When I am King

Somewhere in Moscow

So there I was, watching the cold grey light of a new day filter through the windows of the luxurious Moscow apartment belonging to the exhausted Russian beauty laying next to me. Opening her eyes and seeing me awake, she stretched like a cat and then, nestling close, asked what was on my mind.

“I have one of the most read blogs on the planet,” I replied, “but I haven’t posted to it in some time.” Her eyes widened, clearly not understanding.

“But you’ve just saved the free world from a threat that, at the request of major world governments, the general populace will never know of.”

“I know.” I shook my head. “But those ungrateful bastards will undoubtedly assume that I’ve been sitting around watching re-runs of Scrubs while neglecting their clamouring for more of my words.”

“Surely your millions of readers must understand that a man of your calibre has limited time to dispense wisdom, in between world-saving military missions, paradigm-shifting scientific discoveries, and the complete satisfaction of women all over the world!” she cried.

“You’d think so,” I mused, “but I’ll make it up to them. While I was sitting here contemplating how to improve the bronzed magnificence of my rippling abs, I decided to solve the health-care crisis in the United States.”

“Incredible!” she breathed. “You satisfy me in every way, including intellectually! Can you tell me what the solution is?”

Of course I can.

It’s like this

There’s something like 47 million uninsured people in the nation, if the breathless caterwauling of the press is to be believed. In a completely unexpected turn of events, posturing by congressional politicians–who incidentally have a superb healthcare plan that shockingly isn’t available to the peasants general public–has been completely ineffective at solving, well, anything. Fortunately for you, faithful reader, I’m around to sort things out. My ridiculously powerful intellect will light the way, leaving politicians to pursue their own noble tasks (liquor and prostitutes) in their natural habitat (expensive hotel rooms). Bastards.

Economics

People with no real schooling and/or liberal arts degrees (but I repeat myself) can’t seem to grasp basic economic principles, such as supply and demand. Medical professionals, especially doctors, are in limited supply. This is going to become especially true once the baby-boomers truly start sucking the life out of the medical system, as they have for just about every other aspect of life as they’ve whined their way through their self-absorbed, self-righteous, petty little lives.

Doctors will become rarer than a straight model in an Aber-Crombie catalogue. For those of us holding the coveted title of doctor, it means that we’ll be able to demand high salaries, fast cars, and a hooker allowance in any employment contract. For you, the teeming masses of the sick, it means that you’ll either have no access to care, have access to care that will destroy everything you’ve built up over your lifetime, or you’ll be making friends with the strange, smelly guy in the ER who is perfectly content to spend twelve hours sitting there because it’s air-conditioned and the nurses have nice arses.

Not ideal, I think you’ll agree.

Thus, crying “free healthcare for everyone!” is not only moronic, but completely impossible. Not only does everything have a cost, but it ignores a very simple fact: when something is free, people don’t value it.

Incidentally, arguing that people have a “right” to healthcare is also grounds for being slapped like the weeping socialist that you are, because you can’t have a right to something that is the product of other people’s labour. This is called slavery and a lot of people have died to prevent this pestilential idea from spreading. Rights are inherent, and do not require other people. In the wilderness, you can exercise every real right: say what you like, worship as you choose, carry a weapon if you want, and wander around without restrictions. But try demanding that someone take care of your health needs in the middle of nowhere and you’ll suddenly understand that healthcare isn’t a right, it’s a service.

But shouldn’t we take care of each other?

You know, I really do think we should. But we need to do so rationally, taking into account the foibles of human nature that guarantee free-loading and abuse of the system if we allow it. First, we need to acknowledge some fundamental principles:

1) Medical professionals are in limited supply, perform a valuable service to the community, and are not our slaves.

2) When something is free, people will use/take it, even if they don’t really need it. There’s no motivation to preserve the resource, as self-interest trumps group interest in a phenomenon known as the Tragedy of the Commons.

3) Medical care costs money, which has to come from somewhere. There is no free ride.

4) We, as a society, have to decide where our priorities lie. What do we want our society to look like?

Fair enough, I’m ready to hear the solution.

Two problems exist with the current system.

For those paying for medical care, it’s ridiculously expensive. Insurance often will not cover the full costs of procedures and, in an effort to increase profits for shareholders, will often dictate medical decisions that they have absolutely no business being involved with. For those without health insurance, especially those with major health problems (e.g. cancer), medical treatment can wipe out a lifetime’s worth of work and cause people to lose their homes.

In contrast, those who have their medical bills paid for by various government programs have little incentive to limit their use of the medical system. The slightest health-problem, even if caused by poor life-style choices, can be presented to a physician for little more than the cost of their time. The payment scheme of these programs towards physicians is appalling at best, involving labyrinthine paperwork (for which the physician is not paid) and time-consuming hoops through which the harassed doctor must jump. Unsurprisingly, primary physicians are telling the Medicare program and its ilk to get stuffed at an ever-increasing rate. Good luck finding a medical doctor willing to put up with such idiocy in ten years.

That wasn’t a solution.

Shut up, I’m getting to it. Those of you with college degrees that didn’t have classes in which you talked about your feelings will be familiar with the concept of a rationing mechanism. Essentially, we need a filter to take a limited resource and ensure that it reaches the people who really need it. Simultaneously, we need to ensure that people with serious health problems don’t shy away from seeking medical care due to cost considerations. In short, we need to decide that we, as a society, want a country in which no-one loses their life-savings or their house due to an illness, but also a country in which the lives of the working populace aren’t sacrificed upon the altar of the sick, old, or infirm.

How can such an impossible task be accomplished, you ask? Can even my piercing intellect truly have a solution? Yes indeed.

A two-tiered system.

One of the tiers will be a comprehensive catastrophic national heathcare system, paid for by increased taxes. Socialists, you can hug yourself for joy now, if you like. Capitalists, I’d remind you of the concept of value for value. There is no free ride, and increased taxes are the price we’d have to pay for such a society as I described above. Fortunately, the tax rate wouldn’t have to be nearly as high as is seen in Europe, because I’m smarter than that.

The rationing mechanism for the national healthcare system would be the health problems themselves. I’m not entirely sure when the line would be drawn, but I’m thinking probably anything more serious than a simple fracture of the arm, or long-term illnesses such as Lupus. Such injuries are self-limiting, as few people deliberately get into serious car accidents, develop cancer, or have a heart-attack.

And the second tier?

Is the one that deals with everyday medical care and the part that makes this whole thing so bloody brilliant. For everything less serious than an arm fracture (say), such as coughs, colds, flu, and so on, medical care would be a purely private system. Families would still have health insurance, but it would be drastically more affordable (I’m talking like $10 a month) because there would be no possibility of the health-insurance company having to pay out exorbitant sums of money for major medical problems.

With a small co-pay for each doctor visit (say, $5 to $10), the rationing mechanism is that people are suddenly drastically less likely to visit the doctor for a minor cold that will go away by itself with a few bowls of hot soup and a day in bed. For those who couldn’t afford even that small amount, the cost is low enough that community groups (churches and the like) could afford to help out the truly needy. Suddenly, the community is taking care of itself again.

The final change I’d make is to require all health insurance companies to be non-profit. Now, I’m a hardcore capitalist in many ways, but insurance companies haven’t been subject to actual capitalist economic pressures for a very long time and they’ve abused their position. The current situation, in which the cost of patient care is competing with the interests of shareholders is intolerable and must not continue.

I’m…stunned.

Of course you are. This comprehensive overhaul will drastically reduce the workload of the primary care system and remove one of the main reasons why new physicians are shunning that speciality. It provides a rationing mechanism for basic care, allowing full access to healthcare at an affordable price while avoiding the mess that a full-on socialised healthcare system has wrought in Europe. It simultaneously allows people to work and live without worrying about losing everything if they are injured or become sick, creating a society in which we all look out for each other when things get serious.

Of course, you realise that this will never happen.

Probably not, but I might send along a copy to the Obamarama team on the off-chance they’re looking for ideas. In all likelihood though, it’ll only happen when I am King.