Why Health Care Is Not Like Groceries

Whet on comparison-shopping for organic produce:

If Mackey lost his conscience and Whole Foods started selling shitty
food, that’s easily addressed by consumers – they might have to pitch
one trip’s worth of groceries, but they’d go somewhere else.

But if those consumers got screwed out of their health care by an
insurance company, they can’t go elsewhere. If you get cancer, and your
insurance company decides not to cover it because they ginned up some
pre-existing condition that you didn’t know you had or shouldn’t be
relevant (this is calledrescission,
and it’s a serious issue), you can’t just go to another insurance
company and say “hey, treat my cancer, and pick up my tab at the old
insurance company while you’re at it.” A shitty grocery store can’t
destroy your life – figuratively or literally – with one decision. A
shitty health insurer can.

Also, keep in mind that Mackey has, for his entire life, been
selling to well-informed, well-heeled customers. Not everyone has lots
of money or information.
Some people are poor, some people are
desperate, some people are dumb, and some people are all of that and
more. Those people are easy marks (especially when it comes to
something as arcane as health insurance) or unappealing targets, in no
way able to keep up their end of the ideal free-market transaction, and
that’s where a lot of liberals diverge from libertarian views
– they think those people should be provided for and protected by the
government, either directly or through the legislation of private
business. Liberals think that should be the case because of moral
beliefs, or because they think a healthier populace would make America
more functional and productive.

Emphasis mine, because I was having this conversation with an acquaintance the other day about all the information you’re expected to find on your own when you’re going through some medical drama. The doctors and nurses I deal with on a near-daily basis are absolutely astonished whenever I don’t know something, like if a test result is what you’d call normal or what some number might indicate or even in what order certain procedures are done and how many times. They look at me like teachers who are pissed I haven’t studied for their tests.

And, yes, I have the time and wherewithal to seek out information (except the medical Internet isbonkers, which is another post, plus dammit sometimes I just want them to do their jobs and tell me what I need to know) but what if I didn’t? What if I didn’t have a job that was flexible in its hours so I could get to appointments which are whenever the doctor feels like it, what if I didn’t have the time to research things and call friends and get second opinions and really be in charge of this myself? Not everyone can, and we have designed a system that is basically made to weed out the old, very sick and easily frustrated, to shove them into underfunded emergency rooms because if they can’t deal with the constant hassle they just wait until they can’t wait anymore.


11 thoughts on “Why Health Care Is Not Like Groceries

  1. Also: Privatization is not just the transfer of risk to individuals but the transfer ofwork. President Baucus talks about co-ops as though there’s this huge pool of knowledgable people just saturating the land and champing at the bit for the opportunity to run their own little slice of the American Capitalist Dream. (“Hey everyone! Let’s start an HMO!”) And that the rest of us want to wade through the various options such watered down noncompetitors to the current giants would offer. That would be a pain in the ass. Just like it’s a pain in the ass to keep track of various defined contribution plans (which accumulate as job situations change, don’t roll themselves over when that happens, and go up – or, for the last decade or so, sharply down – with the movements of a market being gamed by Goldman Sachs et. al.) I keep investing in because I am convinced Adam Smith’s lunatic inbred descendents will kill their much more sensible government-run counterpart by the time I retire.
    Yes the free market is a wonderful thing, but that doesn’t mean people want to wade through a huge array of choices from the moment they roll out of bed in the morning.

  2. You’ve touched on something that’s a problem in other areas, too, in addition to health care. Take credit, banking and consumer issues, for example. On one hand we have larcenous, unregulated corporations, with their stables of accountants and lawyers, and on the other, we have some ordinary, over-worked, under-educated consumer who can’t hope to avoid the scams and the fine print. It’s asymmetric, and it ain’t right.

  3. On the nose, Snarkworth.
    And as has been late night TV fodder, all this talk of healthcare reform has started advertisements of insurance companies which make it sound like they are part of the govt plan.
    And the banks we bailed out, they reward us with charging more fees which work out to several thousand percent profit per year.

  4. There is a Catch-22 there though. If you know the medical information, then they decide you are probably a hypochondriac.

  5. My mom was the primary caretaker for both her parents, who each declined in health over about a period of eight years, first one, then the other – so she had to deal with the health-care system constantly over a long period of time.
    And as normal people go, we’re very fortunate. They were classic off-the-farm American dreamers who managed to save a surprising amount of money working (actual) middle-class jobs; they had two well-educated kids, one of whom became an engineer and the head of a company and made a fair amount of money; and I have three aunts who are nurses (and that really, really helps, more than anything).
    As these things go, it went as well as we could have hoped. No one went bankrupt, quality of life was maintained as well as could be.
    And it was still incredibly complicated and took an enormous amount of her time. I’m always surprised at how little this comes up – I really don’t think it’s a minor issue: people don’t want a part-time unpaid forced internship in navigating the health-care system.

  6. whet moser:
    I had one of those, too. I was my dad’s “hearing-ear dog” for several years before my mother’s final illness, throughout her 3-month-long stay in an ICU, and then for the 2 years he survived her.
    unpaid forced internship is *exactly* what it became.
    On the plus side, three years after dad died, because I could read medical charts and SOAP notes, I got a pretty decent job with the state health department. That ended 13 months ago, though.

  7. DJA, you are so right! If you do know anything, they just seem to resent you even more.
    I have the opposite problem of usually being better informed than my doctors. My shrink always tells me what a great doctor I would have been! I talked him into the medication I currently use — it was an off-label use at the time. He thanks me to this day since he has so many patients on it now. It took almost five years to convince doctors I had hypertension — had to change doctors eventually because the asshole just wouldn’t believe it wasn’t white-coat hypertension — I was “too young”. I had to see three opthamologist to get my cataracts diagnosed, because I was “too young” to have cataracts. I’ve also been “too young” to have arthritis, which I eventually had to go to a chiropractor to get proper treatment for, since the other doctors just put me on painkillers, one side effect of which was, you guessed it, hypertension… OTOH, my doc now wants me to get a bone density scan I don’t need, because I have no history of bone density problems, get plenty of calcium, and work out with weights.
    I once diagnosed a friend’s daughter with diabetes — her Mom was a nurse, she eventually went for a second opinion after the doctor denied her daughter was diabetic, and sure enough, she was.
    Doctors don’t know everything, and insurance companies know less. How the hell do they know what procedures I need or don’t need, when they’ve never even met me?
    So sick of the bullshit that is our medical system, even with the BEST of insurance and care!

  8. I really don’t think it’s a minor issue: people don’t want a part-time unpaid forced internship in navigating the health-care system.
    So true. Plus we do not address in any way the humiliation factor that comes from dealing with being ill. Using my crazy as an example, if the first doctor I’d seen had told me I was full of shit and making my problems up, I likely wouldn’t be here right now. Only by sheer chance or the grace of the whatever did I end up with somebody gentle and kind who immediately saw how close to the edge I was. By the time I saw doctor number two, who did tell me I was a silly girl who just needed to snap out of it, at least I was coping well enough to tell him to eat a bowl of dicks.
    When you’re sick, man, all you want is somebody to tell you it’s going to be okay. It’s astonishing how little of that we actually get anymore.
    ps. I later found out that asshole doctor had chased off half the patients in the practice because he was fond of solving, you know, actual mental illness with admonitions to take up punishing endurance workouts and take vitamins. To this day I wonder if he was a secret Scientologist.

  9. the medical Internet is bonkers
    Absolutely–the amount of time I’ve wasted trying to weed through various medical web sites is a whole new level of frustration.

  10. For medical information I use the online Merck Manual, but since I was just diagnosed with Graves Disease plus the appearance of two nodules in my thyroid, one of them 3.5cm x 2.5cm. That’s big – in stupid US terms, it’s 1.3 inches x 1 inch. The endocrinologist (a woman, by the way) explained things to me at the consultation, and has given me three excellent medical articlesfor patients explaining the options I have, their up sides, their down sides, and everything else I need to make an informed decision on my treatment. I find that the younger the MD, the more informative they are, especially the women. Perhaps a sign for the future?

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