Medical Competition: A Satirical Op-Ed from the Future (by Melvin Bray)
I have the pleasure of starting us off. Allow me to jump into the future about 24 years. A freelance language artist, Langstyn Huse (one of several figments of my imagination), has a recently syndicated column, the Absurdity of Modernity. In brief, it's political satire related to the issues of the 2032 election. Enjoy...
Melvin Bray is a language artist and a member of theGuild, along with Lisa Samson (novelist), Yaisha Harding (writer), Ercell Watson (comedian), Daniel Ra (singer-songwriter), Eugene Russell (singer-songwriter-rapper-actor), Russell Rathbun (storyteller), Daley Hake (photographer), Ed Sohn (multimedia artist), Prisca Kim (writer), and Claudia Burney (novelist). Learn more on theGuild's Facebook page.
Medical Competition: A Satirical Op-Ed from the Future
The conservative think tank Privileged Individuals for Increased Medical Profits released a study today that confirms what conservative pundits have been purporting for some time: America's healthcare system is languishing for lack of increased competition.
"Sick Americans are lazy and don't want to compete for the health services that they want," says Will Underhaul, chair of the recently formed MIOC (Medically Indifferent Obstacle Course) committee, which chose as its logo the Invisible Hand.
The first organized competition instituted was in honor of our soldiers—The Iraq Veterans Victory Lap. What better way to celebrate the inevitable victory of 30 years of globally antagonistic U.S. foreign policy. The Victory Lap is an orienteering challenge—complete with compasses, maps, and hidden flags (that are collected and later exchanged for increased face-to-face time with an actual doctor)—that really makes use of veterans' survival training. It involves both military and civilian bureaucracy trials. "Between the paperwork, runaround, and misinformation, it's a most grueling endeavor. A kind of boot camp for re-entry into civilian life," said the first finalist, now able to afford his full post-traumatic stress disorder treatment.
Another prominent feature of the MIOC commission's Patient Elimination Process is the Asthmatics Endurance Challenge. It involves shuffling asthmatic children from one inflammatory environment to the next to see who can best ration their limited meds and stave off attack the longest. The winner gets "a month's supply" of new medication—proportioned, of course, according to their Endurance Challenge intake levels. "Knowing how little medication a child can get by on helps healthcare providers save, thus make, billions a year," offered one pharmaceutical rep who asked not to be identified.
A progressive business owner out to lunch commented, "It's despicable what the healthcare industry is doing in the name of their bottom line, which I would think should be health and care. Still you can't buy everything the neo-liberals are selling either. A market-based healthcare-for-all program would be filled with graft. I would much prefer a British NHS program or, at the very least, a U.S. congressional-style plan." His compassionate free-marketeer lunch partner countered, "Although I disagree somewhat with my friend, what we currently have is definitely all wrong. It's the healthcare companies that should be competing for the public's business, not the other way around. That's what would drive healthcare costs down. And if it takes the fed to manage the bargaining side of that, so be it."
Industry insiders question what incentive healthcare companies presently have to drive health premiums down. "Why not just keep scaring middle-class Americans into thinking their healthcare will diminish and that they will pay more in taxes than they currently collectively do in premiums if everyone is enrolled in the U.S. Congressional Healthcare plan. Americans are so nationally provincial. They don't know that the poor in many countries with publicly-funded medicine have better healthcare at better rates than middle-class Americans can individually afford. Besides, you can't forget the psychology of capital wealth: Those who can will unconsciously pay much more for something they know the poor can't afford (at least that's what my automaker friends tell me). As for turning the tables and demanding the sick compete for services, that's just fun!"
Despite the more than century-long trend of exponentially mounting healthcare costs, latest polls reveal that 77% of all Americans believe the healthcare market will eventually correct itself (a conclusion extrapolated from 2,500 Iowans polled). But how can the market correct itself when 90% of the power (wealth) needed to correct it rests in the hands of the 7% benefiting from the market's imbalance?
Some say improving healthcare is a simple question of political will, which it may be. But isn't it first and foremost a question of imagination—or lack thereof? How long are we to believe the snake oil salesman who says that our real lack of imagination lies in our inability to grasp the rationale for buying more snake oil? How many times do we return to see the sideshow illusionist who convinces us that there's no other way to do healthcare while he makes Canada, Cuba, Austria, Belgium, Bosnia, Bulgaria, Croatia, the Czech Republic, Denmark, Finland, Estonia, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Malta, the Netherlands, Norway, Latvia, Liechtenstein, Luxembourg, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom, Australia, New Zealand, Israel, Kuwait, Qatar, UAE, Saudi Arabia, Brunei, China, Hong Kong, India, Japan, Malaysia, South Korea, Seychelles, Sri Lanka, Taiwan, and Thailand (yes, 55 nations) disappear from the globe of our consciousness? How often will we embrace economic double-talk from politicians, pundits, and other 7-percenters regarding the failures of healthcare-for-all systems over our own ingenuity and common sense to consider what other nations have and improve upon it?
Who knows? This is, after all, 2032, and Americans have been dancing around this issue for 100+ years (since Teddy Roosevelt). Imagination is a scarce commodity, I guess. But the truth of the matter is this isn't solely about healthcare, now is it?
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Comments
very weak.
Posted by: SunKilMoon | June 3, 2008 10:23 AM
So this is what that last esoteric post was getting at?
Will satire be this preachy in the future?
Posted by: kevin s. | June 3, 2008 10:57 AM
Yup, real convincing this one: combines the humor of a root canal with the subtlety of a baseball bat to the mouth and the policy wisdom of Beavis and Butthead.
This is supposed to be the creative cutting edge? Looks more to me like a secretion of bile.
Wolverine
Posted by: Wolverine | June 3, 2008 11:05 AM
Wolverine,
You're missing the nuance. Take, for example, this:
"Privileged Individuals for Increased Medical Profits "
Brilliant in its own right, but look at the acronym suggested by the name. That's a whole added layer. And they'll PIiMP you too, if you're not careful.
Posted by: kevin s. | June 3, 2008 11:26 AM
Good satire is notoriously difficult to pull off. Maybe we should leave it to the Wittenburg Door folk. Or better yet, to Mark Twain and Jonathan Swift.
Posted by: carl copas | June 3, 2008 11:35 AM
Get it?! They chose the Invisible Hand as their logo. Like, from Adam Smith... As in, the invisible hand of the market. Get it? hahahaha...
I can't wait for more from theGuild.
Posted by: Eric | June 3, 2008 12:55 PM
gentlemen, before you roast me further, allow me to suggest that if i were of the caliber of twain and swift, GP would not be my only venue!
please be reminded that this is 'satirical op-ed'. the purpose of satire is to ridicule and provoke (judging by your condemnation, i have accomplished this). and opinion-editorials are just that--the purpose of which are to advance a point of view. how that becomes "preachy" (if "preachy" means something other than 'advancing a definite point of view') i'm not sure, unless you see the gospel in it, in which case I've accomplished another hope as well.
you are right to note that i'm not much of an humorist (which i'll never claim to be, i promise). but you have yet to deal with any of the key points (some of which are hidden in the "layers;" but you'll have to dig deeper, kevin ;-) of the piece. one of the one's i'd love to hear your thoughts on is:
how can the market correct itself when 90% of the power (wealth) needed to correct it rests in the hands of the 7% benefiting from the market's imbalance?
Posted by: melvin bray | June 3, 2008 12:55 PM
This might be a silly question, Melvin, but how am I supposed to see the gospel in this piece?
Posted by: Bob | June 3, 2008 1:36 PM
"how can the market correct itself when 90% of the power (wealth) needed to correct it rests in the hands of the 7% benefiting from the market's imbalance?"
The premise of this question is part of the problem with the piece.
First of all, as it is presently constituted, we do not have a free market health system. Rather, we have a complicated web of tax incentives and regulations that tether health insurance to employment. Calling on the free markets to correct the problem is an unfair burden.
Second, it is a misnomer to suggest that 90% of the wealth needed to correct the healthcare system lies in the hands of 7% of the population.
I'll grant you that 7% of the population do possess 90% of the wealth in this nation. However, healthcare is not a commodity. It requires the same effort to operate on a rich man's knee as a poor man's knee.
One cannot reasonably "horde" healthcare. In fact, we have every incentive to do the opposite. Going to the hospital requires time, and the wealthy don't like hospitals any more than the poor, to my knowledge.
Further, as healthcare cannot be horded, neither can research. A preponderance of a particular malady will almost assuredly improve treatment of that particular malady. Since we are all vulnerable to disease, the wealthy stand to benefit from universal access (see? Everyone likes the word "universal")
Research aside, the wealthier 7% benefit from greater access created by higher volumes. The ability to benefit from world-class arthoscopic surgery is contingent upon the ability for a hospital to fill a surgeon's daybook with patients.
As such, the power to influence health care resides in the hands of the majority who have access to it. Similarly, are here is the real obstacle, "fixing" the system will also require sacrifices of the majority.
Increased costs, fewer treatment options, decreased care for the elderly and terminally-ill children. One of the pins has to fall, and anyone who pretends otherwise is lying.
Posted by: kevin s. | June 3, 2008 2:35 PM
thanks for the conversation, bob. (and i apologize up front to everyone else that i'll be unable to engage everyone in this same way.)
in hopes of not chasing too far down a theological rabbit trail, i'll say this much. i see the gospel as more than just "jesus lived, jesus died, jesus rose again" (although i must admit this is good news in and of itself).
nonetheless, mark tells the story of a jesus traversing palestine (long before his death and resurrection) saying, "hear the good news: the kingdom of GOD is at hand." then he proceeds to illustrate this new reality in a variety of ways, not the least of which was healing the sick. now that's not exactly what we mean by health care, but i think it does drive at what i propose should be the bottom line of it.
i believe the gospel of the kingdom of GOD is as much a contextual reality as recognizing health care as a basic human dignity, as it is a spiritual truth like recognizing the new possibilities that the life, death and resurrection of jesus makes possible.
Posted by: melvin bray | June 3, 2008 2:40 PM
Well, the one thing I noticed in this little satire is that if we're still in Iraq thirty years from now, we won't be worrying about health care much. We'll have gone bankrupt long since for sure.
D
Posted by: Don | June 3, 2008 4:08 PM
Amen, Bro Melvin;
When Jesus identified Himself with us, taking on our nature, perforce He took upon Him atoms, sub-atomic particles, quarks, and however far down His subatomic infrastructure goes, and thus perforce the entire physical cosmos out to the farthest star. Somewhere in all that complexity, between our humanity and the stars and galaxies, fits society, the world, the cosmos, of man. Of course He's wants Justice for His human creatures. Of course He wants healing, medical care, for them and all their children.
It's the Law, the Prophets, and the Psalms
Psalm 82:
1 A Psalm of Asaph:
God stands in the Congregation of God:
He judges among the gods.
2 "How long will you judge unjustly
And accept the faces of the wicked? Çelah.
3 Judge the poor and fatherless:
Do Justice
to the afflicted and needy.
4 Deliver the poor and needy:
Rid them out of the hand
of the wicked."
5 They do not know,
nor will they understand;
They walk on in darkness:
All the foundations of the earth
are moved.
6 "I have said, 'You [are] gods;
And children of the Most High,
all of you.'
7 But you shall die like men,
And fall like one of the princes."
8 Arise, O God, judge the earth:
For You shalt inherit all nations.
Posted by: Ted Voth Jr | June 3, 2008 4:19 PM
melvin - I still don't get your answer to Bob's question, but i've never claimed to be real smart, as you've never claimed to be a humorist..
But anyway, I read the satire with the geico voice in my head as seeing the possibility one day that there will be numerous commericals from even the fly by nighters eagerly trying to help us to save money by offering up low cost helth insurance as the reptile does today with automobile insurance.
Melvin, I for one enjoyed the distraction from the face to face challanges of today's issues with a glace into the wonderland looking glass at the continuance of our healthcare delimma.
So thanks, but don't take too many of these comments personal, they are meant to help us all grow I'm sure.
Posted by: d.e.sharp | June 3, 2008 4:23 PM
kevin s. wrote: "However, healthcare is not a commodity. It requires the same effort to operate on a rich man's knee as a poor man's knee.
One cannot reasonably "horde" healthcare."
Tell that to someone with a physical disfigurement without the financial means to have it taken care of in comparison to those that stroll into a plastic surgeon's office every other week to have their breast size adjusted to the comfort level of the moment. Or to those that need legitimate medical attention yet the only affortable healthcare insurance they have leaves them with deductibles they makes bankruptcy all the more relevent despite the governmental shut down of the bankruptcy free for all attitude of days gone by. They work everyday to make a "living" yet there are no bridges that allow them access sometimes even to what the impoverished have through governmental assistance programs.
Here in the real world the idea that complete and immediate healthcare is already being "horded" by those with the financial means (and the hell with the rest of us)is already, and has been for some time now too much of a reality.
Posted by: d.e.sharp | June 3, 2008 4:49 PM
"Tell that to someone with a physical disfigurement without the financial means to have it taken care of in comparison to those that stroll into a plastic surgeon's office every other week to have their breast size adjusted to the comfort level of the moment."
I wouldn't call the latter healthcare, though it obviously requires a trained doctor. Are those seeking recreational surgeries taking away from those who genuinely need them, or are they simply increasing the demand for plastic surgeons?
"Here in the real world the idea that complete and immediate healthcare is already being "horded" by those with the financial means (and the hell with the rest of us)is already, and has been for some time now too much of a reality."
I think you missed my point. Having the means to attain legitimate medical care is not the same as hording medical care. My point is that the healthcare issue does not lend itself so easily to the sort of 90/10 questions Melvin is posing.
As such, this particular satire identifies the wrong targets.
Posted by: kevin s. | June 3, 2008 6:02 PM
Melvin,
As you were listing those 55 countries were you at all troubled by the lack of medical innovation of those countries? Call it greed if it makes you feel better, but the reality is innovation rarely happens without market incentives. America leads the world in medical innovations because we have more market competition and incentives than your favorite national healthcare nations.
Competition is not the bad guy. Can you think of any industry that lowed prices by reducing competition?
Posted by: DITE | June 3, 2008 7:01 PM
As such, this particular satire identifies the wrong targets. Posted by: kevin s. | June 3, 2008 6:02 PM
On this we both agree.
Posted by: d.e.sharp | June 3, 2008 7:41 PM
Health care is a real mess. I know becaue I've spent most orf my career as an executive in health care. I'm interested in talking with people who are not "single payer" or. "free market", but want to solve the problem.
What we often forget is that the primary goal of the “health care system” is...health. From that vantage point, the next goal is doing all we can as individuals and a society to promote good health. It falls under the "promote the general welfare" language of the Declaration of Independence.
Moving down the food chain...next to health, comes health care, which is intended primarily to restore health, cure disease, ease our suffering or learn to live with our disease.
Then finally, there is health care insurance which was originally, and still should be, designed to protect us from the high costs of health care and be a way to provide financial access to health care. Insurance deals with the financing of health care and health care is there only to restore or maintain health. These are separate and distinct functions—at least under a system that pays providers for illness on a fee-for-service basis.
We often forget that the greatest improvements in American health and improved health status in countries that enjoy such a blessing, result from clean water, sanitation, functioning sewers, breathable air, and immunizations. Those are public health functions and we should all gladly pay our taxes to support public health and prevention. We also ignore the facts that much disease is either preventable or at least influenced by lifestyle. Lifestyle is behind 71% of cancers, 70% of strokes, 82% of heart disease and 91% of diabetes. That does not mean we blame the patient, but it should mean that whatever we do should encourage wellness, personal responsibility and a shared responsibility for disease and illness that cannot be prevented.
Our system has plenty of money to pay for the care of every child born with congenital heart disease and to provide good wheelchairs and other equipment for quadriplegics. We also have all the money we’d need to ensure immunizations are available, premature babies are given every chance at life, emergency services are available, transplants are paid for, etc.
But we're kidding ourselves to think that we should all pay for poor lifestyle choices and that the "health care system"--whichreally does not exist--should somehow shield people from the costs of all care.
I'm not sure what all the answers are but I do know that:
• When everyone—insurers, hospitals, physicians, consultants, labs, non-profit health organizations, drug companies—everyone but the patient—profits from higher costs and more use of services, it is virtually impossible to control costs.
• We should de-couple health insurance from employment. Having a job should not be so tightly linked to health care coverage.
• Health care is hugely subsidized by U.S. taxpayers. Medicare, Medicaid, tax deductible medical expenses, business deductions for health care, government research, tax subsidized contributions to charities, etc.
Taxpayers should demand that we first guarantee public and preventive services for all people. Second, taxpayers should demand an end to the unnecessary duplication of taxpayer subsidized hospital services in almost every metropolitan community in our country. Third, taxpayers should demand that a universal electronic medical record be created so that every American has a comprehensive, transportable and secure record that covers all services. Fourth, taxpayers should demand that all American health care providers and insurers agree to a common language and format for bills, insurance forms, “Explanations” of Benefits that don’t explain, etc. so that patients easily understand what they owe. Fifth, taxpayers should demand that the payments for services become consistent across the country so that providers are indeed accountable and so that clear comparisons can be made. Sixth, taxpayers should demand that quality and cost comparisons that are being developed and promulgated by health care providers and insurers are consistent, and understood by patients. At present the move toward “transparency” will lead to a decade or two of confusion. Seventh, taxpayers should demand that pharmaceuticals, medical equipment, and medical and surgical procedures have sound, evidenced-based, cost-benefit support for them before the patient or an insurer should pay for the service.
• Neighborhoods and retail areas should all be linked with sidewalks or greenways so that people can walk, jog, bicycle, Segway, ride scooters, or otherwise transport themselves around so they get outside and maybe get some exercise.
• Schools should be required to promote physical fitness.
Lastly, I’d say that generally the less health care you receive the better off you are. I think the only way to manage the demand for services and to thus control costs is to increase cost-sharing for the patient. And only through higher cost sharing will we be able to make insurance affordable and attractive. However, without increased cost sharing, insurance premiums cannot do anything but increase and that will lead to more uninsured, which will lead to higher premiums and lead to more uninsured…and the beat goes on.
Posted by: Al Mytty | June 4, 2008 12:19 AM
How many heart attacks have the American taxpayers covered Dick Cheney for now? Now there's money well spent. Who says pouring mega$$$ into an aging career politician is a good use of apparently limited healthcare dollars?
Keep raising the questions, Melvin, but it's best to do it in monosyllables for some of the crowd here.
Posted by: canucklehead | June 4, 2008 12:59 AM
Whether you intended to or not, you ask a decent question canucklehead. Who should be deciding whether a particular health care expenditure is a good investment or not? When there's a limited supply of a public good is it worth using it on an "aging career politician"?
Posted by: Eric | June 4, 2008 1:45 PM
15 years ago I was a Student in Japan.
Even though I was considered an alien I received the same level of health care as privileged Japanese citizens.
They covered all of my dental problems while I was there for 3 years with minor minor copays. The work was done by dentist with degrees from the US.
Now that I am back in America, most days of the year I owe my dentist about an average of $800. or more.
As far as I can tell Japan has not gone bankrupt paying for the dental care of its citizens.
Posted by: Ms. Cynthia | June 5, 2008 6:15 AM
Sojourners always talks about interconnected people and systems except on this sort of issue. Our health systems needs the innovative systems (the ones that use competition, as in"America leads the world in medical innovations because we have more market competition and incentives than your favorite national healthcare nations.
Competition is not the bad guy. Can you think of any industry that lowed prices by reducing competition?")
We can't imitate other countries' socialized systems and then just assume that innovations will come out of nowhere.
Innovations cut the cost of care, reduce pain and hospital stays. And incisionless surgery (i.e. from the inside, see www.noscar.org) actually has the potential to bring surgery to regions that can't afford sterile operating rooms. This sort of progress doesn't arise from government diktat.
Posted by: witness for peace | June 5, 2008 5:19 PM
I thought it was GREAT satire!
I especially enjoyed the idea of a logo (made of ink?) that is ... invisible.
If Twain had blogs, heda had fleas like your peanut gallery critics on his dog. Oh, wait. he did.
Posted by: Max | June 6, 2008 8:07 AM
QUESTION AND COMMENT TO Al Mytty :
Al Mytty said, "Fourth, taxpayers should demand that all American health care providers and insurers agree to a common language and format for bills, insurance forms, “Explanations” of Benefits that don’t explain, etc. so that patients easily understand what they owe."
QUESTION: As a former health care executive, could you explain why I get letters that say "THIS IS NOT A BILL" with various numbers and codes and words I don't know, then months later I get a nastygram claiming if I don't pay $x,sess.?? by next week it will go to collections? No bill in between the two! I've come to expect it because its SO COMMON. Why do they do that?
Al you also said, "Second, taxpayers should demand an end to the unnecessary duplication of taxpayer subsidized hospital services in almost every metropolitan community in our country. "
I would enjoy an expansion on this point. I don't currently understand what you mean.
Do you mean like PBS paying for financial news elevating the gambling of Wall Street to real news in direct duplication of the dozens of private financial news channels? (meanwhile, there's no "Doug Jones Average" and news of the worker).
Or do you mean something else entirely?
Thanks for a great post!
Sincerely, Max
Posted by: Max | June 6, 2008 8:22 AM
competition--in terms of something outside one's self that pushes one beyond what one previously thought were her/his limits--is not a bad thing. in fact, it is a very good thing.
but using the same term within the context of capitalism as a wholesale description of the interaction between businesses and between businesses and the public is more often than not a misnomer. "competition" only describes a small minority of the activities businesses--more particularly, corporations--engage in to increase market and profit share, which theoretically is supposed to drive down prices but often doesn't because so-called "competition" fails to provide adequate incentive. "manipulation" or "exploitation," though some are loathed to admit it, would be a more accurate term to describe the bulk of corporate activity (i.e. marketing, planned obsolescence, monopolizing, price gouging, externalizing costs, tax evasion, mis-accounting, lobbying, job exportation, currency manipulation, speculation, etc) to increase market and profit share within the context of capitalism.
capitalism is not the only and definitely not the best form of market economics, but even using other, less manipulative and exploitative models, one soon finds that health care--and provision for other basic human dignities--is seldom best handled completely in the open market. some things provide for the general welfare of all to such a degree where the profit motive has no place. basic human dignities are just that and should be somehow available to all and not dependent on whether one has the capital necessary to access it.
Posted by: melvin bray | June 11, 2008 4:55 AM
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