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

[chris]

Fran, you wrote:

"You gotta get me some of you're taking. The visual effects must be very interesting, you're seeing things that aren't there."

Wrong. What's obvious to me is beyond your comprehension.

You said US healthcare companies don't operate in other countries. You're simply wrong. They do. But, rather than admit the truth, you keep the blinders on.

Like I said, see AFLAC, one of the most visible insurers in the US. AFLAC is BIG in Japan. That's an easy one.

[chris]

Fran, you wrote:

"You are saying that the APPROPRIATE response to a medical error is to have a lawsuit, and lavish lots of money on lawyers for a legal procedure that does nothing to alleviate the problem?"

You described the response in terms of "appropriateness".

I did not say the realities of lawsuits are "appropriate." Some are. Some are not.

However, medical malpractice lawsuits are a reality. As far as I can tell, they are completely Constitutional, which means there is nothing lawmakers can do to end the practice.

Establishing some limits on awards is possible and has happened. But medical malpractice lawsuits will never disappear. Don't waste your effort attacking me because patients sue doctors.

[chris]

Fran, you wrote:

"There are other ways to get people to do a good job than to threaten them with a lawsuit if they screw up."

Oh. Well, malpractice insurance for many doctors is $100,000 a year. Check the numbers for OB/GYN docs. They get sued every day.

You naively piped up:

"Doctors in particular have a strict code of ethics and any doctor who did this sort of thing would not be a doctor for long in any reasonable society."

There are doctors who lose their medical licenses permanently. But no matter what you believe, a few mistakes won't cost a doctor his career. Even fatal mistakes.

You might recall a woman named Olivia Goldsmith. She wrote a novel titled "The First Wives Club." She made a couple of million bucks off that one. It became a movie and she got a lot of the rewards.

However, the succes of her book and the movie did not improve her looks. Therefore, she went to a plastic surgeon who promised to convert her from a pork chop into a sex goddess.

Instead, she died on the operating table.

Maybe her doctor was permanently barred from practicing his specialty. But I doubt it.

[chris]

Fran, you wrote:

"If it were a really free market I could pick a doctor based on their performance, like I pick a car dealer or a grocery store."

First, you can check a doctor's record and weigh his performance. However, I can't think of any comparisons between doctors and car dealers or doctors and grocery stores. Totally ridiculous.

You wrote:

"But it's not a free market, the insurance companies control it, and they tell me what doctors I can go to."

Every insurer gives a huge phone book listing all the doctors to every policy holder. You can choose any of the doctors on the huge list. Since you are in New Hampshire, perhaps you live a long way from the doctors you would prefer. But that's your decision.

You wrote:

"Stop pretending that this is a free market."

Your statement suggests that medical costs are high because our system is flawed AND that Government Healthcare would cost us less.

This is pure nonsense. Our healthcare system is ripe for improvements. But the last thing we need in this country is the ultimate incentive for illegal aliens to sneak in to give birth to children who would be citizens.

You are supporting an idea that would attract millions -- and there's nothing we can do about it. It's obvious we can't stop illegal aliens from entering. If we give them the added incentive of free healthcare, the steady stream would become a flood.

[Fran]

chris, you are such the realist. We should all just stop thinking and accept things for the way that they are.

I haven't heard anybody come up with a single-payer system that will work. They all have problems, as you so helpfully point out to us.

What I am saying is that we can figure out something better. We shouldn't do what I say or what Hillary says. We should make a serious attempt to sweat all the details and figure out a way to make it work. We did not solve any of our hard problems with an overnight edict. There isn't a single person who can explain all the technology behind a moon mission but we managed to do it anyway. It was a collaborative effort involving years and thousands of people. Other countries are doing working on this. We can learn from them. They can learn from us. The current clusterf*ck is costing us so much money that we have to do something different or it's going to sink us in the long term. The percentage of GDP going to health care in this country is just crazy.

I haven't even heard an objective, to set expectations and give us a goal to shoot for. We don't even have that. Is it to provide for all? For those who can pay for it? For those who can be cured? For those who want it?

I mean, if you made a 'Consumer Reports' rating page of the American health care system compared to others, it would be down there with the Yugos and the WaterWorlds.

If I were a big international company looking for a home, I'd look at the US and say, "screw them. If I set up shop there, I'd have to pay for everyone's health insurance!" and I'd go to another country where I don't have to do that. Just like companies are doing right now. Of course, that's also due to the tanking dollar, but that's another issue.

[Charles Watkins]

You might note that most states have "high risk" pools which provide insurance for those the private companies will not carry. One little problem: the cost of such a policy is normally set at double the cost of the highest cost private policy and the deductibles are ten times as high.

[Terry]

My brother in law was in a horrific accident recently in which his friend died. He was in the hospital for four months and in a rehabilitation center for another couple of months.

My friend’s son requires a $1000 dollars a week of drugs to combat a serious illness.

The cost of all this $0.

Living with Canada’s Medicare system?

Priceless.

[Richard]

Hi all,

I have to admit that I was just playing "Devil's Advocate" to get the discussion going. I do think human nature is "dark", but I am solidly middle class and struggling like the rest of you. I am not rich. I do think that you need universal health care. So no one has to try to track me down (Chianti). I was just trying to put myself in the shoes of the rich, and was having a little fun. Yes, life is brutal, and people are selfish, but we must try to tame these nastier elements of human nature in order to have a more just society. In this way, Europe is much better. Good luck and keep fighting the good fight.

Gruesse aus Deutschland!

Richard von Lowenherz

[Jo]

Well, I haven't looked at the comments for a while now, but I see Chris is still here, soldiering away in his lonely quest to win Barbara's heart by sheer perseverance. And I see he has been joined by Richard! At first I thought Richard was a tongue-in-cheek parody of Chris, but now I'm not so sure because he keeps answering in character.

[buena]

But you're all missing the real point, which Barbara makes clear. Forget the health insurance. Give us health care. Why do we need the profit-consious insurance middleman?

If I didn't have to pay over $800 a month for health insurance, that money could go toward a hell of a lot of actual health care. And, god forbid, more goods and services to keep our economy strong.

[Tom M.]

Chris,

You bloviated:

"If we expand Medicaid to cover 100% of the population..."

Of course, no one has actually proposed this. What's been proposed is Medi*care* for everyone.

You then drooled:

"Medicare is pretty good. But miles from meeting every demand from every beneficiary."

Yes, so unlike the current system -- which, for nearly 50 million Americans (and counting), has failed utterly. This doesn't begin to count the scores who have found that their expensive insurance policies are effectively worthless. Indeed, your Pollyannaish description of the industry is a laughable whitewash. Today's health insurance companies are not in the business of providing a safety net. Rather, they are consciously designed and managed to take the largest possible sum of your money while returning, ideally, nothing. In the old days, this was called "fraud."

By the way, if you'd spent more time on research and less time thinking up sophomoric insults, you would have discovered that the reported satisfaction levels for such major government programs as Social Security and Medicare are spectacularly high. I'm sure they're the envy of such market marvels as car dealers, cell phone providers, airlines, telemarketers, computer customer service departments and, of course, our friends the insurance companies.

[Tom M.]

Richard,

lol. I fell for it hook, line and sinker, too. Damnation. :)

[chris]

Tom M., you wrote:

"What's been proposed is Medi*care* for everyone."

Hey. That will solve everyting in one shot. Particularly the question of pregnancy and childbirth and post-natal care. I know those medical issues are at the top of Medicare's priority list.

At least 50% of the population will feel well served by a system that excludes them.

[chris]

Tom M., you wrote:

"This doesn't begin to count the scores who have found that their expensive insurance policies are effectively worthless."

Scores? Scores? There are 300 million Americans. "Scores" are groups of 20. If you meant that there are groups of 20 whose policies were inadequate, I'd say you were touting the success of the existing system.

You should take your own advice about research and do a little.

[chris]

Tom M., you wrote:

"You bloviated:...

"If we expand Medicaid to cover 100% of the population..."

Of course, no one has actually proposed this."

Of course no one has proposed that we expand Medicaid to incluce the entire population. Who would expand a program where fraud runs rampant and medical services are routinely inferior?

Who would focus national attention on the real face of universal Government Healthcare plan?

Medicaid is obviously the ultimate form a national plan would assume. Thus, the reality check has been completed.

The current annual bill for the inferior coverage of Medicaid is $300 billion. The program covers 20% of all Americans. Thus, in the simplest terms, covering the entire population via this inferior program would cost $1.6 TRILLION.

Or about $5,000 per person served.

But this inferior program would undergo a vast restructuring before its coverage would satisfy constituents. Would that lead to an initial doubling of the annual bill?

Or, we can assess the Medicare model. That program is more expensive than Medicaid by every measure. Roughly $330 billion in 2005. It served around 45 million Americans.

In other words, about $7,500 per person served.

However, Medicare does not cover pregnancy, childbirth and post-natal care.

That aside, expenditures of $7,500 per American equals $7,500 times 300 million, which totals $2.25 TRILLION.

$2.25 Trillion would have been the bill for 2005.

Healthcare costs are rising far faster than the rate of inflation. No government plan can change these facts.

Furthermore, due to our citizenship laws, this plan would become the giveaway of the century to every person who ever thought of sneaking into the US. We would face a flood of illegal immigrants racing into the US to give birth to US citizens eligible for FREE LIFETIME HEALTHCARE.

[gaby]

My sister had a freak accident (not car accident related) in which she fell so unfortunately that she broke her arm in two places and hit her head so hard she lost consciousness. Well, there was an ambulance ride, two surgeries, x-rays, prescriptions, etc etc. Between the deductible, copays, and insurance companies refusal to pay for some of the items, she was stuck with a huge bill - despite having insurance. I wondered what on earth is the point of having insurance when you are not properly covered for anything? She would have been better off not having insurance at all and filing for bankruptcy or medical hardship.

[doog]

Richard, for the love of God, get an enema.

[M]

Hi Barbara, I agree with you. But my concern about the 2 to 3 million employees of insurance companies is that they are also voters. (Although, like the rest of the country, maybe only 30% of them will actually vote next year.) But this issue about employment for the hangers-on to the healthcare industry is genuine. American employment has been hollowed out over the last generation; so much so that many regions are reliant on the health industry to maintain middle class standards of living. My own East Coast city is a center for healthcare and its related industries. So I think this issue about displaced insurance employees is a valid concern for the transition to a humane system of healthcare in America.

But I have another fear that I think is more serious--can our current infrastructure (the number and quality of facilities and staff) handle the demand for services when the restricted population suddenly gains access to care? I think our system is not up to this challenge. As it is, there is already a national shortage of nurses and OB/GYNs. Can our universities pump out enough qualified staff in time to meet increased demand? We need an American NHS, but we need it to be successful during the transition. I think we need community involvement to promote the quality of healthcare services, but just as only a small portion of our population actually votes, I am uncertain about how regular people will support this effort for NHS. Most people will be glad to not have our jobs tied in with our healthcare, but when the reality of our dysfunctional system becomes more blazingly apparent, I think most people will only get involved at the level of disappointed consumers. And that in itself could deep-six NHS even if the plan gets through our electoral system.

Once again Barbara, thanks for your writings and your activism.

[John]

The New Deal made America safe for capitalism.

[Courtney]

I've found myself surprised that Kucinich is actually a perfect match for me, candidate-wise. I'm not quite sure what to do now, knowing that he has little to know chance of getting the nomination and yet, my heart rests with him, even with the whole vegan thing...

[Tysyacha]

I would GLADLY pay health insurance premiums if I could find a company that does not list "cerebral palsy" as a pre-existing condition. I've got it, and it's here to stay, so I guess I'll have to pay out of my own pocket if I want a physician's checkup, dentist appointment et al. I consider myself very lucky that I can afford to, so far, but my luck could run out someday.

My friends at work who have disabilities are covered by Medicaid. They and I all have jobs, but if we make too much money, we lose our services and supports or have them reduced.

Would it cost insurance companies that much more money to treat individuals on an individual basis instead of denying them coverage in a "blanket" sense because of conditions they already have? I'm pretty healthy, and yet I do have CP.

Insurance companies would MAKE more money off of me than they would lose paying for my medical claims.

By the way, my job pays a good salary, but it's a year-to-year deal with no benefits. I love it, though. Wouldn't quit for the world. Or Medicaid! ;)

[Conservative Observer]

Tysyacha,

You have cerebral palsy ? No problem. Just hop on any flight enroute to any International airport in Canada, and once on CDN soil, declare to the Customs officers you wish to claim refugee status. After this takes place, it is encumbent on you to make the authorities know the hardships you face in the US and that you would like to take advantage of Canada's generosity and be granted asylum. Usually people from more obvious nations take advantage of Canada, but we need to look after our American brethren now this crisis looms large.

Heck , if you are really persuasive, you can immediately get free housing, a monthly allowance and a slew of other benefits including furniture, clothing, food, entertainment vouchers (yes it's true).

Health care treatment is always assumed as part of one's landing package, so you need not worry about inquiring. You have full access to any health service any other taxpayer or resident has, so don't worry about discrimination.

Hope to have you aboard soon.

[CanadaKat]

What is the issue folks? I mean, really...

Socialized medicare - I've got it and I love it.

A few things you should know about our Canadian version of it...

-it is not free. Each individual pays for it. Twice actually. Once to the province you reside in and once to the federal government. Even the unemployed pay for it - their welfare or other benefits adjusted accordingly.

-Doctor's rarely, if ever, face lawsuits here so that's a ridiculous argument (I think Chris mentioned this a few postings back).

-Everyone gets to communicate directly with their caregiver regarding the care they need - no non-medical middleman making the decision (how ridiculous is that?)

-it has not prevented us from producing some of the best caregivers, care, and medical technology in the world.

-it in no way seems to cramp the capitalist ambitions of med tech companies, private developers etc. who do quite fine, thank you, selling to healthcare providers.

Oh, and...it serves a capitalist world (which we all must function in)quite well too - by helping to ensure that as many as possible are productive worker bees.

Okay, would someone please explain to me the outright hostility, evident in the postings from those vehemently opposing any form of providing this type of care?

I mean, I just don't get the apparent lack of caring (that's my right brain talking) or the apparent refusal to admit the benefit it provides by making sure we are all fit and able to work - the country actually spends less on unemployment, disability income plans etc. (left brain talking).

And to Chris, who a few postings back made a non sensical assertion that 'universal' health care would cost you so much more...please, please, provide your sources. Everything I have read says otherwise. I suspect you're just blowing hot air.

[CanadaKat]

Chris-you wrote:
"Of course no one has proposed that we expand Medicaid to incluce the entire population. Who would expand a program where fraud runs rampant and medical services are routinely inferior?"

Exactly one of the reasons why the US should revamp the entire system.

And...
"Healthcare costs are rising far faster than the rate of inflation. No government plan can change these facts."

Yeah Yeah, just like every other cost of living expense (too bad wages aren't). And, it means that what I have to pay, via taxes, into my healthcare services increases too. So what - what I (and my entire family) get in return far outweighs anything I have to pay.

Honestly, folks, it really is worth a look. There may actually be some things (not all - I don't like too much big government either) that a government should help provide.

We've long outgrown the days when 'government providing for security of the state' simply meant self-defense.

[Jonathan]

The reason to change the Health care system is not for some altruistic rationale, but because it will be good for American business. The current system is so deeply entrenched in the reimbursement game that it functions at minimal efficiency. The whole system is organized around reimbursements. Providers are organized in ways to maximize reimbursements and pyers are organized to minimize reimbursements. Health care should be organized around providing healthcare, not around the money flows associated with health care. The best way to create competition in the health care sector is to have a single payer system. Then providers can compete for business based on their health care service and outcomes, not on the contractual arrangements that lock in numbers of patients.