Health Care

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The amount of hype, both pro and con, concerning Obamacare/ACA is stupefying.  I'm not making fun of it; after all, this is one of the boldest moves in cultural advancement since Franklin Roosevelt was president, in the USA.  Some folks see it as wrong-headed, and a precursor to a Byzantine government bureaucracy that will destroy every cent of discretionary income anyone might hope to earn in the future.  This fear is completely justified, because Americans have, among them, some of the most creative gangsters outside Russia, and they will surely find ways to siphon off some of the money that has to go back and forth in the Health Care industry of the future, just as they did for food stamps, alcohol, firearms and tobacco, and, best of all, drugs.  (Drugs are so much fun that the CIA got into it, and never got out.)

One problem is that health care professionals command such high salaries.  Medical college is far more expensive, ounce for ounce, than other sorts of education, and everything to do with health care is just more expensive, by association.  A friend of mine recently said that the profit margin for certain insurance companies is around 3.5%, which they know from studying the public information on the companies.  But of course!  Most of the money is eaten up by the high salaries, which are all classified as expenses.

Health professionals in other countries are not paid as much, even allowing for the different standards of living.  When one examines the process through which a kid goes to become a doctor, you begin to see why.

First, a would-be doctor has to get a bachelor's degree.  It need not be in science; in theory, a philosophy major could become an MD, provided he or she takes the required coursework.  Many of these kids are driven by a combination of relentless parental pressure, an insatiable greed for money, a need for social advancement, and a modicum of altruism.

Secondly, because of the high admission standards of the leading medical schools, these students apply a great deal of pressure on their instructors to give them high grades, pointing out that all the extra coursework they're taking is not because they're intrinsically interested in it, but because it is needed by the fact that they're Pre-Med, a state that has lost some of its shine in recent decades (but of course, these kids haven't got the memo).  They must "take" college physics, which means they must also "take" Calculus, something about which roughly half of them care less than nothing.  But those of them who can drive their sheer hate of the subject into maniacal memorization actually do better than physics majors, which shows that hate is a more powerful force than love!  Heh-heh.

Thirdly, now that a vast host of students are applying for entrance into Medical School, these schools can demand almost unbelievably high admission standards, in terms of coursework and grade point averages.  They don't care that the applicants despise practically everything they've ever learned; they know that the successful applicants can take an enormous amount of academic punishment and bullying, which makes it easy for their teachers, who need not put a great deal of effort into the process of teaching.  Luckily for us, graduating competent doctors is a major deal, because the reputation of the school enables the students to be more easily employed.

Fourthly, Medical School professors are paid almost as high as football coaches, and have to carry, I don't doubt, a lot of mal-teaching insurance, which probably contributes to the fact that tuition at medical school is very costly.

Fifthly, students who don't make the grade for acceptance into Medical School end up elsewhere in the Health Care Industry, and because of likelihood of litigation in any branch of the industry, all these people carry their own malpractice insurance, and all of them demand high salaries.

Sixthly, possibly because they deal so closely with people in the medical professions, those employed by the Insurance Industry have historically commanded astronomical salaries.  A lot of the money that consumers pay into health insurance actually stays in the insurance companies, so that while shareholders may not net much out of their holdings in these companies, they're a very dependable source of income.

Finally, once a doctor establishes himself in some location, he or she finds, to his or her astonishment, that the health system administrators make a lot more money than the actual doctors.  The administrators, after all, must negotiate with insurance companies exactly how the moolah is divided up, and the remuneration of all concerned parties is most definitely proportional to the moolah concerned.  Not included in this list are the malpractice lawyers and ambulance-chasers of all stripes, who make money on a per-disaster basis!  It is a lovely win-lose situation that can hardly be improved upon.

[More later]