Monday, August 3, 2009

Background and Biases

The background for why various members of our government are attempting to overhaul our healthcare system are hopefully well-known by now, but just in case you don’t already know, I invite you to read a few background articles (one, two, three), as well as my old nonsensical ramblings that also touch on the subject. But the basic reason for why healthcare has gone to shit can be summed up in this horrible run-on sentence (grammarians, my apologies): Not enough people have access to even marginally adequate care and end up presenting to suboptimal settings (i.e. emergency rooms) on death’s door at much higher cost to society and are assigned to overworked doctors and nurses operating on shoestring hospital budgets who can’t afford to actually take care of these people, while other people with money show up for the same problems and get every obscure test under the sun at massive expense that the insurance company occasionally reimburses after denying coverage seven or twenty times, all while we all get totally fucked over by a pharmaceutical-insurance cabal aimed at capitalizing monetarily from our suffering and lack of access to quality care. Or something like that. Oh, and everyone is way too fat. Yes, I mean you, 400+ lbs woman I saw at Souplantation two days ago mowing down two plates full of pizza, pasta, soup, and cornbread (with a few lettuce leaves on the side) successfully before going back for TWO MORE PLATES. Jesus.

Because of all this, despite spending (by far) the most money on healthcare, our system ranks a pathetic 37th in the world, behind such medically-enlightened luminaries such as Colombia, Morocco, and Luxemborg. While some may doubt the methods behind this particular metric, enough similar studies using different methods have come to similar conclusions to certify that yes, we suck.

As such, a group of Democratic lawmakers in Congress, under the directive of President Obama, have crafted a bill that they hope will alleviate the aforementioned problems. The problem is that depending on who you ask, this will either solve all our problems with ease or lead to the coming of the Antichrist and the destruction of Earth (being a Jew and, therefore, a potential Antichrist, I can only shudder at the possibility of initiating my own ironic destruction). The only way to know for sure (and to drink heavily in case of the latter) is to look at the damn thing and decide for ourselves, which is what we will be doing.

Before we dive in, a little about me and my biases as I write this. I voted for Obama in this most recent presidential election, I think all elected officials (including Obama) take every opportunity to be as crooked and awful as possible, and I have absolutely no qualifications that make me more likely to understand this bill than the average college-educated ridiculously handsome Jewish male. In fact, the last government-oriented class I took was AP Government in 12th grade ten years ago (although I did get a 5 on that test…as well as on 13 other AP tests. Suck on that, Nancy Chang!), and as anyone from my high school could attest, that civics class was not exactly known for being particularly rigorous (we watched Primary Colors over the course of an entire week to teach us about political campaigns and old people sex). Not to belabor the point, but I haven’t even seen the real version of School House Rock’s “How A Bill Becomes A Law”. Basically, I am already completely over my head and we haven't even started yet.

Yet, I am also a physician struggling within the confines of our current health care system and, by virtue of my residency program, I have had the opportunity to see how different health care management systems in three different hospitals (public-county, private, VA) can fuck everything up. On the flip side, I suspect that I have a lot to lose financially if health care reform passes, and will have to forgo my dreams of paying off my medical school loans before I turn 65.

The only position I cannot accept is the one that states our current system is perfectly fine as it is - any system that leaves 50 million people without access to healthcare and millions more with limited or fragmented care at the mercy of profit motives by insurance companies is simply broken. End of story.

So now that I have proven I am completely unqualified to understand this bill or successfully draw any conclusions, let’s dive into the morass and figure out ways to make jokes about it…and maybe learn something.


  1. Random remark: Luxembourg is actually the richest country in the world (relative to population, at least), with a GDP per capita of around $110k. The US GDP per capita is around $45k.

  2. The main and unique target of insurance companies is to get profit much and much