Wednesday, November 7, 2007

We Get It Wrong, Wrong, and then Wrong Again

As I'm sure you already know, I enjoy reading other people's blogs. It helps bring me a different perspective, and often sparks new ideas. I was paging through Ben Casnocha's blog today and came across an interesting quote that pretty much sums up what happens when we constantly judge others, form our first impressions, and decide how someone is going to be even before we know them. A Philip Roth quote from American Pastoral:

You get them [people] wrong before you meet them: you get them wrong while
you're with them and then you get home to tell somebody else about the meeting
and you get them all wrong again. Since the same generally goes for them with
you, the whole thing is really a dazzling illusion empty of all perception, an
astonishing farce of misperception. And yet what are we to do about this
terribly significant business of other people, which gets bled of the
significance we think it has and takes on a significance that is ludicrous, so
ill equipped are we all to envision one another's interior workings and
invisible aims? Is everyone to go off and lock the door and sit secluded like
the lonely writers do, in a soundproof cell, summoning people out of words and
then proposing that these word people are closer to the real thing than the real
people that we mangle with our ignorance every day? The fact remains that
getting people right is not what living is all about anyway. It's getting them
wrong that is living, getting them wrong and wrong and wrong and then, on
careful reconsideration, getting them wrong again. That's how we know we are
alive: we're wrong. Maybe the best thing would be to forget being right or wrong
about people and just go along for the ride.

22 comments:

Akshay said...

Thanks for your comment.

Your first question concerns rationing. And some would say passing the bills of care for illegal immigrants is unfair rationing. The ethics can be difficult to decipher, but the problem first lies with illegal immigration. That is outside the scope of medical care. As you said, hospitals will give care to those who need it.

A lot of medicaid burdened centers file for disproportionate share hopsital status to receive help from the government, whose first step is to recover the lost revenue. There's only so much bad debt that can be written off. I'm sure there are other initiatives in play and I'll update you as I find them.

Your second question is even more difficult to answer. Socialized medicine works in most areas of the world, sometimes delivering better care than we do. Giving up fee-for-service revenue would be incredibly annoying for physicians, but we have to question whether, one: it should be FFS, and two: should 30-40 patients be coming through the hospital doors.

FFS has been proven to only create an incentive towards seeing more patients. And due to asymmetry of information between the doctor and the patient, the doctor sometimes has the power to induce demand. This all leads to some of the rising costs we see today. Insurance companies don't help either by subsidizing our care so that we feel that health care is for free. Right now, employers burden the cost (and that's changing fast). Its really multi-faceted, so I'm not sure if the answer to socialized medicine in America is a flat no. It depends.

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