Sunday, September 20, 2009

Health En-Sewer-Ants

Lately there’s been a lot of debate over this health insurance thing. And then Mike said something about it. And so now, I suppose, I’ll say something about it.

I don’t really have that much to say on the subject. I’m really not all that informed on the healthcare issues. I listen to Rush Limbaugh, and he’s a crazy man. And his problem with this whole thing basically comes down to “Don’t trust anything government run. They do this, and then they’re setting themselves up to have the power to do literally anything else to you.”

That’s… well, I suppose he’s right. If you really believe that Democrats are honestly and truly trying to leverage the country from a representative democracy into socialism or communism, then I guess that’s something you should worry about. But they aren’t. If you really believe that Democrats hate the Constitution and want to do a complete rewrite of it, then I guess all these protesters and right wing nuts have a point. Passing this health care bill could provide the leverage needed to insinuate government into all sorts of aspects of your life. But that doesn’t seem to really be the goal, in the real world.

However, the goal is to socialize medicine. And I’m not entirely sure how I feel about that.

The goal of the Obama White House is, very obviously, to completely socialize medicine. Medicine should be affordable for everyone. Nay, free to everyone. The government should provide health care to all.

That’s a nice thought, and a lofty ambition. I don’t know if it’s practical though.

Immediate health care is currently provided to anyone. This is a fact. If you are currently dying and need to be saved, an ER will do its best to save you, and if you can’t pay for it then you will have massive debt. That debt won’t be paid, maybe, and if you survive you will now have a whole slew of new problems caused by the life saving procedures. But you will have gotten the health care.

Then, when you can’t pay for it and you have to declare bankruptcy or whatever, the hospital is paid for its service through tax money. This system is currently in place. This system could be better, but those changes could ostensibly be relatively small in comparison to the overhaul of the health care system that is being proposed.

As I understand it, this emergency medical treatment is not really what this new plan is about. The plan seems to be more about preventative health care than it is about emergency health care. It’s about health insurance, which is a myth.

So let’s talk about that. What is insurance? Insurance is basically making a bet with an insurance company, in a backwards sort of way. Lemme dig up a Terry Pratchett quote and work from that:

"Well suppose you have a ship loaded with, say, gold bars. it might run into storms or be taken by pirates. You don't want that to happen, so you take out an ensewer-ants-polly-sea. I work out the odds of the cargo being lost, based on weather and piracy records for the last twenty years, then I add on a bit, then you pay me some money based on those odds-"

"-and the bit-" Rincewind said, waggling a finger solemnly.

"Then, if the cargo is lost, I reimburse you."


"Pay you the value of your cargo," said Twoflower patiently

"Oh I get it. It's like a bet, right?"

"A wager? In a way, I suppose."

"And you make money at this inn-sewer-ants?"

"It offers a return on investment, certainly."

So, basically, with insurance you pay a small amount to an insurance company, betting that something is going to happen. Let’s take fire insurance. Ostensibly, you’re betting the insurance company that your house is going to catch fire. The insurance company does some arithmetic and determines the odds that it will, then it takes your money and makes a bet with you that your house is not going to catch fire. If it does, then they pay you.

That’s the way that insurance works. But that’s not what we want with health insurance. We just want them to pay. We want to pay a small amount to some big company and then we want all of our medical expenses to cost less. This is not insurance. This is just health care.

That’s where this whole problem of preexisting conditions and such comes into play. If you have a condition that is guaranteed to cost a bunch of money every month, then you are not a good bet for the insurance company. So it will be very difficult for you to find affordable health care.

The point of the reform in health care is to make health insurance obsolete. The idea is that being healthy is a right, and that the government should provide it. Not based on an insurance, or betting, system, but just always give you the medicine that you need.

So, it’s a good thing then, right? Well. I don’t really know about that. Let’s assume for the moment that this bill is not about any sort of crazy liberal takeover, and it is really just about providing health care to the people who need it.

I think that if we had socialized medicine in this fashion, with the government picking up the bill for anyone who asked them to, that would put most to all of the health insurance companies out of business. That’s fine, I guess. Fuck em, right?

Well, now there’s a standard. Everyone gets the same medical treatment as everyone else. This will benefit people who couldn’t afford medical treatment before, but the people who had really good medical treatment and could afford it could find themselves with sub par treatment now. Their money may no longer be able to buy them the better things that they are accustomed to.

Okay, so let’s assume that this problem has arisen, and to combat it a small but expensive system of private health care is established. Health Insurance companies are now fewer and smaller, and cater to a much more select customer base. So there’s that modestly taken care of.

There will still be doctors. Doctors will still make a nice living. Maybe not as nice a living as they do now, but they will be compensated well for the work they do.

So, let’s discuss the death panels.

That’s silly. The term originated from looking at a provision in the bill that allows for “end of life counseling.” In other words, senior citizens are encouraged to see a doctor and discuss things like DNR, living will… that sort of thing. I think it’s twice a year. And I think it would be free to the person. It’s not mandated. It’s there for people to take advantage of, or to ignore. Stupid stupid republican bullshit scare tactic term.

Okay… but let’s look at how the term has sort of grown up to mean something that’s not QUITE as stupid.

When government takes over the health care system, it will be government bureaucracy that decides what life saving treatments should be paid for and to whom. Effectively, government will be deciding who lives and dies. This is true.

But it’s happening already. It’s sill to think that this will be new. As of now, medicines and procedures are paid for by the insurance companies. So, before you get your medicine it needs to be cleared through your insurance company. And they don’t want to give you your medicine. They want to protect their bet that they placed on you, and so you better believe that the list of things that have to be for them to pay for your treatment is just as suited to not paying for you as the government’s will be. We have the same death panels now that the bill would be proposing, but it’s in the private sector instead of the public.

What about drug companies? This is where, assuming that the bill is done without evil intentions and can be paid for and works to provide everyone with free or affordable health care, I have the biggest potential problem.

Drug companies are seen as evil entities. Drugs are ridiculously overpriced in this country. That’s why we aren’t allowed to buy drugs from Canada or wherever, where they are more affordable. Drug companies have a lock on that.

The $50 pill that you take to control your blood pressure did not cost $50 to manufacture. It was probably less than a dollar. You aren’t eating $50 worth of chemicals.

What you are eating is $50 worth of research.

Yes, drugs are too expensive, and yes, drug companies maybe make more profit off of them than is ethical. But the money is paid for the research to develop the drug, not for the drug itself. And I’m not crazy about the idea of putting drug research solely into the hands of the government.

The government doesn’t know how to do research. Government funded research needs to have a specific goal. It needs to be, say, cancer research. Or whatever. But that’s not always where breakthroughs come from. Lots of things are discovered by accident. Look it up. There you go. I done the work for you.

Not only that, but research in fields like cloning and stem cells are politically sticky territory. I don’t know that I like the idea of politics being behind all of medicine’s research.

So, that’s my, admittedly underinformed, take on the health care issue. Is socialized medicine a good thing? I think it is more good than bad, but there are genuine problems with it that need to be addressed and talked about. All of this Nazi comparison and death panel crap isn’t helping.

Every once in a while I see a republican on The Daily Show or something talking about healthcare reform in an intelligent way. Admitting that our system is in desperate need of change, but that this big sweeping change that’s currently on the table isn’t the way to go. There are substantially smaller changes that could be made to make health care more affordable for everyone, while not throwing out the current system and replacing it with a whole new one. These are the people that I would like to hear more from. But this sort of reasoned analysis gets drowned out by the Rush Limbaughs and the Glenn Becks and their flashy sloganing.

Both sides suck. Both sides need to take a step back and find a middle ground, because that’s really where the proper solution probably lies. But no. In US politics it’s go big or go home. update!:

Shannon says she thinks she’ll be able to put together the site tomorrow. Could Monday be launch day? It’s possible.


Hey, Mike... I'm interested in what you think about this serialshorts website idea. I don't know if I can write a 2-6 page short story in a serialized series manner effectively, or if it can realistically be done at all. Or if it's something that has a chance of gaining an audience on the internets even if it can be done well. What do you think about it? As a concept, since I'm sure you're probably happy to hear that I'm doing... you know... something.

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