Would My Healthcare Solution Work (and Other Bits of Unfairness)

In the two weeks or so since I proposed a simple, comprehensive fix to the healthcare mess (see previous post), I’ve been given three reasons why it wouldn’t work.

  1. It’s politically implausible, either because it involves too much common sense or because it would gore the ox of a large, well-entrenched industry. I’ve lived inside our national sausage factory, so I recognize that these criticisms are legitimate. I can only say that the fact that it would be difficult doesn’t make it a bad idea. The definition of insanity, variously misattributed to Benjamin Franklin, Mark Twain and Albert Einstein, is doing the same thing over and over again and expecting different results. At some point, we’re going to have to do some things differently.
  2. No one walks around wearing a sign that says, “I’m now in the last year of my life. Stop spending money on me.” This is true, but it should be relatively easy to come up with a list of procedures that a national healthcare system won’t pay for beyond a certain age, such that the amount we spend on people in the last year of life would drop from the current 20+% to a more reasonable number – say 5%. I understand that this would be painful, and in some cases perhaps unfair. To that, I can only say that we have to make some difficult choices and that the only way to spend less is to spend less. I’ve said elsewhere (and often) that because it is impossible to place a monetary value on the benefits delivered by healthcare, there has to be SOME exogenous intervention to limit what we spend on whom. Otherwise, we will disappear up our collective exhaust pipe. I would also note that the (exceptionally liberal) state of Oregon has imposed these kinds of limits on state-funded care, and the world hasn’t come to an end. I’m not saying I like this – who would? Only that I think it is both appropriate and necessary. And that the private market would be there to provide supplemental policies, which I think amounts to belt, suspenders, raincoat and umbrella.
  3. We would quickly find ourselves faced with the dilemma of low-income, obese smokers who can’t afford the co-pay, and would have to decide whether to let them go without care (read “die”) or let the rest of the system subsidize them. This is toughest of the critiques. The former is not an option, so it becomes a question of math – would there be enough of these people to make the system I proposed untenable? My answer is a profound “I don’t know.” I think not, but the math, and the question of what would happen if everyone had some skin in the game, is where the answer lies.

Enough seriousness for now. One of these days I’ll take on taxes (God help us) or whine about how we market presidential candidates like hamburgers, or perhaps decry the group insanity that results in a diplomat dying because some nut somewhere made a really bad movie. For now, though, two other, less consequential observations.

First, I was reminded last week that every city has its own driving ethos, and that Chicago’s is generally very civil, but with two notable exceptions. One is that if you’re trying to change lanes on a freeway or busy street, the person in the lane you want to move into will take your turn signal as an indication that he or she should speed up and fill the space you hoped to move into. This is a little like treating a yellow light as a reason to speed up, except that the yellow light is moving at 70 mph, and I’m driving it. The other happens when drivers in downtown Chicago reach an intersection in which the street street they’re on is full on the other side of the cross-street, so they have no place to go. Chicago drivers don’t pull into the intersection, which would cause gridlock. They sit patiently on the near side and wait very politely – right up until the light turns yellow, at which point they zoom into the intersection and gridlock it. I have no idea what this says about Chicagoans, but the consistency of both behaviors never ceases to amaze me.

And lastly. . .this past summer, I restarted my somewhat dormant career as a concert-goer. I don’t know quite how many shows I saw, but it was a lot and I enjoyed them immensely. I also discovered that it is now, apparently, de rigueur at rock concerts of any size to have a sign language interpreter. I have no idea what it’s like to be deaf or to have significant hearing loss. I have a little tinnitus, the result of both listening to and playing too much loud music. For years, I have shamelessly worn earplugs at rock shows to keep it from getting any worse. I also find that I can actually hear the music better that way, which makes me wonder what the sound guys know that I don’t. What I do know is that I can’t understand any of the words anyway, so the presence of the interpreter strikes me as a clear case of reverse discrimination. How come the people who can’t hear are the only ones who know what the singer is singing? Shouldn’t the rest of us get subtitles? I’d also be curious to know exactly how you sign “I’m just lookin’ for some tush.”

A last note: as I went to post this, I discovered that someone found my blog yesterday through a Google image search of the term “chastity belt teasing.” I need to go home and re-think my life.

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4 Responses to “Would My Healthcare Solution Work (and Other Bits of Unfairness)”


  1. 1 qualityhealthcareplease September 16, 2012 at 11:52 pm

    Looking for solutions is fantastic and many steps above our political leaders. In the spirit of healthy debate I think your solution does not go far enough. The US health care system needs an overall budget. If we put a limit on what will be spent people might pay more attention to where the money goes — as it stands now there is no limit and nobody cares about being efficient or cutting losses. The UK has a national health care budget and they get twice the quality at half the price — amazing.

  2. 2 Steve Smolinsky September 17, 2012 at 9:43 am

    As with so many things, difficult choices are involved. Our problem is that we start with people at opposite ends of the spectrum who think compromise is failure rather than a system that is totally disfuntional being failure. Having just returned from London I am impressed at how happy most people are with their national healthcare which manages to cover eyeryone at hour the cost of our system and with better results in many areas of care. As long as our leaders have their heads hidden in their nether regions and are looking for ppolitical gain and personal gain rather than to solve the problem…we are toast.

  3. 3 Steve Smolinsky September 17, 2012 at 9:45 am

    I see my comment wound up with “at hour the cost” Of course it was supposed to say “at half the cost”. Damn computer should know what I mean to type.

  4. 4 Holly Thomas September 17, 2012 at 7:30 pm

    Having so far, with great difficulty, and only because I also use this laptop for work, resisted googling “chastity belt teasing” to find out what that actually involves, and having had to push the inner video screen way off to the side so I could focus on saying something worthwhile instead of picturing creative ways to sign “I’m just lookin’ for some tush”, I’ve mostly forgotten the healthcare solution that leapt to mind when I started reading your post. It had something to do with agreeing to swap baseball for cricket for a season or two if parliament will teach congress a) how to set up a respectable healthcare system and b) how to find its tush with both hands.


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