The image above shows the bill for an emergency room visit that a man without insurance incurred after he was bitten by a snake. It’s been floating around Twitter, where a lot of users assume that it is fake—particularly users from countries that offer some form of socialized medicine, if anecdotal reading is any indication. But this bill is real. CBS News confirms that Todd Fassler got it in 2015, when he posed for a selfie with a rattlesnake and got bitten. That’s a very dumb thing that Fassler did. But the stupidity of taking a picture with a rattlesnake pales in comparison to the evil of charging $83,000 for the antivenom CroFab, which Fassler required to live.
Only one US manufacturer makes antivenom for rattlesnake bites, so they can charge what they want. So can the hospital, which first treated Fassler in its emergency room before moving him to intensive care for a few days. All this stuff is expensive because of concrete market forces, but from the perspective of the person who actually buys health care—the guy with a puffy arm whose heart will stop if he doesn’t agree, in advance, to pay whatever the hospital charges—the system is completely arbitrary.
Imagine if a man dragged himself to your door in the night, dying of an injury that you had the power to treat. “I’ll save your life,” you say, “but you have to buy a house and give it to me. Alternatively, you can become my indentured servant.” You would be an asshole. It’s immoral to extort dying people for more money than the median American household makes in three years. But because this process happens through a series of billing companies and office functionaries, we think of it as unavoidable. No single person is responsible, so it’s nobody’s fault. We have invented a system that ruins lives in the process of saving them, because the alternative is to do the difficult work of overhauling a broken system.
But what about personal responsibility? If Fassler didn’t want so much debt, he shouldn’t have gotten bitten by a snake. I say unto you, dear reader, that this kind of appeal to personal responsibility is a dodge. People are going to get bitten by snakes. They’re going to do really stupid stuff and incur injuries they easily could have prevented, because this is the way of the world. Saying sick people are responsible for what happens to them abdicates our responsibility to treat the sick. It posits an imaginary world without illness, when illness has been an aspect of human life since the beginning. The problem is not that people need medical treatment. It’s that we refuse to think of a fair and decent way to give it to them.
The free market
Possibly for the first time since 2010, good news about Obamacare: premiums on the newly-minted California health insurance exchange are lower than predicted. The rates published last week are so much better than what critics of the Affordable Care Act predicted that no less a Cassandra than Rick Ungar has admitted he was wrong. It seems like this whole insurance exchange thing might work out. Either that, or we are the objects of a clever public relations campaign. Avik Roy argues that individual rates are actually 64% to 146% higher on the exchange. He also bases his analysis on comparisons between the cheapest policies available before Obamacare—the ones that don’t meet the minimum standards for the California exchange—and the bronze-level coverage available now. So we can say with confidence that somebody is well-paid to mislead us, even if we don’t know who.
The United States Supreme Court
I’m as surprised as you: the Supreme Court has ruled to uphold the Patient Protection and Affordable Care Act, better known as Obamacare. The individual mandate is constitutional, albeit on the grounds that it is a tax and not a mandate. But no matter—minus some sticky stuff about federal coercion of the states to expand Medicare, health care reform stands, kit if not caboodle. “It is painful to recognize that the liberties which our forefathers fought a revolution to secure have been lost,” Karen Harned of the National Federation of Independent Businesses writes, “But it is clear that our original constitutional system has been thrown out, and we are left with only the democratic process to preserve our rights.” Let the hyperbole
"I know this is a bad time, but they're saying the adenoids are a pre-existing condition."
Let me head off your objections right now: son of bride of health care is not just son of health care, because Mrs. Health Care subsequently remarried and lives in Ohio. Father of son of former bride of health care is John Boehner, and even though he pretends to be friendly, he keeps subtly insulting health care by saying things like, “I understand where you’re coming from; when I was younger, I had to eke out a living sweeping somebody else’s floors, myself.” Basically, new husband of ex-wife of health care is a dick, and every time he claims to do health care a favor he only humiliates it further. Last week, for example, he organized a purely symbolic overturn of last year’s reforms with the Repealing the Job-Crushing Health Care Law Act, which really puts certain other phrases from this paragraph in perspective. It was a pretty cynical move, incorporating as it did both a purported desire to improve the law and a sure exemption from having to do so. Anyone could see what spray-tanned second husband of health care was doing except those closest to him, and so the duty to say something fell to former coworker of both health care and father of son of former bride of health care, David Frum.
House Minority Leader John "The" Boehner, who believes that words mean something.
I don’t know if you guys heard this, but the House of Representatives passed some sort of doctor bill last night. Assuming the President signs it—and does not just scrawl “Surprise, fuckers!” across the bottom before tearing his shirt off and tongue-kissing Michael Steele—the new law will remove lifetime caps on medical insurance payments, prohibit denials based on pre-existing conditions, expand Medicare to those 50 and older and, eventually, establish insurance exchanges that provide subsidized policies. I’m no lawyer, doctor, economist or constitutional scholar, but I think the implications are pretty obvious:
And thus continue the circumspect deliberations of America’s legislative branch.