24 September, 2007

A problem I want the government to stop solving

If I understand correctly—and I may not, in which case please correct me—Congress has decided that I am too poor to pay for my children's health care. Why? My family's income falls within 250% of poverty level.

Let's run some numbers.

  • I pay something like 20% more on my mortgage than my lender requires. (Fixed-rate; no teaser-rate ARMs for me, thanks.)
  • I send my son to a Catholic school, paying the non-Catholic rate. (Funny, that. Maybe I'll explain it one day, but probably not.)
  • I also pay for my son's braces and my family's regular dental visits.
I cover these bills, and many more, entirely on my income, without outside help. Throw in the health insurance for the kids—currently though a private insurer, since the State and School Employee's Plan doesn't offer much for children unless their health is pooched—and we're singing to the tune of more than $800 a month. Yes, my income level provides that kind of disposable income. Yet Congress implicitly asserts that people at my income level can't afford to pay for their children's health insurance.

(Caveat. Is the poverty level measured by wages and tips, adjusted gross income, taxable income, after-tax income, or other? The news never clarifies these details. If it's gross income, then okay, maybe I don't qualify, but it's close. Wikipedia suggests it's after-tax income, in which case I'm quite sure we qualify. If however it's 300% of poverty level, and I've seen that number tossed about in some opinion pieces, then I'm "too poor" again regardless of the measure. Current law is something like 200%, which rightly excludes me; $10,000 a year makes a big difference.)

There must be a catch in the proposed law, right? Indeed there is: my children have had insurance coverage during the past year, so they aren't eligible for S-CHIP.*

You read that right! Because I pay the premiums to cover my children, rather than pocket the money for, uhm, "worthier causes", my children are ineligible. Put in somewhat plainer language, Congress feels that responsible folks don't deserve help paying for health care. However, an identically-sized family with an identical income that has chosen other ways to to spend the upwards of $800 that I spend on insurance, education, etc. gets a freebee from DC. Sorry, but that is the kind of logic only a vote-seeking legislator could love.

(Come to think of it, cable TV with premium channels, a cell phone plan, and high-speed internet would be nice. Wouldn't have to wait for downloads, or for Battlestar Galactica and Lost to come out on DVD. Tally the cost of that, and you're pretty close to my monthly cost for the kids' health insurance. Of course, in my case I'd likely put that dough into house improvement or college savings.)

Don't get me wrong. I understand that there are people too poor to buy health insurance, or to visit the doctor. I don't object to paying a slightly higher Medicare or Medicaid tax to help such people. I also understand that a lot of people receiving Medicare and Medicaid benefits aren't receiving proper care. I've seen it myself; how could I deny it? I have no problem helping with this problem with a slightly higher tax, although I wish they'd take that money out of all those bridges to nowhere instead—or, if you prefer, out of some of those military bases in Europe that serve no greater purpose than to protect local European economies from the end of the Cold War.

I do object to the idea that some people should pay a higher tax, however slight, to help me!—or, as it turns out, to help people at my income level who have higher priorities than their children's health insurance. If a man at my income level can't afford health insurance for his two children, this program almost certainly won't solve his financial problems.

Okay, well, if Congress wants to classify me as too poor to afford health care, who am I to argue? Isn't our health care system drowning in a tide of rising costs? The public, which is on the front lines of this flood, seems increasingly receptive to plans for the government to take over this mess.

Well, count me out. I have seen government-run health care, and it isn't pretty. No, I haven't seen the sanitized version presented in recent documentaries. I've seen it up close in a first-world European country, when someone I knew was sick and dying. As for non-first-world countries, my wife has firsthand experience, and has seen her family's experience. This is all anecdotal, so it doesn't count as real evidence, I know. I recount it all the same.

Death is never pleasant, and the hospital in Minturno, Italy makes no particular effort to mask this fact. Minturno is a half-hour's drive from Gaeta… on a good day. On a bad day, which is pretty much any summer's day, you sit in four lanes of the superstrada in stop-and-go traffic and wish that the Littorina rail line still connected Gaeta to Formia, which would get you to Minturno that much more easily. Gaeta has a hospital, but I'm told that no one in his right mind goes there. Formia has a hospital, and is closer than Minturno, but there were reasons to go to Minturno. I'll spare you the details.

The area is a relatively wealthy area of Italy. It's rich in cultural sights, beaches, quality restaurants, and hotels. Tourists from all over Europe travel to the area and pump money into the local economy. The hospitals should be high-quality, right? These are the conditions as I recall them some four years later:
  • Four patients to a room. The paint is faded, and the walls have visible plaster repairs. The oxygen tank didn't work, and most of the furnishings looked either of poor quality or in disrepair.
  • Families are expected to keep someone at the patient's bedside 24 hours a day, in case something goes wrong. No one has ever explained to me why Italian nurses aren't sufficient for this, whereas American hospitals don't seem to require a family presence.
  • Forget air conditioning. Ventilation comes from two large windows that look out over the Gulf of Gaeta. It's a pretty view, but I was there on one of the hottest days of the year. There was no breeze to speak of,and the humidity was high, so the room was insufferable.
  • It is against the law for a doctor or nurse to visit someone's house and receive a fee for services rendered. However, this is done all the time. Thus, the rich receive a different quality of health care than the poor.
  • Doctors who have received training in the United States are held in higher regard (and carry higher fees) than those trained in Italy.
  • The national health system is held in such disrepute that Italians refer to it as malsanità, which best translates as The Department of Illness.
I discussed these observations with my wife, and she informs me that the same is true in Russia, with one exception: hospitals usually pack twenty patients to a (much larger) room. Neither in Italy nor in Russia are we talking about backwoods, rural hospitals. The Gulf of Gaeta and Kazan are both major urban and economic centers.

I've seen my share of hospital rooms in the States, and I cannot recall seeing an American hospital that lacks air conditioning and adequate ventilation, where families must keep someone at the patient's bedside 24 hours a day, or where more than two patients are placed in a room. Are these amenities luxuries or necessities? I don't know. Do hospitals lacking these amenities exist in major and not-so-major metropolitan areas? I don't know. Will we lose them if we move to a government-run health scheme? I don't know, but having seen how Medicare-funded nursing homes treat people, I'm not confident. We already spend more per capita than any other country—I think our government alone spent more per capita on health care than almost any other country back in 2001, before Mr. Bush brought his show to town. This may not be a problem that the government can solve, and trying to solve it may well be making it worse.

Obviously, there are lots of things I don't know. Obviously, not every country with government-run health care will have such poor-quality health care as what I saw.

Indeed, an Italian pen pal received excellent care from competent personnel at a regional hospital. The fact that the region was Piemonte, in northern Italy, may explain the difference; people there seem to run things in a more civilized manner than even the most metropolitan and cultured of southern Italian cities. One word: Naples.

So a government-run health care program might work, but it won't work when it's based on lies. Congress implies that I'm too poor to afford health insurance, and my children need the government-run program—unless I bother to take care of them myself? So if my wife and I decide to have another child, will that child be eligible for the government's health care tab, while my other two children will not? After all, the new baby will not have enjoyed a year's coverage beforehand!

I have a novel idea: Direct that money to the families who need it. Families in my income bracket don't need that kind of help. Extending the help under bizarre circumstances—excluding people like me because we were responsible and made sacrifices—seems like a strange way to reward responsibility.

*In my son's case, the irony increases. He's a resident alien who immigrated legally within the past five years. That also disqualifies him from S-CHIP.

Too bad he isn't an illegal immigrant, eh? Church leaders, Congressional leaders, state legislators, and university administrators would fall over themselves to advocate entitlements for him. Only a few years ago, the Catholic bishop of Raleigh and the administrators of the UNC system were pressuring the legislature for things like in-state tuition for illegal aliens, accusing naysayers of being hate-filled xenophobes. I can't be exaggerating, because I wrote a pointed letter to the bishop after reading his editorial on the subject, and I remember his smarmy, condescending language vividly.

But health care for legal immigrants who can't afford it? Perish the thought.

Note: I worked on this stupid post for more than two weeks, and I still hate it. Don't take it too seriously; consider it more a mere storm of recollections and emotions.


Anonymous said...

Hi there,

Interesting post! I enjoy the point of view; very insightful.

I discovered your blog a few days ago by web searching for Catholic + mathematician. As a Catholic and an undergrad in mathematics (only recently become interested in it, was an English major last year) I pose a question to you!: what's the deal with St. Hubert being the patron of mathematics? All I can find on him involves hunting and hounds. (& St. Barbara is another story (forgive the pun)) Am being confirmed this liturgical year and I think I want to pick the best possible patron for a mathematician (all the help I can get and what not). There have been mathematical monks, no doubt, but none canonized. I've read Cauchy was devout & Fermat was faithful, but again... Any advice or thoughts would be much appreciated.

Brendan (countably.wordpress.com)

jack perry said...


Nice to meet you! Not much on your weblog, to my dismay.

I didn't know about St. Hubert at all before your comment, so I have no idea why St. Hubert should be the patron saint of mathematicians. He's also the patron saint of opticians and metalworkers, for some reason.

Another option might be this. Mathematics is a science, and St. Albert the Great is the patron saint of the sciences. He was actually more of a biologist, so I don't know if that appeals to you. I've read in a few places that St. Dominic is also a patron of the sciences, although the reason on that one also eludes me.

You're right that there have been a large number of good mathematicians who were Catholic religious. Maria Gaetana Agnesi was one, as was Girolamo Saccheri. Unfortunately for your search, neither of them is classified as a saint.

Wikipedia has a page on Christian thinkers; you can find Nicolas of Cusa, Marin Mersenne (of Mersenne prime fame), Xu Guangqi, and Francesco Faà di Bruno who has apparently been beatified. If you can take the beatified as patrons, that's an option!

Anonymous said...

Prof. Perry,

Thank you for the reply! Yes, I'm sorry to say my blog has no momentum yet, but I'd really like that to change. I've never kept a blog that was both consistent -and- quality; have had just two before this one: one was consistent and one was quality (arguably).

I'm very interested in Bl. Francis Faa di Bruno; I'd never heard of him until now. Here's a little podcast on him which doesn't mention his math (which is good because before all I could find on him was about his math): http://www.franciscanradio.org/MP3Files/SOD/1335.mp3

I'm not sure about the beatified/canonized issue; I'll have to ask Sister. It does seem however that 'confirmation names' are not universal practice, and what's more, are less common (on the world scale) rather than more, which I didn't know until doing a bit of research today.


Brandon said...

St. Anatolius of Alexandria (3rd century) wrote several books on mathematics (which unfortunately we only have in a few tantalizing fragments), and also introduced important innovations in the calculation of Easter (which, simple as it may seem, was, if you think about it, a many-centuries-long mathematical research project conducted by the Church, one that involved many saints of many backgrounds). When he is painted he is often with globes and geometry books. (He's also known as Anatolius of Laodicea.)

Anonymous said...

Professor Perry,
I hate to have hijacked your post like this. This will be my last comment here; if anything else on math/saints wants or needs to be said, bring it over and comment on my blog at countably.wordpress.com, I'll try to remember to start a post on the subject.

Wow, thank you. Sounds like St. Anatolius might be my man. I'm now looking about online for paintings of him.