21 October 2008


They just now called from the car mechanic. If I do everything they're suggesting, it's going to set me back a bit over three thousand bucks. They offered to have me come in and look at it, but there's a problem. I wouldn't know what I was looking at. I don't know enough about cars to reasonably judge whether I'm begin scammed or not. Most people don't.

If I had the time I could pick up the car and get a second opinion. That would be the smart shopper thing to do. But I don't have the time. The place I take my car - the dealer (I know, I know) - is expensive, but they've always done good (so far as I can tell), fast work and my experiences with them in the past have led me to conclude that they are basically pretty honest.

And I need the car no later than Thursday afternoon - this being Tuesday morning - and the other (independent) mechanic I know can't usually keep a promise to get me the car by a specific time. The car has 125,000 miles on it and hasn't required a whole lot of expensive maintenance so far. I'm about to embark on five to six thousand miles of hard driving on my book tour. So I'm stuck.

All of which makes me think of other aggravating expenses in my life, most notably healthcare.

Since I expect that my body - it's only got 56 years on it - will hold up until after my book tour, I've postponed the treadmill stress test that my doctor thinks I should have. And I'm shopping around for a discount.

My doctor, who I think is a great doctor, charges around $1,800 for a treadmill stress test. That comes on the heels of my having been hit with a bill for $939 for a recent routine visit for a blood workup and an EKG. (My despicable insurance company did fork over $426 for the visit, otherwise the bill would have been $1,366.) The insurance isn't likely to cover any of the stress test.

The thing is, a treadmill stress test is pretty simple. So long as the monitors are positioned correctly and the machine is in decent working order, any idiot can administer one. Hell, even I could administer one to myself if I had to. There can be a little diagnostic art to interpreting the results, but none of this comes from the rocket science side of medicine.

So I'm looking for somewhere cheap, or at least cheaper, to get my stress test. I can have them send the results to my doctor - who will no doubt charge more than I'll be happy about to look them over.

This is, of course, especially of interest during an election year. Both candidates for president say they want to fix healthcare in this country. Neither one of them really has much hope in hell of doing anything about it.

Part of the problem is that healthcare is one of the areas in which free market economics don't work. They can't work. The incentives are skewed.

In most industries the free market creates incentives for companies to provide as high quality goods and services as they can, at competitive prices, so that their customers keep coming back for more.

But, if you are "lucky" enough to have health insurance, your insurance company makes more money when it doesn't provide you with the products you've paid for, than when it does.

It is far more profitable to sell insurance to people who won't use it, or who won't use it much, than it is to people who actually need it. And that's what insurance companies try to do. That's their free market incentive.

You can't really blame them. No company exists out of the goodness of its own heart. They exist to make money. Most of the time, the "enlightened self-interest" of free markets works out pretty well for everyone involved.

But healthcare is a necessity. And when it comes to necessities, the free market can easily get bent out of shape. Sooner or later, everyone needs healthcare to some degree or another. Society at large has a high stake in people remaining relatively healthy.

There is a very good reason why pretty much every single other industrialized nation on the planet has a national, government subsidized (whether administered by the government or not) healthcare system. It is the only way to ensure the greatest good for the greatest number of people.

Some things do require government money, regulation, oversight and even participation. Healthcare is one of them. I'd love to hear one of the presidential candidates own up to that. They'd probably lose some votes. But they'd sure gain my respect.

No comments: