Wednesday, December 19, 2018

"Fee" Health Care

by Glenn T (writer), Las Vegas, NV, August 03, 2009


Some unexpected perspective on the efficacy of "free" health care, and an example you may not have thought of.

As the debate over Universal Health Care or Socialized Medicine (or whatever name you’re currently using to refer to the federal government taking over health care) continues, we seem lost for a decent example of how and whether or not it will work. As European versions seem too far removed, we are constantly being told to take a good, hard look at our national neighbors to the North as anecdotal evidence. But, if Shania Twain, Keanu Reeves and Pamela Anderson are any example of our looking to Canada for informative analogs (of cowgirls, surfers or lifeguards, respectively), perhaps we ought to be looking a little closer to home. As it turns out, there is a significant section of the local population, that we can easily examine to inform our decision on the matter, for whom health care (1) has $0 out-of-pocket cost, (2) is run completely by the federal government, and (3) provides questionable levels of care and care availability, and that is, the military.

During my ten years in the United States Navy, people often told me about how “lucky” I was to have “free” healthcare available to me – as if that were the big upside to the woeful underpayment that they referred to as my “salary” and the opportunity to enter a war zone in defense of my country. Nonetheless, this talisman of a benefit seemed to stand out, to them and to most, amongst the myriad of other perks offered to military members. It was as though it was a “Get Out of Jail Free” card for ever getting sick – the ultimate freedom for a population cowed by the incessant fear mongering of the pharmaceutical and medical industries. But I’m here to tell you, not only is it not what it’s cracked up to be, it’s downright horrible. The policies surrounding military medicine along with anecdotal evidence of its failures leads to one conclusion: it’s a bad idea. I can honestly say, the single best thing about not being in the military anymore is having access real health care, and no matter what it costs me, I’m grateful to pay it.

Policy – Oops, OK.

You don’t have to be an economist to appreciate incentives. In fact, one the most important things I’ve learned in business and in law is to be sure and understand everyone’s incentives to the greatest extent possible before negotiating or dealing with them in any way. Incentives can explain even the most ludicrous behaviors. For example, say you’re the heiress to a global hotel empire, and you’ve got a completely unthinkable amount of money at your disposal. Not only do you not have an incentive to work or create any value whatsoever, you also have little incentive to behave in a polite or even lawful manner. You can see what I’m getting at. Of course, these incentives still can’t explain why such a person would be famous, but hey, it’s not a perfect science.

But, with regard to military medicine, the incentive structure is set up to create mediocre practitioners. One of the first documents you sign when you join the military is an agreement not to sue the Government. That’s right, immediately after signing over your life and freedom, you also give up your Constitutional right to legal redress should they fail to live up to their part of the bargain. This also means you can’t sue anyone else in the military. So, you cannot file a suit for medical malpractice, no matter what happens to you. What’s more, the military’s doctors don’t even need to carry malpractice insurance – they can make as many life-altering mistakes as they would like, and the worst thing that can happen to them is a bad evaluation. How free does that medical care sound now?

Seriously, you’re better protected from the kid serving you ice cream at the 31 flavors than you are from your military doctor. Which is great, except that the ice cream guy isn’t cutting you open.

Practice – Don’t Touch the Sides!

Of course, all of this policy jibber-jabber doesn’t really mean much to you in the abstract. Well, lucky for you, I had a few run-ins with my “free” medical care that went a little south of “good practice.”

When I was stationed in North Charleston, South Carolina, I was assigned to shift work aboard a moored training ship to learn how to operate a naval nuclear power plant. One day I had noticed a lump on my inner thigh and wasn’t feeling well. I went to work anyway and began to feel worse. My head was throbbing; I was sweating and had chills. As my visible condition began to worsen I was allowed to go to the clinic on base. After waiting for over an hour just to have my vitals taken, they noted my fever was 103, at which time they instructed me to go to the local Naval Hospital to be admitted. I never saw a doctor there, and they didn’t offer me a ride. So, nearly delirious, and with my temperature rising, I drove myself to the hospital, over ten miles away, where I waited for another hour to have my vitals taken again. This time an actual doctor saw my temperature and admitted me immediately. Safe, right?


After five days they finally determined that my lymph node was infected and would need to be biopsied to determine what was going on. My fever was still up over 102. They ultimately strapped me to a table under local anesthetic to cut into my groin and remove it. Which sounded like an o.k. idea until I actually felt the scalpel cut my leg, to which “doctor” responded: “You felt that?”

In addition this parade of horrors, I also personally experienced the following medical mishaps:

  • Waking up in the middle of my septoplasty (surgery to correct my deviated septum – under general anesthetic);
  • Four dry sockets after wisdom tooth removal; and
  • Having a root canal done on the wrong tooth!

I’d be better off with a medical student whose only surgical experience was playing Operation while drunk at a frat party than letting these quacks cut into me again. At least for him there was some sort of penalty for screwing up – even if it was only having to take a shot of Jagermeister.

There’s no “u” in “free”

Listen, the idea of universal health care is a fantastic one. The altruism is so pervasive that it even feels good just to talk about it. Pairing common access with the world’s finest medical care seems like a no-brainer. But, just like things you buy after midnight from the Home Shopping Network, the reality is a far cry from the promises (OxyClean, anyone?). When the government takes over health care, and more importantly when it takes over compensation to physicians, the incentives to excel, and even the incentives simply not to suck at your job, simply disappear. Much like teenagers, doctors in a consequence-free environment are bound to do some damage – the difference is that the worst thing teenagers will do is raid your liquor cabinet, make too much noise and maybe ruin a shrub or too.

Uniform Health Care will be much the same as “Uniformed” health care – the doctors will have no reason to be exceptional, and you’ll have no recourse if they aren’t. You don’t need to take my word for it, you likely know someone who’s served – and they’ll be happy to tell you. Of course, it’s true, no one will be turned away, but what makes you think that if we forced to world’s automakers to give everyone a car at a fixed, low price that they’d deliver everyone a Mercedes?

About the Writer

Glenn T is a writer for BrooWaha. For more information, visit the writer's website.
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10 comments on "Fee" Health Care

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By Lady D on August 03, 2009 at 10:59 pm

Good points Dean. Did you know when you become President you are assigned a military doctor and you can no longer have a private doctor.

And maybe if all the Doctors out there would tell use what kind of healthcare plan they would like to work with (no chiming in from insurance companies) and then maybe we could get somewhere.

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By D. E. Carson on August 03, 2009 at 11:39 pm


I love it.  You write a compelling argument against Obama-care and Category Five up there still manages to marginalize your experience claiming that American health care ranks 37th in the world when people from all over the world scramble to get to America for treatments they can't get elsehwere.  Of course Cat Five will bring up all the people who leave America to subject themselves to some experimental treatment in a foreign country because that treatment isn't available in America.  How many of those Americans who have gone overseas for a treatment have you heard from since?  Even ABC's 20/20 has tried to track down some of those people and cannot because either the treatment didn't work and they're DEAD or they're still undergoing that treatment.  Either way, that's fodder for liberals who claim that there's better healthcare out there than ours.  So long as I have the option, I'll stay right here in America where the healthcare system really is better than anywhere else in the world (Category Five's 36 provinces of Fantasyland not withstanding).

Nice article.  It agrees with much of the anecdotal evidence I've gathered from people who live in Canada and England where socialized medicine is actually on the way out -- assuming they can actually find a way out.

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By Glenn T on August 04, 2009 at 04:29 pm

Wow... well, I certainly didn't expect to ignite such a firestorm, but I appreciate all the discussion and praise, and can surely understand how this issue can get very personal very quickly.  But I just wanted to explain my thesis for the piece without any unnecessary vitriol.

I don't think it should come as any surprise that there are issues my piece fails to address.  This is for a couple of reasons: first, because it's only a page and a half long.  Anyone who tells you they've completed a comprehensive review of the socialized healthcare issue in 1500 words should be immediately suspect.  I would never even dream of oversimplifying to that degree.  Second, I didn't purport to.  The point of the article was to highlight the fact that we seem to be bent on looking abroad for good examples (i.e. Canada and Europe) when we've got a comprable (albeit smaller scale) example right here at home. 

The problem with anecdotal evidence is that it's both subjective and limited - and trutfully can't be relied on to reach any sort of conclusion.  So please understand that I am truly and deeply sorry for what's happened to Dean and his girlfriend, and I don't mean to marginalize their pain in any way. 

But, I would rather see readers also address the economics arguments I raised - because regardless of our personal passions and experiences, economic incentives will always prevail as an explanation and predictor for behaviors.  And, inasmuch, socialized medicine appears to be a recipie for mediocre care for all us, rather than exceptional care for some of us.  

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By wolviela on August 04, 2009 at 05:02 pm

Well this explains why my Navy Corpman is able to do stuff I consider only a doctor would be qualified for. So I guess my article on Continuating Medical Education would fly(no pun intended) over the military's head

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By Glenn T on August 05, 2009 at 03:43 pm

Dean, it is difficult to allege a lack of vitriol and then accuse an opinion piece of being "bent on avoiding the facts . . . in favor of anecdotal stories."  Even as a humor essayist, I know when I'm being called out. 

Additionally, you suggested that I had an ulterior motive for my writing, inasmuch as I might be a bankruptcy attorney and I would support any policy that would contribute to additional personal bankruptcies so as to increase the number of paying clients I might receive. 

In truth, I find both of these to be off-putting, and an unnecessarily combatitive - especially given my history here on Broo.  I do appreciate your contributions to the site, but I don't mind losing 1 reader if I don't have to deal with this type of criticism.

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By Karen Soltero on August 05, 2009 at 07:24 pm

After reading the article and all the ensuing commentary, I'm gonna have to back Glenn on his responses to Hurricane Dean's thoughts on the piece.  What Glenn wrote was an opinion piece - meaning that he assigned himself the topic, opted to write the piece, did not submit it to anyone in return for compensation or write it at the request of anyone else.  Therefore, he is not under any obligation to include anything in the article other than exactly what he wants to put in it.  And if he chooses to write something anectodal rather than fact-based, well, then that's his perogative.  So, Hurricane, you are more than entitled to offer up your own opinion and agree to disagree with Glenn, and, since you have so many facts, and such a strong opinion of your own, I invite you to write your own article, and you present your side of the argument rather than berate Glenn for his failure to do so for you.  But to assert that Glenn neglected to include certain information in his piece is, in fact, an attack on him personally, rather than on his writing.  This was not a homework assignment.  There was no requirement to include certain information involved in the writing of this piece.  And honestly, if he did stand to gain financially from the current health care system (for the record, he is not that kind of lawyer and does not stand to gain a thing, which you would know if you had been paying closer attention), (1) don't you think he won't go after an audience that was slightly larger and infinitely more influential and (2) it still wouldn't matter, because, again, this is an opionion piece, which by it's nature, means it's his opinion.  Please understand that I certainly believe you have every right to disagree with Glenn, and if you do, you are more than entitled to voice that and offer up your counter argument, just quit asking him to do it for you.  It's not his job.

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By Glenn T on August 05, 2009 at 11:12 pm

Dean, let me be as plain as I can to avoid any further confusion:

1.  I don't want you to read anything that I've written.

2.  I don't want to read your opinion on anything that I've written.  I have my reasons, which I would love to detail, but I trust that, in the interests of keeping things courteous, that not wanting to will suffice.

3.  I find your personal attacks disgusting, and if you would like to carry on a more personal discussion, I would invite you to contact me personally.

4.  This is the last comment I will offer on this matter, and in keeping with the traditions of intellectual discourse, you will be correct to assume that as I have addressed none of the points you raise, that you are, in fact, the "winner".

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By Just Average Joe on August 09, 2009 at 07:04 pm

Like the comments way better than I do the anemic article.  Where's the facts?


1.  I don't want you to read anything that I've written.

lol typical arrogant lawyer here.  Jen who I think is this contributer's girlfriend, wrote here somewhere during the El G broowaha that if you can't take the heat of the Broo kitchen, then stay out of the Broo kitchen.   Smart girl that Jen.  Listen to Jen Glenn T. if you can't take courteous, temperate, and constructive criticism or answer valid questions here and get this pissy when someone reads and comments in such courteous, temperate, and constructive terms in a public forum, don't publish here.

economic incentives will always prevail as an explanation and predictor for behaviors. 

No, they don't always.

And, inasmuch, socialized medicine appears to be a recipie for mediocre care for all us, rather than exceptional care for some of us. 

No, it doesn't appear such.

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By D'Ann Redondo on August 17, 2009 at 02:42 pm

A little review.

Dean: In all of your exhaustive research into the personal and professional life of Glenn T, you may have missed that, as much as Glenn takes a contra-left position on the topic of National Health Care, he did in fact vote for Barrack Obama.  I know, I know, not far left enough to get a free pass from you, but considerably farther left than you give him credit for in this debate.

As for whether or not your digging into Glenn's professional dossier is going a bit too far to "prove your point", just know that this is an option open to all who read here... about all who write here.  Anecdotally speaking, Glenn claims no more to be a shill for the anti government health care lobby than you do being a poet... oh wait, you do claim to be a poet... sorry.  Really sorry.

For now, I've come to the (anecdotal) conclusion that the only difference between a community organizer and a rabble-rouser is a law degree.

HDW, your apparent man-crush on Glenn (and its equally apparent pre-adolescent way of demonstrating itself) is just as over-the-top as you poem about Hillary Clinton - and just as unsettling.  

You playing the role of Big Brother in this 3rd grade stage play is very unbecoming someone of your stature (and publically available personal history).  Don't let the pot hit you in the kettle on your way out.

Just Average: You're a realtor.  After you've given all your money to the poor (ask Dean - or his parents - what that line is referring to) then you can talk to us about the speck in Glenn's eye, having removed the log from your own.

Let's all remember to play nice around here. 

Courteous, temperate, and constructive hugs and kisses to everyone,


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By D. E. Carson on August 18, 2009 at 01:05 am

Dean:  Please explain to me (and the rest of us here) how expressing courteous, temperate and constructive terms includes an outright personal attack on Glenn?  I've read through all of that which has been written since my last visit to this article and most of what I'm seeing is from you and it seems you've gone too far -- even for you.  The observation has been made that this is an opinion piece -- a fact clearly stated from the beginning.  The nice thing about opinion pieces is that they are able to envoke stimulating conversation and agree or not, Glenn has certainly opened a Pandora's box here.  But by and large, opinion pieces -- even those as liberally biased as the ones found in the New York Times and the Los Angeles Times are allowed to make personal comments.  The great difference between Broowaha and the Times would have to be that responses that contain personal attacks directed at the Times staff are often not published for the general public to read.  Remember Dean, your First Amendment right to free speech stops when you begin personally attacking someone else just because he or she happens to have an opinion that differs from yours.  Frankly, I liked this piece because I recognize from whence Glenn was speaking.  You claim to be former military yourself, do you not? (If I am incorrect on this, I apologize in advance, but as I recall you once excoriated one of my articles and in doing so I believe you made a reference to such a detail).  My point is this, anyone who has served in the United States Military is acutely aware of how the healthcare system operates and should recognize that our military is treated like doormats by our government.  Glenn was merely making an observation.  A personal attack on him for that observation places you squarely in the same camp as those who have called concerned Americans "Nazis" or "Brown Shirts" and accused them of bringing swastikas to town hall meetings.

You and I get into it a lot on this site and the reality is that for the most part, I've been ignoring you because I would prefer to leave things at "we agree to disagree", but I cannot remain quiet when I see someone cross the line, which your responses appear to do.  Honest debate counters points in an argument not attacks the person making the points.

Oh, and for the record ... all of this is just my opinion.

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