The Universal Evil Health Care Plan

April 19, 1994|By JOAN I. GRECO

NEW YORK — New York. -- That mind-bending mire of health care plans being cooked up by various Democrats, Republicans and others differ most fundamentally in their definition of Who's Evil. For example:

* Hillary and Bill Plan: Drug companies are Evil Incarnate; insurance companies are Satan's minions; doctors are being corrupted by all that filthy money they're getting, and it's up to us to save them from it.

* Wall Street Journal Plan: Government is evil; taxation crushes the soul; price controls = Stalinism.

* There's-No-Health-Care-Crisis Plan: Sick people are evil.

All these plans will fail, of course, because of their petty lack of vision, their failure to grasp the greater truth: We are all evil -- desperate, greedy, heartless, lazy, whining jerks, from the doctor acquaintance of mine who complained that having to listen to his patients was the worst part of the job, to the drug companies trying to explain why we should be happy to pay seven times as much as Canadians or Europeans for the same drugs, to everyone who thinks that spending 14 percent of GNP on health care is just unacceptable but would kill anyone who tried to stop them from getting a heart-lung-liver transplant at the age of 68 if they needed it. (I include myself in this last group, by the way.)

To work, a health care plan must be based on Universal Evil. Here is my proposal, broken down by villain:

Doctors. Brainwashing, sleep deprivation, instilling a disrespect for human life: These are the training tactics for the Symbionese Liberation Army, and apparently also for your average pediatrician. The humanity is sucked out of doctors early. They spend their college years actually attending classes, their early twenties playing with corpses, and their late twenties learning that, unlike playing golf well or driving to Fort Lauderdale, treating emergency-room patients doesn't require having had any sleep the night before. In most cases the character that emerges from this process is deeply scary. Trained assassins probably feel intimidated when they go to the doctor.

So what do we do about it? Well, as much fun as it might be, we can't just force them to take less money. They're dangerously un-empathetic as it is; I don't want to be around when they get really ticked off. Besides, it will never work. Picture this: You or someone you love is sick. You can either wait your turn to get health care as good as everyone else's, or you can (legally or illegally) get better or faster care by paying a doctor more. Which do you do? This is a country of people who in their hearts believe they deserve every good thing their money can buy. So just forget about capping doctor's fees.

(By the way, I make absolutely no pretense of knowing whether the Clintons' health-care plan requires this, or what it says at all. From my extensive reading of other people's commentary, I conclude that the plan is either: (a) Anyone straying from the government-imposed HMO and its controlled prices will be shot on sight; or (b) Everyone gets to see any doctor he'd like for any reason at all for free for ever and ever.)

The only rational thing to do with doctors is to make more of them, and to make them more humanely. We need more medical schools, and we need them to encourage more general practitioners (without putting limits on the number of specialists). We could also benefit from training nurses to take on a lot more responsibility. Doctors who had more competition -- and who weren't tortured as residents -- might actually start treating their patients like human beings.

Don't worry about lowering our standards by creating more medical schools. As it is, we have lots of doctors who were trained in other countries. If we can license doctors from all over the planet, I don't think a few more from New Jersey will kill us.

Insurance Companies. Let's say you're in a business where (1) people pay you thousands and thousands of dollars years before they need your services; (2) when they do need your services, they're weak and vulnerable, and (3) even if you're absurdly bad at what you do, by the time your customers realize this they're sick and can't change companies. How good a job would you do?

Like nuclear power, the insurance business is one of those pinnacle-of-human-cleverness/ unimaginable-nightmare sort of things, and, like nukes, it has to be regulated to the hilt if it's going to do anybody any good. The industry has been heavily regulated for ages, and it seems that, after years of perfecting ways to avoid paying out to sick people under current regulations, the industry needs a new challenge.

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