Baxil (baxil) wrote,

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So, our cat decided to celebrate Appreciate a Dragon Day by ... politely waiting until after midnight to freak out and savagely bite my arm.

I've had cat bites before, but this one was a lot worse than I'm used to. At least one fang left a gap the width of a pencil eraser and tore down into muscle. I tried to tough it out by cleaning the area and irrigating the wound*, but after a night of bleeding and a day of increasing pain and restricted range of motion, I went to the hospital.

The doctor wasn't at all helpful, but I did at least get a prescription for antibiotics. (If the bite made it that far down, I'm not taking any chances.) And after spending probably about $200 on medical care, I was relieved to see that our friendly local drugstore had a special deal on the drugs I needed: Buy ten boxes of macaroni and cheese for $105, get the cefuroxime free.

One thing that I've been increasingly noticing is that every time I'm forced to deal with health issues, my loathing of Libertarianism rises a notch.

The usual argument for an American-type system is that having a broad variety of insurers and no government intervention keeps costs low and consumer options open. Which is to say, that market forces will work the same way for medical care that they will for, say, iPods. That the market for medical services is rational.

This is, flatly, bullshit.

What happened today is a great illustration of that point. When I got off job #1 and called in late to job #2 so that I could sneak in a trip for medical care, I did my best to find cheap care (since our insurance plan has a huge deductible and I knew I would end up paying everything out-of-pocket anyway). I went to Miner's Clinic, the local po'-like-me chop shop, only to discover that their walk-in hours had ended 45 minutes ago. At that point, I didn't see an option for immediate care besides the hospital (hello $300+ visit).

I could have chosen to postpone the visit. Were I buying an iPod, you'd better believe I'd have done so; money is tight this month and I hadn't budgeted anything for cat spazzing. But continuing to wait would have meant risking a much more serious (and costly) infection. As much as I can't afford a hospital visit, I REALLY can't afford in-patient care and weeks off from work.

I could have stopped and done research. Or could I have? I actually did make a few calls before I left the house, but kept running into a wall of voicemail, and with an increasingly painful arm and the clock ticking on business hours, I didn't have the time or focus to gather the information for an informed decision.

Even if I had, you can't gather that information! What was I going to do, call every health care provider in town and ask them for a quote on urgent care and antibiotics? It's ridiculous to think you can walk into a doctor's office knowing what your treatment will cost. (Even that is assuming the patient knows what the problem is. I've taken a wilderness first aid course and knew the course of treatment for animal bites. What payment questions does somebody with a mysterious hacking cough ask the nurse?)

When I got home, of course, kadyg recommended, "You should have gone to YubaDocs. They've been cheap before." Ah, yes. Well, if I'd had the luxury of time, etc.

Another failure of the market model is even more straightforward: Health care isn't a commodity, it's a necessity. Even if I'd chosen to refuse care ... at some point, since I've got a muscle laceration and high probability of infection, I would have to go to the hospital. I'm not choosing between no care and yes care, I'm choosing between preventive care and critical care. (Or death. Because, y'know, in a rational market, all rational consumers try to keep the dying option open. It's cheap.)

Supply and demand cannot make the market magically work here. Demand is fixed and choice is restricted.

None of this is even touching on the distribution of care. The U.S.' model of employer-subsidized care provides rich care for those with steady, affluent jobs; yes, well, good for them. Employer care fails completely in three cases: 1) The poor or unemployed; 2) the self-employed; and 3) those with sudden health issues that temporarily prevent them from working.

1) are the people who most need that safety net, because they don't have the money to pay for care; what a catch-22! 3) are exactly the people any sane system is designed to assist -- don't we all have an enlightened interest in keeping productive employees that way? But most employers can't afford to keep paying for someone on a months-long medical leave, and can't afford to leave their position open rather than hire someone else; whoops. And 2) are the people whose ill health subtly but deeply wounds the country. The self-employed are the nation's entrepreneurs, the country's artists -- those who take risks, move us forward. Why is it that we want to penalize them again?

Meanwhile, the current system of for-profit care means that everybody in the system is out to make money at the patient's expense. An insurer's job is ostensibly to ensure care for its subscribers ... which is exactly at cross purposes with the desire to make profits by collecting higher fees and restricting treatment. That medical system is unconscionable. "Evil" might not even be too strong a word.

And the counterarguments seem less convincing to me every day. "But Bax! In an eeeeeevil socialist system, you'd be paying for insurance whether you wanted it or not, and you'd be locked into a single plan instead of having all the wonderful choice of a billion health insurers!" Yeah, believe me, I would be crushed if I had to live in a world where I didn't understand the meaning of "pre-existing conditions." And it really would be awful to have insurance so arcane and useless that I could only get care by ignoring it and paying out-of-pocket ... oh, wait. Out of my last three insurers, not a single one has paid me even a single dollar in benefits. I've now been screwed by out-of-network costs, "pre-existing condition" costs, high deductibles and lack of prescription coverage within the last 12 months; the only thing that keeps me insured at all is the fear that I might get in an accident and rack up six digits' worth of debt. Contrast that with a system where the eeeeeeevil government tells me I have to use the $75,000 drug regimen instead of the $100,000 operation to fix my heart arrhythmia. I think I can live with that sacrifice.

So can most people, apparently. The Americans who most highly rate their quality of care are the ones who use government care: Veterans and senior citizens.

Unfortunately, I'm neither. So I get to sit here and stew over my $100 bottle of pills. There goes the money that I was hoping to save for dental care; my chipped front tooth has been bothering me for months, but since the American health care system is the finest in the world, neither of my employers offers dental and I get to try to decide every month between rent and pretty smiles.

* "Irrigating" a wound is the technical term for taking a syringe, filling it with water, aligning the syringe with the puncture, and OW OW OH MY GOD OW HOLY SHIT THAT FUCKING SON OF A COCKSMOKING OW PAIN. It is important because sometimes you can wash bacteria out this way. Or else you can shoot jets of water at your bodymeats until they bleed, and the blood washes out bacteria too.
Tags: american health care is a piece of shit, best of baxil, politics
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