Friday, November 11, 2011

More Conversations with Bean: Dogging Healthcare

We've had our greyhound, Bean, for a year now. Every day he grows in wisdom and grace. He is a good dog, eager to please and eager to learn. We have begun to engage one another in conversation with some frequency. He seems to enjoy our little talks, and I find, as his powers of observation grow, so do I. Here is another recent exchange.

BEAN: You remember when you took me to the Vet last week?
ME: Yes. Sorry. It was time for your annual shots.
BEAN: Oh, I don't mind going to the Vet. I mean once they took my nuts, I figured it couldn't get any worse.
ME: Not my fault, Buddy. They did that before I got you.
BEAN: Yeah, I know. Still it seems like a cruel fate. You don't have any idea what's about to happen. They give you a lovely nap, and when you wake up you're carrying an empty sack around. It's embarrassing. I'm mostly over it now, but every once in a while, when I think about it, it gets my back up. You might want to reconsider sleeping in the know, for your own safety. I'm just sayin'.
ME: Yeah. Okay. Thanks for the warning. We were talking about the Vet.
BEAN: Yeah. What I was wondering is, how come it's so much cheaper for me to go to the Vet than it is for you to go to the Doctor?
ME: I don't know, Bean. I haven't thought about it much.
BEAN: It's not like the Doctor is smarter than the Vet. In fact it's probably the opposite. The Doctor only needs to know how to fix people. The Vet has to know how to fix dogs, cats, hamsters, boa constrictors, guinea hens, cows, horses, giraffes, and hippopotami—just to name a few.
ME: You make a good point.
BEAN: So what's the difference then? Are people more valuable than dogs?
ME: I don't think anyone I know would make an argument like that.
BEAN: Me either. Clearly that would be ludicrous. So what is the difference then?
ME: Well I think it might be the insurance companies. Insurance companies are in charge of most of the healthcare system for people. They decide who gets covered and how much it costs to get covered on the one side, then, on the other side, they determine who gets paid, what services get paid for, and, to a large extent, how much gets paid. They have a significant say in every aspect of the money flow for healthcare in humans, but very little say about healthcare for animals.
BEAN: So you think insurance companies have bid up the cost of healthcare for humans?
ME: I don't know. It's very complicated. If you think about it though, the insurance companies are handling all the money and taking a piece of the action on everything, so the more healthcare costs, they more money they will make. They really don't have a vested interest in keeping medical costs down - only their own costs. They keep their own costs down by limiting coverage to people who are not likely to get sick and then denying the claims of the people they do cover.
BEAN: Sounds to me like you guys need to get the insurance companies out of healthcare.
ME: Maybe so, but that's way easier said than done.
BEAN: Why's that?
ME: Well for one thing, the insurance companies have a lot of money left over from collecting big premiums, limiting coverage, and denying claims. They use that money to make campaign contributions and to pay lobbyists in Washington to make sure that no one in Congress messes with the system. They pay good money, in other words, to keep things as they are.
BEAN: And people put up with this nonsense?
ME: So it would seem.
BEAN: I think someone needs to take this system out on the back porch and chew it up like a rawhide bone.
ME: As usual, you make a lot of sense, my friend.
BEAN: Yeah, and meanwhile you ought to consider just getting your work done at the Vet.

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