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Rational DecisionsApril 22, 2006 Tell you one good thing about the Commonwealth of Massachusetts's compulsory insurance scheme: it's got me paying attention to the news. At least the news about the compulsory insurance scheme. At least if you consider paying attention to the news a good thing. I've been reading up on the Republicanskis' "health savings accounts." Hadn't paid much attention to these because they seem to be mostly employer-based. My employer is myself and she won't shell out for much of anything beyond groceries, shelter, and office supplies. What intrigues me about the Republicanskis is that they seem to know why "people" go or don't go to doctors. I'm pretty sure we don't know the same "people": after all, I make about $30K a year, and most of my friends are not exactly well-off. The better-off ones are not exactly fools. All of which is to say that I don't think many of them are on good terms with the Republicanskis. An editorial in today's Boston Globe quoted Shrubya as saying, "I believe that the more the consumer is involved in pricing, the more the consumer is involved in the decision-making, the more likely it is people will start making rational decisions for their own needs." Right. Set aside for the moment the question of whether any of us "consumers" are involved in pricing or decision-making. As I see it, I've been making rational decisions for my own needs since I was in my teens. I last had a checkup in 1977. I was just shy of my 26th birthday, and I'd just been hired by a big nonprofit that required pre-employment physicals of its new employees. This particular physical was such a perfunctory thing that I can't seriously consider it a "physical." My last one of those was probably when I was still in high school and my parents were picking up the tab. Let me make one thing perfectly clear: I never at any point resolved that I would never have another physical exam. As a neophyte adult -- the term these days would be "twenty-something" -- I fell in with female companions. A daunting number of these female companions had nasty stories to tell about their interactions with the medical profession. I was fat enough in those days to be harassed on the street and to have a very hard time buying shorts I could bike to work in. My fat friends had particularly nasty stories to tell about their interactions with the medical profession: the doctors, the nurses, and the insurance companies seemed to think that the #1 solution to whatever ailed them was "lose weight." Why subject myself to this crap? I thought. I would only go to a doctor when it was absolutely necessary. I'll be 55 in June. Other than a couple of visits to a walk-in clinic, I've never been to an internist- or gynecologist-type doctor. My most recent visit, about four years ago, was for my first encounter with the flu. After a couple of weeks of drinking liquids, snoozing a lot, and taking a few aspirin, I went to the clinic in search of relief. I wanted my voice, my airways, and my energy back. Physician's assistant was worried about my blood pressure. She prescribed antibiotics. (Isn't flu a viral thing?) I figured to hell with it. Waited it out. It went away. Once again I could sing, I could breathe, I could go for long walks in the woods. No physician required, but I was out 75 bucks. OK, so I'm going too far when I attribute my good health to my not subjecting myself to mammograms, angiograms, bone-density tests, and MRIs, but put it this way: so far I haven't been a drain on anyone's health-care system. I can testify that the lack of money and/or insurance is not the only reason that people avoid doctors. I wish I could elect to be treated in a health-care system whose overhead hadn't been jacked out of sight by insurance companies, pharmaceutical companies, and the American Medical Association. That Boston Globe editorial said: "Some people do overuse healthcare, but that's not the nation's most pressing health problem. Rather, it's the national scandal that 46 million Americans lack health insurance. The system ought to stress prevention and discourage excessive use, but it ought to cover everybody with policies that do not impose severe financial strains if the person or family member gets sick." Got that right. More, it shouldn't force, or even encourage, people to stay in lousy jobs just to maintain coverage for themselves and their families. And it shouldn't be stomping on the fingers of those of us who are barely hanging on to the wall.
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