There is the business cycle – of around eleven years – and there is the Investor Relations cycle, which is about twenty miles. The latter version goes on two wheels along the bank of the East River. But they both have boom and bust periods as well. I boomed as I flew downhill along York Avenue, past New York’s most prestigious hospitals, and the bust came in the vicinity of the towering Triborough bridge.
I applied the brakes with a federal regulator’s sixth sense when I saw chaotic conditions ahead. They took the form of an unrestrained and unnaturally exuberant toddler racing about as his insouciant young mother strolled chatting to her friend. He ran into the road and beamed at me trustingly. His trust was not unjustified, since I slammed on the brakes in a shockingly deflationary manner, went over the handlebars, and landed athwart him – with a crash.
Luckily for him, the full force of my six feet and several hundred pounds weight was taken by my left arm. He screamed in shock, pretty much the way I would if a large quantity of redhead suddenly dropped from the skies on top of me. His mother was as insouciant after as before, which led me to dampen my unworthy suspicion that she had recently taken out a large life insurance policy on the fruit of her loins.
It was Sunday, and previous experience suggested that it was silly to pay top-of-the-market rates while hanging about for eight hours to confirm what was already fairly obvious: an arm fractured in three places. There are better ways to suffer pain than waiting in line behind all the uninsured for whom the casualty ward serves the same purpose as a general practitioner’s surgery in the UK. Better lie abed at home and wait for the orthopedist to open in the morning.
Besides which, another time, when a car had run into my right knee, the casualty nurse had tried to put my left arm in a sling. Until the misunderstanding had been cleared up, she had treated my offer to take off my pants as a perfectly reasonable, but temporarily inconvenient, sexual advance. The consolation was that this error had not taken place on the operating table. Let me tell you, in this free market, Adam Smith’s hand was invisible because it was amputated when he went to get a corn cut off his foot!
About three months after overshooting my cycle, surgery was called for, and I watched with semi-befuddled interest as the surgeon delved around inside my shoulder. I remember with proprietorial pride his exclamation of surprise when he saw the mess inside the joint where the soft tissue had formed an angry inflamed ball.
And I remember the unanesthetized pain when my insurance company wrote to say that they were not going to pay $2,000 of the surgeon’s bill because, they claimed, it was above prevailing rates. A year later, and I was still arguing. Was I really supposed to jump off the table, and argue the procedure, or shop around to get a cheaper surgeon while all the tubes were still poking out?
Later, arguing with the anesthetist’s secretary over a much smaller sum, she told me how lucky I was that I had full insurance and was not in an HMO, where some snotty nurse could have vetoed the whole thing because her little Domesday Book of permitted ailments had no cost code for the operation. HMOs now cover 60-70 mn Americans and the number is rising all the time.
In the tortuous attempt to avoid ‘socialized’ medicine, the US has produced a system that has the worst features of the national health systems of the world – only in an ever more chronic form. It has a vast, expensive and uncaring bureaucracy that swallows up a huge proportion of the system’s resources, interferes with medical decisions, and constantly squeezes the patients’ freedom of choice.
Of course, few people will shed tears for the shrinking salaries of US medical practitioners, who still have a long way to go before they qualify for food stamps. But a lot of people are concerned when HMOs pay doctors a premium for refusing treatment, and when decisions on cures are made by medically underqualified bureaucrats. Or, worse, when cures are foregone entirely because indefinite chronic care yields a healthier bottom line.
Even those offering what is laughably called full insurance, arbitrarily cut claims because they are above what they have determined to be the prevailing rate. This mythical figure presumably includes the flat fees fixed by the HMOs and also probably conceals a piece of economic lunacy. At any given moment, half of any group will be above average. As good math teachers tell their pupils, the ‘average’ person is hermaphrodite, half male and half female.
If we really want to cut costs in the US, a single payer system like Canada’s is more just, more economical and better for the national health, not to mention economic health, since the biggest cause of personal bankruptcies in the US is medical bills. And as my own contribution to control costs, insurers could stop paying for most forms of pseudoscientific psychotherapy, be it Freudian, Jungian or Rolfian: Oedipus wrecks domestic and national budgets.
The Speculator
