It’s not serious, more preventive maintenance than anything, but in a couple of weeks, I have to have a minor, non-invasive procedure done, related to my kidney stones. What with the looming PPACA decision (which might have been handed down by the time this post sees the light of blog), it strikes me that so much about the politics of healthcare appears to have been written by those haven’t had to use it in any significant way.

The most shocking case is something written by Tyler Cowen where he lays out what the Right should stand for when it comes to healthcare (boldface mine):

2. A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor. Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor. Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree. We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.

We’ll ignore the notion that health problems can lead to someone becoming poor. What kills me is this from Cowen’s post:

You can think of this post as an “ideal type” analysis which may or may not apply to many actual people.

“Ideal type” versus actual people. That’s what all the fuss is about, actually. Here’s one instance of a ‘non-ideal’ person:

The one I tell most often, out on the stump, is this: A few yrs ago, a 39 year old woman, Susan, came in by ambulance, in full cardiac arrest… tried to resuscitate her, to no avail– she died… She worked at a job that had no insurance, & her hubby was a stay-at-home dad… He was grieving fiercely in the E.R. (appropriately), and he told me that one week earlier, Susan had had chest pains and was seen at a different E.R…. She’d received nitroglycerin, the pain subsided, and it was recommended (appropriately) that she be admitted for further evaluation, including a stress test… But because of her lack of insurance, she & her husband decided that they couldn’t afford to have her stay at that hospital… And now, a week later, here she was with me, stone cold dead, leaving behind 2 beautiful daughters (ages 6 & 4)… She had joined the ranks of the Americans who die every 12 minutes just for lack of insurance…

Here’s another example.

In the case of some of the wonky technobrats, I understand this: they’re usually young (and reasonably healthy). While youth is no surety, it does lower the odds of needing care significantly. But like it or not, as the Preacher writes, “the time of mischance comes to all.” I’ve been plodding along for more than a few decades, and I’ve been very fortunate. After some tests this week, it’s safe to say I’m not only healthy for someone my age, but for someone twenty years younger. One long-time reader was an iron man until his late fifties. Compared to him, Lazarus was a fucking wimp–the number of sick days over thirty years could be counted on one hand.

But the time of mischance does come to all, for some when you’re twenty and for some when you’re sixty. Sooner or later, you’re going to have something pretty significant go off the rails, and you’re going to be subjected to the healthcare system. That’s what was (and still is) so frustrating about the pre- and post-Obamacare debate: there was so much discussion about ‘coverage’ and ‘cost control’, but very little about what really matters–providing healthcare.

Just like I believe more economists would think differently about unemployment if their own were looming large in the rear view, I wonder what the final legislation would have looked like if more legislators and members of the chattering class didn’t go out of their way to ignore the reality of health and its absence.