A Republican Drama

Via @Billy, Just Billy, who saved screenshots:

I understand that the reason his insurance claim was denied is that he was using his own car for his job (delivering pizza), but had a personal insurance policy, not a professional one, which costs more but covers job-related accidents.

So now he’s running a GoFundMe campaign to pay his bills. As of this writing, he’s raised $2,225 of his $15,000 goal.

In a book or movie, this would be the point where Our Hero has an epiphany: that accidents can happen to anyone, even the young and healthy. That medical care is fucking expensive (and replacement cars ain’t cheap either). That having to ask people for money while you’re busy getting your spine, your car, and your job back together is another pain in the ass.

It might also lead one to wonder: what if he didn’t have 30,000 Twitter followers who could chip in? Or if he didn’t happen to be young and photogenic? How long would it take him to pay his medical bills on a pizza delivery guy’s salary?

Wouldn’t it be great if there were some way to have something like a GoFundMe that scales? Maybe something where people pay in while they’re healthy and able to draw a salary, and can then get help paying unexpected bills so they don’t go broke from being sick or in an accident? What if, in short, there were such a thing as medical insurance?

However, we don’t live in a movie, and as of this writing, Sassy Gay Republican still seems to equate universal healthcare insurance with tyranny or some similar right-wing talking point. But while he may be cutting off his nose to spite his face, the rest of us can use him as an object lesson.

I’d Rather Have a Long List of Scary Warnings than Nothing at All

I recently participated in a coversation—or maybe I’m conflating two or more conversations, but no matter—in which my interlocutor said that she prefers alt-med natural remedies because mainstream drugs all have a long list of scary potential side effects.

But when I asked whether alt-med drugs actually lower cholesterol or help prevent heart attacks or whatever they claim to do, she said that people who sell alternative medicines tend to avoid making medical claims. They’ll say the product “enhances well-being” or some such, but not “this product helps regulate LDL”.

Because what happens is this: if you make a specific claim about physiological effects or the like, that’s a medical claim, and the FDA expects you to back it up. So Pfizer comes along and says, “this new drug, XYZ, improves blood-clotting.” The FDA says, “Oh, yeah? Show me.” And so Pfizer performs studies, or cites independent studies, that show that yes, as a matter of fact, patients who receive XYZ tend to clot better than patients who don’t, even after taking into account other possible explanations, like luck or the placebo effect. And the FDA says “All right, you’ve made your case. You can claim that XYZ improves blood-clotting in your advertisements.” At least, that’s how we want it to go; how we hope that it goes.

Unfortunately, the world is complicated, and it’s never as simple as “take this drug and you’ll get better.” Different people have different bodies and react to things differently—for instance, I have a friend who doesn’t drink caffeine because it puts him to sleep. So at best you’ll have “take this drug, and it’ll most likely help, but it might not do anything.” More often, you get a drug that does what it’s intended to do in the majority of cases, but also has a list of possible, hopefully rare, side effects. But the more participants in the study (which is good), the greater the chance that one of them will have a heart attack or something that can be plausibly be attributed to the drug being studied. So the Scary List O’ Adverse Effects grows.

So yeah, traditional herbal remedies that don’t have words like “vomiting” or “stroke” on the label look appealing by comparison. But that’s only because the people selling the herbs aren’t required to test them, or to publish the negative results. If someone out there did make a specific claim, like “echinacea helps relieve flu symptoms”, and the FDA said “Oh, yeah? Show me”, and they showed ’em, and ran tests and studies and such, there would almost certainly be some adverse side effects to report. If you’re not seeing any, then either someone’s hiding them, or else no one’s looked for them.

In the real world, everything has problems. Saying you prefer alternative remedies to conventional medicine because it doesn’t have a scary list of adverse effects is like getting your financial advice from a psychic instead of an investment banker because instead of scary disclaimers about lawsuits and patents and the possibility of losing all your money, she just has the friendly statement “For entertainment purposes only.”

Some Bloody Obvious Observations About Health Care

In all the recent talk about US health care reform, one comparison
that hasn’t been made enough, IMO, is with public schools.

Yes, US public schools have their share of problems (don’t get me
started on students who can’t find the US on a map), but they do serve
two important functions: they’re a backstop and a floor.

Backstop: if, for whatever reason, you can’t send your kid to a
private school — perhaps your school of choice is too far away,
or too expensive, or the uniform clashes dreadfully with her hair, or
whatever — there’s always the public school option. That is, you
never have to choose between education you can’t afford and no
education, only between education and better education.

Right now, too many people are having to choose between health
insurance they can’t afford, and no health insurance.

Floor: private schools can remain in business only if they suck less
than public schools. If you’re of the “government can’t do anything
right” school of thought, this sets the bar low enough that it
shouldn’t be a problem.

But on the whole, public schools haven’t driven private schools out of
business, any more than public libraries killed off Blockbuster or
Netflix. the US Postal Service has killed off UPS and FedEx. In fact,
those two came along after the USPS, and thrived because USPS
was widely seen as being sucky.

So a government-run health insurance plan would define the lowest
level of quality that a plan would have to achieve. If your insurance
company sucks more than the federal government, you don’t deserve to
remain in business.

Backstop again: a lot of jobs that the government does are ones that
are unprofitable, but ought to be done. When No Child Left Behind
required schools to show how much bang they were giving for the
education buck, a lot of private schools tried to dump their special
needs students, simply because kids who need special attention or
staff training are less profitable than average kids. Public schools
don’t have that option. Again, by analogy, a public plan should cover
those people too unprofitable for private plans (I’m thinking Stephen
Hawking without the wealth and fame).

Now feel free to leave a comment saying how fucking obvious all of
this is.