We Have Seen the Enemy — And Surrendered

Bow your heads and raise the white flags. After facing down the Third Reich, the Japanese Empire, the U.S.S.R., Manuel Noriega and Saddam Hussein, the United States has met an enemy it dares not confront – the American private health insurance industry.

With the courageous exception of Dennis Kucinich, the Democratic candidates have all rolled out health “reform” plans that represent total, Chamberlain-like, appeasement. Edwards and Obama propose universal health insurance plans that would in no way ease the death grip of Aetna, Unicare, MetLife, and the rest of the evil-doers. Clinton – why are we not surprised? – has gone even further, borrowing the Republican idea of actually feeding the private insurers by making it mandatory to buy their product. Will I be arrested if I resist paying $10,000 a year for a private policy laden with killer co-pays and deductibles?

It’s not only the Democratic candidates who are capitulating. The surrender-buzz is everywhere. I heard it from a notable liberal political scientist on a panel in August: We can’t just leap to a single payer system, he said in so many words, because it would be too disruptive, given the size of the private health insurance industry. Then I heard it yesterday from a Chicago woman who leads a nonprofit agency serving the poor: How can we go to a Canadian-style system when the private industry has gotten so “big”?

Yes, it is big. Leighton Ku, at the Center for Budget and Policy Priorities, gave me the figure of $776 billion in expenditures on private health insurance for this year. It’s also a big-time employer, paying what economist Paul Krugman has estimated two to three million people just turn down claims.

This in turn generates ever more employment in doctors’ offices to battle the insurance companies. Dr. Atul Gawande, a practicing physician, wrote in The New Yorker that ''a well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That’s how a doctor makes money. It's a war with insurance, every step of the way.'' And that’s another thing your insurance premium has to pay for: the ongoing “war” between doctors and insurers.

Note: The private health insurance industry is not big because it relentlessly seeks out new customers. Unlike any other industry, this one grows by rejecting customers. No matter how shabby you look, Cartier, Lexus, or Nordstrom’s will happily take your money. Not Aetna. If you have a prior conviction – excuse me, a pre-existing condition – it doesn’t want your business. Private health insurance is only for people who aren’t likely to ever get sick. In fact, why call it “insurance,” which normally embodies the notion of risk-sharing? This is extortion.

Think of the damage. An estimated 18,000 Americans die every year because they can’t afford or can’t qualify for health insurance. That’s the 9/11 carnage multiplied by three-- every year. Not to mention all the people who are stuck in jobs they hate because they don’t dare lose their current insurance.

Saddam Hussein never killed 18,000 Americans or anything close; nor did the U.S.S.R. Yet we faced down those “enemies” with huge patriotic bluster, vast military expenditures, and, in the case of Saddam, armed intervention. So why does the U.S. soil its pants and cower in fear when confronted with the insurance industry?

Here’s a plan: First, locate the major companies. No major intelligence effort will be required, since Google should suffice. Second, estimate their armed strength. No doubt there are legions of security guards involved in protecting the company headquarters from irate consumers, but these should be manageable with a few brigades. Next, consider an air strike, followed by an infantry assault.

And what about the two to three million insurance industry employees whose sole job it is to turn down claims? Well, I have a plan for them: It’s called unemployment. What country in its right mind would pay millions of people to deny other people health care?

I’m not mean, though. If we had the kind of universal, single-payer, health insurance Kucinich is advocating, private health insurance workers would continue to be covered even after they are laid off. As for the health insurance company executives, there should be an adequate job training program for them – perhaps as home health aides.

Fellow citizens, where is the old macho spirit that has sustained us through countless conflicts against enemies both real and imagined? In the case of health care, we have identified the enemy, and the time has come to crush it.

Comments

[paperpusher666]

Why not hire some of the health insurance workers to work in the new program? If they can keep track of the many changes that are put through in various plans annually, they ought to be able to keep up with one set of rules. They'd probably have a pay cut, but they wouldn't have to be unemployed. It would be the reverse of Circular A-76, which is the process for contracting out work normally done by federal employees.

Private health insurance doesn't necessarily disappear in countries that provide universal health care. In England, having private insurance is a way to jump the queue and have elective procedures performed sooner.

[Richard]

Barbara,

Enough with the liberal banter. Communism has already failed. I don't care if lazy, stupid people have insurance or not. Survival of the fittest! Human nature is not about being "nice." Human nature is about being selfish! Even a fetus in the womb of the mother is fighting the mother for survival, for nutrients. There is not enough wealth to go around. The clever ones, like me, will make a killing, the average and below average will get by or worse. That is nature. Pretending that human beings are kind and caring is a joke. Study history. We are more of "killer primate" than a "kind ape." Let's accept our human nature, and the triumph of pure killer Capitalism. Capitalism has succeeded because it best mirrors human nature. A few will win the spoils, and the rest will fight over the scraps. Stop pretending that you care, you don't! You are just massaging your status and ego that was built up by being Ms. Liberal- I care so much about the downtrodden. I don't lose any sleep thinking about those less fortunate. I can pretend, and tell women I do, but I don't, no one does! Why do men join "save the whales?" There is probably a hot girl working there that they want to get with. Human nature is "evil." No one wants to share, and sharing isn't natural. Anything you have to teach in Kindergarten is not "natural." You don't have to teach an infant to take, or to attack. Those are natural, human reactions. No one wants to share their hard work with the dumb masses, believe me. Those on the bottom usually belong there. There have always been the "rich" and the "poor." There always will be. Also, you can't compare America with Europe. There is no communal feeling here in America. We are too diverse now. In Ireland there is a collective sense of purpose. I ride the subway in Chicago, and feel no connection with those fellow passengers, none at all. No shared humanity, no shared language, nothing...America is all about Individualism. Now, we are supposed to care about all of the freaks that live here, I don't think so. That is the end result of Multiculturalism. You end up having to move into your own enclave. I'm sure that you live in your own protected little yuppie enclave where rich people give money to bums so that they can buy more drugs. So caring! I live in my world, and the other groups live in their worlds. That is o.k., that is tribalism, another hallmark of human nature. I want to be surrounded by people who are like me. I don't want to be surrounded by uneducated, obese morons. In light of these points I think you should drop the health care B.S. No one wants it. No one wants to tax the wealthy because everyone has the misguided notion that they can be wealthy, get it? Drop the charade. America is balkanizing by the minute, more by wealth than race. I know that the truth hurts, but it is still the truth nonetheless. I would always prefer the brutal truth than a charade or "fantasy" about what human beings are and will always be. Wouldn't you?

Richard

[grennels]

Shoot the health care insurance industry for the
mad dog it is.

Vote Kucinich. Screw the
Democratic Party. They have sold out.

Yes,Kucinich is a
Democrat. What else could he be and retain whatever feeble hope he might have of any national audience?

The two party system is a
hoax perpetrating the fiction that American voters have any voice whatsoever in their fate.

[namvetted]

Richard, no need to be bitter. Your life is worthless and there is no god. How sad to be you.

[grennels]

By the way, Richard, go sit in the corner and diddle yourself.

[Hattie]

Richard. You must be a superstud! Drool...

[Tom M.]

>>"Human nature is not about being 'nice.' Human nature is about being selfish!"

Then why isn't the rest of the industrialized world so brutally uncivilized? It isn't "human nature" that fosters your kind of greed, Richard; it's the twisted, dehumanized brainwashing -- er, "socialization " -- we receive here in America. You acknowledge this yourself when you observe, "[Y]ou can't compare America with Europe...America is all about Individualism." Of course, the proper clinical term here would be "extreme, pathological" individualism. But whatever else you call it, it's still propaganda. And it's still bullshit.

More broadly, the essentialist claim that "it's human nature; it's inevitable" is one of the most common and devious forms of propaganda out there, insofar as such statements cleverly seek to disarm dissent before it can get off the ground.

It's obviously too late to warn you away from this noxious Kool Aid. Have fun in your "Lord of the Flies" hell world. Just don't try to force it on the rest of us. We don't want to live there.

[Richard]

Hey, don't shoot the messenger. We all live in the same world, and it is a brutal one. Human beings are selfish by nature. It's all about evolution. Yes, some more enlightened societies have tried to temper and control the nastier aspects of human nature, but it wasn't always so. Underneath the veneer of civilization lurks the beast, and if you are honest with yourself, you will admit that it lurks in all of us, especially males. Women, via evolution seem to have a more caring DNA chip that males do not have. I have just grown tired of the "charade" that people care. Read Dale Carnegie, the only thing people care about is themselves! We have evolved from those that were vicious and cruel and the kind ones likely didn't reproduce as often. Sharpen your teeth! To quote "The Most Dangerous Game," an excellent story for our times: there are two kinds of people in the world, the hunters and huntees. Once we can admit the dark truths about ourselves then we can start to make progress. But this pretending to care about strangers is making me nauseous. It is like an alcoholic that has to admit to his problem, people have to admit how we really are. Global systems that are predicated on a "false" view of human beings has and will continue to "fail." Capitalism, though cruel, especially in the American form, is most in tune with our nature. I am not saying it is a plesant truth, but it is the truth nonetheless. Let's all admit the truth, and stop the whining and b.s. You are all optimists and dreamers, which is amusing. I am a realist, and I live in the real America. You can whine and cry for the next twenty years, but those in power will never give it up easily. Start building your wealth, and best your fellow man. That has been the game for a million years, and it will be the game for a million more. Go read some books on Evolutionary Psychology and get a "real" education.

Richard

[Tom M.]

Richard,

Two more points I neglected:

1) >>"There is no communal feeling here in America."

Because people and "philosophies" like yours have largely eroded it. Divide and conquer! Great way to subjugate the masses.

However, survey after survey of Americans has revealed that a restored sense of collectivity is widely wanted and missed. We are seeing signs of such a restoration now. Solidarity, anyone?

2) Ultimately, we can *choose* our beliefs and behaviors. Our big, evolved brains enable us *not* to be selfish assholes (well, most of us)....

[Tom M.]

Richard,

One last comment. Your understanding of psychology and history is simplistic. Given that your key sources for the former seem to be Dale Carnegie (!) and the unempirical speculations of evolutionary psychologists (who, incidentally, have theorized a prominent role for empathy and community in human survival), that's not so surprising.

You also seem to assume the rest of us share your emotional deficits. We don't. For the sake of those around you, you may want to Google the term "sociopath" and get some help.

[jacqui, Australia]

Richard,

While I, unfortunately, cannot disagree with you arguments, you and everyone of your ilk, every last greedy, grasping, self-centered one of you, are the reasons why many people on this planet will be dead in our lifetime. You take, believe it is your right to take, whatever you want regardless of the consequences. You continue to take even when the consequences of your actions are obvious. It is my sincere wish that you, and everyone like you, are among the first to die from the consequences of human greed and selfishness. Of course, that will not happen. The poorest, the least deserving of it, will be the first to suffer the consequences.

You are truly a worthless, miserable example of a human being.

That an estimated 18,000 Americans die every year because they can’t afford or can’t qualify for health insurance should be a national scandal - especially in a first world country that considers itself an example of democracy and freedom to the rest of the world. That, of course, is arguable anyway other issues considered.

What a shining example the USA, and Americans like you, have become to us in the rest of the world of what NOT to become…

[Richard]

Jacqui,

Oh yes, the Australians, what a noble lot. Wasn't Australia one big prison? Didn't the male prisoners constantly rape the female prisoners, and this evolved into our friendly Australia, which we all know and love. How is your experiment in multiculturalism going?

I am not a "sociopath" because I care about my family and don't care about strangers. "Blut ist dicker als Wasser!" I have never broken a law or commited a crime in my life (excluding traffic tickets). What I do is legal and respected.

Tom,

Maybe if you went out and looked for work instead of blogging, you might accrue a little wealth of your own. I don't need to work. I can philosophize now. I have already won "the game." For the record, I started out as a nice young man, sensitive, kind, until I found out that "nice guys finish last." I decided to get rid of that side of myself and let another harder, aggresive part come out. Presto, women suddenly found me attractive, men respected me, etc.

There is no saving the environment. Human beings will use and use till it is all gone. This is happening, and will continue to happen. I am facing reality. The only way Americans will give up gas consumption is to take away their cars by gunpoint. Give me a break! Everyone wants to get their own. Wake up people.

Think back to when you were a kid on the playground. You were a nice, sensitive guy and got beat up or picked on until you made a bloody example of the bully. I taught my son boxing, and I told him the first kid who gives you crap, I want you to make a bloody example of him, and I will deal with the school.

Next time you speak to someone, look to see if they are really listening to you, or are they just thinking of the next thing to say. No one cares about you! My philosophy clearly explains human behavior in society and in historical context. Your theory of human beings is naive, dangerous (to your own well being), and a pipe dream. Wake up, take the "red" pill. Read the following books and try to understand them:
Heart of Darkness
Lord of the Flies
Candide
Gullivers Travels

What are these great minds trying to tell you? Are they telling you that people are "caring" and "sharing", or are they telling you that "man is a beast to man." Maybe Tom is a new evolved, sensitive kind of human. You have adapted to our times of peace and prosperity.

Richard (Gute Nacht!)

[Tom M.]

Richard,

I have a job. (I need two of them, in fact, thanks to the economic depredations of your rape-and-pillage brethren. And there are a lot of people like me -- more of them every day. Given the historical failure of highly unequal societies, I'd say it's *your* P.O.V. that's dangerous, for all of us.)

The works you cite -- yes, I have read them -- describe only one aspect of human nature. They are *cautionary tales,* Richard. You're not supposed to use them as a model for living. (A hint for the irony impaired.)

[chris]

Ahhh, the cry is loud and long for Government Healthcare.

The supporters repeat the same silliness every time they talk about Government Healthcare.

They claim it will be less expensive because the Government will handle everything -- cutting out that greedy middleman.

Here's a few interesting facts.

Medicare expenses reached $260 billion for the last reported year.

Roughly 44 million citizens received Medicare benefits.

In addition, MedicAID expenses hit roughly $305 billion in the last reported year. About 58 million people -- 20% of the population -- received Medicaid benefits in the last reported year.

Adding the expenses of the two programs together equals $565 Billion.

The total enrollment in the two programs was 102 million.

Thus, the bill for providing some level of medical coverage to one-third of the population was $565 Billion.

To provide that same level -- insufficient -- of healthcare to the entire population, we would spend $1.7 TRILLION.

You can be sure the Medicaid coverage does not match the level of quality expected by people dreaming of 100% Government Healtcare.

You can be sure that Medicare is not good enough to satisfy the proponents of Government Healthcare.

Therefore, $1.7 TRILLION per year won't cover the bills.

In addition to the outright operating expenses that would easily top $2 TRILLION annually, there is the lawsuit issue.

Medicaid doctors are sued with great success. Thus awards from lawsuits will boost the total expense of Government Healthcare to unimagined levels.

[Tom M.]

Richard never really addressed the fundamental flaw of his argument -- denying the possibility of a more decent society, he omits the reality that more decent societies *exist*. The real question is: can Americans overcome their ingrained hyperindividualism, and their I-too-will-be-rich magical thinking, to create one? Are we *really* greedier than Europeans?

[JD]

"Survival of the fittest!"
Man, that's pretty pathetic and sad...
Yes, why even bother to become more civilised...?
We should just exterminate the poors, right?
Then, people with a low IQ are too much of a burden, let's get rid of them!
How much is your IQ richard? Maybe you are not intelligent enough to stay among us... Maybe you should leave us alone and go live your selfish life alone somewhere else...

[barbsright]

Jacqui, are Redback (i think that is their name) spiders as poisonous as I have read. I would not mind moving to 'Oz' except for all the poisonous creatures. Richard, I agree with you about human nature. I was part of a school reform group and met at least one very selfish man whose motivations changed how I viewed the average American. The truth is that most people do not realize 'it is better to be lucky rather then smart.' Most successful people want to believe their hard work made them successful, so they can ignore their less successful human beings. As Woody Allen supposedly said: "80% of success is just showing up!" Truth is a single payer plan is what Medicare is so we could just expand Medicare to cover everyone, and just have the insurance companies process claims. It would be more efficient. But the real problem is that a lot of medical treatments turn out to be poor long term investments. I have met three people who were treated for cancer , one a physician, they, I am sad to say, all died. This is what is bankrupting our country.

[roger]

would you listen you yourselves. you cite woody allen and dale carngie to illuminate the true nature of the human soul. try reading primo levi or solzhenitsyn or eugenia ginzburg and get back with me when you have something valid to share. it is no wonder that we need an educated, sophisticated ruling class to shape the quality of our societal relations and introduce a degree of perspective.

http://query.nytimes.com/gst/fullpage.html?res=9E01E4DE1F38F931A25754C0A967948260

[Thomas Brown]

My, my, Richard. Quite the feisty one, aren't we? I'm sure you will be delicious... I've already ordered some fava beans and a nice Chianti.

[chris]

Barbara writes:

"An estimated 18,000 Americans die every year because they can’t afford or can’t qualify for health insurance. That’s the 9/11 carnage multiplied by three-- every year."

First, let's note that roughly 3,000 people died on 9/11. In addition, Barb claims 18,000 people died for some absurd reason relating to healthcare coverage. But she claims 18,000 divided by 3,000 equal 3. Proving once again that yet another woman can't perform simple mathematics -- and neither can the proofreader.

Next, were there any deaths on 9/11 resulting from lack of healthcare coverage? Or did 3,000 people die in a catastrophic attack?

Thus, why link healthcare coverage with an act of war? Why? Dramatic impact. In other words, cheap shot.

Second. She claims 18,000 people died "because they can’t afford or can’t qualify for health insurance."

About 20% of adult Americans smoke cigarettes. Smoking is more common among the less affluent. The smarter people have read the warning labels and accepted the advice of the Surgeon General: Smoking causes cancer, emphysema and heart disease.

How many of the 18,000 are smokers? Plenty. Anyone who smokes has found enough money to support cigarette purchases. At today's prices, anyone who smokes a pack a day can afford some healthcare coverage.

Meanwhile, about 45,000 people die in motor vehicle accidents EVERY YEAR. Alcohol is involved in about 17,000 of those fatalities. Driver error is a huge contributor to roadway fatalities.

Should we ban cars? Or prevent some people from driving?

Okay, that's not equivalent to the question of who among us should receive total healthcare coverage. But the question of self-destruction surfaces.

Many life insurance policies are voided if the insured commits suicide. Of those policies that will compensate the survivors, all include a minimum two-year moratorium on pay-outs for suicides.

Property & Casualty insurance companies do not compensate for losses due to floods. That job goes to the federal government. And, as we have seen in the aftermath of Katrina, the federal government is unable to respond to catastrophes of Katrina's magnitude.

Let's see. Where else has the federal government shown its inability to serve the entire US population?

The Post Office. The phrase "Going Postal" does not suggest speedy delivery of mail.

Is there any aspect of US Post Office Service that is better than the alternatives -- when there are alternatives? No. FedEx, DHL, UPS, Airborne Express all kicked the ass of the Post Office.

The only advantage of the Post Office is its willingness and ability to deliver mail to people living miles from the nearest town.

How about Social Security? The SSA handles the routine delivery of SS old-age checks reasonably well. But try your luck obtaining SS disability payments. Try applying and receiving benefits from other programs.

Does any recipient praise the generosity of the SS system? Is anyone satisfied with the amount of his/her check? No.

How about schools? Well, schools are not managed and run by the federal government. No. They are basically under the control of states and municipalities.

How are they doing? The answer depends on the location of the school and the students who attend. Funding is not the variable that determines the outcome for students.

In general, suburban schools are far, far better than their urban counterparts. Meanwhile, the per-capita expenditures at suburban schools is less than outlays at urban schools.

This situation is a little like comparing the health and well being of people who smoke with those who don't.

We do have a few federal universities, otherwise known at West Point, Annapolis and the Air Force Academy. As educational institutions go, they are successful because they are selective about whom they admit.

The question boils down to whether taxpayers should foot the healthcare bill for people who willingly and knowingly put their health at extreme risk by smoking, drinking, drug use and engaging in dangerous sex.

Do people who cannot "afford" healthcare have a right to create enormous healthcare burdens through their health-damaging activities AND expect others to pay the price of their misbehavior?

Additionally, in the vast and heavenly world envisioned by those who believe Government Healthcare is the answer -- where will we draw the line for treatments and services?

[Fran Taylor]

I love these folks who argue against single-payer universal health care. It's so easy to make them look really stupid. Let's take our chris here. Replace the word 'healthcare' with the word 'police' in his rant and you see how ridiculous this is. I suppose we need to get rid of those commie pinko cops and firemen next. How dare they provide equitable service to all, regardless of income! How Unamerican! I'm not saying there is anything wrong with Capitalism, but you sure can't solve your problems by wrapping a free market around them.

[chris]

On another note -- education:

There are plenty of less expensive colleges and universities to attend -- if cost is a major concern.

Try Delaware State University. Tuition is $6,000 a year. A dorm room is $5,600 for the year. And the meal plan costs $3,000 for the year.

Thus, the total is less than $15,000 a year. That's if you pay full retail, which no one does.

It's probably worth observing that Delaware State is a black school.

What forces and conditions lead to the existence of a black university in the US today? Seems a bit racist to me.

[Dawn]

Dennis Kucinich has been saying the right things for a very long time. Yet, he's a bit scary in his zealous ways. It is a shame we can't separate the message from the messenger and figure out how to make major changes. Instead we continue to be apathetic and hide our heads in the sands of materialism. I keep seeing that lab experiment where frogs sit in a beaker of comfortable water atop a bunsen burner flame that slowly cooks him....we Americans are such frogs!

It looks like the true heroes of our country are the activists, the few lone voices who speak out and offer alternatives to injustices and put their bodies between us and those who want to grab all of our rights. And yes, I'm idealist enough to think that good health is one of those inalienable rights along with free education and rights to privacy and free speech and equality. Not to mention clean air and water and....

Right now I also think affordable housing should be an inalienable right! But that's another story....

Dawn

[anonymous]

Inequity rules!

True story. My friend and I both went to college. We are both from broke families. I went to MIT and she went to U. Mass. Amherst. We compared our benefits and expenses, and I ended up paying a lot less to go to MIT than she did to go to U.Mass. Yes, we were both in college at the same time. Go figure.

[chris]

Fran Taylor, you wrote:

"I love these folks who argue against single-payer universal health care. It's so easy to make them look really stupid."

And Franny takes her best shot:

"Let's take our chris here. Replace the word 'healthcare' with the word 'police' in his rant and you see how ridiculous this is."

Let's examine this bizarre claim. I think most police departments -- which are state, city and local, not federal -- do a reasonable job. Many disagree. Is every criminal caught? No. Are there unsolved major crimes? Yes. Does police brutality occur? Yes.

If the level of healthcare offered to every American by Government Healthcare equaled the crime-fighting success of the police, would our healthcare needs be met fully? Not a chance.

She reels:

"I suppose we need to get rid of those commie pinko cops and firemen next."

In this country we have private police and fire departments. They meet specific needs not addressed by municipal police and fire organizations.

Those guys with guns who transport money to and from banks in armored cars are not members of the local police force. But they are licensed to shoot robbers.

Meanwhile, many towns don't employ firemen. Many towns rely on volunteers, many of whom are known to hang around the bar next to the firehouse while waiting for emergency calls. They are great guys, however, and perform a heroic service. But they are private citizens serving the public for free.

Franny goes into the deep end of the pool:

"How dare they provide equitable service to all, regardless of income!"

The performance of this equitable service is distributed inversely according to neighborhood income. Less money, more crime and cops. Less money, more fires and firemen.

The delivery of police and fire services moves in tandem with healthcare needs, which rise as income falls.

She struggles:

"I'm not saying there is anything wrong with Capitalism, but you sure can't solve your problems by wrapping a free market around them."

Really? Do you even one example of a communist nation that offers the quality of life you seek?