Sorry about being away so long. Mid-August I had a minor health concern. Thankfully, the clinically suggestion of something bad ultimately turned out to be nothing. Still, it took me out of commission for nearly a week. Trust me – nothing reminds you just how asinine and immature it is to stress about your career trajectory, or any of the infantile sources of neuroses our Type A society elevates to primary concerns, like waiting out a medical test.
After that, I went to the beach, on a long vacation, and now, following a heroic bout of self-pollution and sloth with friends and family, I’m back. New material will resume this week.
In the interim, I’ve a couple links to offer – things I think you ought to read. The first is an interview of Rudius CEO/Author/Director and Producer Tucker Max conducted by the folks at Bitterlawyer. Why is this a must read? It’s funny, but it’s also enlightening. The back and forth of the thing touches an issue most of the 18-30 year old demographic reading this site will appreciate. In the past several months, as the harsher realities of our economic future have been clarified, numerous articles and editorials discussing the “entitlement complex” of young workers have cropped up in the press. Pundits and scowls are suggesting young workers downgrade their career goals and expectations – give up the notion of finding fulfilling work, of doing what they want to for a living. Accept that work sucks and adjust themselves to the concept of toiling at something that bores them to tears and they hate solely for money, as their elders allegedly did.
Max says otherwise. And his point has considerable merit. Can everybody do what they want and succeed on the level he has? Of course not. Most people aren’t talented or hard-working enough to even approach that level of success. But for those of you gifted with actual ability, and with a shrewd business eye and a willingness to work, meteoric success, or at a minimum, the mere modest achievement of having your own business – of not taking orders from a boss you can barely stomach or suffering the general idiocy and annoyance of the average corporate hierarchy – can accrue from an idea as simple as writing funny stories about your drunken, sex-addicted self.
The other article is an excellent follow-up to the last piece I did on health care reform, “How American Health Care Killed My Father,” by David Goldhill, printed in September’s Atlantic. Of everything I’ve read on the subject, this is hands down the most articulate and insightful dissection of the health care mess, and what needs to be done to fix it. Chief among his list of problems in our current system, Mr. Goldhill highlights the same issue I did in my piece and numerous moderate analysts and economists have been citing for years – that health care cannot and will not be fixed until Americans are required to pay out of their own pockets for the majority of their preventative care. The present system, where a consumer hands an insurance card to a doctor and leaves a disconnected third party to reimburse, or not reimburse, the provider invites rampant abusive consumption.
As we’ve seen with the crisis of ballooning credit card debt, when the source of a consumer’s payment is a lender’s money, when the transaction does not involve an immediate debit against the purchaser’s bank account or exchange of cash for the service or good bought, people become spendthrifts. Make them pay out of their own pockets for something, however, and suddenly they’re bean counters. With a direct payment structure for all non-emergency and non-chronic care, the cost of preventative medical services, presently inflated by providers fivefold or more to offset the nickels-on-the-dollar reimbursements received from insurers, would drop, allowing consumers to be both prudent and vigilant in managing their health. That’s the devil at the heart of this health care debacle, and until we address that issue – until we force Americans to manage their own care and use health insurance like actual “insurance,” as opposed to a health care credit card that may or may not pay for all the elective and preventative care they feel like charging on it – there will be no true reform.
That’s all I have for now. See you in a few days with new stuff.
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Good to have you back. Stay healthy and keep hacking away at the new book.
PL: I’m fine. The concern I ran into had nothing to do with any vices, by the way. Totally unrelated, obscure thing. Thank you.
Dude, why pay insurance companies at all? People should pay premiums every month and then pay additional costs for preventative care? I have worked in Clinical Informatics for years and have seen the imbalance when 6 out of 10 patients to 1 one out of 4 facilities are uninsured. Nobody gets turned away and the hospitals end up eating the cost. The recent stimulus package is the first time our clinical institutions are being given a subsidy/incentive to switch to EHR/EMR.
I hate how everybody becomes an expert on the topic because it has “touched” them in some way. American hospitals are still far cleaner and safer than most European, African, South American, Asian, and Middle Eastern hospitals (Dubai is the exception, not the rule). I want a public option where I can pay the government, and I don’t want a free service like the NHS provides in the UK that will increase our deficit. The private sector has had an opportunity for the last two decades to reform the health insurance industry and has failed miserably.
You know what is not being addressed? Burger King, McDonalds, Popeyes, and KFC. If people eat at these places and have high cholesterol and other conditions (fat, unhealthy, and possibly stupider), they get to walk off the plank on the death panels. Personally, I think that would make great reality TV, and that is how American Health Care should be killing people.
FYI – I am a fan of your writings but I don’t agree with you on everything.
PL: People should pay exceedingly low premiums for catastrophic care, along with a fraction of the current rate for preventative procedures. The middleman managing health care has to be removed. Replacing insurers with the govt or continuing to use both for preventative care still leaves the TPA system that encourages excessive consumption and absurd cost inflation.
There are two things that strike me about the idea that I should go ahead and take a crappy job in order to eat.
One is that the people who write this kind of thing probably either have a job they like or a job that isn’t as bad as they think it is. It would be similar to the way that articles written in the 1950′s about the joy and value of being a housewife were never written by housewives.
The other is that these people apparently have never met people who actually have miserable jobs. I could write an article called “How the Cook County Public Defender’s Office Destroyed My Parents’ Souls.” They, of course, have done everything humanly possible to keep me away from the law.
PL: Most of the people spouting that view are cranky. They’re not the sort encouraged by or interested in change. Any mess like the one we have now provides a chance for them to finger wag and suggest we revert to some older, less ambitious view of life, which, in their revisionist view was somehow more realistic, or likely to succeed.
The majority of Americans engage in what I can only call “pendulum think” – that the best response to a problem is to immediately and radically change course. The actual best responses involve minor tweaks to the present systems. But our mindset is simple. We think that some massive failure, as opposed to a small number of bad policies (short term focus on stock prices, a short term-fixated bonus structure, govt intervention to compel banks to provide loans to people who shouldn’t have had them, etc.) must have caused such a massive mess. And simpler yet, we assume the answer to it is a radical restructuring. We never took a breath and considered the mess with a cold analytical eye and learn the simple, constructive lessons at the heart of it:
1. Spreading risk via securitization does not, and will never, make bad loans borrowers can’t afford into performing loans;
2. The govt should never be in the business of telling banks they should be lending more money to people who can’t afford loans;
3. A market as perverse as the speculative derivatives market, which was nothing more than a betting track, should have been killed before it started; and
4. Selling insurance without reserves is not a good idea.
These aren’t pandemic problems. They can all be cured with prudent regulation. Instead, we’re going to go nuts and create a climate where credit markets thaw more slowly due to massively increasing regulations. Why? Because we’re in the left-swinging pendulum phase of the reaction.
That crap about entitlement complex pisses me off. I keep reading the same bullshit over and over from old bitter assholes who don’t even remember what it was like to be a college grad with no experience looking for meaningful work, any work at all — or at least something which leads to it.
All the job posts I see keep having this goddamn 2-5 years experience minimum requirement that it’s a fucking miracle when I see something different. Don’t even get me started on the 1-2 years relevant experience ones that also look for superstar “well rounded” college leaders who also happen to shit gold and fart rainbows.
PL: This derives from three sources. One, HR people seek out candidates mechanically, the same way these simple functionaries do everything else in their lives. Hence, you have to work around these gatekeepers and get wired to someone in actual management if you want a job. Two, we worship a false meritocracy in this country. It’s all about degrees and institutions and class rank. Again, you have to get past the gatekeepers – to people in positions of real power who can hire outside the 3.9 GPA requirement management tells HR to use. Third, we’re in a long term jobless recovery. You will see white collar professionals worked harder and harder in coming years. The productivity required will be nothing short of 80 hour a week, 100% commitment for those who retain positions. Companies are cut so close to the bone, the current bump in consumer spending so manufactured (the uptick there is Cash for Clunkers) and the corporate recovery so concocted of smoke and mirrors (it largely derives from cost cutting and in many cases, sale of assets companies might otherwise hold to create quick liquid), that I can’t foresee any real upward trend in hiring for at least 24 months.
Lesson in all of this? These scowls telling you to run out and become a new generation of men in grey flannel suits are missing a big problem: There are no corporate jobs. Look for work in a start-up. And don’t sweat the resume. Nobody will ever fault a person for taking chances on his own business, or some wild new venture, in a time like this. They’ll applaud it.
i know you have to plug tucker because he’s provided you a platform and some exposure, but does it ever get frustrating knowing that your writing blows the doors off of his in every conceivable way, yet he’s the poster child for lawyer-turned-rapscallion? you’re the arrested development to his 2 and a half men.
PL: I see no reason to compare. We do two different things. If you like his work and not mine, or vice versa, it’s just a matter of taste. If you like both, great.
I don’t have to plug his stuff. The only direction he’s ever offered to me is to write whatever I please. And really, he doesn’t need anything from me. I just happened to like the interview and I also write for Bitterlawyer, so I figured it was something worth citing. Also, Tucker’s recent success is worth noting. He deserves his prominence because he’s worked like a madman to get it. And I’d like to see him “ride the torpedo” as far as he can. Like his stuff or not, what he’s done is pretty amazing. I hope he gets the private jet, and not just because his success helps me some. It’s great to see someone make it on his own wits, outside the usual channels.
But I thank you for the much undeserved comparison to Arrested Development. Still the best written comedy on TV in the past decade.
glad to hear you’re still fighting the good fight. keep a thumb on it.
PL: I know no other way to go. Damn writing thing. Can’t stop.
Hey tb!
Don’t rock the boat, asshole!
PL:No rocking there. No worries.
Pay for preventive health care out of pocket. Great idea. Except what is “preventive” health care? I have to see a cardiologist, and endocrinologist, and an internist every 6 months. The combined full fare charge for these visits would cost me $1500/year. Even if they reduced their fees to $100 per visit (HAH!), that’s still $600/year.
Tell me how someone making $30,000/year with 3 kids is going to pay for school physicals, dental appointments, and a physical for herself at $100 a pop, cash on the barrelhead?
New Diarist
PL: You’re missing an important piece of my point. The reason the cost of services is so inflated is the insurers’ involvement. They pay low reimbursements, so the providers jack up the price many multiples to make their margins. If we adopted a direct pay preventative care structure, the price would have to drop back to a reasonable level individuals who aren’t merely reimbursing providers at a nickels-on-the-dollar rate could pay.
And as to your seeing a cardiologist and endocrinologist so frequently, it’s clear you’re talking about a chronic/emergency situation, which would be covered by the chronic/emergency insurance I proposed.
I think we can agree, the guy seeing his GP because he wants antibiotics for a bad sinus infection ought to pay out of pocket and not even be allowed to attempt to submit his bill to insurance. Same with the overprotective parent whose kid skins his knee. Insurance should be used for serious issues only, like the ones you describe.
do you know tucker max in real life? like drink together and stuff? coz i thought maybe you’re slingblade. :D
PL: I have had a drink with him, and spoken to him many times. Slingblade? I’ve been alleged to be dead and accused of being a professional writer moonlighting, but that’s the first time that suggestion’s been made.
That article by Mr. Goldhill was fantastic. It should be mandatory reading for all of Congress. I wish I had read it before your last post; maybe my comments would have been more intelligent. Great to have you back.
PL: Amazing. It ought to be dropped from airplanes on the cities and handed out at every town hall on health care.
Don’t worry about your comments being intelligent or not. Most of the ones I write here are furious back of the envelope things. I read one or two a month later and often say to myself, “What the fuck was I thinking there?”
I hope this posts! I have tried three times, dammit! Anyway, not sure if you read this, but it seems relavent given our current situation.
http://www.theamericanscholar.org/the-disadvantages-of-an-elite-education/
PL: Dude, I haven’t had a chance to read this, but I encourage others to do so and comment. I’ll offer my comment later.
Good to have you back. I was starting to suffer from withdraw symptoms.
PL: So am I. I’m getting fucking killed with business shit now. Take time off and you get sooo far behind the eight ball.
And not the good kind of eight ball.
You are missing the point in BigCity’s comment.
If a patient is brought in on a stretcher, is the ER doc supposed to say, “Sorry buddy, cash up front or those bullets stay in?” The truth is they won’t and they can’t say that.
Health Insurance companies were initially created by doctors unhappy with not getting paid. Did you think they always existed?
People will not pay their bill. The reason for that is simple; you come into a doctors office sick. You feel terrible, and sure, 500 bucks to get fixed sounds fine. Then, when the bill comes, you are feeling fine, and you actually get angry. “I feel fine. That doctor didn’t do much, all he did was give me some pills and tell me to rest. I could have done that on my own.”
I know this will happen because it happened before.
Know how the government can really lower healthcare costs? This is a long-term solution, so of course it won’t happen without significant local pushing, but oddly enough, grants to fund and create after-school programs. Programs like this allow children a safe place and can supplement their education. Little Tommy can’t go out to play with his friends anymore, because his mother is working and is afraid something will happen. As a result, he’s at home, watching television and eating potato chips, lowering the median age of obesity with every bite. Think costs are high now? Just wait.
PL: I got that point. Hence my recommendation that the direct purchase structure only be used for emergency and chronic care. The guy with the bullets in him of course gets care. But who needs an insurer in the game for preventative care? It’s a TPA that does nothing but ad administrative costs and encourage overuse of services.
I agree with you on the education thing, but that’s never going to happen. The average American doesn’t want to be responsible for his own health care. They want someone else to do it for them. It’s too hard for them to think about. And they’d rather spend the money on a flat screen TV, or a down payment on a Hummer. We’ve been trained by Madison Avenue to only want what’s tactile and flashy, or involves gratuitous immediate enjoyment (“I’m going to Disneyworld!”).
Frankly, the people who could get health care and instead use the money to buy home entertainment systems or cars they can’t afford ought to get no treatment. Darwinism ought to be allowed to work its magic on their genes.
Goldhill article:
“Indeed, I suspect that our collective search for villains–for someone to blame–has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care–from doctors to insurers to pharmaceutical companies–work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that–most important–remove consumers from our irreplaceable role as the ultimate ensurer of value.”
Paragraph of the Year.
My main and very minor critique is that “the new tests and treatments” are offered a section but that’s still glossed over. The article shows Lasik procedure prices going down and I’ve heard of analogies with plastic surgery, but even the most neurotic people concerned about their appearance can wait to have those elective procedures.
The new treatments and new tests for life-and-death matters are awesome. Some real next-level shit. It’s that whole American capitalist innovation thing. This next-level shit is expensive as hell and everyone demands it because 1) no one takes short cuts on medical care – used car, yes; medical care, never 2) it’s financed by insurance companies or the government.
Elite Education article:
“Yet it is precisely that opportunity that an elite education takes away. How can I be a schoolteacher–wouldn’t that be a waste of my expensive education? Wouldn’t I be squandering the opportunities my parents worked so hard to provide? What will my friends think? How will I face my classmates at our 20th reunion, when they’re all rich lawyers or important people in New York? And the question that lies behind all these: Isn’t it beneath me? So a whole universe of possibility closes, and you miss your true calling.”
And this neurosis has taken grip over the entire nation as thousands of colleges are outrageously overpriced and saddling kids with high five-figure and low six-figure debts plus a sense of self as overinflated as their GPA’s.
PL: No argument with either paragraph here. But I think we gave up on following true callings long ago. There’s a giant unspoken recognition among people who can see where we’re headed that one’s best move is to grab as much as he can as quick as he can, put it in a safely diversified portfolio and get the hell the hell out of the game. The complaints about your generation having entitlement complexes are only half true. A lot of you are shrewder at a younger age than people in my generation were, due to the information you’ve had at your fingertips from a very early age. And I think you’ve noticed that (a) office work has become such a soulless, demeaning slog that accepting it as a foregone reality for 40 years of your life is basically a form of passive suicide and (b) its economic rewards are getting smaller and smaller every day.
I don’t think it’s all an entitlement mindset. I think a lot of you are just rationally assessing the situation for what it is and reacting to it. The question remains, “What;s your option?” Only so many of you can become entrepreneurs. What happens to the rest will be interesting.
I do believe you are one of the few in our age bracket that actually think that there IS a sense of entitlement in today’s society as well as agreeing that people should be held responsible for their own sustainable medical care which doesn’t involve a crisis or chronic treatment. I am of the mindset that there is no accountability anymore nor a sense of EARNED pride. People are most certainly full of pride, but they have done nothing to be proud of. To those out there whining about not finding a “fulfilling” job- TOUGH! Whoever said life would be enjoyable, fair, entertaining, rewarding and make you rich LIED! that is the exception to the rule. it’s a lofty goal, but rarely attainable. You want food, shelter, clothing and some spending cash? you have to make some sacrifices- being content in your employment may be that sacrifice. Thank you for allowing me to see that I am not the only 30-38 year old out there that thinks this way. It is an “old school” thought process and i like it… I like it just fine…
PL: Of course there’s a sense of entitlement. You should see it in law. These little wind up dolls think they’re entitled to respect because they graduated from law school with some horseshit honor or clerkship under their belts. “Get in line, you little shit, and shut the fuck up. You’re nothing until you’ve handled real stress and demonstrated you can think on your feet. Stuff the law in this brief and shut the fuck up.”