Skin in the Game

 Love in Malibu - photo by JoAnn Sturman

Scott Sturman

John Hancock signed his name boldly on the Declaration of Independence, so King George could not help but see it.  Few know the names of most of the other 56 signatories, much less what happened to them. All were well to do and faced a certain trip to the gallows, if defeated by the British.  As it was, many lost their lives, fortunes, and families during the Revolutionary War in order to gain independence for the fledgling nation.  (See Paul Harvey's video discussing the subject.)  Unlike today’s political class, who live by different rules than those they serve, the signers had skin in the game.
 
I saw a patient yesterday, who doesn’t have skin in the game.  She is on welfare, always has been, and probably always will be.  She’s eating herself to death and costing taxpayers a lot of money as her diabetes and hypertension riddle her body.  In her early 30s, 5 foot 2 inches tall and 260 pounds, she’s substantial but not unusually large for a patient population which grows heftier by the year.  She didn’t seem bothered by the prospect of losing her vision, going to dialysis three days a week until she receives a kidney transplant, or dying long before her time.  The staggering costs incurred to treat diseases caused by over indulgence are the least of her concerns; that responsibility has always been somebody else’s problem.

I’m not a primary care doctor but with her mother in attendance and a few extra minutes at hand before a procedure to treat her diabetic retinopathy, why not talk about losing a pound or two?  Who knows?  Maybe something will click this time around.

“Your high blood sugar and blood pressure are more than just numbers.  Now they are destroying your eyesight.  Your kidneys and heart will be next.  Has anyone ever talked to you about the importance of losing weight?  Just a few pounds can make a difference.”

Before the patient could answer, her mother piped in, “We’ve heard this before.  We don’t believe what you’re saying.  We’re just big people.  It’s genetics.”  Sounding like South Africa’s former President Thabo Mbeke, who denied HIV causes AIDs, her enabling mother had the last word when it came to discussing her adult daughter’s health.

ObamaCare and its end result, socialized medicine, theoretically guarantees equal access to health care.  No line jumping or individual considerations are allowed except for Congressmen, who exempt themselves from the program, the very wealthy, for whom expense is no object, or those with special needs, which are determined by politicians.

Perhaps the primary advantages of the private insurance system is the ability to obtain both emergent and non emergent, high quality care quickly and to maintain a personal relationship with one’s physician over an extended period of time.  The costs to obtain these benefits have spiraled out of control due to a complete cost-demand disconnect, waste, fraud, and a rapacious personal injury industry.  Furthermore, the ultimate “skin in the game” solution, the health savings account model, has not received wide spread support due to its emphasis on personal responsibility and financial prudence.

Imagine shopping in Barrak-o-Mart, a grocery store where you are one of half the customers who have pre purchased every product within the building.  It’s all basic merchandise–nothing fancy but good enough to keep the masses from going to the barricades.  Despite the allure of limitless chocolate chip cookies, potato chips, and sugar laden soft drinks, you pass them by for healthier fare.  Having to return to work in a few minutes, there is no time to while away the hours browsing the shelves or devouring every food sample thrust upon you by obliged employees.  You rush to the check out area looking for an express line, but there is none.  The lines are long, and the checkers work with the speed of Third World bureaucrats.  Half of the customers have two grocery carts brimming with food products selected for sweetness and mega calorie counts.  Forget returning to work on time.  The checkout time is measured more aptly in days or months than minutes.

Beleaguered, but with the cash register finally in sight, the store manager halts your progress and allows two customers with more pressing needs to cut in front.  One resembles the patient described earlier in the article to such a degree that he could be her twin brother.  The other is Senator XX, whose comely assistant is pushing a cart packed with caviar, truffles, filet mignon, and bottles of the finest wine.

“Excuse me, Senator.  Where did you find such bounty?”

“I don’t shop in the same part of the store as you, lad.  Now enough of your pretense, let me through!”