Rhymes With Cars & Girls

Let me try to bypass some of the emotion surrounding the health-care issue and just use a simpler example: Everyone knows that phone bills are too complicated.

Your phone contract – whether cell phone or land line – the “service”, and setup, and whatever, is plagued by a metric-kajillion of special rules, fine print, exceptions, surtaxes, and random fees. The whole experience is completely bureaucratized and kommissared to death, not only because the cell phone companies are trying to be a ‘clever’ as they can about squeezing you (while competing with rivals in the game of tricking you into thinking that they squeeze you less than they do), but because it’s such a big business, and (because it relies on things like phone lines and cell towers) a blatant part of the infrastructure, that the government has gotten its grubby hands on the whole thing in a big way. How much money you pay per month is the result of a giant whirlwind of forces being applied to these companies. Alas, ‘the market’ is only a small component of those forces.

In part this is because, when shopping around for phone service, it is almost impossible for a normal person to figure out if they’re getting a good deal or not. What people do is try to compare and contrast this company with that – find some number, any number, to compare the two – and pick the smaller. But when they do this they are inevitably comparing applies to oranges, because there is no such thing as a single, obvious, bottom-line figure anyone can quote you regarding how much you’ll end up paying. People try to make an educated guess, of course, but are likely to be wrong. After all, that’s how these companies make their money.

Even if every phone company’s bill were as simple as something like (flat fee) + (cost per minute) x (number of minutes used), to actually do the analysis properly you’d have to somehow make a complete statistical projection regarding how many minutes you’re going to spend on the phone throughout the life of your service. But you could always be wrong. The costs of being wrong could be wildly different from one company to the next, which you’d have to take into account. Or you could be right most of the time, but have that one month where you had that giant teary all-night phone marathon breakup with your long-distance girlfriend, which blows up your entire analysis. And to top it off, if you pick wrong at the start, you’re stuck with it, because all these companies have you sign “contracts” that lock you in for a length of time (or charge you a hefty early-term fee). Or maybe they don’t force you to sign a contract – and advertise this as a feature – but to compensate they charge you more for it. Is that worth it? How much is it worth?

So the whole problem becomes essentially the problem Wall Street had analyzing mortgage bonds, only, you don’t have an army of PhD’s at your disposal like they had.

I don’t have the time to do that analysis. So I’m probably getting ripped off on my cell phone service. I don’t have the time to do much about it. See, I have a life. People who don’t have a life, or who don’t value their free time as highly as I do, probably do indeed dig into their phone contracts, shop around, look for deals and coupons and tricks to save money. Some people (unlike me) don’t mind doing stuff like that with their free time (or at least, they have far more free time than I do). These are the coupon-clippers, the fine-print readers, the people who call the 1-800 number. They do these things, they save money, and they’re presumably ok with the status quo, which in part involves me subsidizing the fact that they save money, because I end up paying what amounts to an “I-have-a-life” tax.

A lot of my views on economics come from resentment of having-a-life taxes. There’s no having-a-life tax on, say, books. If I want to buy the latest stupid-ass bestseller by Malcolm Gladwell, I can look at Barnes & Noble or Borders or Amazon.com and look at a bottom-line, flat, transparent number called the “price”. I can compare this “price” directly between one vendor and another. And I can choose the vendor with the lowest “price” if I want. Or let’s say it’s cheaper at one store but it’s farther away, if I buy it at a higher price at the closer store, at least I know how much I’m paying-up for that convenience. There’s no fine print, there’s no special surtax, there’s no ‘contract’. There’s no analysis to be done. I don’t have to set up a spreadsheet and run statistical simulations to get comfort that I’m getting a fair deal. I want a thing, they have the thing, they tell me directly how much money they want in exchange, I can compare that amount to that of other vendors, and on that basis I make the decision whether or not to hand it over.

To a good approximation, my deepest economic wish is for all markets to function like the book market.

Now let’s think about health insurance. In a way, how health insurance works is like how phone service works, multiplied a thousandfold. You have to sign up for a “plan”. It comes (probably) from your employer. You get a giant packet that no one with a life could possibly read. You get a little plastic card that you have to carry around with you. You might lose it.

You have to do stuff on websites and such, to enter your personal information. Pick a “primary” doctor. How do you pick a doctor? Oh, they have a convenient PDF-formatted list of their doctors that you can choose from. Who are they? Names on a list! Now you’ve picked your doctor. How do you see him, and when can you see him, how do you arrange this? Just read the packet! It’s all there! If you need help with any of this there’s a 1-800 number to call…

Dudes.

I. Have. A. Life.

Let’s say I got sick and needed to see a doctor tomorrow. I’m only partially joking when I say that I wouldn’t have the first clue how. I know that I can, because I have “insurance”, I have a “plan”. But as for the mechanics of how? Who I would see and where I would go and what I would have to do and what little cards I would have to dig up out of my giant file folder and what phone numbers I would have to call and what eleven-digit numbers I would have to have at hand? No clue. No clue whatsoever. I could do it if I really had to, mind you. But as you can see, I rarely do. The cost – for me – is too high. My healthcare is essentially being rationed already, by making it so freaking complicated to actually get that I’m only likely to think it worth my while when the blood is already spurting.

This is the result of the insurance system in all its glory. This is the effect it has on people like me. I almost never go to doctors. It’s not because I’m scared of doctors. Not at all. It’s just because it’s too much of a pain in the ass.

I don’t have this problem with buying books, or soap, or getting haircuts. Why is that?

I recognize that there are people not so much like me, for whom none of this is (as much of) a problem. They are the fine-print-readers. They don’t mind or resent, as I do, investing (sinking. wasting.) that amount of their free time in reading packets and pamphlets and instruction manuals. Well good for them. But my point here is that if the health-care market functioned sanely, I wouldn’t have to. Nobody would. There would be a business establishment called “the doctor’s office”. And if I wanted to see him, I would just freaking go there. He’d tell me how much he’d charge to see me, and I’d either do it or not.

The health-care market is not like this. That is part and parcel of why it is not a market. Not really. My point is that it should be. It used to be, and could be, and should be. There is no good reason why it couldn’t be.

Ironically, my annoyance with the insurance system is so high that it actually lessens my opposition to government-run health care. I may not be in favor of government health-care as a matter of principle, but at least if health-care was distributed by state kommissars in state offices where anyone could just freaking go there and get what they needed, there wouldn’t be this whole insurance rigamarole to deal with. You would still have a card, and a number, and the fine-print readers would still be able to deal with the bureaucracy better than I (especially if they know somebody who knows somebody…). But at least the playing field would be a bit more level. I wouldn’t be taxed quite as much for having a freaking life.

In fact, sometimes I wonder if maybe that was the idea all along – make health-care so unendurable that government-run health-care starts to seem like the lesser evil. If so, I think it’s worked.