All my real writing is suffering from procrastination, but I can always drop a few words when something comes to mind, so here’s what I think about health care these days.
What the hell is it? “Health care”? “Healthcare”, as it is frequently contracted? What we are talking about is medical treatment. A need is asserted, and various goods and services- heavy on the services- is provided. And that’s it. The need itself is pretty vague, often if not always, and the outcome is vague too.
Healthcare- I’ll use the socialist contraction, since it’s a fundamentally socialist product we are talking about- it an appealing good to most people, because when they are sick or injured they want to feel, at least, comforted and cared for. Whether they are being done any objective good or not is beside the point. Scientific medical treatment has been available for less than 150 years, and yet there have been physicians for millennia. If you paid a doctor 2000 0r 200 years ago you must have felt like you were getting something of value, although except for simple injuries you probably weren’t.
Medical treatment is also mentally associated with maternal care. The psychoanalyst Sandor Ferenczi had a woman who told him, “If you can help me, I will give you everything I have.” To which he replied, “Madame, I shall be satisfied with 60 kroner per hour.” She answered “Isn’t that excessive?” He speculated that people expected free treatment- even though they regarded the treatment as being extremely valuable- because they received free treatment from their mothers as children. Actually, they received mostly comfort, but that’s what they really wanted anyway.
So- we have a very interesting product. People regard it as very valuable and yet expect to get it for free. The need and the efficacy are both ambiguous.
However what makes “healthcare” (I feel the need to use those scare quotes) an ideal socialist product is that it’s easy to produce, and creates clients both on the production and consumption side. Despite the mystique around it, medical treatment is not hard to provide. The science behind it is sophisticated. Understanding the human body and disease, creating effective drugs, and creating machines for diagnosis and treatment all require a high level of intelligence. Once they have been created though, it doesn’t take much intelligence to use them effectively, and hardly above average intelligence to use them ineffectively.
Despite all the hoo-ha it doesn’t take much brains to be a doctor. You see him with a complaint, he asks you a few questions and maybe pokes you a little, and gives you a prescription. It might help you a lot, a little, or not at all. It might not help you at all but you get better by the workings of your body, so you’re happy and don’t go back. Maybe the problem continues or gets worse, you go back and try something else, or he sends you to another doctor. Even if the doctor is stupid and incompetent, the treatments will probably not do you any harm. If you need surgery, then you will need to go to a more highly-trained, intelligent and competent set of doctors. But even surgery really isn’t brain surgery, even if it’s brain surgery. A really smart guy figures out how to remove a brain tumor, shows some other fairly smart guys how to do it, and they do it. Surgeons say- “See one, do one, teach one.” The anesthesiologist has to be a pretty on-the-ball guy, but not necessarily that smart either, he mainly needs to be very conscientious in giving you enough drugs to knock you out but not enough to kill you, a fine line but something someone with somewhat above average intelligence and the ability to focus for a few hours can do.
Nevertheless, there is a hushed reverence and amazement about the process carefully nurtured by TV shows, healthcare marketing people and the government. Surprisingly, actual medical people don’t seem to try to foster this mystique very much- they’re always pretty blasé about the whole thing, or have been any time I’ve been in. In the old days it was much more important for a doctor to maintain this image of sage wizardry- Trollope talks about this in his novels- than it is today, where scientific medicine can actually help you.
Large numbers of people are employed, in a setting that’s almost industrial, providing a service that needs to provide little objective benefit. People will pay whatever they can for the service, if they have to, but prefer to get it for little or nothing. The large-scale healthcare we have now isn’t exactly a socialist product- it was invented largely by Kaiser as a way around wage controls in World War II- but if somebody can be found to pay, it’s the ideal thing for socialists to offer. It’s probably even better than education. The old idea of the factory worker as the front-line foot soldier of socialism has long since faded away, now it’s the teacher and the “healthcare” worker.
It should be remembered that Kaiser was a military contractor at the time they began offering healthcare as part of the pay, since they couldn’t offer higher wages. The era of fat government and fat corporations offering healthcare benefits along with their good wages is fading away. That’s probably a big part of the appeal of Obamacare- the job with medical benefits that almost all adults could expect no more than a few years after school is fading away too. Just put more Demo voters on government insurance, and put others on private insurance subsidized by Republican voters, and you’ve got another program cementing loyalty.
As part of this whole socialist corruption, the science and law surrounding health and medical treatment is totally corrupted. Medical treatment really isn’t a big deal. People should be able to stay reasonably healthy by their own efforts, avoiding vice and exercising, and eating healthy food, but unfortunately official science supports a diet that will give you heart disease and diabetes. In a rational world you would be able to go to a care provider and get most treatments at a reasonable out of pocket cost, but we don’t live in a rational world.
In the dystopia of the future, if there are hospitals, they will be run by minority quacks, staffed by minority quacks, offer non-scientific treatments created and promoted by white elite quacks, and be hostile towards non-elite white patients. One thing we are going to have to do is create some kind of an underground system for ourselves, with high costs covered by group pools.