The Cost of Individualism to our Health
Much has been said about healthcare in the last few months. It seems there is nothing more to talk about. I mean come one we’re headed towards National Socialism or Communism (interesting how one policy can lead to wildly divergent political outcomes eh?), we’re going to kill grandma, we’re going to ration healthcare, we’re going to take healthcare decisions out of the hands of patients and put it in the hands of bureaucrats (a dramatic shift, no doubt, from my insurance company denying any and every treatment I’ve ever needed until I called in to bust some balls). Well this post is about absolutely none of those things, so I’d appreciate it if we could avoid such silliness.
No, this post is about the costs to our healthcare that arise from our social isolationism. Okay, so the title is a bit misleading, it says individualism, but I tend to not see a dramatic difference. Individualism encourages us to look to no one but ourselves for our necessities, which when taken to its logical endpoint, means we become more isolated. Semantics aside, my argument is pretty simple: our isolationism is costing us in our healthcare spending – and big time.
One thing that we don’t really hear about in healthcare debates, particularly when comparing the United States to other countries is that virtually all of the other countries with universal healthcare also have much tighter social webs, community life, and place less emphasis on individualism. I don’t think there is a direct 1:1 correlation between community attachment and healthcare spending, only that there is an indirect link that probably hasn’t been studied very much. A few areas strike me here as very likely areas where this matters a lot:
1) the elderly. Older people are notoriously lonely, especially in the US. In my relatively limited travel, I’ve noticed that older people rarely live alone in other places, they usually live in multi-generational households. They watch their grandkids (or great grandkids) and their children take care of them. The psychological toll of that constant loneliness really gets to people and lonely people are more likely to be depressed, get sick, and generally be less happy. I imagine that older people like to see their doctors more because they have someone to talk to. Hell a lot of older people I know base a good chunk of their social lives around discussing their health conditions and ailments. Who better than a doctor . . . which leads me to . . .
2) Hypochondriacs. People who think they are always sick. Have a sore thoat? Maybe it’s tonsilitis. Oh God! a bump on your neck? must be a tumor…or so WebMD suggests. More information isn’t good if the person receiving the information doesn’t know how to interpret it properly, but that’s an aside. Without people, family, close friends, co-workers to give us that reality check and tell us it’s ok, every sneeze sends us to the doctor and every chest pain demands an MRI. Which of course leads to . . .
3) Pill Popping. Suburban housewives are huge drug users. They just pop prozac and antidepressants. They put their kids on ritalin because they’re hyper (really? a hyper kid needs medication? Really? God what would have happened to me if ritalin were widely prescribed when I was 5). We turn ourselves into blank zombies. We’re not any happier because of all of the pills. We don’t feel any better. If anything our isolation and self-medication make us feel worse, hate our lives, and become depressed. Which leads me to . . .
4) Psychiatric Care. Now I’ve never been to a psychiatrist, a psychologist, or a therapist of any kind. Some who know me well enough might suggest it could help. Maybe, maybe not. I have, however, known many people with severe problems who were and are on multiple meds and seeing multiple therapists. Some people genuinely need this. For a lot of people, however, I get the feeling that having a loving family around and good, supportive friends would be as good or better. Even people with serious issues could probably benefit from a tight social network. I’m not spouting here, because I’ve seen the difference in people (primarily with depression) who deal dramatically better with their issues when they’re around family and friends than when they feel alone.
And of course all this stems from the belief that *I* (not me specifically, but the Ego “I”) am a special and unique snowflake and my life is worth an infinite amount of money (well as long as I’m not picking up the tab) and of course so are my loved ones’. Now when it comes to *your* life and you will cost a million dollars for the possibility of living another two months, to hell with you. Ah the Ego bias.
This isn’t nuts, it’s probably a series “well duh” things. I know. But no one’s talking about it.
Point being that we can do a lot to “fix” health care by expanding coverage, cutting costs and all that jazz, but we may still face higher costs than we have to because of our culture of isolation and individualism. I’m not suggesting we all hug and sing kumbaya. I’m not suggesting we have group hugs (although I do enjoy hugs). Point simply being that we’re treating conditions more than we need to or that probably shouldn’t exist as a result of our culture. I don’t know how to “fix” it. I don’t know that it can be “fixed.” Just an observation.
Comment by Tom Trumpinski on 19 September 2009 at 12:39 pm:
Brandon, there is a great deal of difference between individualism and social isolation. The former is a virtue upon which this society was originally built; the latter is a maladjustment introduced with the creation of the “nuclear family” following the Second World War.
You and I have, in the past, both railed against the latter and this comment is not being written to diss the ideas within your article, merely correct your improper usage.
I agree one hundred percent that the lack of family network is creating neuroses which are running up our health-care costs. Mankind’s natural state is the tribe or clan, so smaller groups are bound to be less healthy, since they’re different from what we were evolved to be most comfortable within. All but the first of your items can be lessened by a return to our human roots.
Health-care costs are one-seventh of our GDP. The highest category of expenses within that one-seventh is “end-of-life” care. The elderly and dying should not be being pushed off onto a cold, heartless set of machines or the bureaucratic nightmares (a shocking preview of government-run health care) that are nursing homes and the VA.
In a sane and moral society, we would be wiping the sweat from the brow of our eldest and sickest and washing their wounded feet ourselves, in the living rooms of large, laughter-filled homes filled with small children to learn from their grandparents. Our neglect of these people, if we don’t reverse this trend, will go down in history as one of the sins which led to the fall of our people.
Health-care “reform” in American is as dead a concept as it was in 1993. The Democratic Party itself won’t allow it to happen–the Blue Dogs will vote against anything with a public option and the Liberal Wing will vote against anything without one. There is simply not enough votes to pass it. It saddens me that there’s been so much fuss over something so ultimately destructive, but I take heart that this bullet has been dodged once again.
We can take consolation, though, that our government has the power *today* to take two steps that would drastically lower our health-care costs at a fraction of the cost of the interest on the money we’ve had to borrow to pay for Medicare.
1) Cap malpractice damages at the “real” cost to the plaintiff.
A large part of the money that goes to doctors and hospitals do not go into their pockets as profit, but instead goes directly into the hands of the insurance companies that insure them against malpractice suits. Many of the redundant tests that doctors prescribe in routine cases are not necessary to insure that the patients are cured, but instead to protect themselves from accusations that “they didn’t do everything possible” to diagnose or treat a patient.
Not one bill so far proposed in Congress touches the trial lawyer industry. One legislator was quoted as saying “we don’t want to have them against us on top of everyone else–we’d never get anything passed.” Note that once again, expediency is trumping the proper course of action–a false road that I’ve cursed again and again.
Cap damages, remove “punative” damages, and keep lawyers from being paid in percentages of the final settlement and health-care costs will plummet.
2) Increase supply of medical professionals
Once the above expenses of operation are removed from the medical profession, it’s time to replace those who have been driven out of business by the law firms.
Since universities charge far more than is reasonable for medical school, a ten-year government subsidy for medical, nursing, and medical technician programs could be instituted. If doctors and other medical personnel emerge from their educational institutions without a hundred thousand dollars of debt and no exorbitant insurance costs, they can afford to charge much, much less than present for their services.
How much would this cost us?
If *every* 22-year old in the country decided to go to medical school, it would cost $32 billion dollars to put them through–a fraction of what any government sponsored health-care program would entail. Obviously, the price would be far lower than that–most people aren’t suited for the job. It would be a pittance and would significantly improve our current situation.
We need to spend some time discussing practical solutions that will work–while reducing the impact of government.
Got any others?
Tom
Comment by Brandon on 19 September 2009 at 9:11 pm:
Actually, one of the best non-partisan no-bullshit solutions I’ve seen is to get rid of state-specific health insurance altogether because in many states one or two big insurers corner the market. Blowing that system up so that you can get insurance across the country would definitely help. The employer system is dying and probably should die. I mean I’d love insurance, but employer health care is unsustainable and will only get more so as time wears on unless something changes dramatically. Employer health care also distorts the market and makes choice a complete joke.
I’m probably one of the few left-leaners who would be perfectly satisfied with a fully national 100% individual-insurance marketplace. Something like not being able to deny insurance based on pre-existing conditions, but allowing for adjustments for health conditions that are lifestyle choices (most obvious is smoking). Of course I’d also support subsidies for people who can’t afford insurance on their own on some sort of a sliding scale, but I don’t think it’s absolutely necessary to have a government plan. I mean I’d really prefer that we have a Japanese-style system with regulated private insurance.
One reason I actually rather like the 100% individual marketplace thing is that I find the idea of subsidizing someone else’s deliberate awful choices that they know to be awful (like smoking, excessive drinking, just run down the list) a bit disconcerting. I’d rather let them make their choices, but let their choices haunt their pocket books in some way (without, of course advocating allowing them to die). The individual market would allow us to avoid “social engineering” and “telling people what’s best for them” while essentially achieving the same results – discouraging bad behavior while encouraging good.
Comment by Tom Trumpinski on 20 September 2009 at 2:20 pm:
See, Brandon, we have the lifestyle regulation that you speak of now, with the ability of insurance companies to deny coverage. You’re just arguing that your set of folks should get fucked rather than the insurance companies’ sets of folks.
The end of employer insurance is nothing important–the employers would just have the money available to give their employees as wages instead. In a free society the employees could choose to use it on insurance or on a bass boat or private schools for their kids.
The problem with your plan is that if you require everyone to have insurance and no one to be refused because of pre-existing conditions, you end up with a lot of “SafeAuto”-type insurance companies that sell you insurance you don’t want to have to use for more money than you have to spend on it (check out the situation in Massachusetts for an example of this). At the same time, legit companies end up raising their rates because they can’t refuse folks who are going to receive $45,000 in benefits in the next two years and then die before paying more than a fraction of that cost in premiums. This *reduces* the number of people with decent insurance and is a disservice.
In truth, we have a system in the US now in which the very poor are covered by the government, the lower middle-class uninsured end up negotiating with their health-care providers directly for reduced rates, the middle class gets insurance paid for by their employer, and the upper class gets the best health care in the world.
If we could simply reduce the overall cost of health care (without further rationing) to move each of the categories down one notch, we’d have the best system in the world. Increasing supply is the answer, I’m certain, and it’s possible to do it with the ways I outlined in my earlier comment.
Tom
Comment by Tim on 21 September 2009 at 1:37 pm:
Oh and I want to add that the education subsidy, on its face, sounds like an excellent argument. An investment in human capital is a real investment that every consumer of health care can take to the bank. Considering the low cost and potentially very high return, I definitely could see that as something worthwhile of at least researching.
The AMA and other special interests might have serious problems if it were to depress the wages of doctors, but if combined with reasonable tort reform and lower malpractice insurance costs, it could be a potential cost saver.
I do not support eliminating punitive damages, however. My grandmother was paralyzed by a doctor who severed her spinal cord in 1957. For the next 11 years of her life, she lived a miserable existence and my family suffers for it to this day. Closing the door to punitive damages would be a tremendous injustice to those who have really suffered.
Capping punitive damages at some number or making a statutory way to calculate it, I can see as something I’d possibly support, even though I’m generally not in favor of more statutes as I think we have too many already.
Comment by Brandon on 22 September 2009 at 4:10 pm:
Tim,
It doesn’t matter that employers self-insure really because the aim is to get insurance companies to lower prices. It doesn’t matter what self-insurers do because they are only the big boys. Insurance companies are going after the small and medium sized employers (or individuals) who are not big enough to self-insure. There’s a reason that bigger employers self-insure in large numbers rather than going with private insurance. It seems highly unlikely that private insurers would give two licks about what self-insurers are doing because that’s simply not their market. It’s a red herring.
Tom,
If we had a 100% free marketplace there would be a few issues.
1) You would never be able to get health insurance ;-) (not to insult you, but I don’t think you could pay enough to get an insurer to cover a middle aged man with a dodgy heart)
2) I’m not sure that employers would raise incomes enough to compensate for the loss of benefits. It could be the case. Do you have any numbers or references? (not a challenge, I’m genuinely curious)
3) Increasing supply is a great idea. Same goes for nurses.
4) I’m highly concerned by the ramifications of such a move if only because we are not isolates and if someone chooses not to carry insurance, someone will have to pay for whatever happens, even if “whatever” happens to be their imminent death. A truly free market would not require hospitals to treat anyone regardless of ability to pay, so we could see people dying on hospital doorsteps because they didn’t have an insurance card. Also, just because YOU (generalized you) chose to buy a beamer instead of health insurance, that doesn’t mean that your family wouldn’t want to save your life if you were dying. Then you just shift the burden of your stupidity on to others which is completely unfair to them. In all honesty, I just see this as rewarding irresponsibility for those who are relatively healthy and punishing those unfortunate enough to have been born with or later develop a serious condition that requires regular attention.
Comment by Tom Trumpinski on 22 September 2009 at 5:28 pm:
Note on the above–for the life expectancy data, I took the numbers for white males, since we are both such. The numbers for the others don’t differ that much, surprisingly.
Tom
Comment by Brandon on 22 September 2009 at 10:51 pm:
Tom,
On #1 I was saying if there was no such thing as employer health insurance as you advocate then it would be impossible for you to get health insurance. I know you have it now, but that’s through the university, isn’t it?
Comment by Tom Trumpinski on 23 September 2009 at 12:17 pm:
In a true free-market society, I, like everyone else would have about 20% more money to begin with, but I won’t even include that–let’s say I bought my kids braces or a private education with that extra.
Without employer health insurance, I would have, most likely, invested the extra money that I received from my first job in industry, setting up a fund which would payoff later in life. During these healthy years, the only medical expenses that would have been paid would have been the birth of my three children. (Note, the factory’s insurance was horrible–we never went to the doctor during this time in this world. I would have been money ahead by taking it as payout, for sure.)
About 1992, at age forty, I was still in great physical shape. At that point, I would have bought the kind of insurance coverage (at a higher rate than a man of twenty) that would provide for me and my family. My pay at the University would have been about seven percent higher than it was in our real world–more than enough to get what I needed, especially since rates would be lower due to the competition.
If the company cancelled after my heart attack, I would probably have to switch to “high-risk” insurance, with a different price/coverage level to take care of big, catastrophic expenses.
Note, please, that this system will not work without removing the high cost of torts and medical education–there is simply not enough supply in the country now due to those problems. A middle-class person like myself cannot afford paying the real costs due to those.
Once again, fix those two things and many of our current problems will evaporate.
Tom
Comment by Tim on 28 September 2009 at 6:42 am:
Actually, your point about savings is a good one. Assuming that you actually saved money rather than consumed it, chances are, even if you paid out of pocket, most likely you would be dollars ahead NOT having insurance. High deductible health insurance would be a great way to insure many people at a lower cost, if they had such savings to make the deductible. Further, transferring some of the real “price” of medical services onto individuals for routine things (like the overwhelming majority already do for dentistry, orthodontics, and eyeglasses) would benefit the market considerably.
The idea that everyone can have health insurance like most employer plans at an affordable cost to all is impossible to achieve. This country spends almost 1/5 of its income on health care. Even if you made this very progressive, it’s simply unsustainable without figuring out a way to control future growth in costs. Also, with increased insurance would come increased expectations, even for very expensive care, which would drive up costs for everyone by shifting demand outward.
The solution is ultimately going to have to involve reducing the expected standard of insurance coverage and increasing out of pocket expenses for everyone as a norm (to disincentive hypochondriacs from consuming benefits that would otherwise go to legitimately sick people).
Further, the idea of “expanding coverage” and “lower costs” at the same time is impossible in a world of scarce resources. There’s no reason to believe that for-profit, non-profit, or government can cover more people at a lower cost. Politically, this is discussed often (because unintended consequences of such a policy are not considered by people who are not economists), but the CBO has pretty much ended that debate on every plan that is on the table right now. Even preventative care, which was long touted as a solution to controlling costs, was recognized as increasing costs, because the number of people who would have to consume care in order to avoid the low probability of a very high cost illness overcame any benefits.
In a world of scarcity, we have to realize that we will never get something for nothing. Even if something uber-progressive is passed and the wealthy paid for a large portion of it, it will require massive reform even in the short run because rate of change in the cost of health care is much higher than inflation. I really don’t know of any way to control that without stifling innovation, as well, and that’s certainly not a consequence that any of us want.
Let me also add that I am not arguing for the status quo, but rather, if we’re going to have reform, it must be able to provide social gain from the status quo, or we’re wasting our time drafting the statute.
Comment by Benga on 7 October 2009 at 7:44 am:
Mr. Ruiz,
You make several valid points here. I am a firm believer in limited individualism (individualism in accord with regard for others’ well being) and limited collectivism (collectivism with regard for the individual’s well being). There can be no perfect system as one group or individual will be negatively affected. Although not articulated clearly, I think you brought up some key issues affecting our system. Individualism, collectivism or social isolation is not even our problem here. Our problems are the low acceptable standards which we have set for ourselves. There are several problematic areas that we as Americans are not truly ready to address. First, let me note that I have lived and traveled through most of the World so my responses are not based on notions of cultural isolationism or relativism. Now, to elucidate those low standards, I’ll briefly and only address your elderly area as I am currently pressed for time.
As far as the elderly are concerned, yes, you are absolutely right! Elderly people do often live alone. Here in Chicago, we are forced to waste already limited tax dollars on well being checks in the winter and during excessive heat periods in the summer. Why? Well, that reason can be manifold. But, the underlying reason is that these elderly people are alone and often they have no family who care enough to check up on them. Also, we have long term care organizations (nursing homes) where elderly citizens are just dumped off as if they are problems that we don’t want to deal with. Honestly, before coming to reside in the States, I never knew what a nursing home was. Not to digress from the issue at hand here but the underlying problem in this area is the cultural way and standards by which we view our elderly. Like I said earlier, some of the real questions we need to be asking are questions that we can look ourselves in the mirror and ask. So I’ll ask, CAN WE ADMIT THAT COLLECTIVELY, WE TREAT OUR ELDERLY LIKE CRAP? I say yes, which is the objective truth. However, society seems to try to sway that truth by portraying it as an acceptable way in which our culture operates. Our elderly should be treated as sources of wisdom, knowledge, and growth as opposed to trash that is not to be bothered with and left to live alone in isolation!