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John Oliver, The Surprisingly Interesting History Of Dialysis Treatment, And What That Means About Our Healthcare System

By Emily Cutler | Last Week Tonight | May 15, 2017 |

By Emily Cutler | Last Week Tonight | May 15, 2017 |

So here’s a fun party game to play at your next get together: How Do We Fix Healthcare? Oh, and when I say “fun” I mean certain to devolve into a screaming match which gets at least one family member disowned. Because healthcare is that glorious meeting spot where people are telling you what to do with both your body and your money. What could possibly go wrong?

But if you’re willing to indulge me. Let’s, for a very quick second, set aside things like “cost” and “morality” in caring for the ill and dying, and focus on the very real practicalities of designing a new healthcare system. First question: do we treat patients who are experiencing a life threatening injury or illness? Specifically, if someone is close to death and arrives at the emergency room with no insurance, do we let them die? If you say, “no, of course not. We’re a developed nation, and not an evil empire so we don’t literally stand by and watch someone die,” congrats on being a passably decent human being. More on you in a second.

But let’s say you’re more … practical. You argue that while you don’t want people to die from treatable ailments, you believe in personal responsibility. If an individual is too stupid or irresponsible to get proper medical coverage, they forfeit the right to medical treatment. It is, at least in a very pragmatic sense, justified. So how do we set up a system that is completely accurate literally all of the time to track who has valid insurance and who doesn’t? We can’t just give them a medical card in cases of mugging victims. Nor can we have a system where the hospital just asks for your insurance carrier, because a shitton of the people who come into emergency care centers are unconsciousness or unresponsive. Can’t be fingerprints because people can survive injuries which severely damage their hands or arms. In fact, the only thing I’ve been able to come up with (and I’ve spent a good deal of time thinking about it), is some sort of microchip or bar code tattoo at the base of your neck that holds all of your insurance info. And even that isn’t foolproof given that you could have superficial injuries to the skin on your head and neck that wouldn’t kill you. Nor would that take into account human errors that happen every day with data entry. This is a system which would inadvertently kill a person because Marcy in Accounting didn’t get enough coffee this morning. Fucking Marcy.

So it seems a safer bet to at least stabilize every patient who comes into the ER regardless of insurance, and figure out the money later. Except of course this leads to the same issues of emergency rooms being used as primary care services for far too many people. It’s more expensive for the uninsured patient, which means it’s often more expensive for all of us, and is often not as good of care as a person could get from a primary care physician. There are also those horrifying cases where things like a common toothache ending up killing a child. No, for real. Instead of giving a kid some antibiotics to fix a tooth, we spent the money to perform two brain surgeries, and, oh yeah, also a child died.

So the logical step is to extend some form of preventative care, right? If prevention is more cost effective and healthier than emergency care, wouldn’t we want more people seeing a doctor regularly? Except we’ve been hearing for years that the country can’t afford to extend healthcare to all. Which would make perfect sense if our current system of healthcare didn’t cost more than any other nation’s. On the plus side, all that spending has gotten us significantly lower levels of patient satisfaction than other countries. Because why pay more if you’re not going to get a shittier product?

So what does all of this have to do with a for-profit dialysis giant abusing its patients? That the largest issue is that that for-profit giant doesn’t see them as patients, but customers. Businesses aren’t responsible for giving a fuck if their products are the best for you, just that you’re willing to buy them. Which is fine when it’s a Cheesy Gordita Crunch. It’s significantly less fine when the product is a goddamn kidney transplant. We can either have government playing a role in guaranteeing healthcare for everyone and thereby preventing exactly these kinds of abuses, or we can have the government follow-up afterward and try to root out the problem after it’s already caused its damage. Personally, I’m in favor of the method that doesn’t result it deaths by toothache.

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