"We" just had a baby. I say this, for it is apparently the new normal for fathers to claim equal credit for the event even though it clearly and undeniably resides with my wife. But hey, green is the new black, thirty is the new twenty, and some of us are more equal than others. Get with the times.
Anyhow, while smoking cigars and quaffing tumblers of scotch in the antechamber, I was contemplating the economics of childbirth and the healthcare market in general. Not sure what my bride was contemplating, but judging by the choice of epithets it wasn't as esoteric. I digress.
We are covered, as military reservists, under some kind of labyrinthine healthcare program that is by all accounts a "good deal." In fact it looks an awful lot like the proposed national coverage we can all expect to enjoy in the near future. Not having the constitution to digest red tape, I have obligingly pawned the management of this program entirely onto my wife. She spends a yeoman's lifetime attempting to update profiles, correct and re-correct mistaken records, explain legitimate claims, and wheedle a helping hand from someone, anyone, who speaks intelligibly over the phone. Sure, the system is inadequate, inhuman, and inefficient, but at least someone else pays for it.
During "our" labor, which I've always viewed with the same hallowed respect reserved for pitched infantry action, I was drawn into a trembling fury by the cool incompetency of the check-in. The check-in desk takes up more real estate than the delivery room and is inhabited by a species of fast-typing harridan guarding the gates of triage. Apparently our insurance card didn't match expectations and we spent a good quarter of an hour (my wife claims it was longer…) calling back and forth with Tricare Reserve Select to assure the hospital (which she had visited continuously for months) that we were in fact real people with real coverage. We were eventually granted admission and didn't make any interesting headlines, but the foul taste of absurdity remains.
Fast-forward a few hours (Glenfiddich time), and all is well in the recovery room. Surrounded by the miracles of modern medical technology, "we" and the infant were poked, prodded, tested and molested to our heart's content. Now we were getting our money's worth. In an odd moment we discovered that buried in the fine print of the piles of paperwork was a note regarding "Private-payer Delivery." The cost of safely delivering a functioning addition to the human race is around $1,800 if you care to be so bold as to go it alone. That seems a little steep but considering the folks involved, I'd probably pay that over the discount option of a five-hundred rupee field-delivery in Gujarat.
But here's the kicker. Eighteen hundred dollars is just for your average, hum-drum, no-frills delivery. Like a new car, it's the options that get you... Turns out, with nobody so much as asking us, we were regaled with every extra, luxury, and superfluity other people's money can buy. Extra blood tests "just to be sure," three hot meals a day delivered steaming to the door, an additional two days of hospital hospitality, linens, name-brand infant formula in expensive bottles, even a nifty pull-out couch for the new dad…
In fact (and this is where my antennae started to tingle), a helpful lady strolled in one morning with an expensive-looking cart laden with electronic gizmos. She wore scrubs and an air of authority, so we meekly acceded to the "standard" hearing test. Some other tortuous procedure to "stimulate" our poor baby no doubt, but who wants to find out their kid is hearing impaired after they leave the hospital? A lengthy wait for the deposed daddy, an official-looking "Quiet Please, Hearing Test in Progress" sign on the door, a flurry of terribly necessary paperwork and we're through another hurdle.
Well, as it turns out, this "nurse" was in fact a private contractor working within the bowels of the hospital preying on signatures authorizing payment from insurance companies. I like to think I'm no fool; if someone else is buying, I don't pinch pennies. All the extras were really nice, particularly the couch. The procedures undoubtedly contribute to the extraordinarily low rates of infant mortality and disease that plagued previous generations. But that extra margin of safety and health lies at the end of a hockey-stick shaped diminishing-returns curve. What's missing here is price. At no point during this process were we interested or even aware of the cost. Our blissful ignorance stopped up our ears, shielding us from that irritating sucking sound that is our national healthcare binge.
Put it this way: if instead of nationalized healthcare we had nationalized vehicle provision ("Congratulations! Your five-year plan is up and you are entitled to a brand new Yugo!"), do we think the average consumer would choose more or fewer "options"? And therein lies the rub. For all the complaints about the "exorbitant" costs of healthcare, finger-pointing at insurance companies, and foul calls on Big Pharma, what's lost is the realization that we have found the spender and he is us. Our delivery, which apparently could have been safely accomplished for the equivalent of some 'bling,' cost, I conservatively estimate, well over $10,000. To whom, I'm not quite sure. You, I guess.
This is of course not the whole of our problems in healthcare. I'm certain there are inconsistencies, collusions in industry, and any number of shady practices and nefarious dealings. But if we're looking for salient causes, one that cannot be overlooked is the fact that individuals, removed from price signals, are consistently over-consuming resources in healthcare. According to experts, Americans are spending somewhere near double what they would if they were actually paying attention to costs. I have heard a number of central-management type solutions to our healthcare problems, but none of them promise cutting those costs in half…
When price ceases to be an issue, we all (patients, doctors, bureaucrats, even healthcare insurance providers) bear the collective and tragically unnecessary burden.