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Debunking Free Market Republican/Libertarian healthcare myths, an Intro to Healthcare economics, an overview of Health Policy, and presenting the Neoliberal solution to the Healthcare problem.
Note: This post is not a critique of the American healthcare system. I understand that American healthcare is not a free market, but I'm not criticizing the American system. I'm highlighting the problems with the healthcare markets themselves.
Now before we get into the market failures that plague healthcare markets, it is first and foremost important to understand what a market failure is. A market failure occurs when there is an inefficient distribution of goods and services in the free market. In other words, it occurs when individuals acting in rational self-interest produce a less than optimal or economically inefficient outcome for the group. If you don't fully understand what a market failure is, I suggest you read through the article before you continue reading.
Part 1: Competition for Healthcare Services.Or more specifically, the lack thereof. There is significant evidence that people don't shop around in healthcare, including those who are uninsured, so the mechanism of competition in healthcare is far weaker. This is largely due to an information asymmetry between patients and doctors. When you get sick, you may not know what the best treatment is. You rely on the advice of a physician, who has years of specialized training. And even with hindsight, you cannot reliably judge for yourself whether the treatment the physician offered you was the right one. Sometimes state-of-the-art medicine fails to improve a patient’s health. And given the natural restorative power of the human body, the wrong treatment can sometimes appear to work.
The fact that people don’t shop is especially obvious for emergency care, since a person cannot be expected to price shop in the throes of death, but it remains the case for non-emergency services as well. A study that looks at the rates at which people shop around for MRIs found that people typically get their M.R.I.s wherever their doctors advise. In fact, on the way to their M.R.I., patients drove by an average of six other places where the procedure could have been done more cheaply. Read this article for a more in-depth explanation of the study.
This leads me to my next point, regarding price transparency. It seems intuitive that ensuring that all prices are available would make it easier to shop, so more people would do so. After all, people can't shop around if they can't even see the prices to begin with! Unfortunately, transparent pricing doesn't seem to help either, largely because most people simply don't use them. This isn't because of any lack of encouragement or enthusiasm either. This study surveyed 2,996 non-elderly Americans and found that despite the vast majority strongly agreeing that shopping around is a great idea, only 13% of them actually sought out price info while only 3% actually compared prices before receiving care. For further reading, I suggest you look into these:  & .
These results aren't unique to the US either. A study on the effects of transparent pricing in Singapore found that there is no evidence of any marked decrease in prices in the years following the implementation of price transparency legislation. Even more interesting is that this research paper found that healthcare costs in Singapore actually increased when the government loosened regulations, because hospitals bought expensive new technology and focused on premium care while neglecting the lower levels for poorer citizens. This led to the government once again tightening its hold.
A German study looking at hospital selection found that it was physician referrals that had the greatest influence in a patient's choice, and pricing wasn't even in the list of factors. This is consistent with evidence from the US. For further reading on how physician behavior affects healthcare spending, read this: , , , and .
Now, will making people more responsible for their spending incentivize them to shop around more often? Well for one, evidence is clear that it does lead to a marked decrease in healthcare spending, but that's mainly because people cut back on spending entirely. Sometimes even for medically necessary services! However, a study looking at evidence from HDHPs found that while consumers do reduce their healthcare expenditure when more responsible for their money, cost-sharing does not seem to decrease prices. This conclusion is supported by further evidence.
All in all, it seems competition for healthcare services is a bit of a lost cause… Leading into the next section: Health insurance markets.
Part 2: Competition in Health Insurance Markets.Like the market for healthcare services, health insurance is similarly uncompetitive. However, unlike the market for healthcare services, health insurance is not a lost cause and sufficient competition can not only be induced through regulation, but competition even seems to improve quality and cut costs.
In a free market, health insurance will play a much smaller role. Only those who are rich and/or healthy will be able to afford health insurance because insurance companies price premiums for the sick much higher that of the healthy, largely due to the greater risk involved. Unfortunately, since poverty is heavily correlated with bad health, it just so turns out that the poorest people will be paying the highest prices. Prices that they cannot afford. This is hardly ideal, it makes little sense to have a healthcare system that denies access to those who need it the most. Even when insurance companies have to charge the same premiums regardless of risk, they will find that insuring the healthy is far more profitable, and tend to actively reach out to the healthy while holding the sick in reserve. This is what we call “risk selection”. As David Cutler puts it in his books “The Quality Cure” (Seriously recommend reading this book if you’re interested in health econ. It's a great intro.):
This same dynamic explains why people find it hard to identify good insurance plans, even when they are in good health. Insurers do not reach out to people readily, like sellers of other goods. Rather, they wait in reserve, checking whether the person is profitable to insure before offering a policy. Their mentality is: don’t encourage people to sign up for insurance unless you know they are healthy. This makes it difficult to comparison shop.Now let’s take a look at the evidence. We know people often misunderstand insurance, which leads them to pick suboptimal plans (Like in Medicare Part D). There is even evidence that this behavior is exploited by insurers to raise prices and offer less. For further reading, see here: , , and .
Fixing this is rather straightforward. We can prevent insurance companies from denying health insurance based on pre-existing conditions (or sicker people in general), limit the variance of premiums between healthy and sick, and prevent them from tossing aside the sick when they need the most care. This policy is implemented in many different nations, including the US (with the Affordable Care Act), but this alone isn’t enough to make competition in health insurance viable. The problem with preventing insurance from denying coverage and limiting variability is that while sicker people gain coverage, healthier people forgo it because they no longer see it as a good deal and can insure themselves easily when they do get sick. This leads to the risk pool getting ever sicker leading to increasing premiums until the market collapses as a whole! This is what we call Adverse selection (aka the Death Spiral). David Cutler has a pretty good paper over how Adverse Selection destroyed an insurance market in Massachusetts.
How do we fix this problem? Why yes, the individual mandate of course! The individual mandate ensures even the healthy have insurance, so that the market remains stable. The healthy subsidize some of the sick and benefit from usage of general healthcare services themselves! There is an abundance of evidence that the individual mandate helps by reducing insurance premiums like Effects of Eliminating IM penalty in California, Adverse selection and individual mandate, and many more: , , and .
Part 3: Moral Hazard and the Merits of Cost Sharing.Moral Hazard is a market failure that occurs when one party in a transaction has the opportunity to assume additional risks that negatively affect the other party. In the case of healthcare, it would be the customer unnecessarily using healthcare services far more frequently (since the insurance company will pay for it), which increases costs for the insurance company, increases wait times due to a larger demand, and overall leads to wastage in healthcare usage. Insurance companies combat this through the use of cost sharing methods such as deductibles, co-pays, co-insurance, etc to ensure that people are responsible and discourage them from overusing healthcare.
I’d already touched on cost-sharing and its effects a little in Part 1, but this section intends to go more in depth into the topic. As I stated before, cost-sharing does lead to customers cutting back on healthcare usage, but sometimes it results in customers cutting back on healthcare that is actually necessary! So it's important to strike a good balance between the two, to minimize wastage and ensure customers get the healthcare they need.
Moral Hazard is a huge problem in most universal healthcare systems, and there is an ongoing debate within these nations regarding what should be done about it. To properly highlight the effects of cost sharing on moral hazard, take a look at this study, which is considered the gold standard for determining the effects of insurance reform on medical spending. I would provide more, but this is really all that's needed.
Note: The lack of cost sharing is actually one of the largest issues with Senator Bernie Sanders’s Medicare for all plan. He claims no co-pays or deductibles as if that’s a good thing, but it just so happens that it could lead to billions in waste every year, while driving up wait times all the same. If we apply the results from the RAND study cited above, it could lead to as much as a 30% increase in spending, which is rather ludicrous.
Part 4: Drugs and Price ControlsOne of the most common questions people seem to have regarding healthcare is why price controls are advocated for by many, when they are usually seen as economically damaging elsewhere. Well, the answer to that question is that Price controls in healthcare work because market forces don’t. As I’ve stated before, most people don’t shop around, which gives healthcare providers significant market power to increase prices far beyond the market equilibrium and it doesn’t help that healthcare is both demand inelastic and not substitutable. All the price controls are doing is bringing prices down to the market equilibrium... in theory (some go further, resulting in negative effects like loss of innovation).
It just so happens that price controls and drugs in the United States are intricately linked, because the high prices of drugs are a direct result of Medicare’s abysmal price control policy. Many believe that drug costs are incredibly high in the USA, and they aren’t entirely wrong. However, it should be noted that we pay drug molecule costs that are similar to other advanced economies, such as Germany. So why exactly are the prices so high? As I stated before, it has to do with Medicare.
Currently, the Medicare price control policy is based on a drug’s ingredient cost, which makes absolutely no sense. The wack pricing scheme often leads to increased demand for drugs that happen to be less efficient, leading to higher usage of less efficient drugs, resulting in higher costs and expenditure. That said, this isn’t the only reason why drugs are expensive. Some others include:
- US physicians & consumers have a preference for branded drugs.
- US physicians prefer new drugs over old drugs irrespective of relative efficacy. A new drug that is more expensive than an older drug but has the same efficacy will be used more simply because it's new.
- US physicians writing no-substitution script.
- Medicare rules don't allow for substitution if a brand name is on a script.
- The US doesn't allow insurers (including CMS) to refuse to cover expensive drugs with poor efficacy. There are many drugs that offer little or no clinical advantage but are common anyway, this is particularly rife with end of life care. In other countries this is dealt with by central negotiating authorities who impose efficacy/cost restrictions on new drugs, as a result there are many drugs which are either not available at all outside the US or have heavily restricted use outside of the US.
- Switch to an efficacy based price control system (like every other country lol), which would bring down the prices of the best drugs, leading to decreased demand (since people are now using less but better drugs).
- Streamline FDA approval processes to ensure entry into American markets is easier, remove allow insurers to deny coverage for drugs deemed inefficient, encourage physicians to prescribe generics, etc.
- Negotiate fair payment rates with other nations to ensure innovation thrives (DIFFICULT!!!)
Part 5: Frequently Asked QuestionsQuestion 1 - What about Surgery Center of Oklahoma and other direct primary care facilities? They seem to have cut costs and the free market appears to be working there!
At first glance, DPC does appear to reduce prices. This study finds that DPCs have lower prices across the nation (although it should be noted that data regarding quality is lacking). This is largely due to the much lower overhead from dropping insurance and because regulations like MACRA and other quality and cost regulations don't apply. And while this is great for smaller items, such as lab work, routine check-ups, minor injuries, etc, it fails when someone actually needs medical treatment and is unable to get it because they either don't have insurance and/or the hospital doesn't participate in the cash model! Emergencies are a whole nother problem, because they aren't covered by most membership fees at all, which can be financially ruinous because surgeries may cost in the tens of thousands of dollars (lower than the cost in a non-DPC, but financially ruinous nonetheless). Therefore, it's actually recommended by some DPCs to buy insurance in addition to the monthly membership fees if you have a major health problem and/or afraid of emergencies, so it may not save very much money at all for those who aren't healthy or committed the heinous crime of having a pre-existing condition (as many as 100 million Americans)!
Lastly, is that the study I cited above, regarding lower costs, may not apply to its fullest extent in a truly free market, because they are a vertically-differentiated site of care that may or may not exist under free market conditions and the DPCs themselves benefit from insurance companies reducing prices through their bargaining power (See: Medicare Part D reduced drug prices by introducing drug coverage), so prices may rise in their absence. There is no guarantee that a free market would work! Even at this point, there is evidence that lack of regulation has actually become a bit of a problem in DPCs because there is evidence that stronger perverse incentives are present, which may further increase costs and wastage in the healthcare system! In addition, this study by the American College of Physicians notes that:
Retainer practices note that they are able to see their patients more often throughout the year. Once again, there is no evidence to suggest that this is always necessary or effective. With all of the “amenities” offered by these practices, it is important to do a cost–benefit analysis to understand the true effect of the “extras” in a practice. At this time, no research or data are available to indicate that many of these amenities in a practice yield better clinical outcomes. It is important to be aware of the potential for overutilization of physician time and medical services.This shows that the data regarding service quality in DPCs are also very lacking. There is very little evidence to indicate that extra time and additional visits, one of the so-called major benefits of DPCs, actually improve health outcomes. There is rationale to believe that DPCs may also offer lower quality services because they may not participate in quality measurement programs and have no interoperability with other electronic health record systems. The lack of oversight and accountability can lead to certain doctors abusing their power and overload their practices with subscribing patients and compromise on quality of care. Since people don't price shop, competition won't be around to save you either.
Question 2 - But what about LASIK and Cosmetic Surgeries? Aren’t they proof that reducing insurance coverage and increasing competition helps? After all, Competition reduced their prices!
The problem with this claim is that it ignores the elasticity of demand of cosmetic surgery and other healthcare treatments. If someone charges too much for a cosmetic surgery, you can simply refrain from buying the surgeon's service because you don't need it to live. Can't exactly say the same for something like heart or brain surgery because you will die without it, so you will be forced to pay the price, regardless of how high. Healthcare providers take advantage of this to raise prices. It's not just life and death surgeries that are demand inelastic though. This study finds that most healthcare services in general are demand inelastic. This article explains it better.
Additionally, it should also be noted that unlike other healthcare services, people who seek out cosmetic surgery are usually much wealthier and better informed and the quality of the cosmetic surgery is very easy to assess, unlike other health services, all of which make it much easier to shop around. Move away from cosmetic surgery, and you can see the argument fall apart pretty quickly. Take a look at dental procedures for example. Like cosmetic surgery, they aren’t covered as much by insurance, yet dental costs have been rising just as quickly as other health services. For another example, take a look at veterinary care, which is seldom covered by insurance. Vet costs have also been rising rather quickly.
Question 3 - Isn’t there a lot of bad regulation in the USA that hurts healthcare?
The answer is yes, there most certainly is. However, while removing them would help, healthcare markets themselves are fundamentally flawed, and most major problems would persist. Even the ACA has some bad regulations within it that inhibit competition and counteract the effects of the good regulations, although that’s beyond the scope of this post. Next up, take CON Laws for example, I agree 100% that they need to go. There was actually a great post about it over on neoliberal. However, there is evidence that repealing CON Laws may help by introducing new competitors into the market, it is doubtful that they will improve quality without first addressing physician scarcity.
The next most common bad regulation I hear about is how the US prevents insurers from selling across state lines, and that preventing this from happening would result in lower costs due to competition. However, most evidence points to the fact that it would do very little. At most, it would reduce variance in healthcare premiums across the nation, but not the overall cost, so some may benefit, but some will definitely lose. Now to the evidence, the Affordable Care Act allows states to form agreements with each other and five states already allow insurers to sell across state lines. However, no insurer actually takes advantage of this as of now. As this study puts it:
According to many insurance experts, the primary barrier for an insurer looking to enter a new market is not the state’s regulations, it’s the cost of building up a provider network at discounted prices.The massive cost of negotiating new networks deters insurers from expanding their plans beyond that of their state. Lastly, this study states that regulation is only one of many drivers of high cost of health insurance, so it is clear that the free market will not be able to adequately address the cost.
Part 6: The Neoliberal SolutionTo recap, healthcare markets are unique. They are unlike any other markets due to them facing the worst market failures of any insurance industry and much more powerful information asymmetry, resulting in a sector that’s barely better than functional at its very best. However, there are many ways to tame the beast that is healthcare through a combination of various policies built on an abundance of research. From my perspective, the list of most important policies (assuming we want to keep a market-based system) would be in no specific order:
- Prevent health insurers from denying coverage based on health and limit variability of premiums based on health.
- Individual Mandate
- Implement an All-payer System
- Public option (or something like medicare/caid) in order to remove the sickest and poorest individuals from the private health insurance markets, which significantly reduces premiums.
- Proper price controls (I may make a separate post on this later)
- Necessitate a basic level of coverage private insurers must provide, such a cancer screening, etc
- Any regulations necessary to ensure competitive practices within health insurance markets (competition within insurance leads to better outcomes for lower prices).
Fine. I won't wear those boots anymore. You win. Another tale of me and dress codes.
(side note, I would read my recess story first if you want to do things chronologically)
TL;DR: School says my boots are within code but they don't like them and I can't wear them. So I stop trying to look nice anymore at all.
Background (you can skip this part if you like a shorter read):
If you read my recess MC story, then you already know I'm not a fan of dress codes for the sake of dress codes. So when I left for boarding school, I was utterly thrilled to go to a school that didn't have any uniform at all!
OK-So it's not really that I have a problem with dress codes. I have a problem with conforming. So if you say socks have to be black or blue, 99.999999% of people will assume that you mean navy blue. I'm the person who would show up with sky blue. Just to silently stand out for a day. Just to give a smirk to the 5 other people who'll think "well, they did just say blue!" Just to highlight to the bureaucrat who wrote the rules that they're not as airtight as they thought they were. In short, I am (as my hubby would say) a brat. It's just fun (to me) to show people that "eitheor" doesn't always have to be your only choices.
We'll just say I was an "adventurous dresser". I liked unusual combinations and had I been encouraged instead of discouraged (and taught how to sew) I very probably would have ended up as a low level fashion designer. Clothes were like paint to me after an entire childhood in the same plaid. I wanted to mix colors and textures and brushes. Boarding school is not really a colorful, choose your own adventure kind of place.
Well, though I was a precocious child, I was never a rule breaker (save for very calculated rule breaking in my previous story). My mother always said "VooDooDaughter's obedient and well behaved. She will bend a rule into a pretzel. But she'll never intentionally break one." She was the kind of parent who had to carefully word rules and restrictions when leaving me to my own devices.... but also be careful not to put ideas into my head, at the same time. Basically if you give me the impression that you believe something is ironclad, I'll pick it apart just because I enjoy the mental exercise of seeing if it really is ironclad. But if you're a jerk, I'm going to find the worst way to show you it's not iron clad.
My mother firmly believed that "Critical Thinking is the key to success in life. If you can assess a problem and find a path to a solution then you don't need to know everything. You just need to know how to find answers." (Mind you, this was about a decade before google and smart phones so I don't blame parents today for different mentalities....but I do still think I would raise my kids this way if I were going to have any.) So I had been raised to believe that the people who get ahead in life are the people who don't just say "Apple" when asked what that red round thing on the desk is. You pick it up. You turn it over. You note the feel and the weight. You mark the smell and the reflections in the wax. And you file that away for later. Never know when someone's going to ask you what the bottom of an apple looks like when there are no apples to look at, right?
Anyhow, when you spend your life mentally picking up every problem, question, and object so you can flip it over, turn it inside out, change the colors, etc. Mundane things like school handbooks actually become a bit fun.
I went to a boarding school with two types of dress code. We had "Classroom Dress" which was exactly what it sounds like. We were basically expected to look like young professionals. All the normal rules you would expect. Skirts below the fingertips for girls, shirts and ties for the boys. The handbook was pretty specific, as most are. The alternative was what we could wear in our free time "Town Dress" and it was the standard we were expected to dress to when seen in public off campus or just spending time in the students' lounge. This was more relaxed but still rules to keep the girls from wearing anything too sexy or the boys from looking too ragged in torn/cut off/worn out clothes. That sort of stuff.
I had a pair of knee high suede moccasin boots with fringe at the top, just below the knee. Actually, I had two pairs. One in black. One in brown. They were the most comfortable, warm boots I ever owned (long before the days of uggs). My mother and I fought constantly over these boots and it was a great triumph to me that she'd allowed me to spirit them away to school with me.
Then one day I was approached by a teacher who told me that the teachers had had a discussion and my boots "Weren't in the spirit of Classroom Dress."
"But I've read the dress code. There's nothing in there against them." I protested.
"I know. It's just been decided they don't meet the spirit of the dress code." She elaborated.
"But they're the right color."
"They're the right fabric. Suede is allowed."
"There's no restriction on boot length. You allow riding boots for the equestrian club!"
"Then WHY?!" I don't really know if I was angry or sad or an even split of both. But I was emotional.
"I wish I had better answers for you." She was a teacher I liked and I knew liked me. I realized it's why they'd sent her. I wasn't the sort to make a scene or cause a fuss...... I was the sort to get even.
"Ok." I said, and walked off. That night, I studied the dress code front to back. I read every sentence forwards and backwards. I said them out loud. I held up every article of clothing mentioned and studied it as if I were an alien who had nothing but the handbook and that piece of clothing to figure out how it was used by humans. It was a pretty strict handbook, I had to give them that. But they had made 2 mistakes.
- The handbook was oddly UNspecific about which items of clothing were to be worn where.
- Nowhere did the handbook say we had to make an effort to actually look good. They discussed what articles of clothing needed to be what colors and how far they needed to extend in certain directions (skirts below the finger tips, socks above the ankles, sleeves past the elbows, etc). Shoes had to be reasonable colors like black or brown (like my boots were!) or other earth tones. But it never said they couldn't be elf shoes, for example. Granted, elf shoes wouldn't be "in the spirit of classroom dress". But I digress.
The next morning, I woke up still pissed and began a mental list of the worst boys in my grade as I walked to breakfast. When I got there, I found a few of them and pointed out that the handbook specified that ties were to be tied in a single or double windsor knot at all times unless it was a bowtie and then it was to be tied in the traditional manner (don't know what that's called). What it DIDN'T specify is what part of the body it was to be affixed to. Nowhere did it specify that ties had to be tied around the neck. Just how they needed to be tied. I told them they didn't have to believe me. Just read their handbooks that night and do what they will with the information.
The next day, there were ties on wrists, around eyeglasses, foreheads, ankles, knees, thighs, tied then wrapped around hands as if to stop bleeding knuckles.... anywhere you could attach a windsor knot to the human body, there was a boy in my school with a tie there.
I was feeling pretty darn proud of myself. Phase one was a total success. The teachers were annoyed but most found it amusing.... Until we got to math class. There was a kid in class without his tie on. The one who always wore a bowtie. The teacher walked up to his desk and looked down her nose at him. "I understand you boys are having some fun with your ties today. And I think we've been pretty good sports. But if you know the handbook this well, then you know you at least have to be wearing a tie."
He raised his head, smirked, and said "Oh I'm wearing one. You just can't see it." The class erupted. Now maybe he just had it under his pants on his ankle. Or tied around his elbow under his blazer. I'll never know. But he went down as the kid who came to class with his tie around his penis. By the end of the day, I was a legend for finding the loophole and he was a legend for what he had put the loophole around. By morning announcements, the dress code had been updated (we were all handed a printed page so we couldn't claim we didn't know) to include specifications about ties around necks and the fun was over for the boys.
Phase 2 was a little more in depth - read on if you're not already bored. I studied the handbook and I took mental notes.
I had been eyeing the most ridiculous pair of boots I'd ever seen at the mall. They were silver with holographic rainbow interlocking circles on them. They sported a 2 inch platform with a chunky 4 inch heel and laced up just above the ankles. They looked like something Romy and Michelle would have worn in their final Prom scene or Fran Drescher in the Nanny. Ungodly. I knew I couldn't wear them to class but I wanted them for town days soooooooo bad. Like I said, after 9 years in uniform, I was having fun with fashion. I saved for months and "visited" them at the mall every chance I got. I had been slowly talking myself out of such a frivolous pair of boots (they were SO expensive!) but the loss of my favorite classroom boots had reinvigorated my lust for them. And right after my moccasins were revoked, I had managed to save up just enough to afford them. Lucky me!
I practically skipped to the store to get my holographic rainbow platform boots that weekend. They were out of my size! I nearly cried. Until I noticed right next to them was the black patent leather version. Until now, they had seemed so tame by comparison. But the dress code had a special section about patent leather footwear. It was specifically permitted but only when wearing pants (there's an old, idiotic, belief that you can see the reflection of a girl's panties in patent leather shoes if she's wearing a skirt). So I could not wear the rainbow boots to class. But their sister boots in black patent leather with silver details were totally permitted (silver, also being specifically permitted on shoes as some might have grommets for laces bwahahahaha!). Still sporting the 2 inch platform and 4 inch heel, mind you. The school didn't have any limits on heel size, assuming high schoolers wouldn't want to be in heels all day, I guess? Something about losing the whimsy of the silver holographic rainbows also had the bonus effect of taking them from a "club kid" mood to a darker "hooker boots" realm. And to think, I would never have even considered the black pair if it weren't for my recent fascination with our dress code.
The black boots also happened to be on discount whereas my silver ones would have been full price. So I walked away with enough money to buy a pair of pants to wear with my new boots. A plan began to formulate in my devious brain. I invited my friends to join me at one of the local thrift stores and we spent the afternoon hunting for the ugliest pants we could find that were still within the guidelines of the school dress code. And we did. They were bright orange polyester pants with little grey-green amorphous dots on them. Something akin to an incredibly tiny giraffe print. You almost couldn't make out the green, just that there was a pattern to the orange. Something about the two colors clashed enough that they almost vibrated in front of your eyes, making you half dizzy/half nauseated if you stared too long. And, as luck would have it, I scored a deal on an orange, shag sweater that was the exact same shade! I looked like a half finished sesame street character on top and a lost disco reject on bottom.... oh, did mention they were slightly belled straight legged orange polyester pants?
I strolled into class on monday looking like a rejected extra from Saturday Night Fever. My new platform boots had heavy wooden heels that clunked loudly everywhere I walked. I now stood four inches taller making me stand out even more in the halls, and rivaling some of my teachers for presence in the classroom. I watched some of them glare at my new boots and began to figure out which ones had taken issue with my knee high moccasins. I could tell the teachers who were getting a laugh out of it, too. But I didn't' stop there. It became my life's mission to seek out the most horrendous clothing and outfits I could concoct. I didn't care how I looked anymore. I had been so careful when I packed to make sure my clothes had all been suitable. And by their own admission, my boots were within the code. They just hadn't liked them. I had done my utmost to dress within their rules and they had arbitrarily decided something wasn't good enough because they didn't like it. So now I wore something hideous every single day so they had to see me in something nobody liked. Every. Single. Day. After all, what could they do? Just tell me EVERY SINGLE DAY that I wasn't dressed appropriately but never in violation? At some point I would cry it was personal, maybe even racial. By their own admission it didn't violate the rules. And I was certain to never violate the rules. That just wasn't my style. Plus, at this point in a battle of wills, you can't afford to get sloppy and give the other side any advantage. (Mom always said I was stubborn)
The nice thing about boarding school is the girls are happy to share clothes around with anyone who will share back. So instead of just one closet, I had like 30 to pick from just in my dorm. Sure most of my clothes matched each other by intent and planning. But they looked absurd with clothes picked by/for other people. Someone might have a loud shirt they only wear with a black skirt. But I'd pair it with a printed skirt from 3 rooms down in clashing colors just because I could. Still within code.
I wore those hooker boots any time I didn't have on a skirt. I invested in more polyester than a school should legally be allowed to have on campus for fire safety reasons. I sought out every consignment, vintage, second hand shop in town (and there were a lot! it was a largely hippie town so the pickings were fantastic). I put together 3 piece suits (with ties) that made me look so butch they actually asked my mother if I was gay at her parent teacher conference (apparently dressing badly makes you a lesbian?). I braided my bangs into a single braid and would put heavy earrings at the end to weigh it down then swing it around like a pendulum over my desk or book during class by swirling my head (only if I was bored in a class of a teacher I suspected of costing me my boots). Anything and everything I could do to be visually assaulting to the senses, I did.
At the above mentioned parent teacher meeting, they asked my mom if she could speak to me about my clothing and she asked, surprised, if I was breaking any rules. They explained about the boots. Mom told me she laughed and said there was nothing she could do. "If there's one thing my daughter hates, it's being punished for a rule she didn't know existed or a rule that never existed in the first place. If you want to make a rule today to stop her, she won't do it tomorrow....I bet you never saw those boots again. But you took away something she loved for seemingly no good reason. She sees that as a punishment even if you only saw it as a request. And now she's punishing you back. Simple as that. I suggest you just let it go and fix your handbook over the summer. Otherwise, you'll run out of paper, trying to print daily changes to keep up with the loopholes she'll find. My daughter loves finding loopholes. I should never have given her so many riddles as a child." Upon hearing this, they admitted that the only reason my new boots had been "ignored" thus far is that; this having been my reaction to the banning of the first pair, some were fearful what I might find to wear in retaliation if a second pair was banned. And, obedient student that I was, I never did wear my knee high suede moccasins again.
Random Conclusion stuffs:
They never did come after me for a single other dress code issue...except once when my skirt was too short (honestly not intentional, each teacher measured slightly differently). And I didn't return the next year for entirely unrelated reasons so I don't know what changes they may have made.
I'll include a photo of the boots. I've kept them all these years later just for the smile I get when I find them in the bottom of a box while looking for something else. And here's the last shirt I'm sure I have from those days. It's literally the ugliest piece of clothing I've ever owned and I can't bring myself to throw it away because I think of this story every time I see it and laugh. And I know somewhere is one photo of me in my orange shag outfit. If I ever find it, I will share that, as well. I had a blast tearing that dress code to shreds.
So remember to take your problems, turn them on their side, flip them inside out, look at life from a funny angle and you never know what cracks you might find.
And it's another great story of my awesome mom totally having my back.... Though looking back as an adult, I'll bet she was a little pissed they banned her boots, too. I mean, after all, if they had been more specific in the handbook, she could have kept them at home the entire time instead of in my closet at school, gathering dust!
Miss you, Mom!
edited for grammar
edit for comments: No, I'm not a lawyer in my adult life. It just wasn't my path. But I'm self employed, starting a business in an industry I'm extremely excited and passionate about and I enjoy nearly every single minute of work I have put into it. I'm blessed and thankful to love what I do.
another edit: This took place in the mid 90s.