Posted by: emjb | May 2, 2006

The Elephant in the ER

As I might have mentioned, I just spent a few weeks working for a hospital’s nursing education department. The last few days I was there was the time of the hospital’s skills fair. Basically, nurses, techs, and some secretaries had to come in and demonstrate that they knew basic hospital policy and whatever techniques applied to them (reading EKGs, etc.) by taking a multiple choice test. That we let them retake if they failed. And they could consult with each other to figure out answers. So it was dead easy, which didn’t stop everyone from complaining about it.

But anyway, while manning the sign-in table, I overheard a conversation between two nurses that went something like this:

Nurse A: My friend Loretta just got back from rock climbing on vacation and she had a massive hematoma right over her hip! She didn’t want to go to the doctor! She fell right down the cliff!

Nurse B: She has to go in, because (rattles off a list of medical complications that Loretta could suffer but that I can’t remember. Basically, internal bleeding was involved and serious injury..possibly death). With an injury like that, you have to go in.

Nurse A: I told her that, but she says she doesn’t have health insurance.

(pause in conversation)

Nurse B: Well, I bet it’s just getting worse if she just treating it with ice and Tylenol.

Now, that pause, that very significant pause, caught my attention. Because it illustrates in a few awkward moments the state of healthcare in the U.S. and what it’s costing us. These two nurses knew that the woman in question might die from her injuries, or suffer other complications. But when faced with the reality–that she had no money for treatment–they didn’t know what to say.

The obvious thing to say would be “well that’s why we need some national fucking healthcare.” But nurses, who you would think would know this as well as anyone, are just as scared to say it because it’s politically unpopular. National healthcare still equals Communism, still is somehow aligned with Bad Things. For some reason, using your taxes to start wars of convenience is ok, but using them to give all U.S. citizens access to basic healthcare is not. Much better to let us go bankrupt giving our cash to insurance companies that are free to refuse us treatment, or drop our coverage, whenever they want.

Well, obviously, I’m a liberal, and if you think the preceding paragraph is nonsensical, you’re not going to listen to me. That’s fine. So let’s talk numbers. Let’s talk a recent study that showed that even controlling for as many factors as possible, our lack of national healthcare shortens our lives and makes us sicker than those of citizens in other industrialized nations. Oh, and it’s costing us more too. (via Washington Monthly; emphasis added).

The researchers studied health outcomes in both countries and controlled for age by comparing only people aged 55-64. They controlled for race by studying only non-Hispanic whites. They controlled for obesity. They controlled for income. They controlled for education. They controlled for everything they could think of. Here’s what they found:

“At every point in the social hierarchy there is more illness in the United States than in England and the differences are really dramatic,” said study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.

….The upper crust in both countries was healthier than middle-class and low-income people in the same country. But richer Americans’ health status resembled the health of the low-income British.

The researchers are careful to say that their study doesn’t prove that Britain’s healthcare system is better than America’s — something that would be nearly impossible to demonstrate conclusively with a study like this in any case. But that’s not the point. The point is that it’s obviously not worse even though the British spend about half as much as we do per capita.

So here’s the deal: under the British system, you don’t have to worry about which doctors your HMO allows you to see. You don’t have to worry about losing coverage if you get laid off. You don’t have to worry about being unable to get a new job because you have a pre-existing condition. You don’t have to worry about being bankrupted if you contract a serious chronic illness. And large corporations don’t have to worry about going out of business because of spiraling healthcare obligations.

So there it is. It helps more people, for less money out of those people’s pockets (I won’t dispute the fact that it will take money out of the insurance industry’s pockets. Though I will bet you that they find a way to survive). It will even help businesses like GM which are going bankrupt due to making crappy cars, but also because they can’t afford their employee healthcare benefits. It will help small businesses which can’t afford employee healthcare and thus can’t attract good people. It will increase entrepreneurship, as people who have great ideas can go ahead and start up new businesses instead of staying where they are so their kids can afford to go to the doctor. It will increase personal freedom, as people who stay in crappy soulless jobs can now take a chance doing what they love without worrying about losing their coverage.

It’s not perfect, it’s not without problems, but it’s better than what we have, and cheaper. Since I was talking about GM earlier, let’s put it this way: our current system is a crappy, polluting, gas-guzzling, chrome-laden beater that requires massive amounts of oil and still tends to crap out and leave you stranded on the roadside. National healthcare, if we aren’t complete morons about it, can be like a Honda; dependable, not glamorous, maybe not as sexy as we’d like, but cheaper, and it gets you where you need to go almost every time.

Back in the 70s, there was a massive outcry about buying Japanese, just like there is an outcry today about creating national healthcare. It’s unpatriotic, say opponents. Not the American way. But 30 years later, how many of us drive fuel-efficient foreign cars and prefer it?

No matter what the diehards say, a few years of even the most basic healthcare coverage would make converts of most Americans, because rhetoric would give way to reality. And once we had it, we’d never give it up again. The insurance companies know this, and the politicians in their pocket know it too. That’s why they’re howling so loudly. After all, they can afford all the healthcare they need. They will never have to debate whether to pay rent or take their child to the ER, or whether to let a massive hematoma go untreated. The rest of us live in a different reality. And we’ve gotten so used to it that we let the anti-healthcare contingent tell us horror stories about how awful it would be if things changed, stories that aren’t backed up by facts or common sense. Sort of a national case of Battered Wife Syndrome.

I think we’ll wake up eventually, but I’m hoping it’s sooner rather than later. For Nathan’s sake, for my aging parents’ sake, and for my sake.

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Responses

  1. > National healthcare still equals Communism, still is somehow aligned with Bad Things. For some reason, using your taxes to start wars of convenience is ok, but using them to give all U.S. citizens access to basic healthcare is not. Much better to let us go bankrupt giving our cash to insurance companies that are free to refuse us treatment, or drop our coverage, whenever they want.

    I just wanted to point out that there are those of us who object to national healthcare who also object to pointless wars (among other things). We’re in the minority to be sure, but we’re the consistent ones on the side of fiscal conservatism and personal liberty.

    And may we not forget that only in the last few months have even a _few_ brave Democrats taken a firm, unequivocating stance against the war by saying their initial vote for presidential power was wrong.

    I realize that the criminals currently in power are an easy target, but they’re so evil they are almost literally strawmen for an easy argument.

    As for the rest, I’m still waiting on my justification for why “the greater good” (and what exactly that is) justifies stealing the money of individuals at the point of a gun. If I can afford good health insurance, that’s my money I choose to spend. If someone poorer than I cannot, it’s sad, and there are other ways to help besides threatening me with jail if we don’t help him. Why don’t we do something constructive (and moral) like force health insurance companies to stand by their policies or choose to buy insurance in companies with better reputations instead of cheaper prices? I don’t think even the hippy Jesus that liberals like to invoke would be too keen on solving a mass problem by going door-to-door with guns and taking people’s money to solve it. What the gospels say he taught was all about choice. (Whether I agree with his elevation of altruism to a moral trait is really moot here.)

    And the fact that insurance companies have renewal clauses and caps on care costs is simply a part of the bargain you make with them. You don’t want it? Don’t make it.

    Also, just a little twinkling of a hypothesis (seriously, not sarcastic here). Is it possible that the very rich white men in Britain, most of whose ancestors, by the way, gained their wealth via extortion, virtual enslavement, and simple “birthright”, have been rich since birth? Is it also possible that the very rich in America tend to be self-made and perhaps had substandard health insurance as children and were thus merely exposed to the real world instead of raised in the bubble of high society? Thus the rich white dude in America, who has far superior medical care, is just not as healthy because of childhood illnesses he suffered. I don’t know that it’s true, but I think it’s worth thinking about.

  2. Okay, I wasn’t going to comment (due to admitted ignorance as far as offering a plan that would actually work), but I have to reply to some of Dean’s comments.

    First, I am a working, married, middle-class woman married with a husband who works full-time. We have two children, one who is severely and permanantly disabled.

    Both of our company’s insurance plans changed in the past year, forcing us to pay hundreds and thousands of dollars out of pocket for things that were previously covered. It has been a hard year, but we know it is only getting harder. Costs are increasing, our son needs more and more medication and will need more and more treatments as he gets older.

    We had no say in these changes. Our company told us what was changing, and if we wanted to keep our insurance, we had to go along with it. There was no cafeteria style options available that allowed us to spend as much as we wanted on extra coverage.

    Comments like this:
    “If I can afford good health insurance, that’s my money I choose to spend.”

    and this:
    “And the fact that insurance companies have renewal clauses and caps on care costs is simply a part of the bargain you make with them. You don’t want it? Don’t make it.”

    really got to me.

    “Don’t make [the bargain]?” Obviously that is not a choice that an employee has, it is the choice of the higher-ups in private industry, who will look for the cheapest method possible for themselves.

    Where do you propose a consumer should go to get a “good” health insurance? Should I search out a new job, possibly in another state, to find a better plan? Even if I do, what guarantee is there that the new company won’t change their plan to help their bottom line tomorrow?

    What do I do if I get laid off? COBRA premiums are huge, and even if I found a new job, most companies force waiting periods before enrolling in the health insurance plan. Who pays for my son’s therapies and prescriptions and surgeries in the meantime?

    Health insurance is a sore subject in my household. I admit, it is something that I never thought about until our son was born and had permanant, lifelong conditions that require constant treatment. The truth is, it isn’t a choice whether or not to get sick. It isn’t a choice whether or not to go bankrupt someday because of medical costs. And it happens far more often than we’d like to think.

    It’s easy to be the complacent healthy person with the steady job and once-a-year copay for a routine physical. It’s only when you are hit with something else – bad living, bad planning, or even just bad luck – that you realize how fragile the entire system is.

    My ramble is over for now, other than to say that I agree with your original post. I wish I knew more how to fix things. I wish I had any hope that things WILL improve in my lifetime, or my children’s lifetimes. But I see nothing to convince me we are heading in any direction but down.

  3. Hey, I’m not ignoring you guys..I’ll get back to your comments later. Just have another post I’m working on and unexpectedly had to work temp today and tomorrow. mjb

  4. Dean, you’re a libertarian, and as such, refuse to recognize the utility/morality (take your pick) of almost all taxes. You and I start from such widely differing viewpoints in that regard that I’m not sure there’s any such thing as a productive argument between us on any subject in which taxation is involved. You think less government (in general)=more freedom. I think (in general) that it depends on the issue–in some cases, less government equals less freedom. In other cases, it leads to widespread inefficiencies, needless suffering, class stratification, and anarchy.

    Of course feel free to pick that apart, but that’s how I see it.

    Speaking of class stratification, America is no less plagued by inherited power than England is. We don’t call the Bushes “lords” but they and a remarkably small contingent of other wealthy families have held power in the United States for much of the past century. There was a study recently

    (here it is: http://tinyurl.com/zyh86) that didn’t have much encouraging to say about economic mobility in the U.S. I don’t think it’s impossible to improve your economic status, but it’s not necessarily the norm, and it’s getting harder as more holes appear in the safety nets that allow people to climb out of chronic poverty.

    …and that’s not even really my point, which is that I view the unnecessary suffering caused by lack of access to healthcare (suffering that cannot be sufficiently prevented by any amount of planning or savings by your average Joe) as a greater evil than that of being taxed to ensure that we all–myself included–have access to healthcare. Much the same way I approve of taxes for roads, the military, and schools. The need for freedom of movement, protection from invasion, and a literate population outweigh the evil of being taxed to pay for it.

  5. Crap. I meant to say:

    **I think (in general) that it depends on the issue—in some cases, less government equals *more* freedom. In other cases, it leads to widespread inefficiencies, needless suffering, class stratification, and anarchy. **

    sorry.

  6. You said:

    > Dean, you’re a libertarian, and as such, refuse to recognize the utility/morality (take your pick) of almost all taxes.

    Well, yes. I am a libertarian, but that is not the source of my beliefs about government; it is the conclusion. I most certainly do recognize the *utility* of taxes–they do all sorts of good stuff, but I don’t agree that the cost or the logical outcome are worth it. And the morality of taxes? Wouldn’t voluntarily giving money for these things be moral? Isn’t taking them by threat of force immoral? Oh, but that wouldn’t be effective. The arguments for taxes are always utilitarian. “It’s wrong, but it works,” or “It’s right because it works.” I simply don’t buy either of those assertions.

    You said:

    > You and I start from such widely differing viewpoints in that regard that I’m not sure there’s any such thing as a productive argument between us on any subject in which taxation is involved.

    That may be true. I keep hoping to find out where the crux of our difference is, though. Is it utilitarianism?

    You said:

    > You think less government (in general)=more freedom.

    Just to clarify, I don’t believe this as a principle, no. It ends up being true that the consequences of my beliefs about government would lead to a much smaller government than we have _now_.

    The principle is: Government should _protect liberty_. Safety nets are not freedom.

    You said:

    > …and that’s not even really my point, which is that I view the unnecessary suffering caused by lack of access to healthcare (suffering that cannot be sufficiently prevented by any amount of planning or savings by your average Joe) as a greater evil than that of being taxed to ensure that we all—myself included—have access to healthcare.

    Such suffering can be prevented, yes, but is it worth the cost? I think we simply don’t agree on this point. I think that liberty is the foremost principle here–and that eating away at it is a slippery–and nearly irrevocable–slope.

    Also, I don’t think I ever said that everyone can successfully assuage the effects of any disaster in his life with planning or savings. The fact that some cannot, however, is not sufficient cause (there is none save criminality) to take away anyone else’s property to make up for it.

    You said:

    > Much the same way I approve of taxes for roads, the military, and schools. The need for freedom of movement, protection from invasion, and a literate population outweigh the evil of being taxed to pay for it.

    If you want to talk about whether taxation is moral for protection of invasion, I think that is a completely separate argument, as that is a legitimate function of the government. But freedom of movement? That’s not a right. It may certainly have contributed to a healthy economy and the general betterment of citizens, but I no more have the right to go where I please than you have the right to force a random person to take you where you please. _If_ I can employ or produce the transportation necessary, and _if_ I either have the right (un-/government-owned land) or the permission (privately owned land) to take the route I take, and _if_ it’s even possible to take that route, then I have freedom of movement.

    Finally, let me clarify one thing. If I thought that taxation was literally as vile as coming to my home, pointing a gun at me, and taking my money/property, then I would be living on a desert island or the moon or Antarctica or something. I don’t. I do recognize that the taking of my money by force is both less of an offense and less of a burden than being a wholesale subject of the state. I’m glad for most of the effects of roads and the military and public schools and putting a man on the moon and making sure poor people don’t die from the flu. I’m simply not willing to accept–either in principle or in practice–that any of those things justify coercion.


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