Just a Spoon Full of Sugar

Modern medicine provides miracles, but the sad truth is that medicine only provides miracles because there’s money behind it. So should we expect miracles in our health care? How much are we willing to pay for it?

There’s an easy answer that most people (usually my wife) give: “then we need public health care funded by our taxes! Make it free for all!” First of all, it’s not free – at present, Medicare/Medicaid/CHIP (America’s version of free health care) already covers 25% of Americans and takes up a huge amount of the existing budgets at the federal and state level. Here in Arizona it was 30% of the state budget five years ago; at the federal level, it costs $555 billion/year in matching funds to states. All of that amount goes UP when you add the other 75%. And Americans complain about taxes now.

Second, money drives people. Any family practice doctor will tell you that Medicare pays terribly compared to regular insurance; in fact, many family practice stop seeing Medicare patients for precisely that reason. (Well, most family practice is pointless in my opinion anyway.) “Well, if it’s all public health care, they won’t have a choice. They’ll have to see patients.” Really? To be a surgeon requires 20 years of schooling, 3 years of residency, and 2 (or more) years of fellowship before you’re considered qualified. Sure, they love cutting into people, but the reason they put up with the extra crap involved is because they get paid two to three times the amount of an emergency room doctor.

Now take money out of the equation – doctors get paid like teachers – based on length of education and time in grade. You might say that’s a false argument – specialists would still get paid more for their work… but if you look at Medicare rates, it would still be a lot less. If you’re a new doctor, you might say, “hell with surgery, I’ll be a urologist.” Why? There’s almost never an emergency in urology, so you’re never called in, and you don’t have to work weekends. (That was what my neighbor, the urologist, told me when I asked why he picked his specialty.)

Don’t believe me? Here’s my story – I was trained as a history teacher; I really like teaching history. I worked as an instructional designer (corporate teacher) in hospitals because it pays twice as much. It’s not because I had a great love of medical software – I needed a job and it paid great. After five years, I became a travelling consultant and travelled the country, working in hospitals because (wait for it), it paid twice as much as being an instructional designer. It wasn’t because I had a great love of flying to Allentown, Pennsylvania; I do like flying, but I went to these not-tourist destinations (or tourist destinations in the off-season) because that’s where the job was. If I got the same pay for medical software versus history, hell, I’ll teach history. I get to come home every night and I don’t have to deal with doctors. So you’ll have to wait on that medical software training.

And we can see that in Canada, in the UK, in any place with public health care… you have to wait. Six months for a routine appointment, years before surgeries, and many patients die because there’s no bumping the queue just because you need it more urgently. If you’ve got the money, you fly to somewhere else to get the surgery done faster. There’s a whole industry in Thailand dedicated to cheap surgery for western patients; their hospitals look like frickin’ palaces.

My wife likes to say, “People are willing to pay higher taxes if they see the benefit they get from it.” I agree – in Finland, you’re willing to pay 80% taxes if you get free and quality health care, education, infrastructure… sure, it’s great! My experience with any level of government in the United States tells me you might get free, but you will not get quality. And Americans won’t accept raising their taxes sky-high for not much benefit.

But I could be wrong – what did I miss? What oversimplification did I make? Let me know in the comments below!