A Bottle of Tylenol

The estate of one of the postal workers who died from inhalation anthrax is suing Kaiser-Permanente, his HMO. Seems that he went in with “flu-like symptoms”. Told them that he might have been exposed to anthrax. At that time, everybody knew about the letter that had been sent to Tom Daschle. Congress had been closed down to check for anthrax and to clean up if necessary.

Kaiser’s response? They told him he had the flu, and sent him home with a bottle of Tylenol.

He died three days later.

He died three blocks from my home. Kaiser is my HMO. I’m worried.

Not about anthrax (that threat seems to have been contained for now), but about health care in the US in general.

The main problem is that health care is expensive, and health expenses come in large chunks. Most people can go for years with no medical expenses beyond aspirin, cough syrup, and regular dental checkups. Life lesson: Take care of your teeth. Few things are more miserable and more preventable than dental problems. Then, WHAM, a car accident. Or an inflamed appendix. Or a sick baby. Suddenly, thousands of dollars of expenses, all due at once.

The obvious solution is insurance. Pay in a little each month, and the insurance company pays for the expenses. Ideally, you will pay in less than you get out, as the insurance company invests the money and adds the interest to the pool of cash that can be paid out on claims.

There are two problems with this. The one that gets talked about the most is the people who can’t afford insurance at all. I have health insurance. I’m worried about the other one.

Problem is, medical expenses are uneven. When you first start working, you’re young and enthusiastic and healthy. Health expenses will be regular checkups and the occasional athletic injury. You get older, you have kids. Much more expensive. As you continue to get older, your health deteriorates, and your expenses go up. Eventually, you are getting more out of the insurance system than you’re paying in.

The traditional way for insurance companies to deal with this is to put the insured into “groups”. Usually, people are put into groups by age. As the group gets older, the insurance company raises the premium. This means that by retirement, you’re paying a huge chunk of money to the insurance company.

Health maintenance organizations (HMOs) have a different philosophy. There, everybody goes into the same “group” and pays the same rates. The kids pay for the old folks.

Think about it for a minute. From the point of view of profit and loss, what is the best case? Why, as soon as somebody is taking more money out of the system than they’re putting in, they should die.

Now, mention this to a doctor, and I guarantee that you’ll get your head bitten off. Doctors don’t think that way.

Yet.

HMOs and insurance companies are not run by doctors. Doctors have better things to do with their time. They’re run by accountants, who do think that way. And in HMOs, they hire the doctors.

Not the First Time

This isn’t the first time this argument has come up. First time I saw it, it was talking about tobacco subsidies. Why does the US Government subsidize the production of a substance that causes 100,000 deaths per year?

Well, the obvious answer is Sen. Jessie Helms. Our current system of government consists of legalized bribery (“campaign contributions”) in one direction and Government handouts (“pork”) in the other direction. As the Senator from North Carolina, Helms is expected to produce pork for his constituents, regardless of any other merits. North Carolina is a big tobacco producing state. As the US Congress runs on seniority, a Senator or Representative’s power is determined by longevity rather than anything resembling merit. Seniority matters; senility doesn’t (aside – in Helms’ case, how can you tell?)

That’s no fun. Easier to play Paranoid Conspiracy.

When the Social Security system was first put into place, the average life expectancy at age 65 was something like three years. Now it’s something like 15 years. (Anybody out there have the real numbers? Send them to me, with references, and I’ll put them here.) It’s been an open secret for a long time that Social Security is going to be in Real Trouble in the not-so-distant future. One of the obvious ways to save money is to convince people to die sooner. Smokers tend to live about eight years less than non-smokers. This means eight years less, on average, of Social Security payments. Yeah, lung cancer is a nasty and expensive way to die, but so are most others. Basically, the Social Security system saves eight years’ payments for each smoker.

I posted this idea a while back on sci.med; it generated a number of replies, mostly in the category of “How dare you say something like this!!”. The numbers that people posted varied by a factor of about 100. As with anything else like this, it depends radically on how you do the numbers. Personally, I doubt that our esteemed Government is smart enough to do something like this on purpose.

Life lesson: Never assume Evil when stupidity or greed will do.

Time moves on, things change, and most people won't look at anything further away then their own toes. We'll see what happens.

Excuse me. I have to go take some Tylenol.