Unkind cuts for nosy columnists
A hospital is a silly idea really - gathering invalids in one place to share their diseases. The other problem is that it's also a sort of bureaucratic petri dish, a growth culture for administrators and accountants. As they spawn, these specimens try to apply rigorous market principles in an entirely inappropriate field.
An efficient health system would mean no-one was ill, and there would be no need - or at least a considerably reduced need - for hospitals, doctors, nurses and administrators, let alone insurance companies. All this became clear for me last year when a friend went into one of New York's most prestigious hospitals for minor back surgery. When, after a week, he developed a raving fever, no one wanted to readmit him, until his formidable spouse battered her way through the layers of bureaucratic ineptitude and insouciance. It was then discovered that no less than two iatrogenic antibiotic-resistant bacterial infections were making hay in his bloodstream. If he weren't close to death, he'd have been quite proud of the achievement.
Some studies suggest antibiotics have made hospitals lazy. In the old days of asepsis, carbolic acid and scrubbing kept down the death-dealing biota count. Now it seems hospital staff do not wash their hands the way that restaurant staff are always enjoined to in washrooms and the curtains around hospital beds are often a-hummin' and a-jumpin' with all the bugs you'd least like to have swinging from your sutures.
However, metaphorical hand-washing of the Pontius Pilate kind is still a hospital speciality. Sensibly, they put my delirious chum in his own personal isolation ward so he wouldn't infect anyone else, nor pick up any bugs who missed their munch the previous time. His insurance company decided it did not pay for single rooms and the hospital administration sent him the not inconsiderable bill for the difference. When he pointed out his surest source of funds to pay it would be a lawsuit for the involuntary near-death experience caused by the hospital's own proprietary bugs, a sort of administrative triage was practiced. The bill was forgotten.
Now if it had been a hotel and he didn't like room service, he would have had a range of responses from a zero tip, to moving to another hotel. Such free market responses, appropriate to feisty, healthy and discerning consumers, are not available to invalids who tend to form a modest plurality of hospital inmates.
In the health sector, the market interface is usually between insurance companies and care providers, which cuts the consumer out of the equation almost entirely. It reminds me of the astronaut who was asked what he thought about while waiting for the blue touch paper for one of those huge Saturn rockets. It usually crossed his mind, he replied, that the machine had been built by over 50,000 subcontractors - each the lowest bidder. What was he supposed to do - get off and buy a Ford?
It was in a similar state of economic disenfranchisement that I went to Streptococcus Park (as I call my friend's hospital) for a long overdue operation on a badly deviated septum. The bright young doctor doing the pre-op blood work gave a gasp, which surprised me. After all, it was my arm she'd just stuck the needle into.
'I don't think the computer's got this right,' she said, scrutinizing the form. She had a point: the computer said I was down for an abortion - a D&C, hysteroscopy and removal of endocervical polyps to be precise. A longtime supporter of a woman's right to choose, I had hitherto been happy to relinquish any residual rights the male gender might want to claim in this respect. It certainly added a whole new perspective to the alleged popularity of nose jobs in New York.
I'm no stranger to this type of thing, being the only male ever to have suffered a clitoridectomy. Having been at its very first pre-premiere performance in Liverpool decades ago, I wrote the program notes for Willy Russell's Shirley Valentine for a theater in Louisville, Kentucky, in which I said the play chronicled Shirley's discovery that Clitoris is not in fact an Aegean island. The director shamefacedly admitted that in deference to the local methodist church, he had excised the offending word.
'If they were the type to be offended by it, then they probably wouldn't know what it was anyway,' I remonstrated. 'You cut out my clitoris!' And that certainly raised the attention of some nearby feminist critics.
Fast forward to the hospital and my impending surgery, and the computer print-out that was worrying me. 'Um, what should I do?' I asked the doctor. 'Well, you could always keep your legs crossed on the operating table,' she suggested brightly.
Personally, I'd rather let them check it out down there and hope they'd discover their mistake at an earlier, non-intrusive stage of the proceedings than wait until they burrowed their way down through what I was now thinking of as my seriously deviant right nostril. On the other hand, if we are going to have free market rules in health care, maybe I should insist on every man's right to full Ob-Gyn care. After all, it's a question of market choice.
The Speculator