Snowplows and Health Care

I love snowplows. They make the winter driving months so much easier. They also provide a great illustration of the problems we face with health care.

On an ideal day, a snowplow driver has a working vehicle, salt or sand, and fuel. The snowplow driver takes these resources and does what? Clears out the most vital paths of travel. Vitality is assigned based on traffic patterns. In other words, the roads that get the most use are plowed first, such as highways and main roads. After these major paths are clear, the plow driver will turn to the secondary streets.

As most of us in Michigan have heard for the past few years, the secondary streets are becoming more difficult to plow. The resources simply are not there. And, of course, there are people like my boss and her husband who live on a back road that will probably never be plowed by the county. For the people who find themselves in such a situation, there are options. First, they can self-diagnose and dig themselves out. The right equipment and time is needed for this. The second option is to pay someone who owns their own snowplow to come and clear the way.

In essence, the government-funded snowplow clears the major arteries and we are responsible for the rest. For example, we often sweep, shovel, or snow-blow or own stairs and driveways. We would not expect the county snowplow to plow our driveway. To be honest, considering their volume of work and inability to honor specific requests, we probably would not want the county to plow our driveways.

That is the ideal situation with the current snowplow system. But what do we do when there are not enough resources to plow the main arteries? And what about the people who do not have the equipment or money to have their tertiary road cleared? What level of responsibility do the county and individuals have in this case? Is it fair to tell people who live on these roads that they should “pick a better place to live”?

Fortunately, we seem to have people in charge of the snowplow system that know a thing or two about the job. They do a pretty good job of planning ahead and rationing. They admit their limited resources and find a way to operate within this. Some people who live on the primary roads may assume that it is their right to have the road plowed every time there is a little swirl of white on the pavement. Just tonight, I passed two salt trucks driving about a quarter-mile apart. So, there is waste, people take advantage of the system, and some people just get left out.

The key points that make snowplowing mostly successful are having subject matter experts making decisions, customizing to the needs of individual counties, having a simple approach and categorizing system, not dealing with overly inflated costs of resources, and adhering to limited resources. Yet, the problem remains that not all people are served by this system. The decision has to be made concerning what level of service all people are entitled to. Are all people entitled to the same service?

In class this evening, we were discussing health care. I suggested that all people deserve primary care. However, as the cost of the care increases (as a result of specialized care), we have to ask how much we can honestly afford. The question was asked, “Who gets those higher levels of care?” Being someone who is not involved on the provider side of medical care and the fact that I am a human, this question is difficult to answer.

We have advanced ourselves into chaos. For the sake of fairness, people like to say that either 1.) everybody get the same level of high care, or 2.) everybody gets the same level of low care. Both are terribly flawed. We cannot afford the former and the latter withholds available treatments at the same time as discouraging the exploration of new treatments. The fact that we do not like to point out is that many of the expensive treatments would not be available without expensive investments. At some point, money is going to come in play. The rich will always have more choices. If the choice does not exist in America, it exists somewhere they can afford to relocate to. Eventually, expensive treatments become affordable and are made available to us common folk.

Now, that is not the end of it. There are many wealthy people who contribute charitably, enabling people to find the care they need, but cannot afford. I think this really touches on the issue of capitalism. There is a lot of talk about salary caps for CEO’s. Eliminating the pay-off inhibits investment. High profits drive corporations to stay in business. The problem is that these high profits are not contributing to society as much as they could. The Bill and Melinda Gates Foundation is proof that at least some of the richest people are willing to give back. What if (crazy idea) we found ways to make rich corporations and individuals want to make the society they live in better? What if their were incentives that encouraged the “haves” to help the “have-nots” in many areas, including health care?

The key flaws in health care legislation are the lack of subject matter experts, the disconnection from the people the legislation effects, the lack of indefinite funding, high levels of complexity applied to broad categories, and oversight by a government with a terrible track record. And I do not just mean the current office-holders. Think about Social Security, child support, Medicaid, etc.

If we did a root cause analysis on the snowplow system, we would find one main problem: people live in a climate to which their methods of transportation are not adequate in providing appropriate service. Some of this can be resolved with proper maintenance, good tires, chains, and selection of an ideal vehicle form the get-go. I drive a Ford Escort, so I cannot complain too much about my inability to make it out of the driveway. We need a root cause analysis with health care and health insurance. Is access to honestly good food a right? Is proper exercise an obligation as a concerned citizen? Good hygiene? Would the combination of these three things and elimination of harmful elements (fluorescent lights, increased amount of radio waves, icy roads, etc.) make a difference in health care? We have many questions to ask. Are a bunch of senators, as well-intended as they could be, really the best people to answer these questions? After all, they have enough concerns on their hands already… like votes.

(This may not quite fit the semi-pro theme, but you have a lot of time to think while following a snowplow down the highway for an hour.)

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