Legal theories and medical crises

The American medical system is suffering from two epistemological errors: the idea that to get any medical treatment you must get a certified doctor’s sign-off, and the idea that if you don’t, you can sue somebody for millions. You can talk all you want about evil insurance companies, but the cost of medical care in the US is the highest in the world, and last time I checked, the average US hospital was breaking even. And I know how much they charge. What’s going on here?

It really boils down to our country’s ethos in matters of money and independence. First: We are not going to be told what to do unless it’s by an expert, and if the expert turns out to be wrong, we will make them pay. Second: The right job will provide riches, though this may require some up-front investment.

We want money. We believe we deserve it. We deserve to live a certain lifestyle. In an economic downturn, this becomes all the more obvious. Many people drop out of the workforce, resenting the idea that they’ll have to take a lesser job, and…

Go to law school. The law schools, meanwhile, have churned out so many graduates that there is no room at the Inn, no positions at big firms, not even for Ivy League graduates. And yet the schools fool these dupes, their supposed students, into believing that riches cost a mere $100,000-plus and three years of study on how to glean money from conflict and vague wording.

Result: a gigantic unemployed workforce with massive debt and a sense of entitlement. More than often, these people also emerge with a malleable view of truth (truth is adhering to certain rules, though these do not apply when I myself find a loophole, which is always). What are they going to do with their time?

Certainly, not every lawyer is, shall we say, an arrogant bloodsucker. At best, law school can attract those wanting to champion social justice. At worst, however, it can attract high-conflict personalities with a devious streak whose ideas about how to get what they want (do anything to get information, double-cross, deny anything not on the record, do not reveal your hand until the time is ripe to strike, research with a pre-determined outcome in mind) only become further entrenched and encouraged. As one lawyer said: “Nobody listened to my crazy ideas until I went to law school. Then they were forced to listen.”

In order for civil attorneys to make a living, they need to encourage other people to disagree. This applies even to the wills and contracts they write. Why would you need a lawyer to draft your will or a contract unless you suspected your preference wouldn’t be enough?

Civil lawyering has ballooned into a monster that touches everything we do, impedes our ability to make decisions, makes us overly cautious and suspicious. You can’t start a business without worrying about all the legal red tape first, even if you’re pretty sure you won’t turn a profit for two years and can’t afford any extra expense. You can’t let acquaintances borrow a bike without the potential that they could hold you legally responsible for the fact that they crashed. You really can’t make a wrong decision or leave something undone if you’re somebody who’s supposed to be rich. Lawyers don’t sue the poor. It just doesn’t pay as well.

You may chalk all this up to exaggeration, but currently, for example, there is no legal way to practice midwifery in New York City because the hospital that backed the midwives with malpractice insurance and the stamp of approval went bankrupt. Yes, hospitals go bankrupt. Especially if they cover professions like midwifery, classified as high-risk from a legal standpoint. Nobody else in NYC wants to take the midwives on for the same reason.

But imagine, if you will, a world in which you didn’t need such backing in order to choose a home birth. Imagine, too, a world in which if you knew concretely what was wrong with you, you could get a pharmacist technician type to look at you and your records and prescribe the appropriate medicine. You have a UTI; you know you do, because you get them often enough. It’s been a week and it’s only gotten worse. It’s agonizing to pee. You know you need antibiotics, stat. Or you’ve developed circular rashes on your body; it looks like classic ringworm, and the herbal remedies haven’t helped. Or you have a migraine and your Imitrex prescription just ran out. Or your kid has strep; you suspect it’s strep, it looks like strep, it smells like strep. You know there’s a simple culture to prove it’s strep, but the visit to the doctor is going to be at least $50, even with co-pay.

You’re going to have to go see a highly trained professional in order to get access to what you already know you need. Because nobody is going to give it to you otherwise… the risk of getting sued is just too great. You pay for a litigious system two ways: with malpractice insurance and with the years and years of expensive training physicians receive in order to rubber-stamp your request.

You want the cost of health care to drop? Shut down the law schools for a couple of years, and send half the lawyers to gut fish in Alaska for 12 hours a day. We have the highest number of lawyers per capita to match our highest cost of health care. I doubt this is a coincidence. We live shorter lives than those with lower costs, after all.