Wednesday, January 18, 2012

Go Read Charles P. Pierce On Health Care

He is telling his own story about what it is like to have good health insurance in the US. Or one tiny aspect of that experience, but I bet it is an aspect many of you have also experienced. I certainly have.

A snippet or two:

Ultimately, after the nice pharmacist lady enters the proper launch codes, I wind up getting one of the two prescriptions I came for. ($600 co-pay, my arse, pal.). Today's scoreboard totals: almost four hours total, an hour or so on hold, four different companies, four different phone trees, 16-20 buttons pushed (I lost count), four different automated voices with which to chat, eight very polite but ultimately unhelpful purportedly live persons. One of two prescriptions filled.

And I'm one of the lucky ones. I can marginally afford to go through all this. I can just imagine what people on the low end of what is laughingly called a "system" must go through.

I mention all of this because, tomorrow night, the five remaining Republican candidates will get up on stage and they will promise to repeal even the tepid, insurance-friendly reform of the way we do health-care in this country.


Every single one of these Republicans will make the argument that, because of the entire morning I spent dealing with the preposterous way we do health-care in this country, that I am a "freer" person than are the people in Canada, or New Zealand, or Germany, or Finland. That I had to spend an entire morning mired in bureaucratic absurdity means I have retained my "freedom" as an American.
And of course Pierce's whole post is, as he writes, written by someone lucky. He can afford health insurance and he has the time, health and ability to fight the system though perhaps not to win that fight.

As I have written until boredom tears flow from my eyes, the market model is extremely problematic in health care. It simply does not work very well, and no country on this earth, not even the Wild West US of conservative dreams, can run a truly market-based health care system without very stringent regulations.

One very simple example of the ways health care markets fail is in the description Pierce gave us: The bureaucracy. Conservatives argue that it's the government which creates bureaucracy but nothing is as good at creating duplication and confusion and impossible-to-interpret clauses than the US private health insurance industry.

There are several reasons for that, but they ultimately boil down to two: The giant information problems which are inextricably tied to many forms health care services and the absence of economies to scale in the administration of the claims.

Though I must admit that Pierce's story also reminded me of the bank mergers in the 1990s when there were days I didn't know what my bank was currently called, and also the mortgage markets where the day's puzzle used to be "Who in the World Owns My Mortgage Today?" I'm not saying that these phenomena are the same in what caused them, though perhaps they are.

But they share in that feeling of increasing consumer powerlessness. You don't know who you are dealing with, you don't know whom to call, and the identity of the firm you signed your initial contract with has become utterly meaningless.