Preview Mode Links will not work in preview mode

Astral Codex Ten Podcast

Apr 25, 2020

My last post didn’t really go to deep into why I dislike the way we do health insurance so much.

Of course, there are the usual criticisms based on compassion and efficiency. Compassion because poor people can’t get access to life-saving medical care. Efficiency because it’s ruinously expensive compared to every other system around. I agree with these arguments. And they’re strong enough that asking whether there are any other reasons is kind of like the proverbial “But besides that, Mrs. Lincoln, how did you like the play?”

But I had already internalized the compassion and efficiency critiques before becoming a doctor. After starting work, I encountered new problems I never would have expected, ones which have yet to fade into the amorphous cloud of injustices we all know about and mostly ignore. Most of my patients have insurance; most of them are well-off; most of them are intelligent enough that they should be able to navigate the bureaucracy. Listen to the usual debate around insurance, and you would expect them to be the winners of our system; the rich people who can turn their financial advantage into better care. And yet barely a day goes by without a reminder that it doesn’t work this way.

Here are some people I have encountered – some of them patients, some of them friends – who have made me skeptical that our system works for anyone at all: