Healthcare: A View From the Can…

Mr. Trashcan himself hasn’t been around all that long.  BUT.  We steel appliances are subject to a form of reincarnation, via the scrap yard, and our sheet metal retains a kind of genetic memory of earlier times.   Thus I am able to take you back to the 1950s, well before the cost of Health Care got out of control in the US.   Blue Cross was just starting to be offered.  Middle class people could afford to pay for health care out of pocket, but the people at Blue Cross saw a market: they would protect you from a sudden, health-related financial hardship by converting it to a steady monthly drain spread over your whole life.  These steady drains, from millions of patients, would form a steady river of money, flowing through them, from which they could dip.

Things were going good.  In the 50s, the middle class included an awful lot of people, don’t forget, and for those below the middle class, if they showed up at the emergency room, or even the doctor’s office, they got treated.  There was plenty of health care to go around.  They didn’t have a fraction of the technology that we do, but they provided a very high level of personalized, professional care using the equipment they had.
Patients were very different in the 50s too.  Their expectations were lower.  They waited until they definitely had something wrong before they sought medical care.  Nobody was making up new diseases for them.
Drug companies produced miracle drugs, life-saving antibiotics and vaccines; they were heroes.
The doctor always had the biggest house in town, and Mr. Trashcan doesn’t remember anyone resenting it; it seemed the natural order of things.  Old Doc Smith was an educated man, very polite, and when you called him in the middle of the night, he would come.  If you were having money trouble, he would give you any kind of break you needed.   People need aristocracy, and the local doctor was a cornerstone of small town aristocracy; respected, admired and downright useful to boot!
What changed all this?
Mr. Trashcan blames the insurance industry, or rather the concept of health insurance itself.  The mighty river of insurance money has destroyed the system; patients continue to dump their money into one end, buying a complex and abstract product.  Health care providers drink greedily from the other end, and a whole second layer of parasites, the lawyers and administrators and bureaucrats all dip from the river, which swells until it threatens to bankrupt everyone on the upstream end.
Medical insurance severed the economic feedback loop between patients and providers.  It was this free market interaction that kept doctors, and drug companies, and everybody else, from just charging whatever they liked for their services.  Of course, the doctors couldn’t immediately demand a million dollars from Blue Cross to remove a wart, but over the years, given the constant pressure for increased profit, costs just naturally rose; it’s as natural as buoyancy or convection.   The insurance companies only resist so much, before just raising the monthly fee a little.
Over the years, insulated from market forces, the whole culture of what a doctor is and does changed; the doctor shape-shifted into a creature that couldn’t even live in the atmosphere of a small town.  They made their way to Manhattan, Miami, Sana Fe, California, Boulder…   Soon they had not only the biggest house in town, but enough income to buy ten houses, and boats and airplanes and clinics and labs and…
But, even today, inside many of these creatures there is still the benevolent, useful, hard-working core of  Old Doc Smith; you can catch glimpses of it as it tries, from time to time, to assert itself on behalf of a patient.  But, basically, it is trapped inside the ugly shell, eating money and growing, nourished by the insurance payout.
As for the pharmaceutical companies, if you want to know what they’re into, just watch the TV commercials.  We might be less than one antibiotic away from deadly infections, but you can get maintenance drugs out the wazoo.  The epitaph for the human race will read: they died with stiff pricks!  It’s not only expensive and dangerous, its silly.
No point in lambasting lawyers here.  They’re already thoroughly lambasted.
And then there’s the patients:  having put money into the system, they want to get as much out as possible.  They want instant access to any procedure, without consideration of cost.
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How can humans rescue the Health Care System?  Looks pretty obvious to Mr. Trashcan.  Of course, it’s easy for him to talk, since his health care needs are minimal and, unlike you, he has factual information about the afterlife.  But, notwithstanding, here’s what has to happen:  The feedback loop has to be put back in place.  There has to be some kind of immediate cost associated with medical services.  People have to pay the doctor themselves.  If we decide we want to help them, we need to slip them a few bucks before they go in for their appointment, so that they experience the dollars in their hand, and experience handing them over to the Doc.
That’s the only way you’ll ever put the brakes back on; every single patient has to drag his feet a little, and the juggernaut will bog down.
And everyone who participates in this system will have to give up a lot.   Providers have to give up profit and income.  Patients can’t have limitless, infinite access to any procedure dreamed up by the mind of man.   I don’t know what’s going to happen to the middlemen, the insurance companies, but if they continue to exist, it will surely be in a highly regulated form.    That’s why it’s going to be so unpleasant.  But, bear in mind, the unpleasantness is only in the delta, it will all settle down to something you will like.
Of course, Mr. Trashcan is much more sophisticated than you would think from looking at him (remember the obelisk from 2001 Space Odyssey?)  so he knows there are other things that have to be done, things that must even be done by (shudder) government.  Somebody has to police the obvious conflicts of interest that doctors-as-investors get themselves into when they own a piece of a lab or an MRI machine.  A New Yorker Magazine was thrown into Mr. T recently, and it contained an article suggesting that this may be the single most pernicious influence on the whole system.
Mr. Trashcan hopes that humans will do these things.  He would like to see the doctors freed from their financial lust, so that they could once again be just hard working guys with big houses and Lexuses.   It would be nice if the Drug companies could go back to making drugs that cure real diseases, instead of  just helping you focus or helping your kid adapt to his strait jacket or suppressing restless leg syndrome, but that’s probably too much to hope for.
More later, I’m sure…

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