Private or public, it’s still the health-care bureaucracy

September 13, 2011

Back in the days when dinosaurs roamed the Earth and I was in elementary school, my first writing assignment of the new school year would invariably be “My Summer Vacation.”

So now, with the school year starting again, I’d like to uphold that tradition and share three things I picked up during my summer absence from the office.

Because I spent July on family medical leave — things turned out well, fortunately — I spent lots of time talking with doctors, watching paperwork go by and trying to understand the system. I had plenty of material: My United Healthcare insurance account — which covers just my wife and me — had 155 entries from Dec. 30, 2010, through last week.

What I came to realize is that although Obamacare is horribly flawed, as I’ve written, the alternative isn’t a pastoral world of happy patients interacting with doctors who know them well, take time to deal with their problems and order appropriate treatments without worrying about cost or bureaucratic second-guessing.

Rather, the alternative to Obamacare is what I call United Healthcarecare: a system dominated by for-profit health insurance companies, which are buying medical practices and hospitals, squeezing everyone in sight and becoming increasingly powerful. Talk to enough doctors, and you see that they don’t consider insurance company bureaucrats superior to federal bureaucrats.

With or without Obamacare, the health-care system is splitting into two pieces — “concierge care” for people who can pay full freight to doctors whose practices are popular enough to allow them to avoid dealing with medical insurance, and “commodity care” for everyone else.

Whether or not Obamacare is repealed, I’m afraid, people a decade from now will look back to this time as “the good old days” for health care.

At least the merger flew

As part of my vacation — not to be confused with my family leave — my wife and I attended a terrific wedding in Napa, Calif. The trip home, however, wasn’t so nice — but it taught me something about the on-the-ground realities of corporate takeovers as opposed to the 30,000-foot-level at which I usually deal with them.

This involves Continental Airlines, which United acquired almost a year ago. My Labor Day afternoon flight from San Francisco to Newark on Continental took off about three hours late — a walk in the park compared with the early-morning SFO-Newark flight, which took off more than nine hours late.

You’d think that 11 months after combining into United Continental Holdings, Continental and United would have combined forces on the ground. But, apparently, you’d be wrong — at least when it comes to San Francisco.

How do I know this? Because Wall Street types who attended the same wedding and were booked on the same flight did what comes naturally to them when our flight was indefinitely delayed: They poked around to find out what was happening and tried to get the best deal they could.

Their finding: Continental flights were being held up because Continental had only two mechanics on duty and a backlog of planes that needed their ministrations. Meanwhile, some United mechanics had no planes to fix, but they couldn’t be used on the Continental planes.

United declined comment, so I’ll treat this information as accurate — and as a perfect example of why corporate takeovers that look great on paper frequently don’t work out well in the real world.

The real click and clack

These two lessons are discouraging — but I ran across one that is hopeful. Think of it as back to the future.

At a recent dinner, my wife and I talked about how we had to throw out two typewriters that suffered water damage from Hurricane Irene. But our dinner companions — former BusinessWeek chief economist Mike Mandel and his wife, Judy Scherer — topped us. They told us that their son Elliot, a senior at Cornell, has taken to writing papers on typewriters rather than computers. Given that Elliot, an English and economics major, works part time in Cornell’s IT department, I couldn’t believe it.

But it turns out to be true. Elliot told me he writes on a typewriter because that way, he’s forced to write rather than distract himself by going online. “You can’t tweet on a typewriter,” he quips.

Elliot says it’s a real scene when he shows up at Starbucks with his coral-red Royal portable rather than a laptop. I can believe it. And who knows? Maybe typewriters and solitary discipline will stage a comeback and reduce the temptations and time-suck created by social media. I sure hope so. Even after losing two typewriters to Irene, I’ve still got two left.

Sloan is Fortune magazine’s senior editor at large.

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