Monday, October 11, 2010

The Postal Service is Terrible (Or: Thoughts on Health Care Reform)

The Saturday before last, I ordered a CD online. It shipped from a warehouse in New Jersey that Tuesday at 6:20 am. It arrived in Oklahoma City, and was accepted by the United States Postal Service, at 7:09 am on Friday—almost exactly 3 days of travel time. Travel distance was approximately 1,400 miles.

The CD has yet to arrive in my mailbox.

From Oklahoma City to Norman is 20 miles. I can understand that processing time meant the package could not have arrived on Friday. I can even accept, if not quite understand, that the package did not arrive on Saturday. Yet it is utterly beyond my reach to fathom how the CD cannot have come today.

All this, for a meager 20 miles. If the package comes tomorrow when our mail comes a little after noon (and it had better, or I will be exceptionally grumpy), it will have taken longer to travel those 20 miles than it did the preceding 1,400—even with skipping Sunday.

In short, the United States Postal Service is mind-bogglingly slow—so slow that they would be run out of business within a matter of months if they faced a competitive market. Postal work is hard, and I am not trying to run down the workers; I have friends who are employed by the USPS. But the system is deeply, badly broken. (Sadly, I could say much the same about my own place of employment, but defense contracts are another problem altogether.) Colossal bureaucracy has combined with the effects of monopoly to produce a response so sluggish and unreliable as to be laughable in any other context.

Edit, with chagrin (although the point at large remains): today is Columbus Day. I worked, and so forgot that the Post Office doesn't.

This illustrates almost perfectly why I and many people that I know are deeply opposed to "health care reform" insofar as that means increased government involvement in the health care system. It is not that I do not care about those less fortunate than me, not that I do not see the brokenness of the current medical system, not that I think our current medical insurance system is anything less than a catastrophe. It is, quite simply, that I cannot believe that the government will do it better.

It is beyond question that the health care system is in desperate, urgent need of reform. No one I know disputes that. What is not only open to debate but in equally urgent need of debate is how health care is to be reformed. In last year's political battle, the discussion was almost never nuanced: opponents of the bill were caricatured as greedy misers enriched by the current system, and proponents of the bill as socialists interested in the destruction of American ideals. (Needless to say, I was not impressed by the argumentation on either side: ad hominem is annoying and juvenile, however unfortunately effective it may be.)

Obviously the issues are far more complex than our 30-second soundbyte media culture can readily handle (and that's a future blog post, as well). What worries me is that the issues are apparently more complex than most Americans can handle.

On the one hand, that's not a surprise; after all, any discussion of health care reform automatically involves billions of dollars, insurance companies, pharmaceutical development, hospital management, down-the-street clinics, cancer treatment and research, abortion, euthanasia, and a host of other issues. It's not one problem to be solved; it's dozens of challenges and problems so closely interrelated that any proposed solution for one may deleteriously impact another.

On the other hand, few Americans—including those in Congress—seem willing to make the effort to understand even at a basic level the options available for health care reform. The only options, as the story went last fall, were to reform health care or not—meaning to move health care to the public domain, or not. Rarely was it acknowledged, much less discussed at any length, that many of the issues being debated had more than binary options available. To take the most prominent example, health insurance companies operate on a thoroughly unhealthy model—but a number of issues can be addressed regardless of whether insurance falls under the government's umbrella.

First, it must be acknowledged that we treat medical insurance differently than any other. Imagine paying insurance to cover part of your oil change—and then remember that the oil change on your car is roughly equivalent to your annual physical exam at your family practice doctor. Minor outpatient procedures are in many ways analogous to getting a new transmission—hardly small costs, but things we save for (or, at worst, pay with a credit card). These things cost immensely more than they should—and more than they would, if the system did not involve a positive feedback loop through the insurance system.

I had a medical staple put in my head a few years ago courtesy of a friend's elbow. The total cost of the trip to the ER and the staple—perhaps 7 minutes of time, including checking in, the triage nurse's examination, and the actual insertion of the stable—was over $1000; I paid $100 myself. I sat there for an hour, waiting for a forty-second piece of work by the doctor. The system is broken—but that is because we use it the wrong way. That will not change under government administration.

Similarly, no one can dispute that malpractice suits have been and continue to be one of the drivers of ever-rising insurance costs. The threat of a suit for nearly any failure, real or perceived, has made the cost of even simple procedures exorbitant. This combines with the positive feedback loop mentioned above to produce unbelievable situations with little or no relation to supply and demand. The issue is the threat of lawsuit—not the cost or real risk of the procedure.

Health care reform must begin by addressing these sorts of issues, if it is to be successful. Moreover, it can address these issues without bringing up the far more difficult and heated topics like government-run systems. I would wholeheartedly support legal (that is, regulatory) measures designed to curb the issues mentioned above, even while my ongoing experiences with the federal government would lead me to wholeheartedly oppose taking health insurance into the public sector. In short, there is room for a great deal to be done without leaping to either extreme in this area.

I do not trust the federal government to run the medical practice of this country any more effectively than it does the mail system, and accordingly could never support taking health care public. At the same time, I recognize that unregulated capitalism has produced a tower of cards that is certain to topple disastrously sometime in our future. Somewhere between the two is probably our safest bet, balancing great powers against each other. Where that line is will remain up for debate—but there is much we can do in the meantime. Hopefully, we can do it civilly and reasonably, recognizing that on many issues (including those I highlighted above) there is probably a great deal of agreement among most Americans, whatever their views on last year's bill.


  1. Great diatribe Chris! You voice these thoughts extremely well.
    I would like insert a hopeful thought. You mention your concern that there is an appearance that many Americans can't handle the complexities of this issue. I maintain a hope that most people can handle the issue on a deeper level and do so consistently.
    Social Commentators and Political leaders must always be raising money. Sound bytes work well for this purpose and these people maintain the loudest voice in the discussion. That's why it seems like the discussion is dominated by sound bytes. Many people, however, understand what broken parts can be fixed readily, given the right political go-ahead.

  2. I hope you're right. My concern is that I see increasing apathy on the parts of Americans—not least because of the apparent (and often actual) impotence of both parties. There is no vision, and certainly no will to put vision into action. Especially if it might be personally costly.


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