Stein’s Law and the Human Condition

Stein’s Law states that “If something cannot go on forever, it will stop,” so when I came across two articles and some little-known statistics last night, it got me thinking about this whole “Obamacare” debate.

Could it be that the real reason for all the fuss — and why no alternative to the ACA has been offered by those who oppose it — is because there is actually not enough health care to go around? And that voters are demanding the elimination of entire demographic groups by any means possible, mostly by attrition?

First, a story from NEJM about a guy who weeded himself out of the living:

During our appointment with Mr. Davis, he worried aloud that under the ACA, “the government would tax him for not having insurance.” He was unaware (as many of our poor and uninsured patients may be) that under that law’s final rule, he and his family would meet the eligibility criteria for Medicaid and hence have access to comprehensive and affordable care.

Sounds like a familiar complaint, especially from right wingers who insist that they have a right to “choice” of purchasing Dollar Store policies or foregoing insurance because they “don’t need it”.

Once you know Mr. Davis’ back-story, you wonder what goes on in the mind of someone like him, why he would know that the ACA is a tax, but NOT KNOW that he would by eligible for Medicaid. Oh right, Fox News “fair and balanced” reporting kept Mr. Davis ignorant until the bitter end:

We met Tommy Davis in our hospital’s clinic for indigent persons in March 2013 (the name and date have been changed to protect the patient’s privacy). He and his wife had been chronically uninsured despite working full-time jobs and were now facing disastrous consequences.

The week before this appointment, Mr. Davis had come to our emergency department with abdominal pain and obstipation. His examination, laboratory tests, and CT scan had cost him $10,000 (his entire life savings), and at evening’s end he’d been sent home with a diagnosis of metastatic colon cancer.

The year before, he’d had similar symptoms and visited a primary care physician, who had taken a cursory history, told Mr. Davis he’d need insurance to be adequately evaluated, and billed him $200 for the appointment. Since Mr. Davis was poor and ineligible for Kentucky Medicaid, however, he’d simply used enemas until he was unable to defecate. By the time of his emergency department evaluation, he had a fully obstructed colon and widespread disease and chose to forgo treatment.

Mr. Davis had had an inkling that something was awry, but he’d been unable to pay for an evaluation. As his wife sobbed next to him in our examination room, he recounted his months of weight loss, the unbearable pain of his bowel movements, and his gnawing suspicion that he had cancer. “If we’d found it sooner,” he contended, “it would have made a difference. But now I’m just a dead man walking.”

The next story was from England, where the National Health Service is buckling under the weight of a huge influx of Eastern European migrants and … those over the age of 75:

A third of emergency admissions are for over-75s and most of these could have been avoided with better primary care.

Crikey. The number of people aged 75 and over in the UK was 4.905 million in 2010 and is expected to go up to 5.388 million by 2015.

What about the United States? The CDC reports, “In 2009–2010, a total of 19.6 million emergency department (ED) visits in the United States were made by persons aged 65 and over. The visit rate for this age group was 511 per 1,000 persons and increased with age.”

The number of residents age 65 and over? 41.4 million in the U.S. in 2011.

Next up, the Kaiser commission reports [PDF]:

Hispanics account for nearly a third (32%) of the total nonelderly uninsured population (Figure 5). Among racial and ethnic groups, Hispanics account for the largest share of the uninsured. As of 2011, 15.5 million nonelderly Hispanics were uninsured, including 12.6 million adults and nearly 3 million children. Over four in five uninsured Hispanics are adults and nearly seven in ten are in families with at least one full-time worker, but many are very poor (Figure 6). Some 40% of uninsured Hispanics have income below poverty and more than 1 in 5 (23%) have income below half of poverty.

The chart at the top of this article is from CDC Health, United States, 2012 [PDF].

What the government already knows

The bureaucrats all know there will be nothing to govern shortly, other than cut checks for social programs. We must have faith that they will save their own jobs, somehow. From Ontario’s Action Plan For Health Care [PDF]:

Today, health care consumes 42 cents of every dollar spent on provincial programs. Without a change of course, health spending would eat up 70 per cent of the provincial budget within 12 years, crowding out our ability to pay for many other important priorities.

The solution? On one hand, those who can’t pay to get diagnosed eliminate themselves while healthy people are encouraged to remain UNinsured. On the other hand, the states’ refusal to expand Medicaid (even when the Federal government pays for it) decreases emergency room visits.

For a state such as Texas, keeping the mostly Hispanic uninsured while not expanding Medicaid might be the only way to keep the system up for those who voted for the current state government. The next logical step would be to restrict voting of those overloading the system: Medicaid recipients, tighten voter ID laws for seniors, especially for older women who live the longest. Oops, already done.

Maybe this is how survival of the fittest manifests itself in a democratic system. The game theory of “free market” health care rationing makes total sense to me now.