Two years ago, I was cycling through a small town on my way into some nearby mountains. As I approached an intersection, a car passed me, then abruptly turned right, blocking my path. I slammed into the side of the car and when I ricocheted onto the pavement, I fractured my T10 vertebra. Several days later, I went for an MRI to suss out the extent of the damage.
Fortunately, and oddly enough, my auto insurance covered all of my medical costs. I'm not sure how that works, but I was glad to have it. Nevertheless, the MRI procedure cost around $2,000. (This included about 30 seconds inside a regular MRI machine and, because I unexpectedly freaked out from being wedged into what amounted to a plastic toilet paper tube, the rest of the examination took place inside an "open MRI" unit next door.)
Yet in a health care system proposed by Nevada candidate for the U.S. Senate, Sue Lowden, I would have had the option of paying for the MRI with a barter. A trade. Literally, X number of chickens in exchange for the $2,000 procedure. Or X number of lawn-mowings for the open MRI.
She was absolutely serious. A barter system for health care.
When asked at a town hall meeting how she might have contributed to the health care reform bill, the Republican candidate replied, "I would have suggested," she stumbled, before saying finally, "... and I think that bartering is really good."
Often in American politics, these kinds of statements are blown out of proportion. Within minutes of a gaffe, staffers swing into action penning retractions and clarifications for the press. Not Sue Lowden.
Several days later, on local Nevada news program, Lowden said, "I'm telling you, this works. Before we all started having health care, in the olden days, our grandparents, they would bring a chicken to the doctor. They would say I'll paint your house."
Of course she probably meant "health insurance" rather than the broader "health care." We've always had some form of health care in America. But I'm nit-picking. The fact that a serious major party candidate running for the U.S. Senate is suggesting that we ought to be able to trade chickens and other items for health care is certainly, at the very least, a cause for concern.
She concluded, "I'm not backing down from that system."
And the Lowden campaign is building a serious pitch for this idea, wheeling out a testimonial from a doctor, Robin L. Titus M.D., who wrote, "I have bartered with patients -- for alfalfa hay, a bath tub, yard work and horse shoeing in exchange for my care."
That might be fine, if you're a very rural doctor performing very basic services for people without money or insurance. Such a barter arrangement would cover, perhaps, minor primary care for the Amish population, but -- and I can't believe I even have to spell this out -- it's entirely impractical as a means of delivering health care to everyone else.
In Nevada, based on age and sex, it costs anywhere from $132,000 to as much as $190,000 for a coronary artery bypass surgery (pdf). Over 1,500 surgeries were performed in Lowden's home state in 2008. Among those, around 11% were performed on uninsured patients for a negotiated rate.
According to Daily Finance's Tom Barlow, North American Surgery, Inc. offers a negotiated price of around $14,000 for a coronary artery bypass surgery. Obviously, that's a fantastic discount, but it still puts the patient deep into debt, it doesn't factor in the obligatory follow-up examinations, it doesn't cover any unforeseen complications, it short-changes providers (who also risk not receiving any payment at all if the patient files bankruptcy or, sadly, dies) and underscores why affordable, accessible health insurance is a crucial feature of any industrialized health care system -- bridging the widening gap between provider costs and patient incomes.
Nevertheless, let's say that Sue Lowden manages to trick enough lawmakers into voting for a barter system to pay for health care. And let's say you actually owned a chicken which you purchased as a chick for around $2. If you needed a bypass surgery and were able to get a negotiated rate, you would have to come up with 7,000 chickens.
But, oops, you don't have any chickens. And besides, if your surgeon is interested in owning 7,000 chickens, it might be a smart idea to look for another surgeon who isn't, you know, insane.
If you were fit enough to mow lawns after your bypass surgery at the going "high school kid" rate of around $30 per mowing, you would need to mow the surgeon's lawn 467 times. With one mowing per week throughout the summer months of June through September, it would take you 29 years to pay off your debt. Again, that's with a negotiated deep-discount on the price.
Good luck with that, Granddad.
Regardless of party affiliation, and snark aside, it's this sort of idea that ought to disqualify candidates from holding elected office. Unfortunately, this doesn't always work out. Former U.S. Senator Ted Stevens (R-AK) once described the internet as a "series of tubes" and "not a big truck you dump something on." Stevens, by the way, was chairman of the Senate committee tasked with regulating the internet.
Sue Lowden's remarks reveal a similar lack of acumen on two very important policy areas: health care and economics. A barter system for modern health care is about as smart as the notion that the internet is a series of tubes. A loophole in American-style democracy is that, while there's a required test for driving a car or going to college, there's no written exam for becoming a lawmaker.
By the way, according to the latest polling out of Nevada, Sue Lowden is leading Senate Majority Leader Harry Reid by 15 points: 54 to 31. And it looks very likely that not only will she win the GOP nomination, but she'll very likely defeat Senator Reid in November. Suffice to say, Senator Reid is in very bad shape if he's losing to the "chickens for health care" candidate.
Gas up the mower, Granny.
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