The first in an occasional series of posts in which I can justify anything I do as anthropological research.
I’m sitting in a dentist’s chair opposite the window. I have a great view, because I’m 19 floors up in downtown Chicago. Opposite is Donald Trump’s controversial sign in giant letters on the side of a skyscraper. I’ve already filled out a host of forms, including a pointed reminder that I have to pay for anything not covered by my insurance, and we’re going through my family history for risk factors.
“Any history of cancer?”
“Well, my grandfather got lung cancer eventually…” I reply, “but he smoked all his life.” Satisfied, she notes this down as a risk factor, and I wonder how often he went to a dentist when he was my age.
We move on to my own health, and she asks if I have elevated stress levels. I say no, and then equivocate. I get stressed at work, I guess, but it’s mostly fun stress? “A lot of people with stressful jobs say yes, with a note that it’s work related”, she suggests. “I think I’ll leave it at no”, I decide. Having not bothered to go the dentist for years, I already know where this is going; if I’m going to do US healthcare, I want to start gently.
She leads me into another room where I place my head as instructed in the midst of a fancy spinning diagnostic machine. “WELCOME TO THE WORLD’S MOST ADVANCED DENTAL PHOTOGRAPHIC SYSTEM” boasts a somewhat sinister recorded message, before playing some classical music around my head. I smile at the absurdity, and the dentist smiles back, which is heartening. If someone in the 1960s had drawn a futuristic comic about a Space Dentist set on the Moon in the year 2014, they would have included this machine.
After much prodding at my teeth later, we’re ready to discuss my results. My teeth are great, but my gums are terrible, and there are helpful videos to illustrate what could happen if this situation is allowed to continue. Reluctantly, I concede in my own head that this seems legit. I’m going to have to start flossing – something which I’d previously dismissed as a conspiratorial joke between dentists. In the UK, when a dentist told me to floss, it was a bit like rebellious teenagers promising not to hold a wild house party when their parents left town for the weekend. Neither side really meant it, it was just something they had to say. But this woman really does want me to floss, and I’m a little scared what might happen if I don’t.
Then the dentist who runs the place arrives, and re-examines me, and agrees wholeheartedly with the existing diagnosis. (I suppose it would be awkward if he didn’t.) And if I agree to stick to my side of the bargain, I can come every three months over the next year to get everything deep-cleaned and fixed up. “Your mouth will feel better… your whole body will feel better!” he says brightly, which is going a little far for me – but as I say, the basics are sound. I don’t doubt that this is going to be good for me. I just want to know about costs.
Costs are handled by a third person, who comes in separately to talk about my insurance. (We’re almost two hours in at this point.) Their charge for all of this work over the year is $1000. She’s going to phone my insurance company to find out if they will agree to this fee. If they will, then they’ll pay 50% of it, after a $50 deducible. So already we’re down to $550, and I smile because I still have time to upgrade my insurance to a slightly-more-expensive but much-more-generous option, now that I know it’s going to be worth the money. Not everyone is so fortunate.
The nonsense of an insurance system is painful. There is no effective control on costs, and a great deal of needless waste and bureaucracy, for something which is fundamentally unsuited to an insurance model. Everyone needs medical care eventually. It’s not some rare event you can protect against by pooling risk, which is what insurance is for. That’s like having an insurance system for food, ‘in case you happen to get hungry’. And because I have a good job, I’m going to pay less than someone on lower pay with a worse job, which you don’t have to be a Marxist to realise is clearly ludicrous.
Equally as sad is that the relationship between the people in this room is all out of kilter. To be very clear: I have no doubt that I’m surrounded by good people who take some professional pride from their skill at stopping my teeth from falling out, and for that I am truly grateful. But due to forces beyond their control, we find ourselves in a consumer relationship. I have come to shop, and they are upselling. Only in this case my decisions are supposed to be life and death, based on claims I can’t possibly evaluate properly, which isn’t quite the same as deciding whether you can afford the smartphone with the better camera.
Fear works, too. When I got back to work, I also opted into vision insurance. I don’t have glasses, I don’t wear contacts – this is purely so that if I wake up and serendipitously decide I want an eye test, I can. More bloated costs, more waste, more fear. Just imagine what the US could achieve if it put its collective spend – by government, companies and individuals – into a real healthcare system.
The collective principle asserts that the resources of medical skill and the apparatus of healing shall be placed at the disposal of the patient, without charge, when he or she needs them; that medical treatment and care should be a communal responsibility; that they should be made available to rich and poor alike in accordance with medical need and by no other criteria…
Society becomes more wholesome, more serene, and spiritually healthier, if it knows that its citizens have at the back of their consciousness the knowledge that not only themselves, but all their fellows, have access, when ill, to the best that medical skill can provide.
Aneurin Bevan, In Place of Fear, 1952
By. No. Other. Criteria.