September 27, 2007 - Looking Goliath in the Eye

I realize I’ve been writing a lot, recently, about the health-care funding debate in this country, but that’s partly been because of the long gaps between medical appointments that lead to lots of “slow news days” with respect to my own health situation. (By the way, there’s going to be a further delay before I hear from the Tumor Board at Hackensack University Medical Center; they’d like me to travel up there next Thursday for a consultation with a Dr. Feldman, a member of the Lymphoma Department, before the Tumor Board makes their decision.)

I was concerned about the plight of the uninsured even before I got sick, but the ever-growing flood of window envelopes pouring through my mailbox has led me to feel even greater compassion for those who keep getting hit with budget-busting medical bills and have no way to pay them. Furthermore, my prior experiences of living in England and Scotland have given me a generally favorable opinion of single-payer, national health programs. I’m convinced that most of the tiresome screed decrying “socialized medicine” that we Americans hear so often is pure invention, promulgated by panicky people with no firsthand experience of how well the European and Canadian systems actually work for most citizens.

So, there it is. My cards are on the table. I believe our health-care funding system has become so bloated and dysfunctional that it's beyond any kind of tinkering. It needs to be rebuilt from the ground up. (Please note that I'm talking about our health-care funding system – the creaky, complex medical-insurance system that puts the needs of stockholders above those of policyholders, and wastes billions of dollars on pointless paper-pushing that could otherwise be spent on patient care. Against all odds, we still somehow have a health-care system we can be proud of - or, at least, that the insured among us can be proud of. The quality of care available to most insured Americans is still among the highest in the world – as is also true of national-health-insurance countries like Britain, France and Canada, that also manage the feat of caring for all their citizenry.)

Given that presupposition of mine, it will come as no surprise to hear that I was terrifically impressed by a recent essay by journalist Barbara Ehrenreich. She's written some interesting things in the past: most notably a provocative book, Nickel and Dimed: On (Not) Getting By in America (Holt, 2002). In that book, she chronicled her experiences working for several months at a time at minimum-wage jobs, trying to live on that salary alone. She had to work two jobs, seven days a week, and still nearly ended up in a homeless shelter. Her conclusion? In our economy, minimum wage is not a living wage – not even close.

In a September 20th blog entry, We Have Seen the Enemy – And Sur- rendered, Ehrenreich suggests that one of the most fearsome enemies the American people are facing today is the multi-billion-dollar medical-insurance industry. So cowed are all the presidential candidates by the bare-knuckle power of this industry (with the sole exception, she says, of the rarely-heeded Dennis Kucinich), that no one has come close to suggesting total, paradigm-busting reform, along the lines of universal health care. The most any of them are suggesting is baby steps.

Big Insurance is a mammoth industry indeed. Citing economist Paul Krugman, Ehrenreich points out that this industry employs "two to three million people just to turn down claims."

Our spiraling medical bills are not only paying all those pointless salaries ("pointless" because they benefit stockholders at the expense of policyholders). They're also indirectly funding both sides of an ongoing, ever-escalating war between doctors and insurers. The insurers get tougher, rejecting more claims. The doctors employ specialized office workers to circumvent the insurers' rejections. The insurers respond in kind, continually increasing their workforce of abominable no-men (and women). And on and on. Caught in the crossfire, uninsured and under-insured patients become "collateral damage."

Unlike other industries, which grow by producing more, the way the medical-insurance industry garners profits is exceedingly odd. It grows by turning potential customers away:

"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?"

I'd encourage you to take a look at the entire essay. If nothing else, it will give you something to think about.