My favorite lesson from high school physics was learning the second law of thermodynamics, that matter cannot be created nor destroyed under ordinary chemical means. It is a really useful concept. What it says is that you can’t make something out of nothing, and that you can’t make that something disappear into thin air either. I find the concept particularly useful when presented with magical thinking from people who seem to believe that the average American is too stupid to pay attention when they are being sold a bogus deal. Are you listening Professor Gruber?
I spend my days talking to ordinary people. I don’t discuss politics with my patients, but I do learn a lot from them and their life experiences because they impact the matters of health that I try to help them with. I had a particularly interesting discussion with a middle-aged man. He came to me with a problem that was fairly straightforward. He started out a bit annoyed with me because he had to wait to see me beyond his scheduled appointment time. I sensed this and asked him to accept my apology because I wanted to focus on why he had come in and what was troubling him. We then struck up a great rapport and he explained that he had missed a half-day of work, and had to make a $50 copayment for my service. He had been in good health most of his life, but was now diabetic, and was having issues related to diabetic complications, and felt he had been shuffled around to multiple specialty physicians, me among them, and that his insurance plan required a $50 copayment for each visit. I learned also that he was highly educated and had been a high school teacher in his birth country.
He was an immigrant who had lived here for over 20 years, spoke very good English and had a good job, but not what he had trained for because his foreign credentials were not acceptable for employment here at his level of skill and training. His job paid decently, but he had not had a raise in 9 years, and his health insurance premiums continued to rise each year, and his copayments and deductibles had become frankly unaffordable. He then went on to say that he felt like he was a sucker. He told me of his neighbors and acquaintances who get everything for free, but that he was too proud to take a handout.
I did my best to tailor my recommendations to him to be mindful of his financial constraints, which he appreciated, but we had a long discussion about what is wrong with health care, and how it is in the process of a monumental failure which is hurting real people right now. He is nominally insured, but he can’t afford to use his benefits, which he is paying for through the nose by salary deduction. So when you hear the politicians crowing about how so many more people are insured now than before Obamacare, bring yourself back to the second law of thermodynamics. You can’t give something to some people for free, without taking it from someone else. You cannot create a new entitlement and tell the American people that it will actually save money. That would be idiocy and would definitely violate the second law of thermodynamics, which I am told they still teach in high school. My patient is paying too much for his health benefits because he is unknowingly cross-subsidizing other peoples’ free benefits. The house of cards is about to collapse under its own weight because free health care or free anything is a big lie.
None of this means that the concept of insurance is not valid. Insurance is something we as a community share by sharing the risk and pooling our resources to prevent catastrophic losses. It only works if everyone who desires the protection shares in funding the benefit. People who have contributed should have some shelter from disastrous costs when health issues arise. My patient has been contributing for years and now feels like a sucker, his words not mine. What cannot be sustained is the ever increasing premiums, copays and deductibles when the person who is experiencing illness cannot afford to access the care he or she needs. Something needs to change.