Little Tombstones

Any one who has visited a graveyard that was in business before the last century will have likely been impressed by the large number of children's tombstones. They tell a simple, sad story: Once upon a time humanity was helpless in the face of bacteria. A simple cold or bout of the flu could lead to a bacterial infection which could lead to pneumonia and death. People lived their lives with numerous tiny reminders of their mortality and their loss.

Such a thing would never happen today. We have antibiotics and modern medical technology that are fully able to stop these deaths. Except when they are not used.

Last month in the SF Bay Area Karen Perez, an otherwise healthy 9 year old died. From the SF Chronicle:

Karen Perez, a fourth-grader at El Monte Elementary School in Concord, was otherwise healthy with no known medical conditions that would complicate her recovery, according to Contra Costa County school and health officials.

She died May 29 but the state wasn't able to confirm that she had swine flu until Wednesday. She had a secondary bacterial infection and officials haven't yet determined whether her death was the result of swine flu, said Dr. Wendel Brunner, Contra Costa County's Public Health director.

No one has reported the full story here - doubtless out of consideration for the family - but Wonks Anonymous will speculate on how this happened. Karen's family were likely uninsured or covered by one of the high out of pocket health insurance plans. One guesses that they were hard working, low paid people with more than one child to worry about.

For people in this situation routine or ordinary medical care is really quite expensive. A visit to the doctors office is at least $75, maybe $100. Medications the doctor might prescribe would add another $30 to $50 to the bill. Which is something like a week's worth of groceries or maybe a payday loan at high interest rates.

Wonks Anonymous would have taken his child in to be seen, because he is not hurting financially and because his health plan does not require high out of pocket spending. Karen's parents, who probably had good reason to be sensitive to the costs of health care, seem to have chosen to substitute less costly treatments until it became clear that these treatments were not working.

In the minds of our free market health policy wonks Karen's parents are model consumers and, if moral derelicts like Wonks Anonymous were only forced to behave as they did, we might well enter into a utopia of inexpensive medical care. See Robert Carroll Senior Fellow at the Tax Foundation blogging in Economix in the NY Times:

The tax subsidy generally increases with how much an individual spends on health insurance. The deduction rewards prefunding routine health care through employer-sponsored insurance, and favors employer-sponsored insurance over insurance purchased directly by individuals. . . .

The result is a health market dominated by low-deductible, employer-sponsored health insurance with generous coverage that dulls consumers’ sensitivity to the price of health care. While many factors affect health spending, the tax exclusion for employer-sponsored insurance has likely contributed to the rising growth in per capita health care costs.

Of course the threat of immediate financial ruin will lead consumers to make some mistakes but they will learn from them. Karen's parents will probably take the next child to the doctor sooner, even if it means taking out a payday loan.

Now this would all be merely disgraceful and immoral, in other words just what we can expect from free market fundies, if it were not also just plain stupid.

Again Wonks Anonymous is filling in the blanks and guessing but it is most likely that Karen Perez died either in the emergency room or in intensive care after heroic and expensive medical treatments.As it turns out, the care that Karen Perez got was not only futile but also the most expensive possible care given her situation. The medical bills for her death easily ran into the thousands of dollars.

If her family had been empowered to seek timely treatment, if they had prefunded routine health care, Karen would probably be alive today. The total cost, $75 to $100 dollars for the doctors office visit and $30 to $50 for the antibiotics would be well below $200.

Our failure to care for our fellow human beings is not just reprehensible. It is costly.


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  • 6/25/2009 12:44 PM Daniel wrote:
    I've enjoyed this blog for many, many months. I agree with most of what you say (when I understand it) and am enlightened on many other subjects (for instance China internal economic policies, etc). I'm not versed in economics enough to offer any comments of value on prior entries.

    As much as I'd hate to make this point (and perhaps it is self evident) but many rat bag actuaries might determine that the chance of Karen's infection worsening to the point that it would cost many thousands of dollars is far less than the cost of many more thousands of parents taking their little ones to the doctor for $150 each.

    I believe that the operative word here is "rat bag". Of course more deaths does tend to reduce the surplus population.


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