Typical American Problem Solving

Here's Scott Adams, the cartoonist who does Dilbert, with a posting on health care. As a Canadian, I'm sensitive to typical American approaches to "problem solving". What got my goat:

• He wants to offload the "doctor problem" to other countries and thinks nothing of using big bucks to pull in specialists from around the world. Countries invest in their doctors and when they lose them, they lose the investment. But Adams, like most Americans treats the rest of the world like "elevator music", i.e. something to be ignored.


• He takes the typical misinformed attitude toward other countries. Specifically he continues to spread the ridiculous myth that because Canada has government health care, people here are subject to queues for everything. He "supposes" it takes 10 months to get a doctor's appointment. For me, I generally get in the same day. At most a one day wait. My parents who lived in the US had to generally wait a few days to get in. And I watched the health care system in the US abuse them. I spent most of one day in an "emergency" room at a hospital trying to get my 85 year old mother in to see a doctor. We finally left because it was obvious we would be waiting another six hours, well into the wee hours of the morning before we had any hope of getting to see anybody. One year I sat in an American hospital and watched as my brother painfully passed a kidney stone in the emergency room. Of course he was billed for the pleasure of passing the stone unattended in the waiting room. American hospitals are big on "tests" even if they are a 'day late and dollar short' in providing real medical care. This kind of poor treatment is something I've never heard of in a Canadian hospital. But Canadian hospitals don't have the hordes of uninsured that treat the emergency room as they "primary care" physicians. Despite all this, Americans are convinced that "socialized" medicine must be bad.


• You will witness below the typical American allergy to paying taxes. I find that insane. If you want to live in a civilized society, it costs money. If you want to live in the Wild West where Wall Street can mug you for a trillion dollars, then pay no taxes and demand deregulation! That is what you get.


• The final paragraph exhibits why "change" doesn't happen in the US. The citizens are cynical about politics. Yes, they have a right to complain, but it is mostly by their own hand. If they voted more intelligently and held their representatives more accountable, if they had more real democracy, then the US wouldn't have the disaster of a political system that it has.

That's what bugs me about this Adams posting. Adams is right-of-center politically with an inclination toward libertarianism, but he is honest about his beliefs. Read his posting it for yourself and form your own opinions. I've bolded the bits I refer to above.

HealthCare Thought Experiment

Before you complain that I'm a socialist who wants to take away your freedoms and your money, what follows is just a thought experiment. I start with the premise that the government of the United States, against all odds, declares universal healthcare a basic right.

Obviously no one has figured out how to pay for universal healthcare in a way that society can swallow. So today's thought experiment imagines that ALL options are on the table except raising taxes, just to make this interesting.

As President Obama has pointed out, there might be some savings involved with covering everyone. At the moment, two-thirds of all bankruptcies are caused by medical bills. If that problem goes away, society saves a bundle.

If we assume a so-called single payer option goes into effect, which means the government offers an insurance program in competition with private insurers, we could eventually see some drops in prices. If you prefer keeping your private insurance company, the only change you would see is a lower bill.

A big benefit of universal healthcare insurance is job mobility. At the moment, lots of people stay at suboptimal jobs because switching jobs would mean losing healthcare for themselves or their families. That's a huge drag on economic efficiency. I suppose wages might creep up if people feel more freedom to job hop, and there would be some extra training involved for all the fresh meat, but on balance I'm guessing job mobility is a boost to the economy, and potentially a big one.

Another economic benefit from universal healthcare coverage is that doctors can catch problems early, before they become more expensive to treat. That's a winner all around.

A big downside of insuring everyone is that in the short run there wouldn't be enough doctors to go around. One solution is to recruit qualified doctors from overseas. If they can pass the same tests as American doctors, they're in. I have to think we'd have plenty of doctors in that case. Then the shortage becomes the problem of other countries.

Next, we legalize doctor-assisted euthanasia, under strict medical guidelines. A disproportionate amount of healthcare costs go toward the last few months of life, when the patient is getting very little bang for the buck. I don't know anyone who wouldn't want the option for himself.

Then we require junk food to be labeled like cigarettes, and make it a national priority to decrease our exposure to unhealthy food. People still have to eat, so perhaps the fast food outlets could make the same profit from offering convenient food that is healthy, even if it isn't as tasty and addicting. The government could bully or legislate unhealthy foods out of our diets if it needed to.

Next, the government could start to push the benefits of exercise. And I don't mean the hand-waving they do now. I mean a serious push, until couch potatoes start feeling like flag burners. Exercise could become a matter of national pride.

The government could tax cigarettes into the realm of novelty. Remember, this is the imaginary world of the thought experiment. If universal healthcare is mandated, and you don't want to wait ten months to see a doctor like you do in Canada (allegedly), then society has to make some hard choices.

The government could also require your doctor to treat patients by e-mail, as my HMO already does. That probably saves 10% on patient visits right off the top. Once hi def cameras are more ubiquitous, you should be able to e-mail photos of your bruises and suspicious moles to your doctor too. And I have read that there is a lot of progress in various types of home medical monitors that can send info to your doctor. That should help.

Imagine also that employers who offer health insurance have to treat cohabitation just like marriage. If you're shacking up with someone, you have the option of being on their insurance plan, no further questions asked. Employers currently don't discriminate against married employees even though their families cost extra to insure. This simply extends that benefit to non-traditional familes.

I can also imagine a loosening of the rules for what a Nurse Practitioner can do without a doctor's direct supervision. Between the Internet and a Nurse Practitioner, patients can eliminate a lot of doctor visits.

Most of what I mentioned here is thoroughly impractical because of lobbyists, morons, bad leadership, superstition, and our addictions to unhealthy behavior. It's just interesting to imagine what universal healthcare would look like if it were a constitutional right and raising taxes was off the table.

Reading this, it is pretty clear to me that the US won't get any real health care reform in my lifetime. Like California, Americans will wait until their system is completely busted (and maybe a bit beyond) before they will countenance any fundamental change in their "live free or die" mentality (and the "he who dies with the most toys wins" mentality).