New APPS

 There is a story told about “Breaking Bad”* and our healthcare system, and it goes like this: “Breaking Bad” demonstrates what’s broken (less so now with the ACA perhaps, but perhaps not) about the healthcare system in the U.S.  Walter had to go in the meth business in order to pay for his healthcare costs.  Had Walter not stepped up, meth money in hand, Hank would never have walked again.  For-profit insurance ensures that the people who need care will be denied it, in order for those insurance companies to reap ever higher profits.  There is a joke, told in comic-form, and in other formats, that implies that had Walter had access to universal health insurance, as exists in most reasonably well-off countries, none of this (the meth, the show) need have happened.

OK, that’s the story, but it’s just wrong.  Really.

Don’t get me wrong.  What we had in the U.S. before the ACA was a disaster, and while ACA is a real improvement, a system that provided truly universal access to adequate healthcare would be better still. Much better. I have a soft spot for single-payer systems, but I’ll support any system that can get us to, or reasonably close to, full, truly universal coverage.  And I think universal access to adequate affordable healthcare is very important.  (Also, I think health-insurance profits are just wasted money.  But that’s another issue.)

But the problem that we had before (and still have) in the U.S. was not with employer-based insurance plans routinely denying medically necessary care.  To a first approximation, that pretty much never happened.  (On the other hand, employer-based insurance plans paying for ridiculously overpriced care that had been shown to be no better than less-expensive alternatives? That happened, and still does happen, pretty much all the time.)  Can one dig up some cases, if one looks hard enough?  Sure.  But on the list of problems with healthcare in the U.S., people with employer-based coverage being denied access to reasonable, medically appropriate, care was pretty far down on the list, if it made it onto the list at all.

Look, Walter had problems.  He had no savings.  His family’s financial situation was grim.  When he died, they’d be screwed.  No getting around that.  Plot-wise, I was on board with that.  And much of that is down to things like the lack of paid maternal leave and reasonably high quality affordable childcare (so Skyler had moved out of the workforce years before, making them a one-income home), the low-pay of public sector workers, the betrayal of the promise of meaningful pensions.   The lack of support for families with children who need reasonable accommodations.  These are serious problems.  Looking at them, and his grim prognosis, I was willing to buy into the story that Walter thought cooking meth was his best option.  And I'd fully buy into a comic-strip that made fun of the U.S. for it pathetic performance in those areas.

But the health insurance angle?  Come on.  That just doesn’t wash.  Even on the show’s own terms.  He had health insurance.  He could have gotten treatment.  (The first doctor he saw seemed to have been a confused asshole, but that’s a different issue. And, plot necessities aside, none of that worked.)

What he wanted (well, what his family wanted) was a (the?) “star” oncologist (the star of NM, anyway).  An oncologist who wasn’t part of his “network.”  Because this guy was “the best.”  (Well the best in NM, but whatevs.)  This is also a very American obsession, come to think of it.  Let’s be clear: The best oncology treatment money can buy is, indeed, better than the merely very good oncology treatment you get in most civilized countries.  But “better” isn’t much better – it changes the odds very slightly, extends average life-span a small amount.  And within the U.S.?  Sure, the best versus everything else matters, but, again, not much.  Every insurance plan pays for (roughly) the same drugs, the same surgery, the same treatments.  (This was also Hank’s problem – his family wanted him to have “the best” physical therapists.  Out of network ones.  Because they were “the best.”)

The show made out like having a star oncologist saves Walt’s life, and having the dream-team of physical therapists made it possible for Hank to walk again.  I’m not buying it.  I’ve seen little in the medical literature to suggest that the differences are that profound.  The best oncology treatments seem to extend lives a few months, on average, at a huge cost, over the merely OK / good treatments that other countries pay for.  I’m rather annoyed at the show for suggesting otherwise. **

This is the opposite of suggesting that universal access to reasonable care might be a good thing.  It is suggesting that there is, and indeed should or must be, fierce competition for the best care, and that anything less than the best is a disaster.  It is prioritizing individual choice, and the importance of individual connections, over decent systems that can work for everyone.  Is it an accident that the two people whose health insurance we are led to believe is inadequate are in the last two major professions that are heavily unionized?  Are we to believe that the health insurance negotiated as part of the DEA’s – the fucking DEA! – union agreement is woefully inadequate?  Are we to believe that teachers’ unions in fact do so little good that even their negotiated health insurance is joke?  And if that is what we are to believe, than what the hell do unions do? 

The story told about the story gets the story wrong.  This isn’t a tale of the importance of universal access to adequate affordable healthcare.  This is a tale of making sure that one has enough money to buy the very best that money can buy, because anything less than the best is shit.***  But that tale isn’t accurate, and it certainly isn’t helpful.

*Yes, we just got around to watching it.  Yes, yes, it was very good.

** Though one doesn't have to read the show as suggesting this in any robust way.  Families are weird.

*** Can we read the show as promoting this view?  (If you can't afford to drive a Bentley and live off the rise in stock price from your start-up, is there really any point in living?) Subtly criticizing it?  (Were Walter and Walt Jr really happier, in the long term, w/ their fancy cars? Did Jessy's speakers really make his life better?)  Discuss.