Tuesday, May 31, 2011

The Most Boring Post Ever

Why am I posting this?  I have no idea. I'm sorry for anyone who reads this, it just bubbled out of me. Actually, I know why I wrote it, my son is trying out for football and basketball this year, and they keep making him have physicals, of course our insurance will only pay for one per year, but they insist that the physical has to be within the last 30 days before it will be accepted by the school. Sigh. It isn't fair. Anyway, I wrote the following in a 15 minute binge of, um, creative whining, enjoy.

Health insurance in the U.S. makes no sense. I often felt like I would have gone a radically different way in life had I not been forced to seek employment for the health benefits. I’m rather conservative by nature, and a bit averse to taking risks. I’m not the type of guy that will have 17 start-ups and declare bankruptcy 6 times before finding the means of succeeding. I’m just not going to do that.

So, what was I going to say? Oh yes, the story about the history of the insurance industry is very interesting, hopefully, interesting enough to read a few hundred words about.  I’m sure I’ll get a few details wrong, as I don’t believe in research. So here goes. Consider it ‘truthy’, if not accurate in every detail.

Way back when the world was young, being a good doctor, at least in the U.S., meant being nice, and having the ability to kinda sorta make people feel better if you could. It didn’t matter if what you were doing was beneficial or not, as long as you were making the effort.

Well, the scientific method had found a firm footing in Europe and some genius decided to put those methodologies into place in regards to medicine. The U.S. lagged behind a bit, but slowly, things started to catch on here too. By the late 1800’s it was still a ‘feel good’ sort of profession here. You wanted to be a doctor? Good, hang a sign in your window and open your shop. You needed more training to be a cobbler than a physician in those days.

Aspirin hit the market and guess what? It actually had some medicinal benefit. After that, folks were starting to expect their doctors to, you know, actually know what they were doing, and prescribing things that would actually help, not just get them drunk.

So, with actual money being spent to develop treatments, drugs, etc, the cost of seeing a doctor was beginning to rise. It was still affordable for the most part, it wasn’t prohibitively expensive, but it was going up. I think that cheap, but still modern medicine (in the sense that the word ‘efficacy’ was being thrown around) was the norm until around the 30’s, when the great depression was wrecking the lives of everyone and even a cheap trip to the doctor was impossible for a lot of folks. A suffering hospital went out into their community and asked if folks wanted to spread the costs out so a single trip to seek medical attention wouldn’t force folks to choose between eating and getting their broken leg set.

Yea, insurance was born. Everyone lived happily ever after.

Until WWII. Damn Nazi’s ruined everything. Companies looking to hire much needed help were competing for a small pool of applicants, with most of the young workforce off fighting across the globe there was a lot of competition for talent. Knowing this was going to be concern, and worried that paying high wages would really screw up our economy, the powers that be froze wages. Companies couldn’t offer more money, they’d have to entice folks with other kinds of… benefits.

A ha!

I won’t get into how, in the 60’s, the modern a la carte model of medical services, dictated by the U.S. government, doomed us all to a runaway inflation for medical services, made middle class doctors into wealthy men, and quickly made the possibility of getting medical care without insurance impossible. That isn’t the point. The point is that every large company in the U.S. was offering health benefits to lure workers in.

That might have been a temporary thing, a stop gap measure until the boys that were off defeating the Axis powers got home to start working again, if it weren’t for one, teeny little thing, an arbitrary decision made by a no-name accountant buried deep within the labyrinth of the government bureaucracy that was asked a simple question one day.

Do we get a tax break for this?

Yep, that’s it, an urban legend was going around that companies that offered medical benefits to their employees could get tax benefits for doing so. There was nothing in the tax code that said it was so at the time, but the rumor persisted, and if the story is to be believed, when a mid-level guy was asked, formally, if this was the case. He had no idea, but said yes.

The official pronouncement spread like wildfire, the government, if they were waffling on the point, had the decision made for them. It was shortly thereafter made official and there it was.

So today, 70 years or so later, workers are tied to their jobs because we can’t pay half a million dollars for a simple procedure because that’s just a bit too much. And the employer based Insurance system we have is all we have. Sure, I could go out and get insurance on my own, but the cost of doing so is also prohibitive, and the level of care I would be getting would be far less than what I get now. For some reason, most Americans think it’s the greatest thing in the world. And if I loved the work I did, like, really loved the work I did, then I might agree. But doggone it. I’m not that thrilled with it. I could make more money doing other things in life. But the person in me who fears that he’ll wake up one day with a third arm sprouting from my skull doesn’t want to lose everything I decide to have said third armed removed. I’ll go and pay my measly little co-pay, have it lopped off, and thank my lucky stars I’ve got medical insurance.

Doesn’t seem right though. It isn’t right. I don’t know what to do about. I may write a blog post about it.


Arlee Bird said...

You oughta write a blog post about it for sure. And what's so bad about that third arm? Could be useful.

I've never had a job where I had medical insurance. Fortunately, my kids and I were always pretty healthy and never had any real bad problems. Later, when I married my present wife, she had good health benefits that covered me just when I started needing them. Now they're a necessary evil for me. Like all big business there are some benefits to the healthcare industry, but the bad may outweigh the good.

Tossing It Out

Rogue Mutt said...

Yeah my salary is about as much as a manager at Starbucks but I get better benefits, so I got that going for me.

Andrew said...

Yeah, the whole insurance thing is one of the three great serpents strangling America. Not just health insurance, all insurance.

Suze said...

Rusty, bro-- yer gonna hafta quit shootin' yourself in the foot before you even get out of the gate. What kind of title is 'the most boring post ever,' friend? :)

Talk nicer to yourself, kid.

Briane P said...

It may get better, if people learn to think like you do and ask why we do things this way. I write about health insurance a lot, and it's one of my big political issues. So keep your chin up and maybe someday, people won't have to choose between feeding their kids and getting them medicine.

America: The only country in the world with universal garbage pickup but not universal health care.

Alex J. Cavanaugh said...

One of the culprits is malpractice insurance. That alone is a frighteningly high percentage.
Downside to universal insurance is it comes from the government - and places us just that much more dependent on the government. No thanks.

Rusty Webb said...

Arlee - I have a friend who is in entering his 40's and has never had health insurance. I'm pretty okay with that for the most part, and if I were single I'd probably either get a catastrophic plan or forego it all together.

But, if he were to have something tragic happen, god forbid, like cancer, then he'll never be able to repay, ever. That cost will get deferred over to everyone who can pay, which is part of the reason why my grandma gets charged $700 for a clean pillow case when she's there.

Which of course is why insurance goes up, and more healthy folks drop out, which of course forces insurance rates to rise even more. That's a nasty feedback loop.

I had a point to all that, what was it? Oh yes, I didn't carry insurance when I was younger either, but once I started having kids it became more of a necessity. Jumping out of second floor windows and playing sports meant lots of trips to the emergency room. It sucks.

Rogue - I don't know if you were serious or not, but I thought Starbucks had some of the best benefits going for that type of work. I don't know how much they make, but I recall a few years ago hearing that they offer pretty decent insurance there even to part time employees. I think the founder had a parent that died destitute when he was young due to large medical bills, and he felt obligated to offer the best medical insurance he could to all employees, even the entry level folks. The last I heard, he's been under a lot of pressure from shareholders to cut out all those benefits, but he pushed back as much as he could to protect his employees. It's been a year or two since I've bothered to see if they changed things there, but it made me respect the founder a great deal... I still can't believe how expensive coffee is there though. Wow.

Andrew - No kidding, I think currently something like 15% of GDP goes to medical services and the costs are still rising exponentially. For profit insurance companies seem like a bad idea to me all of a sudden, although there are non-profits out there too, and they can't offer any better, or cheaper terms than the big boys either.

Suze - Ha! I have a great deal of unease about the nature of blogging. It is about the most narcissistic thing I could partake in. I'm just a guy. I not a scientist, philosopher, teacher, or even that funny. I clearly have issues. I think the self-deprecation is just my way of letting you know that I'm not taking this too seriously.

I've been told in real life that I can be a bit haughty - a smartass, know-it-all - whatever. I don't like that, and don't want to come across that way either.

It keeps me humble.

Briane - Well said. On a side note, I hate that it's become a political issue at all. It forces people to take sides that they might not otherwise have to. I wish healthcare was an apolitical discussion. I really do.

Alex - Agreed, I don't want the govt to become my parent. Of course, insurance only works if everyone participates. If every person opts in then prices remain low, once that snowball got going on rising costs, more and more healthy people starting giving up their insurance, which of course meant more and more people that had insurance were sick, or needed expensive services, which of course makes even more healthy people drop coverage, raising prices even more.... it's an ugly feedback loop, and once started, I don't know if it will sort itself out until only the wealthiest people can even get insurance. I'm starting to think an outside agency (like our govt), might have to step in and do something.

I haven't followed the Obamacare stuff very closely, but what I've heard, from an economist, is that it really didn't do anything to help the fundamental problems that plague the insurance problems we're facing.

Suze said...

I feel what you mean about the narcissism endemic to blogging. But one thing I love about the blogosphere, maybe the thing I love most about the blogosphere, is the egalitarian nature of it all. We're all on the same footing, exactly where we belong. We all need each other's posts to read and comments on our own posts to let us know that others have read-- and have given a damn! :)

I like your blog a lot. And if you're a true smartass it's gonna come through whether you want it to or not. Sorry, Charlie. Come up with a better title next time, all right? ;)

Keep the faith,

Andrew said...

I tagged you on my blog, this morning!

Michael Offutt said...

Our health insurance and the way we treat people in this country is appalling. It's all set up so that the rich get richer.