I remember years ago, when I was dating a girl, getting into a conversation with her cantankerous grandfather about health care. He was a remarkable man — had been a principal in Detroit public high schools for years, and had seen a lot.
Anyways, to Mr Anderson, it was simple. All you had to do was take care of people when something really terrible happened to them. He would tell a story about watching someone fall down and crack his head open on the sidewalk. He and a few other strangers picked the man up and carried him to the hospital a block away. “Nobody asked or worried if he could pay,” he said. “They just saved his life and sent him home.”
That’s some people’s idea of health care — the nurses and doctors in the ER patching you up, so you don’t bleed to death in the street. This is usually because they’ve never gone for a prenatal visit or vaccinations, and they think routine screenings are a waste of time. They don’t ask their doctos about suspicious moles, or what they should be eating, or if they’ve started to have some trouble making it all the way to the bathroom.
This was me, too, not long ago. I once had to go to the emergency room for a terrible nosebleed that wouldn’t stop on its own. I later joked to friends, “I only go to see the doctor exactly when I’m bleeding from an important part of my body for more than a few hours.”
This kind of thinking comes particularly naturally to young men, where they’ve stupidly been told to hide their pain (emotion, too) and to valorize athletes and movie characters who play through pain. The only time you’re allowed to cry is when you’re watching the end of The Natural — not because the main character is slowly bleeding to death, but because he hit a home run anyways.
We’re dumbasses, really. But there are a lot of us.
Anyways, the resident young guy at the NYT op-ed page, Ross Douthat, floats an idea — universal catastrophic health care coverage — that could be kind of a good one, or a totally dumbass one, depending on how it breaks. I’m suspicious, however, that Douthat’s preferred implementation probably leans dumbass.
See, it’s all in the details. If “catastrophe” is defined as health care costs exceeding a defined percentage of one’s income in a calendar year, it plays one way. I’m actually kinda sympathetic to this, although I see problems.
If, however, it’s defined as coverage for really bad things that happen to you, as opposed to “routine” care, that’s actually really problematic. Because — and I think, as someone who’s recently had a catastrophic health care condition, I can say this — catastrophic care and routine care are completely interdependent.
Here’s how it works, in both directions.
Routine care prevents catastrophes from happening. Or, it catches them before they become hard and expensive to treat. I think this is relatively well-understood, so I’m not going to say as much about it.
Catastrophic care demands routine follow-ups. After you’re diagnosed with AIDS, or cancer, you need to meet with your doctor regularly and take steps to stave off infections. After you break your arm and leg, you need extensive physical therapy before you can work (or walk) again. After a C-section delivery, both mom and baby need regular check-ups. That’s most of what your health care is after something major — just people checking up on you, to make sure that whatever they did to put you back together again took, and that you’re not going to get swooped up by something else while you’re vulnerable.
That, and you take a lot of pills. Which usually counts as “routine care” even if your pills are keeping your skin from turning inside out.
I forgot to finish my almost-grandpa-in-law’s story. Later, he asked about the guy with the cracked skull that he’d brought to the hospital. About a week after he was released, he caught pneumonia and died. “After all that, he couldn’t take care of himself,” Mr Anderson sniffed, sad and disgusted, wise and blind, all the same time.
Now, go read Malcolm Gladwell’s “Million Dollar Murray,” and then tell me whether Douthat makes any sense, for anyone other than himself and guys like him.