Submitted by Jim Aune on October 19, 2006 - 9:21am
I have been in constant pain for 36 hours. I actually used a cane to go to the office yesterday for some meetings. The problem? I have a trapped nerve in my abdomen from a double hernia repair a year ago. I got shot up with steroids about 3 weeks ago, and that worked for about 5 days, but I still can't walk without a ripping sensation (as if my right leg were being separated from my side). I'm about to go see the doctor again today (he's a nice guy, as family practice doctors usually are, as the anesthesiologist at the pain clinic), so I decided to read up on the Internets about this condition. Now, a little learning, especially online, is a dangerous thing, but it appears that entrapped nerves have gone from happening in 1% of hernia repair patients to closer to 40%, and the speculation is that the new use of plastic mesh is a possible cause.
Enter the biggest jackass on television: John Stossel of 20/20, who believes that the market solves all problems, and that any government intervention in that frictionless market creates no end of bad "unintended consequences." From his report:
Suppose you had grocery insurance. With your employer paying 80 percent of the bill, you would fill the cart with lobster and filet mignon. Everything would cost more because supermarkets would stop running sales. Why should they, when their customers barely care about the price? Suppose everyone had transportation insurance. The roads would be crowded with Mercedes. Why buy a Chevy if your employer pays?
See also the admirable skewering of Stossel on DailyKos today.
Now here's the problem, in classic Econ 101 terms: markets are wonderful things, but they only work in cases of "symmetric information." That is,they work efficiently when both parties to an exchange have nearly similar information; for example, if I want a clean, cheap copy of Vol. III of J.G.A. Pocock's Barbarism and Religion, I can compare prices across the world (usually using some website such as Abe Books, which I like very much), and, comparing for condition and mailing costs and exchange rates, I can find the copy I want. (It turned out that in this case, I got the cheapest copy from a bookseller in England; I had to wait maybe a week longer, but that wasn't an issue for me.)Everyone was happy. My transaction, if it goes well, also builds up that more intangible, but valuable, bit of information we rhetoricians call "ethos."
This example is Stossel's world, as it is in more ideologically driven economics courses. Enter Akerlof, Spence, and Stiglitz around 1970, who discover what now seems the obvious truth (they won a Nobel Prise for it in 2001; Stiglitz has gone to become the most accessible and persuasive critic of the international neoliberal economic order)--markets do not work efficiently when information is asymmetric. Even after reading a few medical articles online last night, my information about my entrapped nerve isn't remotely close to those of my doctors. And among doctors, quantity and quality of information will vary along a number of only partly predictable dimensions. This, John Stossel, is why medicine is not like a grocery. My choices seem limited at this point (although I will be offered a choice, as is reasonable): try an oral course of steroids, laparoscopic surgery to snip the nerve (I have no clue as yet about the down side of that--"numb nuts," perhaps?), or going to score some smack in the bad side of town. (There's also an asymmetric information problem with drug dealers, but that's another topic.) One final note: both my family doctor and the anesthesiologist said about my surgeon: "He's not with us any more." Do I ever get to find out why?