Health Care for Dummies: The Millionaire's Guidebook

From Paul Krugman in the NYT:

There’s a powerful political faction in this country that’s determined to draw exactly the wrong lesson from the Katrina debacle — namely, that the government always fails when it attempts to help people in need, so it shouldn’t even try. “I don’t want the people who ran the Katrina cleanup to manage our health care system,” says Mitt Romney, as if the Bush administration’s practice of appointing incompetent cronies to key positions and refusing to hold them accountable no matter how badly they perform .... were the way government always works.

This is the core argument between liberals and conservatives, and a tiresome one. One of the reasons it's so tiresome is that the debate over whether government should intervene in social problems is really about whether it should intervene in the problems of the poor. It happily intervenes in the problems of the rich, to mutual advantage, since with the government's help the rich get even richer and the politicians protect their biggest donors. The poor, on the other hand, don't vote in large numbers, and obviously don't donate much to politicians, so we shouldn't be surprise that we've got the system we do. (Watch the subprime meltdown as it plays out on Wall Street and then in people's homes; notice who gets what, and from whom.)

The utter shamelessness of our corporate culture aside, the above quote, from the millionaire Mitt Romney, brings two things to mind. Both are personal experiences of our health care system, which Romney apparently thinks is best run by people with a big financial stake in who gets treated:

My nephew, who is 30, fell last week, dislocating his elbow and breaking one of the bones in his forearm. It was an ugly break, with bones in three different pieces and bone splinters embedded in the muscle. My nephew works as a stone mason, and due to the seasonal nature of his work, ongoing financial struggles and a new baby, he has no health insurance. So you can see where this is going. Instead of going into surgery immediately - that very day - to get the fracture cleaned up and the bone set, he's still waiting for a doctor who will see him without insurance. That will be next week sometime.

In the meantime, my mother, who was an orthopedic nurse for 20 years, is looking at his x-rays and saying he'll end up with diminished function in his arm. Maybe he won't be able to work as a stone mason anymore. I guess we could say it's his fault for not making health insurance a priority. But with the hospital, surgeons, physical therapists and everybody else chasing him for payment and an arm that won't let him work, he'll probably never be able make it a priority. Not now. There just won't be enough money. Maybe he'll end up on disability, costing us all a lot more than if he'd been insured to start with, or, God forbid, if he'd just gotten the free care that would diminished losses in function and got him back to work fast. It's not just about him, of course. What of the house and baby he's supposed to be helping support, and the assistants he would otherwise be hiring? There's a ripple effect, of course, with this kind of injury. One that can cost society a whole of money.

The other thing Mitt Romney has made me think of is my sister. Her surprise breach birth in 1961 (before the time when doctors got their pants sued off for things like this) resulted in severe mental retardation, epilepsy and cerebral palsy. My parents raised her at home until she was about 18, and then, with lots of misgivings, placed her in a nearby nursing home, where they still visit her at least once a day. As a totally disabled person over 18, she gets Medicaid, which pays for her nursing home care and her frequent doctors' and hospital visits.

If not for Medicaid, she'd still be at home, keeping my parents there, too, because she's physically deterioriated over the years and now cannot even walk unassisted. My parents are owners of three successful small businesses, one of which employers a couple of dozen people. Their ability to invest in the business, and to devote their time to it and to other members of the family - like the nephew who just broke his arm, and needs my mother's help daily - would be very much limited if they had to care for my sister as well. And without those businesses, my brother and I wouldn't be inheriting much from them when they die, and nor would our children inherit much from us.

Again, there's a ripple effect.

Can government be in the health care business? It already is. It's taken care of my sister. The care isn't excellent, but it's decent, and my parents provide lots of backup. My nephew, on the other hand, is in the hands of the private health sector. And we see how he's done, and what the likely consequences will be.