Why It’s So Hard to Fix American Health Care

I’ ll get to the burritos and tornados in a second — first, a little on health care.

“Now, more than ever, it’s important to have good health care.” So says an advertisement on the radio. “Now, more than ever,” is a nearly omnipresent advertising convention: Whether someone is trying to sell you a presidential candidate or a mortgage refinance, the issue is urgent “now, more than ever.”

That’s almost never true, of course. In the matter of health care, it arguably is the opposite of the actual facts of the case: Having good health care probably matters now less than ever.

People mean one of two things when they say “health care.” Often, they mean health insurance — 99 percent of American “health-care reform” has been health-insurance regulation of one kind or another. Health insurance is a financial product, not a medical product, and it is good to have good health insurance. But it probably matters less today than at any time since health insurance has been a widely used product. If you are poor, then there are Medicaid and any number of charitable options for accessing medical care. If you are not poor, a surprising selection of medical services is available at quite reasonable prices. Not everything, of course: Getting hit by a bus is still pretty expensive, and so is having a chronic condition. But a lot of ordinary care is surprisingly affordable.

You’ve probably heard a thousand variations on this story, ten of them from me, but here’s another. A month or so ago I went to the doctor about a minor issue, and I had an idea of what I wanted to do about it. “Can’t do that,” the doctor said. “Your insurance won’t cover it unless x, y, and z, none of which is the case.” I replied: “And what if my insurance card says American Express on it?” Doc: “Oh, in that case, no problem.” This was all about an out-of-pocket expense amounting to a couple of hundred dollars — not nothing, but not life-or-death money for most Americans, either. Again, yes, it’s comforting and wise to have insurance for bigger problems, but you can get a lot of medical services that weren’t available at all a decade or two ago at surprisingly accessible prices.

What about medical care per se? Again, it’s better to have it than to not have it. But it probably matters now less than ever. Many infectious diseases that plagued our grandparents are gone or mostly gone (in part because our forebears were not f***ing idiots about vaccines), we are a lot less likely to suffer the kinds of horrible on-the-job injuries that once were common among farm and factory workers, few (very few) of us are underfed or malnourished, etc. If you get into a car accident today, you are less likely to be seriously hurt in it than you were 30 years ago. It is not that it does not matter, but having ready access to a doctor probably matters less now than at any other time in history.

Still, we are very funny when it comes to thinking about serious physical risks. I live in Texas, where there are now a whole bunch of refugees from California, and we argue about a few things: Not the political stuff so much — the Californians know why they left their beautiful state behind — but other pertinent questions, such as what exactly constitutes a burrito. (Californians are confused about this.) Another unending Texan–Californian debate: Would you rather live with the constant risk of earthquakes or the constant risk of tornados?

Almost every Texan I know prefers tornados. I am from a particularly tornado-y part of Texas (you won’t find very many buildings in downtown Lubbock built before 1970), and I have been around a lot of tornados. They are awesome and terrifying. I think that if you didn’t know that tornados were a thing and just got plopped down near a big one with no explanation, then you’d probably spend the next couple of years of your life organizing your affairs in such a way as to ensure that you never got near one again. But if you grow up with them, you just kind of get used to them. If the sky turns a little green, you get ready.

(With apologies to Joe Strummer, I don’t think there is any such thing as “earthquake weather.”)

Californians, on the other hand, typically prefer the earthquake risk to the tornado risk. That is what they are used to.

And I have a sneaking suspicion that Americans are made anxious by the thought of paying out-of-pocket for most ordinary health care — the same way they pay for iPhones and oranges and F-150s — for the same reason: It is not what they are used to. What they are used to is conventional health insurance — a product that (1) we think we can’t live without and that (2) kind of sucks.

But, given how many Americans report recognizing that it kind of sucks, you’d think we’d be open to more radical innovation — now, more than ever.