Bubble, Bubble, Toil and Trouble…
That’s Shakespeare, for you unfortunate products of the L.A. school system who probably think it’s from a Drano commercial.
Happy Birthday to our beloved U. S. of A. Two hundred thirty-six years and still standing, although more than a bit rocky lately. In continuing to travel the Golden State as an itinerant pediatrician, I’ve had time to observe first-hand many of the things ailing our once-great state. California has always been at the forefront of so many trends, good and bad. That has not changed, but it’s pretty much all bad lately. Thousands of acres of valuable farmland sit parched and idle, deprived of water by politicians in thrall to the environmental extremists to whom an obscure 3-inch fish has more rights than American workers and consumers. Cities are declaring bankruptcy, the latest being Stockton, near which I worked much of the past month. Pensions and other benefits promised are the main reason, but graft and corruption are not far behind. This is an act that’s coming to a town near you soon.
The health care scene both reflects what ails our society as well as why. I’m seeing patients in many settings, from private practice on the wealthy West Side to middle-class practices and urgent cares to government clinics. Kids are kids and I try to give them all first-rate care, but it is impossible to ignore certain generalities. The rate of obesity, with its attendant early warning signs of diabetes, is probably 35-40% among the poor, who typically come in carrying Cheetos and soda. Their children stay on the bottle too long, incurring dental damage that can be life-threatening. I have no idea if they are here legally or not, but since our government refuses to enforce its own laws, their future drain on our taxpayers is a fact of life. The “free” health care they get on Medi-Cal is not valued because they have not earned it. Many of their visits are not necessary, but the provision of “free” over-the-counter remedies (e.g. acetaminophen, ibuprofen, Pedialyte) is their “ticket of admission.” Why don’t their food stamps cover these items? In contrast, the well-to-do kids I see are rarely overweight, usually involved in sports, music, and other enriching activities, and in that sense are easier to take care of. Ironically, it is in this shrinking stratum of society where I encounter most of the loony anti-vaccine attitudes and the willingness to latch on to the latest fads promulgated by Dr. Sears, ex-Playboy bunnies and other self-anointed “experts”, which sometimes makes practicing medicine a different kind of uphill battle.
The bubbles in the title are going to erupt sooner or later, as we have seen with Wall Street, the dot-com phenomenon, housing, and public-service unions. One is the health care bubble itself. Last week’s bizarre Supreme Court decision leaves us with lots more gas in the bubble. Government is already controlling half of the market, if I dare call it that. In truth there has not been a true “market” since 1965, the year Medicare was born, followed closely by Medic-Aid for the states. When I started practice in 1966, everyone knew pretty much what office visits and other services cost. Now, privately-insured patients can’t be blamed for thinking an office visit is whatever their co-pay dictates. For Medi-Cal or uninsured folks, it’s “free”, either because “they” (we) will take care of it, or they’ll go the the emergency room and wait 6-8 hours for a sore throat or upset stomach because they can’t be turned away and have no means or intention of paying. And if their lab tests come back positive, I’m told that literally half cannot be contacted because they’ve given phony information. Now if you believe Obama and his spokespersons, this abuse of the ER’s will stop once their socialized system takes over. Wanna bet? Every doctor I’ve covered for is looking for an exit strategy. Those who can will refuse to see government-sponsored patients. I suspect eventually if the next election fails to unseat the incumbents who created this monstrosity, it’s only a matter of time until doctors will be forced to take all comers for whatever pittance the politicians allow.
The second bubble is that of higher education. Are you aware that the total student debt in this country is more than our credit card debt? It’s not just kids either; 40% of that amount is owed by people over 40, and it can’t be discharged in bankruptcy. By keeping the interest rate at 3.4% as a political trick, the politicians are feeding into this unsustainable bubble. It used to be a given that a college degree was worth every dollar it cost, but that is no longer clear. What does the $150,000-$200,000 it costs buy you these days? (The average college student takes six years to finish). Not much unless you think a janitor’s job counts; there are over 100,000 janitors with college degrees out there, folks. Like-wise Starbuck’s. grocery stores, you name it. But could we expect otherwise when so many people in college haven’t the skills needed, and so many are wasting their time and money on phony things like gender studies, LGBT studies, Chicano studies, whatever? Even more traditional social “sciences” like sociology and psychology aren’t helpful in a nation crying out for more engineers and others with useful 21st century skills. Typical college presidents make close to a million dollars a year, with layers of bureaucracy below them also soaking up tons of money.* Professors often teach very few classes; in a typical large university, the students barely see anyone but graduate students until their junior year. Again, this bubble is the result of government policies which have wildly inflated the cost of education without improving outcomes.
So when you hear popping sounds this Fourth of July, better hope they’re firecrackers.
*When I learned that my alma mater, University of Chicago, paid Michelle Obama $317,000 a year for some “diversity” job that they haven’t filled since she left and that the real purpose of this was a bribe to help get their new children’s hospital built, I stopped my annual donations. And I’m waiting to find out what a woman who gave up her law degree to avoid a fraud charge years ago could offer the university in value?