Dentistry, Health Care, and Bildad the Shuhite

I am ill tonight. I am sick to my soul.

Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

This is not, in and of itself, an unusual story. In 2003, nearly 16 percent of the US population was without health insurance. In the US, health insurance is inextricably linked to employment. If you have a job with good benefits, you’ll have relatively low-cost health insurance. If you have a job without medical benefits, or if you are unemployed, you will pay tremendously for health insurance, assuming you can afford it. If you can’t afford it, you’ll pay more for basic health care than the insured plus their insurance company pays.

Let me say that again. If you do not have health insurance, doctors and hospitals will charge you more than they charge insurance companies. Chances are, you’re like me: you have health insurance. Have you ever looked at the claim reports your insurance company sends you? I happen to have received one today. In the itemization section, there’s the following:

Services Submitted Charges Eligible Charges Benefits Paid
LAB-PATHOLOGY $30.00 $6.971 $6.97

1YOUR BLUE CROSS PREFERRED CARE PROVIDER HAS AGREED TO ACCCEPT THE AMOUNT LISTED IN THE ‘ELIGIBLE CHARGE’ COLUMN AS TOTAL PAYMENT FOR SERVICES RENDERED.

Did you catch the footnote there? Our doctor normally charges $30.00 for labwork, but for our insurance company they’re willing to take $6.97.

This leads to a nasty spiral. If you’re employed in low-wage jobs or unemployed, you can’t afford health insurance. That drives up the cost of your health care, to the point that you start playing Russian Roulette with your ailments. You have to guess whether a given illness is bad enough to warrant going to the doctor. That leads to more health problems, which in turn cost more, and soon you’re circling the drain financially.

Insurance companies aren’t helping. They are notoriously optimized for short-term gains over long-term benefits. They’re public companies, and are driven by market forces that reward immediate cost savings. For instance, my insurance company will not pay for physicals, despite the lower cost of early treatment of diseases and cancers.

Deamonte Driver’s case is illustrative. Look back at the article.

Deamonte’s death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.

$250,000 to care for a condition that could have been solved at the beginning for some $80. In 2004, the uninsured cost an estimated $125 billion. That’s out of $1.9 trillion spent on health care costs overall. Roughly ten percent of health care costs are already spent on the uninsured.

We spend more on health care than any other country. Switzerland insures everyone at a cost of some 11% of GDP. Canada does it for 9.7%. Despite our higher rate of spending, our longevity ranks behind all other industrialized countries.

Even if you’re insured now, there’s no guarantee that a life-threatening illness won’t take all of your money and then some. In 2001, half of all personal bankruptcies were due to illness and medical bills. More than 75% of those driven into bankruptcy by medical issues had health insurance when their illnesses began.

There is an overwhelming financial incentive to fix how we pay for medical care. But for me there’s a strong moral component. Why are we willing to let the poor die from easily-preventable diseases?

Among many of my fellow Christians, there is the idea that the poor deserve what they get. If they are poor, it is because of choices they have made.

“Does God pervert justice? Does the Almighty pervert what is right? When your children sinned against him, he gave them over to the penalty of their sin.”

Job 8:3-4

Those are the words of Bildad the Shuhite to his friend Job. The story of Job is a troubling one. God takes away Job’s family, his wealth, and his health. Job and his friends then argue about why God did this to Job. The safe view of the story is that it explains suffering and pain. It doesn’t, really. You can’t turn to the end of the story and get a pat answer to why, in the words of Harold Kushner, bad things happen to good people.

What we do see is a portrait of how people deal with the problem of suffering. I find Job’s friends’ responses extremely enlightening. Their approach to comforting Job is to tell him to repent. “This is your fault,” they say. “Go back to living a righteous life and all will be well.”

This flies in the face of our experience. Ten-year olds realize that bad people prosper. Good people suffer. “Why do the wicked live on, growing old and increasing in power?” Job cries to his friends. And yet, so many of us cling to the idea that luck and circumstance play no role in people’s situations.

If you’re poor, it’s your fault. And that absolves us of our obligation to help.

“They also will answer, ‘Lord, when did we seen you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’

“He will reply, ‘I tell you the truth, whatever you did not do for one of the least of these, you did not do for me.'”

Matthew 26:44-45

I don’t have a solution to the health care crisis. I don’t even know what I personally can do to begin fixing the problem. But that doesn’t mean I should shrug my shoulders and accept the situation as it is. If this is the best we can do for the least of these, then surely we are all damned.

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11 Comments

  1. Mark J Musante
    on March 1, 2007 at 7:34 am | Permalink

    Hear hear.

    Also, here: http://www.amsa.org/uhc/

  2. on March 1, 2007 at 7:42 am | Permalink

    A friend of mine died from menengitis a few years ago. We think, in part, that this was due to the high price that he had to pay for going to the emergency room.

  3. on March 1, 2007 at 9:07 am | Permalink

    If our government really can spend the current health care money better on national care, then it’s a possibility. I just have this fear, often justified by the reality of government control, that such a health care system won’t be any better.

    For every person who dies because they have no insurance, there’s plenty who leave countries with government run health care to the US or Singapore to get a procedure the government won’t cover or can’t do in a timely fashion.

    Heck, even Jim Henson has health insurance … that didn’t save him from deciding not to go to the doctor.

    Insurance has totally screwed up health care in this country. Every private practice doctor I know hates it. I just don’t know if senators can fix it. Every time I stand in a voting line or at the DMV I think “is this what government health care would look like”.

    The charitable part of me would have given him the $80 out of my pocket, but I am not sure if I want the money taken at gunpoint through taxes.

  4. Joyous
    on March 1, 2007 at 9:47 am | Permalink

    I’ve lived without insurance, and you’re right, it sucks. The Russian roulette, thing, yeah…by the time I finally got my first job w/ insurance and could afford a dentist, I had eight cavities.

    I’ve also lived w/ socialied health care…I can’t speak for how other countries do it, but in France they go to the doctor for the slightest little thing. This means loooong wait times when you do go. I remember sitting there all day in a big crowd. (My host family was surprised, and a little suspicious, at my attempt to treat my own cold with Sudafed–I’m not sure they knew what the little red pills were.)

  5. on March 1, 2007 at 10:51 am | Permalink

    Just as another data point, while it’s true that your doctor charges an uninsured person more than he charges the insurance company (Though it’s more complex than that: if your doctor charges $100, and the insurance company agrees that you will pay $20 and they will pay $40, and the doctor only gets $60 — But in addition to that, he generally also gets some sort of yearly “stipend” from the insurance company based on the number of insured patients he has. There’s also some kind of bulk discount going on. So, while I’m sure you do get the shaft a bit, the disparity isn’t really as big as the bill implies), dental insurance tends to work a little differently. The insurance company has a schedule of how much a procedure “ought” to cost, and they pay some percentage of that, and you pay the rest, and the dentist agrees to accept that total amount. My family dentist billed different rates for insured and uninsured patients. If you had insurance, he charged what the insurance allowed. If you didn’t, he charged his own rate, which was generall quite a bit *less* than the insurance rate.

  6. on March 1, 2007 at 12:52 pm | Permalink

    If our government really can spend the current health care money better on national care, then it’s a possibility. I just have this fear, often justified by the reality of government control, that such a health care system won’t be any better.

    There’s no guarantee, of course, but I’m willing to try given how broken the current system is. The problems you mention are not government problems, they’re big organization problems. Large organizations like big pharmaceutical companies or insurance companies have similar inefficiencies, only we don’t get to see those as easily.

    I expect going to a government-controlled health system would add annoyance to run-of-the-mill health care for those of us who already have insurance and are relatively well off. For the working poor, it would make things easier. Being poor adds to the hoops you go through to get routine care. The linked article gives a good view of how much you have to do to get care if you’re poor, whereas I can bop on down to my local doctor or dentist and pay my co-pay.

    More importantly, government-controlled health care would drastically reduce the rate of financial ruin due to illnesses. Given all of that, I’ll take some waiting in line.

    For every person who dies because they have no insurance, there’s plenty who leave countries with government run health care to the US or Singapore to get a procedure the government won’t cover or can’t do in a timely fashion.

    Do you have any stats on the number of people coming here for medical care? That’s an open question to everyone, by the way — I’m interested in seeing how large or small that number is.

  7. on March 1, 2007 at 1:10 pm | Permalink

    “Do you have any stats on the number of people coming here for medical care? That’s an open question to everyone, by the way — I’m interested in seeing how large or small that number is.”

    Numbers … not handy. But Singapore has made it a small industry. Hospitals there have the equivalent of a “travel agent” to book packages for out-of-country patients.

  8. on March 1, 2007 at 5:44 pm | Permalink

    I would argue that the U.S. stands as good of a shot at making nationalized health care a go as any other Western nation given our expertise at management. The reason that developing countries have issues with command economies is the lack of skilled managers in filling key positions. The U.S. has as much of a surplus of competent managerial talent as anyone.

    Government-run healthcare does indeed exist in this country—military members and their dependents. I spent the first 12 years of my life in military health care, during which I was diagnosed with [and saw resolve] a potentially lethal heart defect. I received excellent care and am quite obviously alive today.

    [As a weird sidenote, I’ll note that millitary medicine did dentistry horribly, and that military insurance paid for private dental care.]

    As I’ve thought about this issue more and more lately, I’ve come to the conclusion that, as in education, this country’s best approach is probably a parallel system: public, taxpayer-funded healthcare with a private, for-profit system available. Is the quality of the care in the private system going to be superior, in some cases? Yes. But private healthcare could certainly stand to be the risk-accepting component of the healthcare system, pushing out against new thearpies and pushing the envelope.

  9. Missy Krebs
    on March 2, 2007 at 9:34 am | Permalink

    In the legal profession, we are required to either perform legal services for the poor without pay each year, or contribute several hundred dollars to a fund to provide services for those who can’t afford them. That’s considered your duty because you are able to make a good living in our profession. And I don’t have a problem with that.

    Although I know a few doctors and other medical professionals who do this voluntarily, I’ve never understood why it isn’t (or couldn’t be) required. Medicaid pays for services for the very poor already. It’s the people stuck in the middle that could use some help.

  10. on May 17, 2007 at 1:21 am | Permalink

    “I expect going to a government-controlled health system would add annoyance to run-of-the-mill health care for those of us who already have insurance and are relatively well off.”
    So what would be the solution for everyone then?

  11. on May 17, 2007 at 10:01 am | Permalink

    Government-controlled health care. Ideally, a tiered program like France’s; Ezra Klein has a good summary of how France’s system works.

One Trackback

  1. By A Mind Occasionally Voyaging on March 8, 2007 at 11:41 am

    Economy of Scale…

    As you may know by now, there was some news recently about A guy dying of a toothache because he didn’t have insurance. I hadn’t been planning to comment, because, hey, it happens. Even at my most financially destitute, I……