already does it. Just don't. Millions of people already live quite successfully under universal health care systems, and idiots are trying to tell me that those very systems are physically impossible and can't possibly exist? UGH! The stupid, it burns!

Stupid 4: Well look what socialized health care did for Massachusetts.

::head desk:: Yes, Massachusetts is a mess. And anyone who's taken two weeks of an Intro to Economics course could have told you that Massachusetts would be a mess. I predicted the day I heard about it that it would be a disaster, and my predictions have come true. In part, it's a mess specifically because most of it isn't socialized. Massachusetts' idea of "reform" was to require people to have health care. [sarcasm]Right, because the problem is that people are choosing not to have it.[/sarcasm]

First, the "reform" does absolutely nothing to help those who are uninsurable due to pre-existing medical issues. There are no good numbers for how many people this may include. I've seen estimates from 1% to 15% of the population. I actually suspect it's much higher, especially if you include people who are technically insured but will have their claims rejected for "pre-existing condition" when they submit them. I say this because, for one example, anemia is one of the conditions that will land you on the "uninsurable" list; 20% of women will have a bout of anemia at some point in their life.

Second, all the Massachusetts plan did was make insurance demand inelastic. We all know what happens to the economic supply-demand curve when demand becomes inelastic, right? Cost goes up and/or quality goes down. That is exactly what happened. A year or two into the program Massachusetts went to the insurance companies to negotiate rates for their subsidized plans, and the companies refused to give them any deals. Why should they? By law, the state had to pay no matter what. Why should the companies give them a discount if they can't say 'no' to full price? The state had no negotiating room. Yet policymakers were absolutely shocked by this frankly obvious turn of events. And because they had budgeted assuming they'd get a discount for their huge block, funding came up short and it turned into a disaster.

This is not a problem with socialized medicine. To the contrary, this is a problem inherent in capitalism, and it will be a problem in any capitalistic health care system, including the one we currently have. Health care is just about the ultimate in inelastic demand, and catastrophic care is even more inelastic then normal care. You don't have it, you die -- which is not a valid choice for most of us. And so, price goes up, quality goes down. Remember what I said in the second paragraph about Americans paying more and getting worse care per capita than any other nation? Hey, theory in action! This is capitalism. This is not some outside taint, this is not some failure due to 'impurity' or 'regulation'. This is inherent to a capitalistic system. It is one of the most basic parts of capitalistic theory. This is the kind of thing that makes economists wet themselves in joy because "look, we're right! It's just like the model said it would be!"

I cannot beat this horse enough. Demand for health care, especially catastrophic care, is so inelastic that expensive and/or (usually and) inferior care is an inherent and unavoidable part of any capitalist health care system. The only way to avoid it is for the system to not be capitalist.

OK, I think that's all I can handle for one day. That's OK. I think those are the biggest stupids, the one that most make me want to beat someone with the huge thick binder of legalese that is my insurance plan.