P.J. Makes a House Call to Answer Your Health Care Queries

Letter from the Editor: Editor in Chief P.J. O’Rourke

Supposedly America is engaged in a “Health Care Debate.” I’d say that’s debatable. I’ve never heard much actual argument, disputation, or controversy on the subject of health care per se. When my son Buster falls out of a tree and breaks his arm, it’s not as if this results in strong differences of opinion about health care.

Buster’s mother: “Take him to the emergency room!”

Buster’s sister: “Take him to the funeral parlor!”

Yes, there are questions about American health care. But these aren’t really difficult questions, and they don’t rise to a level that deserves heated polemic.

To begin with, let’s ask about “single-payer health care” (the current term for what used to be called “socialized medicine”).

Q: Does America want a “private” health care system or a “public” health care system?

This is easily answerable by a quick comparison of other examples of private versus public:

Your bathroom vs. public restrooms

Your backyard vs. public parks (especially after dark)

Your car vs. public transportation

Note that the favorability of the private option holds true even if your bathroom is a mess, your yard is a postage stamp, and you own a lousy car.

I own several. I have an ancient Jeep with no roof or doors, a top speed of 25 mph because it’s stuck in 4WD creeper gear, and an agricultural equipment registration that makes it illegal on the highway. I have a splendid 1990 Porsche 911 that’s lots of fun except, due to some Götterdämmerung in the mysterious Teutonic electrical wiring, it’s dead as a smelt. And I have a beat-to-hell Chevy Suburban full to the rearview mirror with hay bales, fence posts, feed sacks, and other farm detritus. Some of the electric windows won’t go up. Others won’t go down. And the seat covers stink inexorably of wet dog.

But I’d rather put my whole family in that private Suburban and drive from New Hampshire to Disney World than entrust my wife and kids to the public in the New York City subway system.

And I feel the same way about our family doctor in private practice. Although why our family doctor would be coming with us to Disney World, I have no idea. But you know what I mean.

No one should lose the house because of medical bills. The boat?… Maybe. But not the house.

Q: Does America spend too much money on health care?

Yes. No. Yes and no. America spends $3.3 trillion a year on health care. This is more than $10,000 per person and about 18% of GDP.

Yes, this is too much health care spending – on you. You with your stupid toenail fungus.

No, this is not enough health care spending – on me. Me with my terrible bad back. A mere $10,000 turns out to be not nearly enough to provide me with highly effective pain relief treatments. (Plus, to go with the highly effective pain relief treatments, I should receive the names and addresses of people selling opioids in my neighborhood in case I run out on weekends. And a Narcan syringe. Or are those extra?)

Also, consider the 18% of GDP. It seems like a lot, but the U.S. national debt is 105.4% of GDP. The 18% of GDP gets us health care. The 105.4% of GDP gets us… What? More debt. As if we didn’t have enough debt of our own. Like we need to get additional debt from the federal government – instead of highly effective pain relief treatment for my back.

Q: Fine for you. But how come I’m paying a fortune for health care?

You aren’t. According to the government’s National Health Expenditure Accounts, only 11% of health care spending is a direct out-of-pocket consumer expense. And according to figures from the U.S. Department of Labor’s Bureau of Labor Statistics, average household health care expenditures are only 6.2% of pre-tax income including health care insurance premiums.

By comparison, average household combined expenditure on “food away from home” and “entertainment” is 8.2%. We all know what “food away from home” means – pizzas and Big Macs. They’re making you obese. And most entertainment these days is, frankly, sickening. No wonder you don’t feel so well.

Q: Don’t tell me how I feel. You’re no doctor. I feel fine. Except when I pay those health care insurance premiums. Don’t you admit that the premiums are sky-high for those of us who don’t qualify for government subsidies?

I do admit it. And we need to fix that. It’s not morally or politically wrong (even from a libertarian or conservative point of view) for a government to provide some kind of “catastrophic” health care insurance. But for this to be practical and affordable it needs to be based on simple and straightforward principles. Here’s one I’d suggest: “No one should lose the house because of medical bills. The boat?… Maybe. But not the house.”

Q: However, all complaints aside, the huge amount of money that America spends on health care buys us the best health care system in the world, right?

Well… Not according to World Health Organization statistics. The WHO says that America ranks No. 31 in life expectancy, well behind countries such as Canada, Belgium, and Slovenia, and only just ahead of No. 32 Cuba.

Of course, we don’t know if Cuba’s government is counting the life expectancy of the political dissidents it lines up in front of firing squads and shoots. And I have personally been to Canada, Belgium, and Slovenia. Do people live longer in those places, or does it just seem longer?

The WHO also gives America’s health care system a poor ranking…

(But, before we hear more of what the WHO has to say, let us recall that it is an agency of the United Nations and that the U.N. is a feckless talking shop with a bureaucracy dominated by denizens of nations such as Potsandpania, Upper Revolta, Trashcanistan, etc., and that the U.N. stood around with its thumb up its… That the U.N. stood around giving a prostate exam to itself while ignoring lethal open wounds – the slaughter of tens of thousands of civilians – in Somalia, Rwanda, Bosnia, Kosovo, Liberia, Sudan, Syria… The list goes on. My point being that maybe information from a U.N. agency should be taken with a grain of that highly effective pain relief treatment for my back. And let us also note that when it comes to the most important kind of health care – caring for the health of America itself – we Americans have the privilege of consulting Dr. Army, Dr. Navy, Dr. Air Force, and Dr. Marines. They make house calls.)

But, as I was saying… The WHO gives America’s health care system a low ranking, No. 37 in the world. This is below not only Switzerland, Japan, and the EU countries, but even below – I am not kidding – Oman (No. 8).

Which of the following two scenarios do you consider most likely?

A rich foreigner with cardiology problems gets in his private jet and tells the pilot:

“Fly me to Cedars-Sinai Medical Center in Los Angeles, I’m getting a heart transplant.”

“Fly me to Muscat in Oman, I’m getting a heart transplant – from a camel.”

Q: These rich foreigners, they don’t stay rich (or alive) by being stupid, do they?

I propose a toast: “Here’s to your health, America!”