Monday, September 30, 2013

Glaucoma and GOP health solutions

This morning my glasses disintegrated beyond even the ability of paperclips to repair. Fortunately, when I packed up, I made sure to put a few pairs of old glasses in the box of desk things. I picked out the pair that is best for driving and went to the nearest optometrist (about twelve miles away). The receptionist asked if I just wanted the glasses replaced or if I wanted a check-up. The old lenses are over five years old and I'm going through the middle-aged phase of my close-up vision changing, so I cringed over the cost and said yes to a checkup. Glaucoma runs in my family. I really should have a full exam every year and it's been two years since my last exam. That means I'm getting the full exam, which means I'll have to wait a few extra days to replace my glasses. Meanwhile, none of the old glasses I have any any good for reading or computering. This means I'm trying out the handicapped settings on the computer. Right now, I have the browser set at 200%. I can't take three or more days off from writing. I'm typing this on Notepad in 28 point font. Those modifications are good enough for reading and writing, though the keyboard is a bit fuzzy.

This is more than an inconvenience for me. It's a solid reminder of the problems of being unemployed and uninsured. Skipping my glaucoma check is Russian roulette. My grandmother, my mom, and my late little sister all had serious glaucoma. Bonnie lost half the vision in one eye because of it. If my glasses had held together, I would have continued to put off the exam. Having to make cost/benefit calculations over something as important as my vision is a terrible thing to do. And it pisses me off. While I sat here trying to figure out how to tape, glue, or wire my glasses back together, I kept thinking of two particular conservative arguments about healthcare and how they relate to my risk of glaucoma.

The first was their mantra that no one lacks medical care in the US because there are emergency rooms. That argument is disingenuous and laughable from several different perspectives. The primary purpose of the argument is to deny that there is a healthcare crisis. Not long ago I had it thrown at me by a relative when I mentioned that an old friend of mine with cancer had died from a lack of insurance. Emergency rooms are for emergencies. They are for accidents and victims of violent crime. They are not a place for me to go for a routine eye exam. And, if I do get glaucoma they will not be the place for me to get my medications or monitoring any more than they are for diabetics. And when Chuck had his cancer, at what point, exactly, did his pain become an emergency? Would an ER have performed the surgery to remove his tumors or supplied the chemotherapy he needed? Emergency rooms are the most expensive way to acquire healthcare. They drive up costs for all of us, and they don't give it away. Hospitals bill patients for ER visits. If the patient can't pay that bill, the cost gets passed on to everyone else who uses the hospital.

The second argument builds on the problem of delay and cost. Even the most rabid conservatives can't deny that healthcare costs have been rising much faster than the rate of inflation or people's incomes. They have three explanations for this problem, all of which are lame. First, people get too much in malpractice settlements. Malpractice insurance is a tiny part of the cost of doing business for doctors and hospitals and hasn't gone up anywhere nearly as much as medical costs. In may states it has gone down. Second, regulations. It's always regulations with these guys. Can they point to the specific new regulations over the last ten or twenty years that have driven the rise in costs? No. When medical professionals complain about paperwork, most of it comes from insurance companies. Third, people using too much healthcare. What? People ("those" people, not us) going to the doctor too often. The first two are so old and worn out that it's not worth spending any more time on them than I already have. It's that third one that I want to beat up on.

Like the ER mantra, this an argument that someone came up with not long ago that has now been repeated enough that it has become accepted wisdom on the right, even though it's completely stupid. The way it is usually described is: insurance pays for too much; because insurance pays for going to the doctor, people go to the doctor too often; if insurance paid for less, people would not go to the doctor and make the insurance companies pay as often; this would lead to more profit for the insurance companies; when the insurance companies feel they are making enough profit, they'll stop raising prices. This, my friends, is how the magic of the free market brings prices down.

Aside from its utter ridiculousness, this argument is also mean-spirited and irresponsible. It's mean-spirited in that it's victim blaming. In saying too many people go to the doctor too often, conservative pundits are not telling their audiences that they go to the doctor too often. No. They are saying that "those people" go to the doctor too often. Who are "those people"? Illogically, "those people" are the undeserving people who want the government to step in and help them with their health costs. That is to say, the people who use too much health insurance are the people without health insurance: the poor, minorities, and older people who aren't quite old enough for Medicare.

If the plan embodied in this argument was actually enacted, it would have almost the exact same negative effect as the current ER situation. Make it more expensive to go to the doctor and people will go to the doctor less often, even if they should. People will get less preventative care and catch fewer problems early on when they are cheaper to treat and when the prospects of total recovery are much higher. The actual effect of this plan, like the ER plan, is that total costs are actually higher and more people die, are permanently disabled, or, in my own example, go blind.

I hope, that when I finally get my glaucoma check on Wednesday, nothing will be wrong. I would be a lot more confident if I were able to have this check-up every year like the doctor recommends. As for the rest of my body, I haven't had a full check-up in three years and don't expect to have one anytime soon unless I get that insurance that the Republican Party is determined to make sure I do not get.


BadTux said...

For more on the insurance thing, malpractice insurance costs are 0.5% of healthcare costs (no, not 5%, zero-dot-five percent), and the GAO finds no difference in healthcare costs between states that have strict tort limits on malpractice lawsuits and states that have loose or no tort limits on malpractice lawsuits. The only real correlation to expense is how many doctors per capita are located in an area. The more doctors per capita, the higher the healthcare costs. Yep, that's right, more doctors means higher costs, because they have fixed costs that they must pay and if they have fewer patients they must raise their rates to pay those costs, and doctors are literally in the position of "your money or your life" since if you don't get the care you need when you need it, you *die*.

So we have *proof* that market forces simply don't work for health care -- if market forces were at work, more doctors would mean lower rates, not higher rates. But doctors don't care not because of insurers, but because they're in the same position as a Central Park mugger -- "your money, or your life." There is no market in Central Park muggings!

Anonymous said...

I think we should organize an Occupy the Emergency Room Eye Exam weekend. Imagine thousands marching into the emergency facility asking for an eye exam... not leaving except if forced. What is the nearest emergency room to the Capitol Building?

In 2014 I think the AHCA changes Medicare will to cover such an exam. Still.. politics... -Jeremy Lansman

John McKay said...

I think there's a tiny emergency room in the basement of the capital building, more like one doctor on standby. We need to wait until Ted Cruz gets a papercut and then swarm.

prakash sharma said...
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