Thursday, August 27, 2009

If That Were Going to Work . . .

health care, crisis, charity,
If charity were a valid solution to the health care crisis in the US, we wouldn't have a health care crisis in the US right now.

Larry Elder of has moved on from "everybody who doesn't have health care is spending their money on cavier instead" to "let the charities handle this because they'd be so good at it."

Since Mr. Elder doesn't live in reality, I'll fill him in on a little secret: we've been trying that. For years. It isn't working.

Unless you live in a very small town, you have a free/low cost clinic where you live. There may be more than one. Here's how they work, or at least how the one in my town works:

  • They are staffed by interns the same way ERs are, only these interns want to be general practitioners. There is one experienced doctor watching over all the interns.
  • They have a very limited capacity. There are only so many exam rooms, so many interns, so many hours in a day, and only so much money. You may wait months for an appointment at a free clinic to see an inexperienced doctor.
  • They offer very little in the way of testing. The one I went to could only do very simple tests on site: finger prick tests for blood sugar, the urine test for protein, etc. Tests for strep and the like had to be sent out to an independent lab, and the patient pays whatever the lab charges, if they can.
  • X-rays, MRI's, echocardiograms, blood tests, etc. all have to be referred out, and if you have to go to a free clinic in the first place, you can't afford to pay for an x-ray, let along an MRI.
  • You see whatever intern you happen to get that time. This makes ongoing treatment for a chronic disorder, even one as relatively simple as arthritis, inconsistent at best.
  • There are no specialists at most free clinics. Medicine has become superspecialized in recent years. A general practice intern, no matter how talented or well trained, just doesn't have the knowledge or experience to effectively deal with heart issues, neurological disorders, etc. I know this because I had to tell several interns how to treat my seizure disorder. I'm lucky I learned this from the neurologist I had previously been seeing. Otherwise, I would have been totally screwed.
  • You pay for medications. Medications are expensive.
  • You pay for surgeries. Surgeries are expensive.
  • You pay for therapy, mental or physical. Therapy is expensive.

A free clinic is an acceptable option for a person that has an ear infection. If all 50,000,000 uninsured persons in the US were young and healthy, free clinics run by charities would be the solution. Unfortunately, that's just not the way things are. If charities were the solution to the problem, there wouldn't be a problem. We already have charities, and we still have a problem. Ergo . . .


  1. Logic, you are using it.

    That is your problem. ;)

  2. I hate this argument so much. My ex (since become a Bible-beating textbook conservative misogynist and 'phobe) brought it up at a symposium for my law/gov class last year, that we shouldn't raise taxes to help the poor and instead we should just all give to charity - and I had my hand up for the rest of the session because I wanted to tell him "if that worked, there wouldn't be a problem."

    People don't refrain from giving to charity because they think the government is taking care of it. They don't have the money, or the time, or the inclination, and leaving people hungry or uninsured or homeless won't change that.

  3. Elder actually makes some good points in a general sense about the greater efficiency of private charity, but they aren't really applicable to health care. The government is already massively involved in health care with medicare, medicaid, the VA, etc. We aren't getting rid of them, and there's really no way to deploy private charity to assist people who aren't even the poorest -- the usual charity recipients.

    What we have is a gap where some people make too much to get Medicaid, but can't get or afford health insurance. I'm not sure how that could reasonably be addressed through charity.

  4. I agree with you, PF. Free clinics suck. I go to a semi-free clinic in San Francisco under the Healthy San Francisco plan. The doctors there are great, but they work under such bad conditions. The building feels more like a dilapidated mortuary than a hospital.

    I'm just glad everyone who doesn't have private insurance in San Francisco is covered under the Healthy San Francisco plan or I would have no health care at all.

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  6. Here in health-care-paradise, Canada, we pay for meds. We get that refunded by extended health care that most of us have through work. However, no one pays for tests or hospitalization.

    It is possible that very poor people and the elderly get meds, but I wouldn't know.

    Our system is very imperfect. But if we get cancer or have a car accident, we don't have to go bankrupt.

  7. "A free clinic is an acceptable option for a person that has an ear infection."

    Not even that, apparently. My family doesn't have health insurance and my little sister developed ear infections in both ears two weeks ago. The first round of antibiotics didn't work so she was prescribed a second, stronger drug which she took for 2 days before experiencing severe G.I. side effects that necessitated a trip to the emergency room. Long story short, after the happy hospital visit her new antibiotics ended up getting left in the car to bake in the hot Texas sun, rendering them useless. That, of course, is our fault and we would be more than happy to pay for replacement antibiotics - obviously it was a careless mistake that can't be blamed on anyone else. However, the antibiotic in question is $83 a bottle. Yeah, you read that right: eighty-three dollars. (In case you're curious by the way, that comes out to 55 cents per milliliter.) Look, obviously if my parents are already taking her to the clinic instead of a real doctor's office, they don't have eight-frickin'-three dollars to spend on a bottle of antibiotics.

    I'm not saying it's the healthcare industry's fault that the antibiotics got left out. (Yeah I did just call it an industry - because that's all it is right now, a business.) That would be unreasonable and extremely ignorant. I'm just trying to illustrate that it's the whole system that's broken - not just a few parts. $83 dollars for a single bottle of medicine is obscene. Any reasonable person has to be able to admit that such an astronomical price makes healthcare a luxury. A god damn luxury for my 8 year old sister to avoid excruciating pain and the possibility of permanent hearing damage.

    Now that is what is truly sick.


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