CSotD: OverTheCounterindicated Treatment
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If I didn't know that Wiley Miller keeps average deadlines for Non Sequitur, I'd suspect he was listening over the state line to NHPR's "The Exchange" last week, when the guest was T.R. Reid and the topic was medical care here and in other countries.
Reid puts the lie to claims that medicine overseas is tremendously limited and involves unconscionable delays, but, on the show, he also mentioned what makes today's Non Sequitur a joke: Doctors often don't know how much the procedures they recommend cost.
On the other hand, he said, they do sometimes know that Medicaid will only fund a particular procedure at a fraction of its actual cost, which means that a poor kid who would benefit from that treatment won't likely get it, while a kid with health insurance will.
Yes, as in Wiley's cartoon, there is a blockage of the poor kid's credit rating.
Like many aspects of our fractured economy, there are a lot of interwoven reasons for the unique, grotesque unfairness of American health care, and some would be easier to fix than others.
We could, for instance, put in a single-payer health care system like every other industrialized country. True, it would damage our insurance industry, but (A) they have their tentacles into so many other industries that they'd likely recover from the blow, and (B) they can still offer private insurance for people who want the belt-and-suspenders coverage some Britons use to augment their public health care system, and (C) screw them.
But here's the sort of embedded issue that makes it hard to just change things: While doctors in those other countries are respected professionals who earn a comfortable living, they do not approach the level of comfort of their American colleagues. (Of course, the answer to that objection is "Yeah? Where you gonna go?" because this is where doctors from other countries go to earn that kind of living. It's not available anywhere else.)
When I was a business reporter on the Canadian border, I often wanted to do a comparison, showing how the deductions from a paycheck in Canada and the deductions from a paycheck in the US lined up. I knew Canadian taxes were high, but there is a factor of avoided costs to be considered.
In the case of health care, yes, they paid higher taxes to cover their medical system, but then they didn't have to pay an additional premium for private health coverage. So how different was their net income?
But I broached the idea with a fellow who worked for an accounting firm that straddled the border, and who was both a CPA and a Chartered Accountant, and he shook his head: It's not simply a matter of lining up check stubs, he said.
There are too many other factors involved to make it practical, including the various co-pays and uncovered expenses in the American system, as well as higher payroll taxes there to cover health care, retirement and other benefits that make it more expensive to hire someone up there.
It could be done, but I'd have to take time off to accomplish it, and it would have to be some kind of longitudinal study: You couldn't do it in a two or three hour sit-down.
Here's what I do know, however:
As a freelancer, I'm part of the working not-quite-poor. I live paycheck to paycheck, but my income is above letting me qualify for any sorts of government benefits. And that's good. I'm proud of that.
But, when I looked around for low-cost health insurance — not full coverage, just the "oh dear God" major crisis stuff — the lowest price I could get would cost me 60% of my gross income each month.
I don't mean take-home. I mean gross income, before taxes. Also before rent or groceries, or, really "instead of" those things.
Talk about a credit blockage!
I'm not alone, and I'm fairly lucky. There are some minor things I'd like to be able to have done, and, if something in the mid-range came up that was genuinely necessary, I could tap out my remaining retirement funds to do it. And, in a catastrophe, I would quickly become poor and qualify for aid.
That's what passes for "fairly lucky" in our system. There are a lot of fairly luck Americans these days, and the younger ones are getting pissed.
For my part, I'm kind of a neutral onlooker: Assuming the Supreme Court doesn't overturn the new health care law, and assuming the GOP doesn't regain power and repeal it entirely, it would kick in a year before I could go on Medicare anyway. Mox nix.
Meanwhile, I've got a doctor's appointment Monday and I know he'll have a few suggestions and I'll say, "Doc, I can't do that," and he'll be frustrated and I'll be frustrated and life will go on for each of us, and three weeks after that, I'll go see my dentist and we'll do it all over again, except that there I do have something that needs to be fixed, so I'll be tapping the IRA after the first of the year.
What a country!
Meanwhile, here's a consolation of becoming old:
I can still remember great strips like Rip Kirby. And because I'm an old guy who believes in paying for what he gets and doesn't resent the $20 a year he spends to subscribe to DailyInk, I can enjoy those old strips. I'm not quite old enough to remember the 1952 adventure that is just starting, but that's good because I plan to enjoy it as fresh as it was when it first ran.
They don't draw'em like this anymore. Click for a full-sized version. (And DailyInk does run'em large.)
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