In Sickness And In Hell, Part I

Well, as the political season moves on, we find that once again the notion of “health care reform” is rearing its ugly head yet again.

I’m no expert, but I have a few observations and opinions.

The first is that we don’t have a health care crisis in this country. We have a health care funding crisis right now, and it’s threatening to bring about an actual crisis in health care, but that is a symptom of the real problem. In the Southwest right now, quite a few hospitals have had to close down their emergency rooms because far too many people (coughillegalaliens) are treating them as their primary care centers — and don’t bother to pay for services rendered.

What we have is a problem of perception — of people conflating “health care” with “health care funding.” For exhibit A, I give you one of my least favorite commenters, “nogo postal/nogo war.”

“last December I woke up late at night unable to wife called 911…as a Substitute teacher I have no medical benefits…for 18 years my wife has been in a kinder classroom…not eligible for benefits…
When the Denver Fire Dpt showed up and an ambulance…we were informed there is no ambulance access to the Denver V.A which was my wife’s first request as I am a service connected Vet…. ….I went to the Denver County Hospital…it turned out I had an inflamed uvula.i spent 3 days in ICU… We are paying off $15,000 in costs $275 a month…”

For those unfamiliar with nogo’s particularly incomprehensible form of English, let me translate:

“Last December, I woke up late at night almost unable to breathe. My wife called 9/11. As I am a substitute teacher, I have no work-related medical benefits. For 18 years my wife has worked in a kindergarten classroom, and (she/I/we am/are) ineligible for benefits through her employment either.

When the Denver Fire Department paramedics showed up with an ambulance, we asked for me to be taken to the Denver Veterans’ Administration hospital, as I am a veteran with a service-related disability. We were informed that there is no ambulance service to the Denver VA hospital, so they took me to Denvery County Hospital. There, they treated my inflamed uvula and I was released after three days in the Intensive Care Unit. We are currently paying off the $15,000 hospital bill at the rate of $275/month.”

nogo wanted to use his story to show how bad the health care system is. Instead, he showed just how good it is.

He was in serious physical distress. He was taken to a hospital that was prepared to deal with his problem, treated successfully, and released. And since he didn’t complain about his treatment, I feel safe presuming it was done well.

His problem is with his health coverage. He says he lacks insurance, as it is offered through neither his job or his wife’s. He apparently has some coverage through the VA, but he didn’t know the details in advance. He did not know that his hospital of choice was not served by ambulances in his area. He did not know that ambulance service was not covered at all.

He did not know in advance just what was covered and what was his responsibility. In short, he was woefully ignorant about the details of what was literally a matter of life and death — his life and death — and is unhappy that no one swooped in and saved him from the consequences of his ignorance.

nogo, as he noted, was treated for his problem. He might even have had his life saved. And there is nothing unique about his story; it happens every day across the United States. Our health care system treats everyone who seeks help, regardless of their ability to pay.

It is those who are unable or unwilling to pay that cause the problems. In that, nogo is to be lauded — he is paying his debt, to the best of his ability.

It boils down to simple economics. Robert Heinlein encapsulated a universal truth in a simple, snappy acronym: TANSTAAFL. There Ain’t No Such Thing As A Free Lunch.

Everything has costs. It might not be strictly financial, but it is inevitable. Every aspect of nogo’s experience had its costs. The ambulance needed to be bought and maintained. The paramedics needed to be paid and equipped. The hospital has its own overhead, as well as the salaries of all the workers who cared for him, provided him with his bed and linens, the cost of all the instruments and drugs and supplies used, and so on.

Even “free” services have their price. The person who is declining to charge for their time is “paying” for it in lost time and opportunity.

At my day job, I’m often asked why a company should use our services instead of simply doing it in-house. I tell them to take what they would pay someone to do the work, and then double it — because while they’re doing the work we do, they’re not doing the normal work they would normally perform. That doubling represents a hidden cost, one most people overlook.

So, we have a health care finance crisis. What should we do about it?

I don’t have a ready solution. But I do have a few ideas about what doesn’t work. I’ll explore that later.

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