Thursday, December 4, 2014

Healthcare, Obamacare, Single Pay, and the American Dream

You probably don't know the name Tim Alsip. Back in 2013 he did something kind of amazing, and stupid, and brilliant. The man walked into a bank, and handed the teller a note saying "This is a holdup. Give me a dollar." After the teller complied, he calmly went and sat down in the lobby and waited for the police to arrive. He went with them quietly, after all, his goal was to get arrested.

Prisoners get free health care, they get three meals a day, and they get a warm place to sleep at night. Alsip was a poor homeless man. He needed health care. He had even tried calling 911 a few times hoping to get emergency medical care that way. The thing is, emergency care, whether in the form of paramedics or going to the emergency room, only has to see to it that you're stabilized, and in no immediate danger. So if you've got a persistent problem that needs treatment, or surgery, or medication, but which is no immediate threat to your life, the emergency room doctors are going to refer you to someone who can help, and turn you out.

The sad thing is, Alsip isn't the first person to go that route. In just the few years preceding that several others had the same idea. Going to prison is the price some folks have had to pay in order to get decent medical care. Alsip was 50, and had some mental health issues. This guy James Verone in 2011 started this trend. He was 59 years old, he'd lost his job of 17 years as a delivery driver, he needed surgery on his back, he had a pain in his foot, he had some lump in his chest that needed diagnosing. He was desperate. He had nothing to lose.

What has our society come to when going to jail is an improvement for some people?

All the ails of society would make for a much larger blog entry than I think reasonable. As it is, this one, focusing on healthcare is going to be so large most people wouldn't read it. So I'll stay focused on that for the moment.

We're rated 38th by the World Health Organization in healthcare. Many Single Payer countries coming ahead of us. While we're 38th in healthcare, we're #1 in spending per capita. So per person we spend more than countries with Universal Health Care, still end up falling behind the pack. We're 34th in life expectancy. Why is that? We're a rich country, we've got medical technological marvels, we've got amazing doctors, we spend more than anyone else on health care. Why don't we have a better life expectancy? Is it because we're fat?

Okay, obesity is a problem, but did you know however that we smoke less and drink less than our contemporaries? Maybe that balances, maybe it doesn't. However, just like you can't simply say that smoking less and drinking less doesn't necessarily balance the obesity you also can't simply blame the entire healthcare problem in America on obesity.

So where does it start? I'll be honest. I'm in favor of a Single Payer system. I'm going to give you two reasons. One reason is economic, the other is humanitarian.

Everyone understands negotiating leverage and buying power. Under the current system, a hospital, or network of hospitals is negotiating using the buying power of that single system of hospitals. Those hospitals with their patients. Single Pay increases your buying power by an order of magnitude. You're running your dinky little hospital with your million or so patient visits each year. When you negotiate you're negotiating with your million or so patient visits each year. A Single Payer system would mean that you're negotiating for 1.2 billion hospital visits each year.

So you've got artificial knees, and you've got your million patients a year, you're gonna get a price, but it's not gonna be the same price as when you can say you've got more than a billion patients a year. At a billion patient visits a year you go to all the companies that make artificial knees and tell them that every fucking knee replacement in the country is going to go to the company that provides the best knee at the best price. You want an economic reason to go single pay? Right now we pay more for everything because we don't have any negotiating leverage.

So how about a humanitarian reason? Well, you've got Tim Alsip and James Verone, but lets say that's not enough. People talk about the long wait times for procedures in Single Pay countries. The first thing to do is dispel that long wait time myth. Some single payer countries have long wait times, some others don't. Here in the U.S. we have relatively short wait times for medical procedures. There are a lot of reasons for that, but one of the most obvious is that Americans don't go to the hospital. Here in the United States we have so many people who lack health care coverage, who who have health care coverage that is inadequate that going to the hospital is a last resort for many.

So you've got this guy, and he's got a scratchy little cough in the back of his throat. It could be nothing, it's probably nothing, or maybe it's allergies. So a week goes by, maybe a couple weeks, the scratchy cough is there. guy goes out, he buys some allergy tablets, and hey, that cough still doesn't go away. It gets worse. We don't go to the hospital. We don't go because we can't afford it. We don't go because we can't miss the time from work. We don't go because if we do we'll be paying it off for the rest of our lives, because we don't have health insurance, or the health insurance we have is inadequate. So after six months this guy is coughing so often and so violently that something in the back of his throat rips. Now he's coughing blood. Now he goes to the hospital.

That's when he finds out he has cancer. if he had gone in five months ago they could have simply cut out a little tumor growing along the esophagus. Chances of survival would have been pretty high. If he had come in three months ago it would have been slightly riskier as the tumor would be larger, but chances of survival would still have been pretty high. At this point however the cancer has spread. There is no surgery. There's drugs and chemo, radiation and prayers. The doctors give him a year, eighteen months at the most.

We don't have a shorter line for medical care, here in the United States, we just step over a bunch of dead bodies to get to the front of the line.

Obamacare wasn't the answer, it was a huge mistake. Tying employment and healthcare together has done nothing but push employers into the idea of having no full time employees, and instead having nothing but people working under 30 hours in order to avoid having to provide them with healthcare. The only good thing about Obamacare was this: Someone tried to do something. That's a change, and it's a good change. Someone pretended to give half a shit for five minutes. Sure, the way they tried to carry out that attempt to make things better was all sorts of wrong, but someone finally did something in an attempt to have a positive impact on the American Healthcare system. That has to count for something.

In the end, maybe the two reasons I give aren't enough to make you think that a single payer system is worthwhile, maybe you need more reasons, and there are plenty of other reasons out there. For me though the amount of money that American's could save on health care, and the number of lives that could be saved, for me that's enough reason. I don't mind standing behind someone in line for healthcare, if it means I'm not stepping over all those corpses anymore.

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