Zen And The Art of Car Maintenance
Click and Clack, the Magliozzi brothers of “Car Talk”, often get asked questions about life embedded in questions about cars. I was listening to one of their archived shows yesterday (alas, they are not making any new ones). It made me think of health care, naturally. Here’s how:
Every 5,000 miles I take my car in for an oil change. Every time I go the technician pulls up a bunch of maintenance requirements based on mileage. I can choose to follow “manufacturers suggested maintenance” or I can just choose to get the oil changed and go on with my day. My choice is based on a number of variables on any given day: how much time do I have? How much will it cost? How much money do I have, now and in the future? How much faith do I put in those suggested maintenance charts put together by Toyota? How much do I care about my car? How old is my car? Do I really believe in the consequences of disregarding the recommendations? How much do I trust this particular garage to competently perform said maintenance?
If you look at this list you notice a few themes. Hang on, this relates to health care, eventually.
1. Notice how three of those variables involve how much I believe what I’m being told. How much do I trust Toyota, and Valvoline, and the particular set of Valvoline employees that are working that day? I recently went to a delightful lunch with a bunch of very smart people sponsored by Trust Across America. People, I can tell you for a fact that people trust their bankers and their mechanics more than they trust their doctors these days. For example, how much faith do I put in the suggested maintenance of my colon, as delineated by the American Society of Gastroenterologists, who get paid for every colonoscopy? How much do I believe I’ll die an early and grisly death of colon cancer if I don’t follow those rules? And if I do follow the rules, how much do I trust this particular doctor to do my procedure? Trust is so important, and needs to be earned. How do I know to trust Toyota and Valvoline? Well, I don’t trust Toyota completely, because there scheduled maintenance recommendations could be set up to maximize profits for their dealerships. So I use my own judgement based on my own beliefs to decide whether to do what Toyota says. Remember that regardless of their motives, they still know a hell of a lot more about cars than I do. As for Valvoline, I trust this particular Valvoline store because they always tell me the truth and they do good work. I don’t think I need to extend the analogy any further, you get the idea.
2. Some of these variables have to do with money. How much do I want to spend? Would I have more money later, if I wait? If I wait, will a small problem become a more expensive problem? Is this Valvoline charging me more than another one would? Should I shop around for the best price on air filters? And the biggie: Will my insurance cover it? Here is where car maintenance deviates from body maintenance. Health insurance takes away most of these questions, except for instances of co-pays and deductibles. The Affordable Care Act has insured 8 million more people. That’s 8 million bodies that need servicing, requiring 8 million more units of money, whatever the conversion factors are. It is no surprise that health care spending is projected to go up. http://www.nytimes.com/2014/04/19/business/economy/health-care-spendings-recent-surge-stirs-unease.html?ref=health. The ACA doesn’t decrease costs. It just hides them from more people.
3. There are variables that have to do with my personal values. How much do I care about this car? How much longer do I expect it to last? How old is my car? How many dings and scratches does it have on it? Do I really like this model anyway? How much time do I have to devote to maintenance of this car? Do I want to sit here in my car while some guys do a bunch of work on it or would I rather go out and enjoy this sunny day? Personal priorities are so important. My oncologist tells me I should get chemo and radiation. Well, maybe I’m old and have had a good life. Maybe I’m a little dinged up and it’s not so easy to get around anymore. Maybe I’d rather see my grandkids than sit in the chemo treatment room. How much longer do I expect to live, and at what cost to me and the people around me?
Trust, money, and personal values. Basic, and often conflicting, decision-making components. That’s why health care reform is so hard.