The American Healthcare System--The Conflicted View of One American Girl

I thought that I would take this moment to go on record about Healthcare.  Because I'm worth it.  Or so Loreal tells me.  Oh, they were talking about expensive hair-care products?  Oh well.

But let's face it. With all of this talk of Healthcare Debate, pretty much not one soul is arguing that the the US healthcare system isn't broken.  They just argue about how to fix it and what broke it.  Well, I guess there are a few people arguing its okay.  I was a teaching assistant for American Heritage at BYU.  It is fun watching conservative, Mormon eighteen-year-olds realize that they have no idea what they're talking about when it comes to healthcare. They realize that beliefs that they have are what we affectionately called "Dinner-Table Opinions" amongst the American Heritage Teaching Staff, and they misunderstood those Dinner-Table Opinions in the first place. They get to realize that the beliefs they espouse under the name of being conservatives who believe in American principles, and Mormons who believe in Christian compassion are not espoused by conservative political parties, nor the Church of Jesus Christ of Latter-day Saints (Mormons), and they aren't even ideologically Mormon or conservative. They are not traditional American ideologies, and they are not compassionate Christian ideologies.  With that tangent done, let's get back to the center of the question.  I'm conflicted on healthcare.

Before I get into my thoughts on the subject, full disclosure is required.  By virtue of my life circumstances, I am conflicted. I have to be honest. First:  I work in healthcare.  This broken system is my livelihood.  I am a Medical Lab Scientist.  That means that I run laboratory testing. My bachelor's degree is in Medical Lab Science.  I am a registered, certified medical lab scientist. Really.  Just ask the American Society of Clinical Pathologists Board of Certifications.  My paycheck each payday comes out of this market.  Second:  A lot of times these analyses of healthcare consisting purely of anecdotal evidence--I admit a lot of this is anecdotal--come from people who have been wronged by the system.  I haven't.  Why?  Because I am a healthy 23-year-old. I would wager a guess that me, my parents and all insurance companies I've ever been covered by have spent less than $10,000 on me in my entire life.  That's including my birth.   I acknowledge that I have probably thrown more money into the health insurance pool of cash than has been removed on my behalf.  Because of that, no insurance company has ever tried to screw me over, or exercise their expanse of loopholes on me, or generally hurt me in any way.  I'm the type they want to keep, not dump. The only warring I have done with insurance companies is on behalf of the patients at the diabetes clinic I worked at about five years back.

It seems like I should be that breed of people I said don't really exist--the ones who have no qualms about the Healthcare System.  Well, I'm not, and here's why.

First:  I'm just a compassionate person.  You wouldn't know it by talking to me--lab scientist, remember?--but I am.  I don't like seeing people in a mess.

Second (full disclosure):  I am involved with the hemophilia community.  And if you want to meet someone who could take an Olympic medal in fighting with insurance companies, look no further than a hemophiliac.  That's what happens when you cost $10,000 a week.   On a good week.

Third:  The stats say we have a problem. We spend more money on healthcare, per American, than any other country. Some say that's because Americans are less healthy than any other country because of  our health habits, but that just isn't true.  We have more obesity, but we don't have more alcoholism.  We don't have more infectious disease.  And if we pay so much, we should have better health outcomes, but we don't.  We don't have bad outcomes by any means.  But we don't have significantly better outcomes compared to other countries of our level of development.

So what problems do I see?

Cost.  Almost every issue I can find with the healthcare system boils down to cost.  Either the root problem is cost, or the problem is a problem because it results in higher costs.  So what do I propose?

I like Adam Smith as much as the next conservative.  But let's face it, we are not dealing with pins. We are dealing with something almost entirely inelastic, meaning that people don't choose not to buy it because it costs too much.  They just bite the bullet and buy. When you analyze if you want to buy healthcare, the value of not dying is pretty high. So you will pay whatever it takes.  Supply and demand means that the buyers need to be able to push the price down. And they can't when how they say "too high" is by not buying it--remember that wasn't an option.  Also, healthcare is not something that we're really okay with some people not getting--and that's something that happens in a pure Adam Smith economy.  Okay, so not everyone can have a Ferbie.  And that's not a crime against humanity. But are we okay with some people not getting life-saving healthcare?  I'm not.  There's a reason that lungs don't go to the highest bidder.  Something inside us believes that lungs should go to the person who would die first if they didn't get them. 

Now I'm  not advocating socialized heatlhcare.  Whenever I read a comment by a Canadian saying, "We get it at no cost!"  I just want to send them back to childhood so their parents can tell them "Money doesn't grow on trees, you know?" just a few more times.  It costs you plenty, just in other ways.  However, it's worth adding that the US already has the  highest government healthcare spending in the world.  That's right. Sweden and the UK's all-inclusive, government-provided healthcare costs their government less than what the US government currently spends on healthcare.  Which brings us, once again, to cost.  Why does it cost so much?  My theories.

No Free Market Effect

We already discussed how a true free market wouldn't really work for healthcare.  But right now?  As much as some conservatives I know hate healthcare reform because it ruins the free market, we need to acknowledge that our system has almost nothing in common with a free market.  For example: I work for a health system. There's another one in competition with us, but not really.  Because buyers don't choose which to use--their insurance companies do.  And insurance companies don't really care about individual costs.  They aren't doing an analysis of who does the cheaper transplant, or who has better quality. It's which has the best overall bottom-line for them.  Same with pharmaceuticals.  Say that you have diabetes.  Maybe you use Lantus insulin.  Because it works better for you than Levemir?  Probably not even in the equation.  Probably because that's what your insurance company covers. Oh, because your insurance company sees that one is cheaper or better?  No.  Because pharmaceutical companies and insurance companies are in each other's pockets.  If you were the one choosing, NovoNordisk (who makes Levemir) would work to make Levemir better and chepaer than Lantus.  Because they love you?  Heck no.  Because they want to make more money than Sanofi-Aventis (who makes Lantus).  And Sanofi-Aventis would be doing the same thing.  Voila!  The ghost of Adam Smith is appeased.  You get to have self-interest benefitting everyone and the prices go down and quality goes up, because people make the choices between competitors.  We have to figure out how to keep this market pressure, and still have everyone able to pay.  But maybe having people actually pay would help everyone be able to pay.

Insurance Company Hoop-Jumping and Subsequent Waste

I remember the day I learned this concept.  I was working at the aforementioned diabetes clinic.  An insurance entity (which shall remain nameless) had decided that they would no longer cover insulin pumps unless they had a C-peptide value on their files. For those not in healthcare, a c-peptide test is a test which documents how much natural insulin your body produces.  We then had to call in all our insulin pump people and get their c-peptides tested.  If they'd had one in the past?  Nope.  You need a new one. Because apparently, pancreases decide to make insulin again after they've quit.  (FYI they generally don't).  And a lot of our patients hadn't had c-peptide tests in the past anyways. A lot of them were diagnosed prior to the advent of c-peptide and c-peptide tests weren't really done anyways unless you suspected something like Brittle Diabetes, wherein the body produces no insulin at all.  That's not really the case anymore, but that's another section.

Sound like I'm complaining about scheduling hundreds of blood draws when I was eighteen?  Here's the bomb I'm going to drop. C-peptide tests run in the $200 area. Depending on the lab.  (Disclaimer:  so that there is less chance of fraud, I am kept in the dark about how much each test in our lab costs.  And our lab doesn't run c-peptide anyways, because it's a specialty lab type of test).  So, imagine.  This insurance entity covers probably close to 10 million insulin-dependent diabetics.  You do the math.

Then a bunch of the tests had to be done twice because the patient's glucose was higher than some specified range at the time of draw.  They would never actually tell us what that range was, and it seemed somewhat arbitrary.  So, we just kept redrawing them and throwing the glucose at the time of draw to the wind and hope that it stuck.  I still remember the day our doc lost it and called the entity and told them, "This entire thing is moronic.  His glucose was too high because he's a diabetic.  Has been for thirty-six years.  But you don't believe that anyways!"

And this isn't an isolated event.  I have too many hemophiliac friends who switched insurance companies, and then their new company won't cover anything until they can prove than they are, in fact, a real hemophiliac.  Do people pretend or something?  ("We've got so many fake crips out there, a real crip don't stand a chance"--Crutchy from "Newsies")  No, they have to prove it.  Prove it to the tune of $500 Factor Assays.  Then there's the Cystic Fibrosis teens who are now doing a $400 sweat chloride test to appease their insurance companies.  It was positive when they were babies.  It probably hasn't changed.  And if it has, there are some researchers who'd love to meet them, because they just found the Holy Grail of Genetic Disease Research.

I know what you're thinking: Their insurance will cover all of that.  Exactly my point.  Insurance companies are paying a lot of money for these "We need proof"" shindigs.  And once again.  Money doesn't grow on trees.  In comes from somewhere.  Aka all of us.

Litigation

I am going to go out on the crazy limb here.  Unless you have actually lost money--through lost wages, earning potential, or needing further health costs to be paid because of it--you shouldn't sue for malpractice.  And then, only if there was extreme negligence.  Someone made a one-time mistake and your three-year-old died.  It's tragic. I can't even express the guilt that I would feel if I were a part of that.  I've never been there, and I don't plan on it.  But everyone in healthcare has felt that "what have I done?" feeling.  When you realize that you made a mistake and someone got hurt?  You don't understand the agony of that until you feel it yourself.  It's bad enough when you notice a mistake and it gets caught before anything happens.  But when someone is actually injured? You can't even imagine.

But unless someone was fully incompetent, I don't believe you are entitled to money.  And is $4.5 million going to bring back your child?  Oh, you just want revenge.  I see.  So now, doctors can raise their prices to pay their malpractice insurance and everyone in the US feels the pain of your $4.5 million revenge.  You are a special kind of person, aren't you?  Once again: all money comes from somewhere.

The argument that you are getting $4.5 million so that no family has to go through what you did just doesn't hold water.  I'm glad you took one for the team there, buddy.  If there was criminal negligence and you press someone losing their license, or going to prison, or something like that.  That's making sure no other family has to go through what you did. But insisting that you get paid millions in settlement, how does that help other families?

Cover Your Behind Spending

You'd be amazed how many extraneous tests and imaging and everything else happen in healthcare.  Because they're afraid of litigation.  Remember the c-peptides?  Yeah. Now diabetes docs order those all the time. Ordering tests that you don't actually need is actually a form of medical fraud. But you're not going to get caught, and if you didn't run a test that you might need in a 1-in-a-million situation, and you didn't do close-to full-body scans, ambulance chasers are going to get you.  So, then someone gets to pay for them. Insurance companies.  And then, eventually, the prices of everything goes up.

So what do we do to fix all this?  I don't know.  But we do something.  And it isn't throwing more money at an already-inflated market.

A few things I can hear in my head from different arguers.

"There's a right to Healthcare." 

This brings a whole 'nother batch of cookies out of the oven that we could discuss for a long time.  But let me put a few things out there.  The Constitution (specifically The Bill of Rights) outlines the protected rights of Americans.  Healthcare is not one of them.  The Ninth Amendment acknowledges that there are rights which exist but aren't listed.  But the Tenth Amendment technically relegates the protection of those rights to the states.  So, if you want to get all American Originalism technical, healthcare should be handled on a state level, ala Massachusetts.

Then, you have to consider positive and negative rights.  Negative rights cannot (or should not) be taken away, whereas positive rights must (or should) be given.  A classic example:  The Right to Freedom of Speech and Expression. Interpret it negatively and government cannot censor.  Interpret it positively and government has a responsibility to ensure literacy.  I think most people believe in negative right to healthcare.  You can't be barred from pursuing healthcare.  Not everyone would agree that you have a positive right to healthcare--that it is something that must be given by the government. I'm not sure I do.

So maybe the argument that the Liberal side is making is that Conservatives are denying rights (which is immoral) because they believe in the positive right. Conservatives feel vilified because they feel they are not being immoral, because they believe in the negative right, but don't think the positive right is existent.  I find a lot of the arguments that Liberals and Conservatives have where it turns into "How could you be so cruel?" are a semantics problem.

"You don't have a right to Healthcare"

Before all you libertarians get all "Yay!" on me for saying that, let me say one more thing about healthcare being a right. I personally don't believe that it is a government-guaranteed right.  But it is not Christian, humanitarian, compassionate, humane or morally right to watch people not get healthcare.  And that's what we as Americans are doing right now.

"Why are we even talking about this?  Healthcare got fixed by PPACA."

Notice I didn't call it Obamacare.  That's derogatory, slang, and we don't call Social Security Rooseveltcurity, do we? But we didn't fix healthcare.  We band-aided it.  Yes, we got rid of pre-existing conditions and lifetime capping, both of which are great triumphs, but we didn't fix the problem. It's still an over-inflated market that isn't going to be fixed by throwing more money at it.  Also, for the record, it isn't even kind of socialized.  Just so everyone knows. 

"Why don't they just get health insurance like a normal, hard-working person?"

Do not delude yourself into believing that those who are in a rough spot with healthcare are merely the lazy.  We as humans like to do this.  When we see someone in a bad place, we then commence to find all the reasons why it's their fault. Why?  I think it's because we have to convince ourselves that we could never be that person.  But don't convince yourself on this one.  Today, I have a happy health insurance company that pays when I want it to, because I hardly ever use it.  But tomorrow, all of us could suddenly become that person the health insurance company is trying every piece of fine print, red tape and every legal loophole they have to say sayonara to and not have to pony up on behalf of.

If that was you tomorrow, would you be able to pay for some of the aspects of our Over-inflated Health Insurance System that might come your way?  I know I couldn't.