Odds and Ends

Living the life of a bachelor again reminds me why so many of us leave it for the confines of marriage. The most difficult part is the meals - eating alone. It's tough to go out to a restaurant: "Table for one?" They don't like it either. Wastes a perfectly good table. The like us to eat at the bar, with all the other lonely castoffs. At least I know mine is temporary.

I've been meaning to get around to a few things on my blog, and now is as good a time as any. I try not to get too political here - I have a different blog for that - because this is my story about living abroad. My recent medical experiences in both Jakarta and Singapore have provided timely insight into a current national debate in the US, and I've now decided, after much internal debate and consideration, that I am in favor of some type of nationalized health care.

I'm a free-market capitalist to the core. Any economist worth his degree, however, will admit that, in the interests of efficiency, the government has to take on some roles. For me, those roles have been limited to: educating the populous, protecting the populous (police, fire, military), providing reliable transportation (roads), regulating (minimally) commerce, and negotiating internationally. I will now add providing basic health care to the population to my list of essential government functions.

Anyone who has had a baby recently and viewed their insurance payout information knows how expensive it is. Nearly $10,000 if you have an epidural and a vaginal delivery. In Singapore, if we had to pay it out of pocket, the cost would be $1,400, including three nights in a private room. My endoscopy, which my father tells me can cost well over $2,000 in the US, had a total cost, including filling my prescriptions, of $500. The procedure itself was just $300.

Health care costs in the US are out of line. Much of this is due to the fact that doctors have to carry malpractice insurance that costs them $100-$200k per year. They have to earn $200,000 just to cover their premiums. It's obvious to me why small towns no longer have doctors. They can't make enough money to cover their premiums, pay their office expenses, and still earn a living.

Another major contributor is the amount of relatively healthy people who visit the ER for a cold. ER's are required by law to not turn anyone away. They can't deny someone treatment for not having insurance. When these people don't pay their bills, the hospitals have to make up the cost somewhere - so they take from people with insurance. If everyone has insurance for basic needs - annual check ups, annual colds; and everyone has catastrophic insurance for major medical like severe car accidents, this problem goes away. We also would still have an auto industry and more small businesses.

Everything in between those two extremes - basic, preventive care and catastrophic injury (like amputation) - would need to be covered by private insurance. Viagra, Ritalin, xanax - those would all be covered by private insurance.

If third world nations are able to keep medical costs low, I would think the US could do a better job. My advice to Obama: Think big, start small, start now.

Tomorrow I'll post on the other topic - career management.