Have you noticed the surge in advertising for private health care facilities? I have. What's the purpose of advertising a hospital or clinic, anyway? They don't want more business, do they? Do they want a bigger market share? I don't like the sound of that. What's going on here? It's darker and more nefarious than you might imagine. Boycott all medical charities!
The slick ad for the Seattle Children's Hospital flashes on the screen. A heart-rending montage of the images of its young patients assails our senses. Their bald heads and braced limbs elicit comments like, "They're so brave!" The girlfriend is nearly in tears, just like when they do a story on the animal shelter on the local news. She vows to increase her contribution this year, "for the children." Oh, good grief.
Anyone aspiring to full curmudgeonhood should see the opening here. This is the archetypal situation where it's so obvious that they are shamelessly playing to sentimentality that a true curmudgeon must instantly point out the disingenuous, manipulative purpose of the ad. But, I was stumped for a moment. I couldn't get past the pointlessness of advertising medical care. It's a really stupid thing to do when you consider it objectively. I don't think they advertise their medical care system in Great Britain. Health care is there when you need it and everyone knows it. But, this is not Britain.
I mean, why? What benefit to society could possibly accrue from advertising a hospital? Would the care be better? Would they get more money in contributions? Bingo. That's it. It's got to be about money. Those stinking, money-grubbing bastards are parading their legions of sick children in front of us to get us to cough up even more money for Cadillac health care for a select few when most of us don't have adequate health care for our own children and ourselves.
This is what happens more often than we want to admit. One lucky victim of a dramatic, severe illness, like brain cancer, gets accepted as a patient. Little Johnny doesn't even have to worry about the huge medical bills because the magnanimous private medical foundation doesn't reject anyone because of their inability to pay. Swell for little Johnny, but what about the rest of us with swine flu and other humdrum disorders?
What if I've got high blood pressure or my kids are pre-diabetic and we don't have insurance or any money? We don't get preventive care and regular checkups because doctor visits cost a lot of money. Even if we have medical insurance, the deductible is so high and the cost of medication so astronomical that we still can't afford it. We put it off and try to ignore the little signs that our health isn't that great. Finally, we collapse and pass out at our dead-end job and get hauled to an emergency room. The insurance company denies the claim for the $1,000 ambulance ride because it wasn't pre-approved. The doctor at the ER is harried and rushed, but still takes time to strongly reprimand me for neglecting to get a regular checkup and be diagnosed. I'm put on medication, but can't go back to work for a while, so the temp shop that farms me out to the high-tech sweat shop and rakes off over half the billing for little more than cutting me a paycheck, terminates me. Since I don't work for them any more, I am offered the crappy COBRA medical coverage for even more money than I'm overpaying now, so I let it lapse. Now, I've got no job, no insurance and rapidly mounting medical debt. What's the remedy? Gee. After the house is gone and all my other assets are depleted, I might get some kind of state aid. But, I have to tap out before I get a dime.
Here's where I earn my curmudgeon's stripes. I think we all ought to withhold all charitable contributions to private medical institutions until we have universal, free, publicly-financed health care. Does it make any sense to do otherwise? If you can't be sure that you won't need every available dollar to pay for unforeseen medical expenses for yourself or members of your family, how can you shell out to some slick huckster fronting for a charity? You might be setting the scene for your own child to die for want of treatment so another kid can get chemotherapy for his disease. Where's the logic in that?
I can hear you bleeding-heart folks shaking your fists in outrage already. "My charity gives every dime to help poor, sick children!" Do they? If your charity advertises by direct mail or has a telethon, then there is a professional fund-raising company taking a huge cut. All those people stuffing envelopes and putting on the show are paid. They make a living doing that. TV time is expensive, too. Don't kid yourself. Private charities constitute a huge surcharge on money intended for the promotion of the general welfare. Do you remember the scandal a few years ago about that charity that supposedly helped poor children overseas, but spent nearly all of the money on TV advertising and their own salaries? If you can't accept that, you're denying reality. What are you, a Republican?
Charity is pretty much a scam. There may be some that do a decent job of keeping the overhead down, like the Salvation Army, but most have highly paid executives and fancy offices. These are largely paid for by working class people who may not have as high a standard of living as the people they are subsidizing. When this happens, it amounts to regressive taxation of the poor for the benefit of the better off. This is sick.
How often have you seen the intimate family profile of a kid getting free treatment at one of these places and remarked, "Hey! They don't look like they have it that bad!" No kidding. I think that a lot of people who were a lot poorer than the kid's family contributed to that charity. Until I started working as a professional after graduate school, I used to routinely observe that the family receiving the largess always had a higher standard of living than my own. When you grow up poor, you know what money looks like. ("Hey! They have a house! I live in a barely-legal ghetto apartment! They have two cars! We don't even have one! He's a manager of a fast food restaurant! My dad's job doesn't pay any more than he pays one of his employees! That color TV is huge! I've got a tiny black-and-white with a coat hanger for an antenna. I've bet they've got cable.") If someone is richer than I am, why in hell should I pay for their medical care?
Alas, it's again obvious. I should pay for it, just as they should pay for mine. Everybody is in this together and no one gets out alive. Health care is a human right, not a luxury or an economic good. We need socialized medicine, and we can't afford to perpetuate a private system that holds out one hand for alms and presents a bill at the same time, then tightly clutches the purse strings in the other, dispensing much less for health care than it takes in.
There's the nub of it. Whenever there is an intermediary between the provider and the recipient, such as a charity or an insurance company, they rake off a big cut. To change the system, you have get rid of the intermediary. Or, you can switch intermediaries to one that is much more efficient and uses more if the money collected for its intended purpose. We have an excellent alternate intermediary; it's called the IRS. Can you think of a more efficient way to collect money for medicine? We already have a national taxation system to collect money to run the government, build roads and fight wars for the benefit of multinational corporations that avoid paying taxes by housing their dummy corporate headquarters in the Cayman Islands. Why not use the IRS to collect the money for little Johnny's brain surgery? It's so simple and obviously true that it doesn't seem right. We have been inundated by socially regressive propaganda for so long that objective reality seems bizarre and exotic.
We would not need an intermediary at all if all people were fully responsible for their own medical care. You could just pay doctors and hospitals directly for your care. But, we all recognize that such a system is unconscionably cruel and manifestly unfair. With that paradigm, catastrophic illness portends financial ruin for all but the most wealthy. To mitigate this situation, we came up with the idea of spreading the risk and the consequent expense of illness among participants in an insurance pool. Later, governments took on the role of managing that pool and collecting the funds to sustain it. When the government collects the money, and spending the money has no connection with the amount that anyone paid in, that's single-payer, socialized medicine. Hell, even a majority of doctors are for it now. Did you know that?
Therein lies the genius of the social contract, that is, the recognition that government is the mechanism to manage what we hold in common as a society. By decoupling the collection of money from its expenditure, you allow the adoption of another system for allocating who gets what than who had what to start with. Getting medical care and what kind of care they get becomes a medical decision, made by medical professionals who have been trained and swore an oath to heal. They are not the MBA's who went to business school with me and have no other motive than to maximize profit for the stockholders and enrich themselves. If a board of doctors in my community has to decide who gets the one kidney available, I feel a lot more confident that it will go to the person who has the greatest need if it's solely a medical decision and the relative finances of the prospective recipients are not even considered.
When money or social or political connections are a factor, the system is always unfair. There was a guy in Texas in 1995 who died, even though he was at the top of the liver transplant list, because he didn't get the liver that went instead to a rich, burned-out, alcoholic ex-athlete. It was a scandal then, but now it is noted as having been "controversial". They guy is dead and forgotten, but I'll wager that his family is still bitter as hell. I remember at the time hearing his kid say in an interview something like, "My dad died because Mickey Mantle is a big star and my dad was not." How many more times has that sort of thing happened since then? God knows. It must end.
The prescription for reforming medical care is pretty simple, and not as hard to do as the insurance companies and the other parasites feeding on human misery would have you think. It only takes a few simple things, the first of which I outlined today. I'll treat the others in subsequent diary posts. Here's my list. It amounts to a demagogic tirade here in the USA, but in the rest of the world, they would say, "So, what else is true?"
- Ban all private, charitable fund raising activity by medical institutions. If someone wants to give money, that's fine, but they may not be solicited by paid employees, nor may contributed money be used to defray expenses or salaries for paid staff.
- Ban private medical insurance. (Yep. I can't wait to dive into this one.)
- Ban medical billing. Outlaw the collection of any money, even "co-payments" and nominal "user fees" for non-elective medical care, treatment or medication anywhere in the USA, its possessions or facilities in foreign countries. That is, if a medical professional prescribes it as medically necessary, it can't be purchased and will be supplied as soon as possible. (If you think this is radical, talk to anyone who has ever been treated for anything in France or Great Britain.)
- All medical facilities continue to provide care, with all current staff who wish to continue working there. They draw their salaries directly from the federal government. Anyone who doesn't want to be a government employee doesn't have to, but they can't be health care providers in a facility that provides non-elective medical care.
- The U.S. Public Health Service, the established uniformed service of medical professionals sworn to provide health services to the public, becomes the administrator of all public medical facilities. That is, the Surgeon General becomes the chief medical officer of the nation rather than an avuncular expert who tells you to stop smoking, lower your cholesterol and masturbate. We already have an army of doctors; it's time put them on the front lines.
- Medical students receive full tuition and a stipend for living modestly in exchange for a number of years of service as a USPHS or military doctor after graduating. Dropouts and those who opt not to serve as doctors will be responsible for the full cost of their education. (Military service or working as a lower-than-MD health worker may be substituted for full payment.) Admittance to medical schools by foreigners will be limited and tightly controlled. It will be reserved mainly as a diplomatic tool and to maintain connections with the medical education systems in foreign countries who also have free, public medical care. (I'm not paying taxes to subsidize medical schools that train doctors who will serve only rich despots in socially regressive foreign nations.)
- Legalize marijuana. The savings in pointless enforcement of absurd laws is mind-boggling. It also opens the doors to the medical benefits of the plant. The taxes collected could finance a good part of the new medical system. No kidding. Let all the pot smokers and dealers out of prison now. That's more money saved.
- Treat drug addicts instead of criminalizing them. Seriously. Let them dry out in free, government-run sanatoriums, where they are remanded instead of to prisons. More savings.
- Stop taking any crap or suffering specious arguments from idiots who don't want medical care. Just stop them short and tell them to shut up.
Please, for today's post, limit your comments to the issue of charitable giving. I promise to do pieces on the each of the other points, and we can discuss them one at a time. Let's focus and beat the death out of this one issue first!