Monday, December 12, 2016

Snark Easy, Mathematics Hard

Those of you who don't drop in and read Fred Reed's blog, Fred On Everything , probably should. At least once in awhile. He's generally intelligent, witty, and anything but politically correct, and his missives will at least get you to thinking, and/or get a laugh from you, if not actually persuade you.

But there's a sweet spot in blogging. If you keep at it long enough, you'll let your typing fingers get beyond your brilliance, and when you fall, you'll step on your dick. Except in front of everybody on the Internet. With golf cleats on.

Which brings me to today's excursion into "Natzsofast, Guido...".

Fred's current polemic is a half-baked diatribe in praise of socialism, specifically socialized medicine.
Wherein we find a veritable clowncarnucopia of meadow muffins in support of the thesis, to wit:

Recently I encountered a casual friend–he was dancing in a local club–whom I had not seen for a while. Where ya been, I asked? In Guadalajara for cardiac surgery, he said, double bypass and valve replacement. The replacement valve was from a pig so we made the mandatory jokes about did he say oink-oink, and parted.
Later, for the hell of it, I asked by email what it had cost. His response, verbatim, except for my conversions to dollars at 17 pesos to the dollar:
“The costs of my surgery were as follows:
330,000 pesos to the surgeon and his surgical team. $19,411
122,000 pesos to the hospital for eight days $7176
15,000 to the blood bank. $882
467,000 total  $27,470
The time frame was March 13 to March 21.  The exchange rate around this time period was about 17.5 which would make the USD cost app. $27.000.”
Wondering what this would cost in the US, I googled around and found things like this:
“For patients not covered by health insurance, valve replacement surgery typically costs from about $80,000-$200,000 or more with an average, according to an American Heart Association report[1] , of $164,238, not including the doctor fee. A surgeon fee can add $5,000 or more to the final bill.”
This was only for the valve replacement. The price for a simple bypass in the US runs to $50,000 to $70,000 at the lower end. What the bypasses would add to the replacement, I don’t know, and shudder to think.
The huge difference in price between American and other care occurs in almost everything.
Having established anecdotally the superiority of health care in Mexico, Fred goes on to diagnose why it clearly sucks balls in the U.S.:

Why the prices? Several reasons offer themselves. Advanced countries–Mexico is not one–have less corruption than does the US, and a greater concern for the well-being of their people. In Europe, for example, this is obvious not just in medical care but in unemployment insurance, length of vacations, and public amenities. In Seville, among my favorite cities, sidewalks are very wide, bicycle lanes are actually usable, in intercity buses are clean and comfortable. In the US all of this would be regarded as hippy dippy or socialism or the malevolent workings of the nanny state.  
I tell you, boys and girls, America is a collection of self-interested interests concerned with maximizing profits and nothing else. Hospitals are run for profit, with the result–surprise, surprise–that they charge what they can get away with.

Americans and their health system are clearly run by evil greedy bastards, QED.
But not content with heaping up a mound of cobblers, Fred doubles down on the stupid:

Invariably you hear of the pregnant woman in London who couldn’t see a doctor under national health care and had to giver herself a Caesarian with a chainsaw. These nightmares are offered as proof that national care doesn’t work. In fact the medical business lobbies to underfund national care, ensuring that it won’t work well. Then they talk about the evils of socialism.
Suppose we did make comparisons?
Military medical care is the obvious, available, and easily studied alternative to Obamacare. So far as I know, nobody thought of this. In the military you go to the hospital or clinic, show your ID card, get done whatever you need, and leave. Thank you, good day.  No paperwork. No paperwork. No insurance forms, deductibles. receipts. No insurance companies trying to pay as little as possible, since that’s how they make money. The doctor doesn’t order a PET scan, three MRIs, and a DNA analysis of your grandmother’s dog to run up the bill.
And finally, having loaded the bases, Fred decides to go for the grand slam, and pull in everyone's favorite socialized medicine plum:
Canadians strongly support the health system’s public rather than for-profit private basis, and a 2009 poll by Nanos Research found 86.2% of Canadians surveyed supported or strongly supported “public solutions to make our public health care stronger.”[18][19] A Strategic Counsel survey found 91% of Canadians prefer their health care system instead of a U.S. style system.[
Well, all that's just ducky, Fred. But now that you've had your fun, largely fact-free, it's the other team's turn at bat, boyo.

What Fred cannot seem to conjure, in his rapturous glee of apples to horse apples comparison of the delights of Mexico's socialized medical system, and its superiority to US health care, is a few wee troublesome factoids.

One yuuuuuuuge reason that the Guadalajara Cardiac Care & Aztec Sacrifice Hospital  could get away with a paltry $7176 bill for eight days' stay in cardiac intensive care for his friend, post-op, is that, among other things - as a cursory internet search turned up - the average salary in Mexico for a nurse comes to a beneficent P834/month, take-home [at least according to 2002 data , which was all I found in a brief search]. Doubtless some changes have occurred, but at Fred's stated exchange rate of P17.5:$1, that's the princely sum of $47.65/month, which works out to $0.28/hour. Viva socialismo!

For comparison, I slaved away for Sears & Roebuck's hardware department for around $3.40/hour in the mid 1980s, a mere thirty-five years ago. We won't talk about what nurses got paid in Guadalajara then, but suffice it to say, no customer ever complained their bill for Craftsman tools when I worked there was so high because evil, greedy capitalism as evidenced by my exorbitant weekly salary, despite the fact that what I made then was over ten times what professional nurses get paid in Mexico (or did, in 2002).

Doubtless, Fred, if we could just get nurses (and everyone else in the hospital) in the US to work for the US minimum wage from 1919, we could lick those pesky health care price hikes.

He also seems incensed by the doctor's fee for surgery coming in at $5000. It doesn't sound as juicy if you note that Uncle Fork It Over, and the state, combined probably make $2500 of that fee, and even less so when one observes that the doctor's malpractice insurance company (by which we mean the lawyers and accountants running that company ) skim another $1250 off that fee, 24/7/365/for the MD's entire career.
(I will note in passing that getting $1250 take home for cutting your beating heart open and fixing it, and you living is a sum within rock-throwing distance of my day rate for an ER shift, here in the land of greedy evil capitalistic health care. I'm a bastard like that.)
Of course, if we could just agree that surgical error should be grounds for a punitive fee, or license revocation, rather than a Powerball Payoff for the plaintiff - and plaintiff's lawyers (John Edwards, call your office), we could get that fee down quite a bit, and if we could stuff government's snout back to, say, 10% total depredations, we could whack it down even farther.

So yes, as Fred noted:
The huge difference in price between American and other care occurs in almost everything.
For reference, Fred, that's why they call where you live now The Third World. You could look it up.

I am, quite frankly, too lazy to look up the morbidity and mortality (i.e. fuck-up & failure) rates of the pride of Mexican health care, vis-à-vis at American hospitals. I can only offer anecdotal evidence of people flying here from Brazil, and coming by the hordes from Mexico, to avail themselves of American medical care, while generally Americans with any sense acquire evacuation insurance to cover medical evac from the blessings of Mexican medical technology, should the need arise.

Nor would I ponder how many Mexicans could afford that $27,400 surgery on anything other than either narco-cartel wages, or ex-pat gringo Social Security/Medicare, in a country whose per capita GDP is $17,500, and where the median household income is $12,800.
It being Mexico, I suppose that if one requires the heart valve replacement, they just skip food and shelter - for a couple of years. Like you do. What could go wrong with that?

As for the next analysis-challenged anecdotal, military care, let's all nota bene that there are, in fact, metric buttloads of paperwork for that care, just not for the patient. Everyone else has to document everything else in triplicate.

And the doctor isn't going to order anything to "run up the bill", because his incentive is to give you as fucking little care as he can get away with, because he answers to his CO, and ultimately to SecDef and POTUS, for the military budget. In case anyone is wondering whether that's a good thing, or not, let's send out a call for testimony from Agent Orange. And say, while you're on the horn, see if you can whistle up the stats on PTSD and veteran suicide from 2001-present, whatsay?

We'll leave virtually unmentioned that military care is predominantly care for fit, health 18-30 year-old males, and that if anyone in the .mil needed a coronary valve replacement in the first place, they'd be medically discharged straight to the other government military health care marvel, known as the V.A.

Anyone can go search archives over at WeaponsMan's blog for a light-hearted view, or simply pull the first 500 horror stories from any fishwrap of record to see what an abortion with legs VA "care" encompasses.

Then, by all means, let's have that for everyone.

Finally, we will stipulate for the record that most Canadians love their health care system.
Provided we note as well that most of them love it so much, they flee the 100 or so miles southward 90% of them live in proximity to the US, to avail themselves of routine procedures on demand that have a 3-5 year wait in Canada, in medical centers in Seattle, Minneapolis-St. Paul, Buffalo, and even NYFC.

If Canadians had to live solely with Canadian health care, President Trump would need to build two fences.

But, while we're onto that, let's note that Mexican socialized health care is so good, fully two-thirds of all babies born in cities like San Diego, Los Angeles, Phoenix, Albuquerque, San Antonio, Dallas-Ft. Worth, and Houston are born to illegal alien mothers from Mexico. So if Mexican health care is so damn good, I'd appreciate it -personally - if you'd spread that word around town in sunny Burritoville, where you live, because my back aches carrying that load every shift up here. To be fair, the Canadian system at least pays their bills.

Your Mexican amigos generally just skip out without paying anything.

Which, truth be told Fred, is the other reason why hospital and health care costs are so damned high up here in the First World: the gringos up here are paying not just their bill, but the three deadbeats' bills of Juan, Jesus, and Guadalupe, along with forty-seven of their anchor-baby offspring burped out just in time north of the border, and the "emergency" bills for an aunt, two uncles, and three grandparents lovingly smuggled up to hospitals in los Estados Unidos with between five and fourteen pre-existing co-morbid conditions because Yes, They Can. Ask me how I know.

We could go further, and reference the other shining triumphs of socialism throughout history.

But what, at this point, does it matter?
A few hundred millions of casualties, entre nous , is hardly worth a mention.

The bookends from Britain on the subject come to mind as well.
But quoting brilliant statesmen to prove the point is like shooting fish in a barrel. With a howitzer.

Instead, let's simply go no farther than the most recent example of a socialist paradise.

Fred, as I said, is a mostly funny guy. Sometimes, he cuts through the PC B.S. like a hot knife through butter, and gets right to the salient points of an issue. And, given his military service in Vietnam, he's got a paltry 60-70 years of life experience, and Old Guys Know Stuff isn't just a cute t-shirt, it's How It Is In The Real World.

But running on pure iconoclastic snark while ignoring the depth sounder telling you you're headed for the rocks is a recipe for philosophical disaster.
And clearly, on economics, if not plain math, Fred's run totally out of his depth.

But don't take my word for it, boys and girls. Nor Fred's either.
Do what Bill Whittle suggested a decade ago: go on down to Key West, and test your prejudice against truth on the ground.
Socialist intellectuals will tell you that Cuba is a model nation: universal free health care, near total literacy, and essentially no gap whatsoever between the rich and the poor. They call it an island paradise where brotherhood and compassion reign in stark contrast to the brutal inequalities of the heartless and racist capitalist monster to the North, ruled by its Imperial Nazi King, who is the devious mastermind of all manner of Conspiratorial Wheels and is also a moron.

Capitalist intellectuals -– and there are not many, since most of these people have jobs -– argue that Cuba is a squalid, corrupt, poverty-ridden basket case, a land of oppression and secret police and torture chambers run by a megalomaniac who practices the most idiotic, inhuman and degrading economic system ever invented.

So here we sit in the chartroom, with our competing maps. What to think?
Well, ask yourself what it would take to give up your home, your country, your family and all your friends. Ask yourself how desperate you would have to be to sneak out in the night, and strap your family – your grandmother and infant son – to a collection of inner tubes lashed together and set out in the dark surf across 90 miles of shark-infested water in the dead of night, hoping against hope to make landfall. We can all agree, I think, that that kind of desperation could only be driven by a fairly passionate first-person opinion of such things. Surely this goes beyond what you or I would do to win a map argument at Starbucks.  
So. Go up on deck, get out the telescope, and answer one simple question for me and for yourself: 
Which way are the rafts headed?



IN RN said...

Thank you sir for saying it so clearly. I am a home health nurse in flyover country and have had this argument with high school and college friends who went off and turned commie. Anecdotally, my sister lives in London yet flies home to pay cash for almost every medical need.

Anonymous said...

In addition:

For those cheap medical procedures performed in Mexico, how many of them were DEVELOPED in the USA, and how many of them COULD have been developed in Mexico?

Imitation is one thing, innovation is quite another.

Mark D

Anonymous said...

I've been involved in some degree (unfortunately) in the US medical system on both the patient side, the clinical side, on the administrative side and on the legal side for close to 20 years noow. My impressions are that the actual caregivers, RNs, LPNs, CMAs, CNAs etc are woefully underpaid in many areas. Doctors are even underpaid in some circumstances but there are also too damn many that should not be practising medicine. How such incompetence gets through the system I do not know. Administrators are wildly overpaid and wildly overstaffed and shot through with useless idiots doing essentially nothing but fucking things up on the ground and collecting fat checks. And doing PowerPoint. They are all about meetings and PowerPoint that accomplish nothing. The insurance companies have been in my experience a bunch of bastards. Entire well paid departments exist in hospitals just to deal the the byzantine paperwork required by insurance companies. There are issues on the patient side too mostly with those on government assistance (medicaid) who abuse the system to a shocking extent and have no conscience about doing so. I'm not sure how to fix what's broken but something has to change. It's costing too much and it's financially devastating middle class and working poor who end up with insurance they can't afford and medical bills they realistically can never pay. Turning the hospitals and insurance companies into non profit charities? Ruthlessly cutting administrative overhead? I have no idea but the status quo is untenable and unless it's fixed soon the public is gonna be demanding a single payer government run healthcare system legitimate protestations about socialism be damned.

Anonymous said...

Administrative overload is a reality in all fields, not just medicine.

I'm a computer programmer, and for the last 19 years I've worked for a consulting company. In those 19 days, I have spent every work day on a billable assignment, which means for 19 years I've generated income for the company I work for. Every day I receive a daily newsletter, and every week I receive two or three weekly newsletters, more for the monthly, and even more for quarter, fiscal-year-end and calendar-year-end.

Seems we have people on the payroll who are paid to write newsletters, which is of course not billable (IOW they're a net expense for the company).

I've always like the ideas Scott Adams (of Dilbert fame) put forth in his book The Dilbert Principle: that everyone working for a company should be either (1) working on the product the company sells or (2) DIRECTLY supporting those people who work on the product (payroll for instance). Unfortunately (or not) that would put a lot of MBAs out of work.

Mark D

Aesop said...

@Anonymous 04:37A
"...the status quo is untenable and unless it's fixed soon the public is gonna be demanding a single payer government run healthcare system legitimate protestations about socialism be damned."

You act as if you don't understand that outcome was the entire point of enacting ObozoCare: make things so bad people would beg for a "solution" that would be orders of magnitude worse.

And at the low low price of Scandinavian confiscatory rates of taxation to pay for a Ponzi scheme even bigger than Social Security, all while putting metric fucktons of Democrap cronies on the government administrative payroll, for life.

What could possibly go wrong with that?

Anonymous said...

The system was fucked long before obamacare came along. It has certainly thrown gasoline on the fire and made things worse if such a thing is possible.

Shrimp said...

I'm not in the medical field in any way. Merely a consumer, if you will. My mother was an RN (decades ago) and her experiences and stories from the 60's and 70's said much the same about nurses and doctors then as today. Nurses and doctors are often dedicated, selfless and tireless workers who bust their behinds and are often underpaid for the privilege. Yes, doctors should make more than they make now. And honestly, the same could be said of most hard working professionals. That's another topic for another day.

Where things really started to go wrong was the view of health insurance as any sort of solution to anything.

Health insurance isn't health care. Making people buy health insurance doesn't equate to providing health care or even access to health care. Saying that health care is a right, and forcing people to buy health insurance makes as much sense as saying driving a car is a right, and then forcing people to buy mechanical breakdown insurance or extended warranties.

Health insurance has a place in the market place, and somewhere in health care choices, much like extended warranties have a place in the market place. But it should be entirely a consumer choice as to whether they even want it. (This isn't an argument against OCare in particular as much as it is against the seemingly stacked deck of health insurance companies and their ever-increasing control within the health care system)

If we allowed extended warranty companies to set the prices we paid for getting car repairs and called that driving, it would be a seriously fouled up and exensive system.

Every so often, I get an offer in the mail, wanting me to buy "car repair insurance." Basically, pay some "small" amount ($39.95 a month, or something) and all (or a lot) of the usual car maintenance (oil changes, tire rotations, etc) is free or reduced. Just doing the math, for me, it's a no-brainer that this is a bad deal. I don't take my car (any of them) in for oil changes, tire rotations or brakes or anything that often that paying the monthly amount would ever make sense. Even the reduced prices on things like repairs (transmissions, engine, etc) don't justify the costs.

But the model they're using is exactly the same model we're using for "health care" in this country right now. Pay a monthly (or annual) fee that allows you access to health care at supposedly reduced costs. For a healthy person who sees the doctor a lot less than someone who is chronically ill, or simply in need of medical care due to an extended need, it's a bad deal. And I can be pretty sure if we implemented this system, the costs of 'car care' would not go down, but up, on both ends.

I don't really know the solution, (and so, maybe I'm entirely ignorant and wrong) but I'm willing to bet it has something to do with removing health insurance companies from the system completely, rather than forcing people to go through them as the gatekeepers to the "health care" castle.

One thing I do know is asking for more government instead of less means costs go up instead of down, services get worse instead of better, and customer choice and satisfaction goes down instead of up. One need look no further than the DMV of any state to see where more government involvement is going to take us.