Single-payer health care system, and a one-act play

Count on Dave Budge to respond quickly to anything that challenges his world-view. In his post, “Allow me to Disabuse,” he pretty much trashed me up and down in his post. Fine. Maybe not fairly, but who am I to complain?

To respond to everything would be a waste of time. Let’s stick with healthcare. In the post, Budge gave a long-winded synopsis on how the industry got where it is, and what’s wrong with a single-payer system.

In it, he claimed that my education and experience make my opinion naive at best, so for the sake of universal health-care I’ll hand over the argument to Paul Krugman and Paul Wells. What kind of health care works best, you wonder?

Over the years since the failure of the Clinton health plan, a great deal of evidence has accumulated on the relative merits of private and public health insurance. As far as we have been able to ascertain, all of that evidence indicates that public insurance of the kind available in several European countries and others such as Taiwan achieves equal or better results at much lower cost. This conclusion applies to comparisons within the United States as well as across countries.

Basically in France the consumer pays half as much per capita in health care costs than in the US – but doesn’t suffer in quality of health care, rivaling the US in physicians, nurses, and hospital beds per capita. The French also enjoy a longer life expectancy and lower infant mortality rate.

But what about those pesky MRI waits Budge refers to? According to “Health Affairs” comparison of health care systems in the world,

“…the United States often stands out for inefficient care and errors and is an outlier on access/cost barriers.” That is, our health care system makes more mistakes than those of other countries, and is unique in denying necessary care to people who lack insurance and can't pay cash. The frequent claim that the United States pays high medical prices to avoid long waiting lists for care also fails to hold up in the face of the evidence: there are long waiting lists for elective surgery in some non-US systems, but not all, and the procedures for which these waiting lists exist account for only 3 percent of US health care spending.

The cause for our system’s inefficiency, according to the article, can be found in administrative inefficiencies, industry fragmentation, and the inability to bargain with drug companies over drug prices.

The report also highlights our own country’s Veterans’ Administration hospitals and clinics, where government-hired workers dole out health care to our nation’s veterans in a government-funded program. Bloated? Inefficient? Non-innovated? Tyrannical? Hardly.

[The VA] provides some of the best-quality health care in America at far lower cost than the private sector. How does the VA do it? It turns out that there are many advantages to having a single health care organization provide individuals with what amounts to lifetime care. For example, the VA has taken the lead in introducing electronic medical records, which it can do far more easily than a private hospital chain because its patients stay with it for decades. The VA also invests heavily and systematically in preventive care, because unlike private health care providers it can expect to realize financial benefits from measures that keep its clients out of the hospital.

The reality is that, even if Budge’s criticisms against socialized medicine were true, what’s a worse system? One in which some patients have to wait for diagnostic tests, in which doctors get paid on a level of software engineers? Or one where an increasing number of people don’t have any health care at all? (And I’m not talking the indigent, but working- and middle- class families. Forty-one percent of Americans with “moderate to middle incomes” don't have health insurance, according to this report.) A system where many insurance provides actively try to cheat their policyholders through denial of claims?

(By the way, I lived under California’s Blue Cross system. In the four years I lived there, and during which I had a number of concerning health issues including a soccer-injured knee, a mysterious stomach ailment, and a suspicion of testicular cancer, I never met with my primary physician. Not once. In addition, Blue Cross denied each and every claim I submitted, and I had to spend an average of forty minutes to an hour for every doctor’s visit on the phone with insurance company reps to get them to pay. And I paid handsomely for the privilege. Budge’s socialized system with its myriad of problems looks pretty good to me.)

Most of you who are reading this post are struggling to pay health insurance fees. You’re well aware of how much they’ve grown in just the past few years. At this point, my monthly health insurance bill for my family rivals my mortgage payments. Having health insurance is like owning a second house you don’t get to use.

While it’s true that Budge admitted the US system is “FUBAR,” as usual he offers no solution to the problem. Health care is a problem that needs a solution, and cherry-picking at ideas is cute and makes a great demonstration of flexing intellectual prowress, but without a solution is not at all constructive.

But I lack the education and experience to really know anything about this. I’m just a starry-eyed MFA who means well, but who…let’s face it…is as dumb as the side of a barn.

Instead of letting that get me down, though, I’m going to harness those powers vested to me by my years in Montana’s creative writing program and pen a little play that addresses the issue:

Mr. Budge Goes to Freemarketon

The scene: A small doctor’s office in a small mountain town in “Freemarketon,” a country operated solely under libertarian free market prinicples. The office is lit by a single, dim bulb. There is a desk, sink, and examining table in the room. Gaudy advertisements are plastered over every surface. Enter MR. BUDGE, a slightly stooped man with graying hair and a moustache that looks faintly damp. His lips are pursed and he mutters to himself as he enters. He has a noticeable limp. He crosses the room and sits on the examining table.

After an uncomfortably long wait, the door swings open and the DOCTOR sweeps in. He is a young man in his early thirties. His hair is gelled and he wears a bolo tie. He advances on his desk, rifling papers. He is chewing gum and snapping bubbles with his tongue.

DOCTOR: (In a near-incomprehensible rush.) Welcome to Medical World. I am your doctor today, my name is Dr. PJ Wodenhose, and I’m glad to assist you. Today’s specials include a flu’ shot at $39.99 and a prescription to a new experimental acid-reflux called, “StayDown,” for $69.99 a month, some side effects may occur. What can I do for you, today, Mr…(glances in his notebook)…Budge (pronouncing it BUD-gee)?

BUDGE: Not interested in the specials, today, Doctor. I haven’t been feeling well lately. I’ve got these lumps under my armpits…they seem to be growing…and they hurt like hell when I press them…

DOCTOR: (Interrupting.) Well, don’t press them then! (Laughs. BUDGE grimaces.)

BUDGE: Lumps…and I have trouble breathing whenever I lay down, and I get dizzy spells whenever I stand up. I black out occasionally. And I’m urinating blood.

DOCTOR: (Writing furiously on a form.) I see. I see. (He hums, then takes the form over to small computer on his desk. He looks at his hands while he types, then pauses and looks at the screen. All the while he makes grunting noises and his face twists into grotesque expressions.) Yes. Yes. So. It looks like we have some major maintenance work to do. First, we’ll need to get an MRI –

BUDGE: An MRI? Those are expensive, aren’t they?

DOCTOR: Well, yes. But frankly I think your condition –

BUDGE: Don’t you have anything less expensive? Like an X-ray?

DOCTOR: Well…X-rays are cheaper –

BUDGE: There. Let’s do an X-ray.

DOCTOR: But Mr…(fumbles around his desk, then into his pocket, retrieving his notebook; he looks into the book)…BUD-gee…the symptoms you describe don’t indicate a condition discoverable with X-rays…

BUDGE: Look, doctor, I’m sure you’re right. But…well…the wife went a little overboard at Christmas this year, and we’re still paying off the credit card. Plus little Tommy’s dialysis treatments have already exhausted our medical budget this year. You say I should have an MRI, but I’m telling you all I can afford is an X-ray.

DOCTOR: But, sir! (BUDGE points to a poster on the wall. Under the poster’s title, Hippocratic Oath, reads, “The customer is always right.” The DOCTOR looks at the poster for a moment then shrugs his shoulders.) X-rays, right. (He resumes tapping his computer keyboard.) Anything else I can get you today?

BUDGE: What else do you recommend? Remember, I’m on a tight budget.

DOCTOR: (Referring to a list displayed on his computer screen.) I can listen to your heart, lungs, check your eyes and ears. That’ll run you about $14.99 each. I can palpate your organs. $0.99 each.

BUDGE: I’ll take the heart and eyes. And palpate my liver, spleen, and kidneys, please. And the X-ray.

DOCTOR: (Turns and faces BUDGE with a stern expression.) Can I be frank?

BUDGE: (Looks slightly taken aback.) Of course, doctor.

DOCTOR: The symptoms you’re describing? I don’t think you have much life left. I think your body is encountering some serious problems. Probable malfunction of some key components. (BUDGE nods.) It could go at any moment.

BUDGE: (Groans and rests his head in his hands.) What is it? What could it be? How much is it going to set me back to fix it?

DOCTOR: Could be cancer. Advanced. We’re talking complete overhaul…(BUDGE groans again.)…two, maybe three hundred thousand. (BUDGE makes grunting noises that might be sobbing.) There is an alternative…cheaper…

BUDGE: (Lifts his head from his hands.) What, doctor?

DOCTOR: We could junk it. If we wait until the symptoms manifest into serious illness, we could be talking ER visits, ambulances, hospitalization, drugs, the whole nine yards. (BUDGE jumps as if suffering electric shocks at the mention of each as the doctor tics off his list on his fingers.) If you junk the body now, you’d save a bundle.

BUDGE: What are my options? And how much does it cost?

DOCTOR: Well…let’s see. Lethal injection administered by me would be $699.99. The home kit is substantially cheaper — $299.99 – but I usually don’t recommend it to people without medical experience. Miss that vein – whoo boy! You’d wish you were dead…

BUDGE: Six ninety nine? You’ve got to be kidding me!

DOCTOR: I could rent you our office gun for $14.99 and sell you a bullet for $2, although I recommend you buy two just in case. And you can do it quickly out behind the storage shed. But you’d be responsible for removing your own body and cleaning up the mess, so you’d need to make some arrangements beforehand.

BUDGE: What am I thinking? I’ve got to pick up the girls from soccer practice at two! No, doctor, it looks like we’ll have to stick with the X-rays…

Fade out…


  1. That play is hilarious.

  2. I decided to unleash my powers. Watch out, blogosphere!

  3. Man, I really tick him off, don’t I?

  4. Good. The blogosphere would be boring without you, Budge.

  1. 1 Dave Budge .com » Blog Archive » Oh My!

    […] The things that are written about me…: Count on Dave Budge to respond quickly to anything that challenges his world-view. […]

  2. 2 Dave Budge .com » Blog Archive » On The Subject of Universal Health Care

    […] While Touchstone has accused me of offering up no solutions with this paragraph: While it’s true that Budge admitted the US system is “FUBAR,” as usual he offers no solution to the problem. Health care is a problem that needs a solution, and cherry-picking at ideas is cute and makes a great demonstration of flexing intellectual prowress, but without a solution is not at all constructive. […]

  3. 3 Left in the West is back up and running « 4&20 blackbirds

    […] But I’m also thinking about taking the site away from the purely political, or “activist” blogging that Matt and Kos and Jonathan Singer do so well, and adding a little more commentary about issues, ideas…and maybe a little political satire. (I’ve already done a little, like this one-act play about health care.) […]

  4. 4 Letting the uninsured hang out to dry « 4&20 blackbirds

    […] making the decisions on what drugs and medical procedures they should consume. (Actually, I wrote a little one-act play about this the last time a Montana libertarian claimed applying “free market” principles would “solve” […]




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