Apr 27, 2011

Healthcare Should NEVER Be Free

Is Healthcare A Right?

Yes, Healthcare
probably is a right, but it should never, ever be free

Now Dr. D is a Socialist (I’m not talking little ‘s’ Palin-calling-Obama-names socialist, but big ‘S’ from-each-according-to-means-to-each-according-to-needs Socialist) but he still believes medicine should never be free if we want to keep it.

So what’s a nice Socialist boy like Dr. D doing defending the financial exploitation of sick people?

Okay, now that I have your attention…

Rights and Responsibilities

If something is a Right then it must be someone’s Responsibility too.

We have the right to vote. This means someone is responsible to run a fair election and count the votes. We have the right to a fair trial. This means someone is responsible for maintaining an impartial court and providing a public defender. Make sense?

If Healthcare is a Right then someone is Responsible for funding and running an efficient healthcare system that cares for everybody... and that someone is Dr. D.

Dr. just paid about $60,000 to the US treasury and as a bleeding-heart he also did a lot of volunteering and giving to healthcare for the poor. (Dr. D puts his money where his Socialist mouth is!) Like most people with well-paying work, D contributes large percentage his resources toward the general welfare.

Dr. D is also the dude that gives away the free healthcare.

WTF, free healthcare in the USA?

Yep, if you are broke ER care is free by law.
News Flash to Republicans: Socialist Medicine has been here for decades! Doesn’t it just make you feel dirty?
If Healthcare is a right then Dr. D is the dude responsible, because over half my waking hours and dollars earned are spent providing that right. Actually, we are all responsible for it.
We're already providing free carewe’re just doing a piss-poor job of it:

Bad enough that Republicans are right to complain that our kids already owe China trillions of dollars we’ve wasted on healthcare.

Also bad enough that Democrats are right to point out that millions of uninsured are sick and dying without the care they need.
The current state of the healthcare system

So let’s think responsibly about this...

Human Nature Is a Bitch

We Socialists are big picture dreamers. We like to feel we do some good, without get bogged down in the details. Young D used to give a $10 to every homeless dude that asked. It felt good and kept me restricted to a diet of mostly ramen during school. Then I started working at homeless shelters and realized that the bills I gave usually ended up spent on crack. Giving a crackhead money isn’t responsible. Responsibility is a lot harder.

Are you comparing sick patients to crackheads? Yep!

We are all subject to the same rules of human nature. The problems of human nature affect everyone and always fuck up our brilliant plans. (This blog has spent considerable time dissecting how the foibles of human nature make doctors one of the most screwed up and difficult types of people you'll meet.)
Humans are naturally self-serving and take the path of least resistance.

We occasionally rise above our natures, but when we create a system we should expect people to generally act like typical human beings—and by ‘typical’ I mean jerks.

We guarantee the Right to vote and to justice, but because we recognize that human nature people lust for power we have to make a Responsible electoral and jury system that isn’t easy to cheat.

I’m in favor of giving free food to people that need it, but if I laid out a buffet of delicious food on the corner with a note that said, “Just take one plate, and only if you’re hungry.” It would likely all end in the trunk of the first person that drove by—even if that person already had a million in the bank.

Sorry, but human nature sucks! Why do we expect free medical care to be any different?

But people wouldn’t do that with medical care would they?

Dr. D sees it every single day: People call ambulances to bring them to the ER for runny noses and dry hands. People getting a free $1000 emergency room visit demand antibiotics for viral and then don’t fill what is prescribed. People come to the ER to get “checked out” just because there’s nothing good on TV.
Most people will treat anything that’s free like it’s worthless and waste it without even thinking. Just look what we did with this planet God freely gave us!

Free Stuff Has Consequences

Medical care actually isn’t free. It is really expensive. It takes a lot of resources and work to create even the simplest doctor’s visit. Somebody is responsible to pay the bills for free care, and even though Dr. D chipped in $60K this year, our kids are still in the hole for 14 trillion bucks.

A responsible system must be sustainable, and free-for-alls just aren’t sustainable.

The freeloaders also screw up system so it can't work for the people who actually need it. Dr. D gets to deal with a microcosm of this every time we don’t have space for real emergency patient because the ER is full with people who checked in because they were bored or lonely. It happens a lot.

Rationing Healthcare

Healthcare is a right. We owe it to our fellow human beings. We would be some sorry bastards if we just sat by and watched poor people die preventable deaths. We owe it to our kids to create a responsible and stable system to guarantee these rights. The only way I see that you could possibly have free medical care is if it is heavily rationed.

OMG, did Dr. D just say rationing? Get the pitchforks and torches! (BTW, I love how my Conservative friends get so worked up about rationing something they don’t want people to have at all.)

Human beings will frequently use their freedom to go all apeshit. We need to have someone responsible enough to prevent us from exercising our rights to the extent that we harm others.
We have the right to be free but we also have the police to arrest those who use their freedom wrongly.
But nobody wants a police state and nobody wants a free medical system that is constantly saying NO.
Totally free healthcare might not be as nice as you hoped.

What we really want is for people to restrain themselves. Some saintly folks may do this, but most of us will follow our baser natures to disastrous results.

Valuing Healthcare

Yeah Dr. D, but if human nature is really that shitty why doesn't everybody misuse their freedom and end up in handcuffs?

Sorry to bruise your college-educated ego, but it isn’t because you’re such a better person. You just have a whole lot of incentives to stop you before the handcuffs. Some are social incentives—you’d be ashamed to act out—but many are financial. Misbehaving will hurt you in the pocketbook.
Everyone has different values and motivations, but we all accept that money has some value. If we want universal access to medical care then it has to cost money.
It doesn’t have to cost much money. In fact healthcare is best if kept inexpensive. The “free market" cost of healthcare is a huge barrier to most people’s access. But there has to be some barrier. Drop the cost to $0 and you get a tidal wave of people wasting very costly care.

I guarantee that if every person who came to the ER had to pay $2 up front the number of frivolous visits would drop by 80%.

I’m not saying that no rationing will ever be a necessary, but if we insure healthcare has value to everyone rationing care will be the exception rather than the norm.

You want everyone to have healthcare? Never give it away for free!

Okay, Dr. D has managed to piss off both the Left and the Right!

The floor is now open to your comments. Just try and be civil with each other.

Next post Dr. D will studiously avoid politics and return to the regularly-scheduled programing on Doctor-Patient Relationships.