The “What’s It All About Alfie” Theory of Health Insurance
Let people use health insurance proceeds to finance vacations
By
David Gottfried
This past Friday night, while I was cleaning, bleach splashed into my right eye. I went to my closest emergency room, the one at New York University Medical Center’s Tisch Hospital, whose CEO, Robert Grossman, was recently compensated to the tune of $3,425,126 per annum in cash alone (Footnote 1)
I hate going to ERs because I hate going to hospitals, and my disgust with hospitals has been explained in many other articles on this newsletter. (Footnote 2) For starters, a) 100,000 Americans every year are killed by infections contracted while in the hospital, b) medical professionals are paid if the forms submitted to third party payors look good (whether you live or die has nothing to do with it), and c) hospitals are such byzantine, chaotic institutions that the treatment plans of different doctors often conflict with one another.
In the ER, all of the bad qualities of hospitals are amplified, like sunlight passing through a magnifying glass and scorching your skin with flames. Of course, they made plenty of errors in my recent visit to the ER. I won’t itemize the list of errors committed, even though some of the errors may have resulted in a permanent loss of vision, because so many other people of course have much worse outcomes. They often drop dead.
Of course, losing your life is more serious than losing your eye, and apologists for the latter day Mengeles of the Medical profession may say they botched my case because they were busy staving off death in another case. However, that argument just won’t hunt. They are “as slow as Molasses in January” even when life hangs in the balance. Consider the case of Libby Zion. She presented to the ER with a fever of 107. For hours the hospital did nothing, and she simply died. Take a look at the Merck’s Manual, which provides simple but accurate descriptions of the pathogenesis, symptoms, treatment and outcomes of almost every disease we know of: It sternly advises the practitioner that a temperature over 105 degrees is a “hyperthermic emergency” requiring “heroic measures.” He must get off of his duff in seconds flat and throw ice cubes galore all over the patient. (For temps like 107, put the patient in a bathtub with ice and cold water and rubbing alcohol – just typing this makes me want to get under a thick woolen blanket.)
Speaking of blankets. Did you ever require a blanket in a hospital. Many people, including yours truly, find hospitals rather chilly. I have not encountered a single hospital, in all of New York City, which furnishes blankets which are more than 2 millimeters thick. Although Medicare will pay these anterooms to funeral parlors 2,000 dollars a day for a single patient for just room and board, the hospitals are devoid of the elemental human kindness to supply blankets which are anything more than glorified sheets, in an off white and often discolored hue suggestive of the piss and shit and blood of previous patients.
Of course, sometimes hospitals can and do save one’s life. There are certain things they can and do do properly, such as Cesarian sections, as they have had 2000 years’ worth of practice in doing them (Julius Caesar was born via Cesarian section)
However, I know that if I had a really difficult illness, I don’t think I could survive a hospital. To survive in a hospital, one needs a family member or friend, who is capable, competent, and reliable, to make sure that the hospital renders appropriate care.
Of course, hospitals employ lots of people. There is an incessant hustle and bustle of doctors and nurses – and people who dress in white but are a far cry from doctors and nurses – buzzing around, making noises, creating a hubbub, but there is no one watching over you to organize your treatment. No one in the hospital is devoted to your case and the resolution of your malady. There may be a brilliant surgeon, but he is gone and lost and far away when complications from the surgery cause aberrations in an organ outside of his area of expertise. Your nurse may draw your blood expeditiously and painlessly, but the minute after she has drawn your blood it is out of her hands, and forgotten, and if the laboratory forgets about it, or loses it, that really is just your tough luck. And so you will see a great succession of people, and they will start procedures that they do not finish, and they will make incisions that they do not close, and they will open avenues of diagnostic inquiry that will soon be forgotten, and you will languish. And when you make a protest, and you try to articulate, as reasonably as possible, your concerns, you will inevitably be shouted down by a big fat nurse who will tell you to behave like a good little impotent, inconsequential patient and watch a soap opera.
If you have an incurable, deadly ailment, and you have six months to live, should you really spend it in a hospital, suffering inedible food, sarcastic and sardonic “nurses” and other cretins in white.
(I have seen nurses ridicule old men for making “pee pee” in their bed, make my Mother, who knew she was dying of colon cancer, cry because of their barrage of insincere, sickening sadistic baby talk. I saw my Grandmother suffer black and blue marks because black nurses heard her say “shvatza” and then struck her. My grandmother was senile, and whenever she saw a black person, she used the Yiddish term for black or dark, shvatza.)
If you have fire insurance, you will get money after the fire, and you can spend that money any way you want.
So why not let the patient go on a vacation and why not pay for the vacation.
Sometimes, when I look at the abundance of illness and pain in New York City, I think the problem is not a lack of medical care. The problem is miserable housing. Homes with roaches and rats and mold and no heat are, perhaps, what are making so many of the people I see on the subway such fractured, feeble human beings.
In the movie “What’s it all about Alfie,” medical care for a working-class London chap entailed a lovely stay in a mansion in the country that was used by the government as a sort of hospital and vacation get away at the same time.
Sometimes, I think that if I could simply spend three months living in a nice home, without mold and asbestos and constant noise, my physical maladies, and consequent emotional gloom, could be vanquished.
If one gets ill in the United States today, one may be expelled from the hospital within hours after the termination of intravenous feeding. I knew one guy who was thrown out of a Florida hospital less than half an hour after the completion of a spinal tap – as he drove home from the Hospital he got into a car accident, and he went straight back to the hospital.
By contrast, Alfie, the hero of our film, is drinking pretty citrus beverages in lovely crystal glasses while sauntering around the sanitarium and sunning himself in the estate’s verdant fields.
Alfie was given a vacation, at government expense, which permitted him to recharge his batteries. Of course, in New York the poor never, ever get vacations. Now of course my discourse seems to most of you to be timeworn, and fixated in the rhetoric of the thirties and the sixties, but examine the concrete, factual reality of what it means to be poor, and what it means to be rich, and you will forever realize that the predominant and overriding political idea of the past four decades, that the rich are really not that bad and that the poor are, for the most part, just a bunch of lazy, stupid shiftless bastards (who are occasionally given lip service on PBS documentaries about the dust bowl or wholly uninspired speeches at pseudo-liberal democratic conventions), is perhaps, the greatest political libel and disgrace of the post war era.
The rich in New York take vacations all the time. In the Summer, they stream East, to Long Island’s posh seaside suburbs, every single Friday afternoon. These people would not think of missing vacations, and they never miss vacations. They go to Long Island’s Hamptons every weekend in the summer and they will of course go to a vast array of destinations and travel spots which will keep them culturally au current, and which will include such perennials as the usual trips to London to witness the latest British developments in all things thespian, the frequent sojourns to Paris and Rome for fashion and food, and an increasing number of out of the way spots, hopefully in Asia or Africa, which will demonstrate one’s political sophistication, liberalism and attentiveness to our new global world.
In a word, these Rich people are always getting their batteries charged. They are vacationing with staggering frequency and abandon. And they will tell us, with a straight face, that the poor are just too lazy to work.
I submit to you that the poor are simply too tired to work. Oh, they can perhaps work, in a plodding sort of way. But they will not work with zest and effectiveness. They will work with drawn, defeated faces and hopeless expressions and a preponderance of doom hanging in the balance. Of course, given their overwhelming exhaustion and utterly sapped and denigrated egos, they will fail in the workplace. But perhaps this is just what the rich want: The demolition of the egos of the poor so that they, the rich, can get even richer. And so when the rich are complaining about the alleged shiftlessness of the poor, they are really enjoying the degradation of the poor, complimenting one another on their ability to so mangle the courage of the poor that the poor cannot compete in the world of work, thereby enabling the rich to partake of more of the poor man’s money; and rejoicing in their deft ability to so brilliantly subvert reality that this country, instead of seeing the abject despondency and moroseness of the poor, is deluded with an image of idleness and laziness.
Very simply, I submit to you that a huge percentage of New York’s population have not had a vacation in twenty years. More specifically, for twenty years they breathed the air of the subways, hades like hot air ransacking their lungs. For twenty years they have endured winters of gray and black snow and summers of sweat and itching and excematous lesions infected with soot. For twenty years their respite has been some imitation Italian Ices from a good humour truck which is soon discolored and bad tasting because a City Bus has farted its prodigious reserves of carbon monoxide and other toxic things into the path of their faces and their sorry little ices. Millions of New Yorkers have spent twenty years like this. They have never been to London. They have never been anywhere. And the rich, the evil vile rich, are laughing at them every day.
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Footnote 1: I found his salary at this web page: https://www.google.com/search?sxsrf=ALiCzsYeE2wO1XjRmF2FbBMxw2gTWqCy5g:1666564493775&q=Who+is+the+CEO+of+NYU+Langone+Medical+Center%3F&sa=X&ved=2ahUKEwi17JXFtPf6AhWRkIkEHb8HBLQQsZYEegQIRhAC&biw=911&bih=347&dpr=1.5
Footnote 2: I address Nine problems in health care that Neither Republicans nor Democrats ever address in this article: https://davidgottfried.substack.com/p/nine-problems-in-health-care-that