fragments of an attempted writing.

slave and free according to paul....

As Murphy's law would have it, after I got laid off and we lost our health insurance my wife and I have had a number of health issues arise that have cost us in the tens of thousands of dollars, and we have a number of things, especially dental, that we are just not dealing with until we have insurance and more income again.  Such is more than just a pain in the ass.

There was a time before kids when we talked about leaving the U.S.  We wish to God we had now.  Our friends in the UK have a level of economic stability we will never have here, in large part because medical conditions are not something which will lead them to bankruptcy so easily as here.

Part of this experience has involved both of us making use of the local "Church Health Center" which has solidified in my mind what a God awful nightmare it would be to have to rely on Christian charity to get healthcare.  The services there have rarely risen above the level of useless, and we still have to pay for them, though we have learned that it is almost always more cost effective to put a few hundred dollars on a credit card for real health care, not knowing how we will pay it off, than it is to spend 40 or 80 bucks or whatever they charge us sliding scale that week for the charity health care.

Some thoughts:

1.  If a "right" to health care requires slavery, then quite obviously a "right" to having police, and interstates, and a military, and state parks, and state funded medical research, and a trademark office, and many such other things also requires slavery.  The Paulies will of course assert that there is this magically immutable piece of paper ratified 224 years ago which leaves the state with the right to sometimes take things away from me to suit its ends in a few situations, which in those cases presumably is not slavery, but does not give it the right to do so in other situations.  Uh, how this in any way relates to a meaningful use of the term slavery is beyond me.  If the government may kick my door down when I refuse to move in a case of immanent domain, I can't see how this is any less slavery in this loosey goosey use of the term than forced universal health care is.  I did not choose to be born into a society with a magical immutable document which grants the state the right to enforce immanent domain rulings.  I wish the hyper free market libertarian people who call me a hypocrite for being a communist who uses a computer and the internet would go the route of the old Catholic Worker hero Eamonn Hennessey and stop using roads.

2.  A curious thing.  A number of libertarian folks I know expressed contentment at me receiving unemployment when I was laid off because I had (or rather my employers had for me) paid into unemployment insurance for many years.  Thus I was getting a return on money I had put in.  But when these same folks found out I took government grants to go to school, there was the usual libertarian disgust.  Again, do these people not drive on government roads?  But aside from roads we might focus on the incredibly sophomoric view of "what is mine" or "what I have coming to me" involved in the sort of assumptions typically made by libertarians on these issues.

Behind the assertions made by libertarians there is the underlying conviction that there are clear delineations to be made with regard to what is mine, what I have rightly earned, and what is rightly due me in our finance/credit driven late capitalism.  Rubbish.

I have worked for 3 large corporations in my lifetime, one among the 200 largest privately owned businesses in the country, one a publicly traded Fortune 100 company, the other publicly traded and in the Fortune 500.  At all three of those corporations any observer of average intellect could quickly observe that pay did not at all correspond to performance or quality of work, especially in management positions.  In one company I worked for a department head was promoted to a vice president position because of work that had been done by two staff members under him (neither of which was me, by the way), both of whom he did not hire but had inherited from his predecessor.  He took enough credit for the work to get the promotion, the people who actually did the work got nothing - no increased wage, no increased Christmas bonus.

That sort of story happens over and over and over again in American business life.  The people who succeed at making the most money are generally not the brightest or the most talented or the most productive.  Generally speaking, they are the most ruthless and ambitious and are among those with the prettiest faces and most practiced in the arts of corporatist charm.  I worked in the mail room of a large corporation (the private one) and all of the managers in the engineering department went golfing each Friday afternoon (weather permitting) with their VP (when the weather was bad they went to an indoor computer golf range place with a bar).  When the VP there was being moved to take over a sister company and he needed to be replaced, his replacement (which he picked), was the manager who was his long time golf partner in the Friday afternoon games.  Everyone in the department, as well as people out of the department who had no reason to be jealous, remarked that the new VP was the dumbest and least productive of the managers in the department, but he was the best golfer.  This sort of thing is how business in America works at almost every level.  If you think otherwise you are fooling yourself.

I have also worked, indeed spent most of my adult like working, for small family owned businesses.  You know - the sort of businesses that often have to actually pay taxes because they don't have as much means to shelter their money from taxation in the manner large corporations do.  The one I worked fulltime at here in Memphis before my layoff, and now work partime at, is typical - the business was started by a man with a utility job he worked during the day.  At night he came home and made chandeliers, literally bending brass tubing over his knee.  He was hardworking and talented.  His wife then sold the lights out of their living room during the day.  Nice story of American entrepreneurial spirit, right?  Uh, yeah, but it ain't the whole story.  The man who did the knee bending came from Southern aristocracy, but his family had lost everything after the Civil War and had been poor for three generations.  Still, in the South coming from a "good family" means you can marry into another one, even if your "good family" has no money and hers does. Hers did.  Memphis elite of the highest caliber.

So when our hardworking man is spending his nights making lights, daddy-in-law is telling all of his elite friends and associates they have to go buy some for their homes and businesses.  In keeping with the rules of Memphis society they do so.  And the lighting business takes off. But to say it took off because of hard work is only part of the story.  It came to be worth many millions because of a social connection that most people have no access to.   And in not a long period of time some of those same lights would be made in sweat shop conditions in Memphis (the rest made in sweat shop conditions elsewhere).  When the knee bender dies, his wife would have to come in and sign checks and she would literally break down crying the first time she did it, upon seeing how little her employees made.  Everybody got a couple dollar an hour raise - which wasn't bad in the 90s, but brought a lot of folks up to just a little past minimum wage.  It would take the founder's grandson to fight with his father to get wages at all comparable to what one might make in a non union Toyota plant in Mississippi or somesuch.  The second generation of this company revealed little business talent, certainly no skill at making or designing or selling lights beyond the means to do those things which he inherited, but the company continued to grow because by the time the founder of the company died it was an establishment among wealthy people in Memphis.  If you have money in Memphis, you go buy your lights there.

Another small business I worked for had an owner who was adept at business, and pulled himself away from almost certain business demise a number of times by securing deals which brought in needed income at the last second.  But this man married a lady who grew up on Martha's Vineyard, and her father, of east coast old money, had to bail out my boss several times over the years, and, again, had it had not been for this father-in-law I never would have worked at that business as it would not have existed.  While this same man (the owner) was able to charm people into seemingly implausible deals from time to time, he had no sense whatsoever when it came to many practical things.  For instance, he always insisted that we take the company van to the Ford dealership the company had bought it from.  We put a lot of miles on the van, and it was in the shop all the time.  Eventually some of us noticed that the van seemed to be going back to the shop for the sames things over and over again.  Finally one of the managers got out all of the receipts from van repairs for the previous 3 years, and discovered that in 3 years time the company had paid more in repairs than they had paid for the van itself.  Considerably more.

In the companies I have worked for, taken as a whole with the occasional exception, I believe I can say without hyperbole or exaggeration that I have contributed far more to the company than the wage I earned - I made a lot of money for them.  I worked hard to make mediocre men, whether owners or managers/execs, richer, while I got very little in the way of financial security or a means to provide for myself long term.  In most cases, the owners or managers/execs I worked for provided the company/corporation little in terms of real net gain.  They have mostly been window dressing.

I realize that this is all anecdote, but I have been fortunate in my life to have worked in a number of settings which brought me into contact with a lot of working people outside of my own workplaces, whether travelling to institutions to buy books, or dealing with designers, retail sales folks, and other shop foremen when I was foreman of a small metal shop.  Perhaps my own workplace experiences and the vast majority of workplaces I have visited are anomalous, but I am inclined to think that my experiences are rather typical.  Having read a lot of American labor history in recent years only increases the strength of this inclination.

Thus when someone talks about it being stealing or "slavery" to tax people like these owners, managers, and execs I describe above in order to pay for health care for folks like me, I can't but scratch my head.  I would not in that case be stealing, nor would anyone or any agency be stealing on my behalf.  I am getting what is due me.  I've spent the bulk of my life working for these and their kind, allowing them to live lives of comfort and ease in return for little more on their part than polished social skills and a pretty face.  And while my caricature of the contemporary man of business may not apply to all - anyone who makes income on the financial markets, or "secures" their wealth on the financial markets, is making or securing wealth via means which necessarily result in wealth distribution not correspondent to skill and productivity.  This means that virtually everyone in America today who has considerable wealth has made it and/or secures it through means which involve doing what has been done unto me - taking the labor of the little guy in order to fill the pockets of people who don't earn what they make by way of a labor that in any meaningful way corresponds to their wealth.  Of course there are exceptions, and the aggregate of those exceptions tends toward the smaller of entrepreneurs. Thus it would seem an appropriate tax scheme might be one which hits the CEO of Goldman Sachs a hell of a lot harder than, say, my friend Henry who sells books out of his home.  But current tax structures are not so ordered.

Aside from the moral equations either side wants to use, in the end it is about the securing of interests.  As Buffet put it, it is class war and his side is winning.  The Rand Pauls of our social order are working to secure the interests of a minority whose wealth and ease is secured because of the work of a majority.  Naturally, I am concerned with the interests of my own family, and the families of my friends, and the interests of those folks requires conflict with the interests of those for whom Rand Paul is an operative.

In this sense, there is one level of discourse I am comfortable with in the language of the libertarian.  There is scarcity in the world.  There are limited resources.  Because of this reality, economic dispossession will always be with us.  The question is who is going to be gaining from the dispossession.  In the current neo-liberal order we see clearly where the lines of dispossession are occurring throughout the world, if we bother to look.  Those with my economic convictions want to see dispossession occur for a decidedly different set of people.  And let's face it - most people endorse a given approach to economic life for reasons that have to do with what they will believe to be best for them and their families.  Find me a person who embraces an economic ordo that they believe will hurt them.  In prior ages we had aristocratic Fabians, but such persons are harder and harder to find as mass capitalism plays out its hand.  Yes, one sees many working class folks in America embracing Rush Limbaugh nonsense, but this is only because they have drunk the kool aid which has convinced them of such lies as tickle down economics still bringing about good jobs and the like.

3.  When talking to Christians who are libertarians, there is an unfortunate moral/spiritual line of thought which enters the discussion.  Namely, that when the state acts as the redistributor of wealth, the opportunity for charity is diminished.  Again this strikes me as specious in the same manner of my roads above.  If we want to be childish in our embrace of truisms, we should note that by providing a military to protect me, the state denies my neighbor some potential opportunities to lay down his life defending me from the attack of a foreign army.  And there is no greater love than laying down your life for a friend, right?

If I were again to sink into anecdote I would note that in my experience in countries with universal health care, local Christian charity work involves less collecting of money than American Christian charities do, but more in the way of volunteering of time, but that is just a tangent.  Another thought that comes to mind is that this is another arena in which the libertarian irrationally asserts that large government efforts are somehow always and of necessity more inhuman than large nonprofit or forprofit efforts.  I wish some of these folks could experience health care at both my local public health clinic here in Memphis and then at the local large charity clinic so as to note the difference in quality of care.  Such an experience might incline them to change their minds on the government always worse regurgitations, though I doubt many libertarians have minds capable of change.

The truism about the loss of potential charity is an assertion with some huge blinders on.  No doubt certain opportunities for individual volitional charity are lost, but then again, opportunities for individual self-righteousness increase exponentially when government redistribution is gone.  The Church Health Center here in Memphis never ceases to miss an opportunity to assert its self-importance and to treat its clients in a condescending manner in which they are informed of how wonderfully Christian the folks providing them "help" are and how wonderful the donors are.  Having lived and worked in a homeless shelter for a year and grown up involved in Christian charities of all sorts I think this rather the norm.  Christians who give the sort of money it takes to keep such formal charities running tend be very assertive about their giving and seemingly incapable of not letting the right hand know what the left it doing.

When the state taxes you in order to provide health care for others, you can know that some of your hard work goes to provide medical care for others.  But you are not special in this manner, as everyone else who works is giving in the same manner.  No one is singling you out for your charity, no one is giving you a pat on the back.  You don't get that good feeling you get when you spend one afternoon every 3 months at a soup kitchen providing for the poor.  And never mind that a single payer health care system could potentially be much better run and much more efficient than a bunch of various and sundry Christian charity programs if such a government program could ever exist free from corporate domination (such as we see with Obamacare) and be allowed to flex government muscle against corporate interests.  Never mind that when you get outside the arena of homeless sheltering and rehab programs and the like and start dealing with issues pertaining to long term support for the working poor Christian charities often have a notorious reputation among other nonprofits dealing with those groups.

Charity seeks what is best for others.  It does not concern itself with the contribution/role it plays in bringing about that best for others outside of a concern for the other person.  But this whole "denial of potential charity" line seems to assume that all human interaction takes place in some sort of anti-human vacuum of social exchange.  As if I don't have the opportunity of being charitable if the government is coordinating charitable acts.    Come with me to the VA hospital sometime and let us watch the different nurses there in action.  The nurses working on a given floor are all making in the same ballpark in terms of salary.  They are all working for the government.  But the degree to which charity is involved in their work varies considerably. Somehow I think the capacity of humans to have charity toward others would survive a single payer health care system just fine.  I have never noticed a decided poverty of charity among practicing British Christians in comparison to practicing American Christians.

To be continued...


  1. I suppose that when I exercise my RIGHT to habeas corpus, I'm enslaving a lawyer?

    (using Randy Paul logic)

  2. I like how Sen. Bernie Sanders responded to Paul's statement by asking a Vermont doctor at the hearing if she thinks she's a slave and if she fears local police will beat down her door in the middle of the night to force her to see a patient. Of course she does not, further highlighting the absurdity of Paul's remarks.

    Perhaps it's time to move to Vermont now that they are on the verge of implementing universal health care.

    As recently as four months ago I would have said that Wisconsin is a humane place to live, thanks in part to BadgerCare health insurance, which was created by a Republican (!), Governor Tommy Thompson, in the 1990s.

    My family has been on BadgerCare for almost two years, after my husband lost his job that provided health insurance. The income guidelines are fairly generous. You don't have to be living in poverty to get BadgerCare like you do for Medicaid. Once one's income ventures too far up into the lower middle class range the parents no longer have access to it, but all children do, as long as their parents pay something of a premium, which can't exceed 5% of their income.

    Now that Walker is governor, he wants to lower the maximum income allowed for parents to remain on BadgerCare and boot many of us parents off the insurance by next summer. Given that my husband has two chronic diseases, I'm not looking forward to that possibility. Even if we do get to stay on BadgerCare it's possible Walker will horribly mangle it beyond recognition anyway, as the bill will give him the power to make any coverage changes he wants.

    At any rate, it's very unfortunate the words "single payer" get the conservatives and libertarians far more worked up than stories like yours of racking up tens of thousands in medical bills while uninsured.

  3. Rand must not have any problem with talk of wage slavery...

  4. The bald Mexican14 May, 2011 04:41

    I'm glad to see you have returned to your rambling posts. I'm conflicted, I suppose. On the one hand, I really don't want to bourgeois state to provide anything. They're just going to fuck it up, or put profits before people, or something. Just look at the privatization of Iraq and the military. Government intervention without workers' control is just going to lead to all sorts of problems. I think the libertarians and the Tea Partiers know this instinctively, but they are just being manipulated by capital to do capital's bidding. The real tragedy is the Ron Paul is the only real major political voice who makes noises about dismantling the imperialist empire. I think it is just for show (maybe he might be an anti-imperialist, since the empire is expensive and some of the bourgeoisie are uncomfortable with it), but in the end, libertarians are just the tragic clowns of finance capital.

    The ironic thing about being "taxed enough already" is that while people complain about income tax, it is really sales tax and inflation that kill the working class and lower petit-bourgeoisie. I say get rid of all taxes for everyone but the capitalists and make them pay for it. Price controls would be nice too. But for that, you would need to have a mass workers' movement, general strikes, factory occupations, and so on. Not holding my breath.

    On the other hand, I am naturally authoritarian, and feel that if we have to coerce people into doing the right thing, so be it. Even if revolution is going to happen, there will no doubt be some form of authoritarianism taking the place of our current order of bread and circuses without the bread. The Hegelian side of me is fine with that.

  5. The other year we had $14k in medical bills with insurance. When we were looking at disability recently, we found out that medicare copays on my perscriptions would take most of the SSDI checks. The entire system is fucked.

    The problem with our society today is that no one is trying to murder guys like Rand Paul.

  6. "The problem with our society today is that no one is trying to murder guys like Rand Paul."

    Were the working classes ever to rise from their slumber, I would like to see them go after capitalists first, say the execs of big pharma companies and pretty much anyone manager or higher at Goldman Sachs, etc. Those folks beg the world for liquidation. Of course, once you start knocking some of their kind off the others will offer more and more reforms, as Arturo suggests, which will only buy Capital more time. Sigh.

  7. I still find it hard to square this excellent post (plus TBM's comment, with which I am largely in agreement) with the comments section, in which words like "murder" and "liquidation" are so casually used. In an abstract way I suppose there is an equivalence between the modern executive and the tyrannical despot, but it doesn't quite work for me. Perhaps I lack the requisite Marxist phronema.

    On another note: Owen, perhaps in another post or comment you could address what you see as the problems of "Church Health Centers."

  8. If I might offer my dissenting view for a moment…

    Without denying that there is a health care problem in the U.S. with respect to individuals who are under- or un-insured, coupled with runaway costs and a poor distribution of resources, I would suggest that the first step is to address the regulatory failures which, if they don’t give rise to these problems, at least exacerbate them.

    The health insurance industry in the U.S. abides as government-sanctioned monopolies in most states. The price for monopolization, however, are counter-productive regulations which compel these firms to avoid risks they might otherwise take and restrict their manner of coverage. For instance, most health insurance companies must, by law, allow its subscribers to opt-out of the insurance program once-a-year. That sounds great, right? Nobody wants to be “trapped” by an insurance company. The problem is that by limiting the ability of insurance companies to enter into long-term contracts with low-risk individuals, it undermines their ability to hedge their bets when they are considering insuring riskier parties. It also raises these companies’ administrative costs and prevents them from engaging in the sort of long-term planning other industries are free to undertake. This is just one example of a regulatory failure, but it’s a substantial one.

    Moreover, state health regulations time and again dissuade low-cost health care providers from entering the market to provide basic services (including preventative care). By not allowing real competition in the health care market, you set the stages for an environment where innovation is stifled, prices are (likely) inflated, and people are effectively forced to seek more expensive avenues of care (whether or not they can afford it).

    I don’t see, for the life of me, how adding new layers of regulation is going to solve a regulatory failure. Had the Obama Administration taken proactive measures to reduce regulatory burdens and see what the market could provide first, I’d be a lot less skeptical about the entire venture. I suspect that there would still be a problem with people receiving inadequate health care coverage/services, but once you see where the market failures exist (assuming that they do), you can take more meaningful steps to correct them (or at least assuage their impact). “Obamacare” won’t do that. Instead it will hand the reins over to the same folks who came up with the U.S. Postal Service. No thanks. I’d rather take my chances with the sort who thought-up FedEx and UPS.

    I’m not in the least bit surprised that the healthcare issue has been hijacked on all sides of the political divide by people who neither care nor understand where the problems lie. The vitriolic rhetoric of the Right is as nauseating as the moralizing of the Left. The problem is that neither side are offering a workable roadmap to meaningful regulatory reform which can leverage the benefits of the market to increase the health care supply before deciding to expend public money on programs which, any way you slice it, will be suboptimal (but “suboptimal” is far better than nothing).

    But on a personal note, I’m not thrilled about the coming health care plan because, well, I like my private plan. Yes, I suppose that’s a selfish reason to be opposed to “Obamacare,” but I don’t see the issue as an either/or. I should be able to keep my plan and many other people should be able to access affordable health care and insurance. We can get closer to that end goal if we think seriously about taking away state-mandated monopolies and letting the market—that great artifice the libertarians are always going on about and yet fail to fall back on if their own interests are compromised by it—carry some of the burden.

  9. Gabriel,

    I hope that I have never written anything which would lead someone to believe I support Obamacare. There are aspects of Obamacare which I support, but by and large I see it as further empowering a system which I believe to be highly ineffective and systemically unjust. The perversity of American liberalism is that it sees Obamacare as addressing the problem.

    Have you ever read any of Wendell Potter's exposes of the health insurance industry, or heard him speak?

    I've used this story before - I heard an interview with a guy doing a pharma start up which was basically coming up with new versions of old anti-biotics for which there were no current intellectual property rights issues. These drugs desperately needed to be updated. But the big pharma companies were not interested in that work because the profit margin was not going to be high enough. This company was going to be redoing drugs which in the end would be cheap because all that was involved was relatively slight alterations of old and cheap anti-biotics, but these alterations would potentially save thousands of lives because these new versions of old drugs would work against so called "super bugs" and have other applications which would be very important from a medical point of view.

    Then I took that Biotech class when I had time to kill last year and learned of how big pharma companies are buying the intellectual property rights to certain recombinant DNA technologies and other more advanced potential technologies with the sole intent of NOT using them in a clinical setting. I wrote a paper on recent Cerebral Palsy research and learned that Biotech firms owned by big Pharma companies have bought the rights to biotech intellectual property which many scientists believe will almost certainly one day provide a quick, easy, and cheap cure for CP in most CP patients with particular genetic patterns. But those companies are not working towards producing those cures. They are sitting on those intellectual properties and paying for research which would lead toward long term treatments of CP - treatments which would effectively end all symptoms of CP, but which would require the sufferer to receive the treatment for life. It is interesting to note that almost all the initial research for CP biotech was done with government funding. So your tax dollars basically found a potential cure for CP, as well as a potential long term effective treatment of CP, and then big pharma bought both, and is only pursuing the treatment instead of the cure because it stands to make a shitload more on the treatment than on the cure. It doesn't want a cure, as cures are bad for business.

    I don't see how deregulation will change anything in pharma in terms of providing greater care or greater efficiency. Pharma companies want to make their money on drugs which they can make a killing on, and they want a significant portion of the American populace to be sick at any given time.

    Coming back to health care - given Potter's utterly damning description of the health care industry (and talk about an insider's insider - I can't think of any other industry which has had a higher ranking and more intimately knowledgeable insider turn against the industry than what we see with Potter), I simply can't accept that it will in any way reform itself in the event of lessened regulation. Sure, there are aspects of current regulation which the companies hate (as you suggest with one year re-ups), but the majority of regulation for health insurance companies was written by lobbyists for the health insurance companies.

  10. cont'd

    You state that you like your health insurance. I am going to assume that you are insured through your employer. The type of institution that your employer happens to be is one of the last types of institutions where one can csn occasionally still get decent health insurance programs, outside of a state job. At my shop the Blue Cross Blue Shield PPO plan the company offers full time employees has been altered in the last 5 years such that employees now pay more than double what they did say 4 years ago for the plan, have a much higher deductible and co-pay, and are insured for less services/treatments/drugs/etc. My wife watches the insurance programs of large employers in our area and has seen the same phenomenon going on in many companies in our metro area. Whilst the increase in health care costs is what we usually hear reported on the news, the actual costs of health care for most Americans who get health care via their employer has shot up much more than the overall increase in health care costs as a raw figure - for the obvious reason that companies will use any excuse they can to pay less benefits, and have passed on considerably more of the cost to employees. My (then full time, now part time) company made record profits in the first quarter of this year, having laid off so many employees but still selling things. But they still have reduced salaries and benefits because they know that in the current Memphis job market nobody is going anywhere.

  11. cont'd

    As you know, my wife fights insurance companies for a living. I realize that any story I tell of her work is only anecdotal, but with the work of Potter and others who are cataloging abuses of the health care industry, we can observe that the abuses my wife sees every day are routine, they are normal for the industry. You may like your insurance now, but in the event of certain medical problems you may find that you quickly hate it, as you or your wife may have to essentially work a part time job to get them to pay what they said they were going to pay. While some have to fight for care in a single payer system in the UK or Canada, I see no indication that the efforts to get needed care there are anywhere near as routine in the UK or Canada as they are hear. The health insurance companies' penchant and obvious motivation for fraud, not to mention their many decades of experience honing their skills at it, is not going to go away in the event there is some sort of near total deregulation of the health insurance industry. The big players are going to still have many means at their disposal to get the big contracts. They are still going to force health care providers to comply to demands (for instance, in many states insurance companies can require providers who are in contract with them to refuse to offer uninsured patients lower pricing scales than insured patients, thus these companies drive up health care costs overall). The idea that smaller, cheaper, better run health insurance companies will arise and clean up the industry in the event of deregulation requires a faith in humanity and in the processes of free market capital that I can't manage. When my auto/life/home insurance company, USAA, started offering policies to anyone and everyone, and not just military and the kids of military, even though they are a non-profit which is far higher rated in customer satisfaction than any of their competitors they still did not take a significant amount of marketshare or do much to change the modus operandi of other insurance companies.

    In the event of deregulation. If these new companies are public and they offer solid competition to the old large rich companies they will be bought out. The same will hold if they are private companies unless some private group thinks it is their calling to offer cheaper better insurance and not take the gobs of cash the big company is offering. Potter has clearly shown that the big insurance companies are in cahoots together, why will that change post de-regulation. It is in their interest to continue to deny paying for care as much as they possibly can.

  12. cont'd

    But in the end the reason I support a single payer system over a libertarian free for all is that we have seen those places where single payer systems work rather effectively, and at far less cost than what Americans pay for health care today. The NHS faces many of the same problems that American hospitals face - increased rates of nosocomial infections, waiting lists, rationing, etc. But we have that in America today - the vast majority of Americans face those issues in some fashion during their lifetime. Britains, usually a quite bitchy lot when it comes to services, routinely rate the NHS quite high (just this month 66% of Britains stated that they believed the NHS provided the best health care in the world). Despite the rather mundane problems one finds in the NHS, in Britain folks who have medical problems rarely have to declare bankruptcy. There are drawbacks, sure. I had a dear friend, Mark, who died in England of a brain aneurysm. He died one week after the discovery aneurysm and was being treated for it. My mother, an RN who got most of the details she could as she had known Mark when he lived here in the States for a year, believes that had Mark been at a decent hospital in a large American city he would have survived. He would also have been bankrupt if uninsured or not sufficiently insured, but he would have survived. That sucks. But for your average 54 year old who has a heart attack, they are a hell of a lot better off in Britain than they are here. And there society is better off for their care, as high medical related bankruptcy rates are highly disruptive to local economies, even if they mean nothing to the Wall Streets of the world.

  13. Even if a liberalized healthcare system would improve care for the general population - which I doubt - it would be disastrous for the chronically ill. There is no free-market reason to cover someone for less than their guaranteed cost of medical care. Though, even under Obamacare, it would still be cheaper for an insurance company to drop someone on the new generation of chemotherapy and take the monthly fine (which is price at a 2000% markup, plus or minus - pharma really fucks you over when your life is on the line).

  14. It took me a day to digest this, but let me see what I can come up with here:

    First, to answer Lotar's point, I readily concede that there will be people who cannot (or will not) be insured in the private market, at least not for a price they are capable of paying. I would rather see government resources diverted to these cases than spread thin by trying to create something that looks like "universal healthcare." There's no need for that. I would object on one point: If insurance companies could be more dynamic about the deals they enter into with individuals/employers, they would be more willing to insure marginal cases for the simple fact that they have more in the bank to back their bet (and, really, all insurnace is a bet to some extent). Does that cover everyone? No. Does it cover the sickest? No. But it does extend the blanket of coverage without the additional administrative costs associated with regulatory oversight or silly penalities which do little more than raise prices for consumers.

    Second, I didn't mean to imply that the regulatory schema is a "failure" from the medical profession's standpoint (though in some instances it is). My definition of regulatory failure rests on whether or not the regulations result in an aggregate social welfare loss (which it does). The state-sanctioned monopolies are a boon for insurance companies; competition would be most unwelcome except, naturally, to those who are fit to compete. It would be a disaster, however, if the current regulatory schema was maintained while attempting to promote a freer market in health care services. At that point, you get none of the benefits of competition and all of the waste of regulation. No thanks.

    Third, I acknowledge the problems with the pharma industry, though I would posit that the issue is more complex. In the U.S. at least, pharma companies are incentivized only to pursue high-profit margin R&D. Why? Because their losses are so spectacular and the oversight process from the FDA is extremely burdensome. This doesn't justify in any way the behavior of pharma companies when it comes to denying the right for others to engage in R&D which, as you note, has the potential to save/improve lives. But that's a larger problem with I.P. law as a whole. I generally favor dialing-down copyright and I.P. protections, along with allowing for a fairly broad menu of defenses to litigation.

    As a final point, my argument is not for keeping the status quo or measuring off the status quo against other health care systems. I generally believe that the U.S. system can be improved, even radically so, through more recourse to the market. Maybe that's the "libertarian" in me, but so be it. I have seen very few instances where heavy-handed government involvement has produced concrete benefits for Americans in need of health care and the process of regulatory capture has given many health care industry stakeholders a free pass to profits without the benefits for consumers at large which are supposed to go with it.

  15. Gabriel,

    Yesterday, Robert Zirkelbach, spokesman for America's Health Insurance Plans (AHIP) took aim at the health care advocacy group Health Care for America Now (HCAN). HCAN took issue with AHIP's assertion that the average profit margin for health insurance firms is just 4.4 percent. Zirkelbach did not explain how he came up with that figure, but considering the fact that the big for-profit insurers had significantly higher margins than 4.4 percent last year (according to Yahoo! Finance), AHIP's calculations must have included the insurers that, at least in theory, don't make profits at all, like the so-called nonprofit Blue Cross and Blue Shield plans.

    In a memo to editors and reporters Thursday afternoon, HCAN took issue with the 4.4 percent figure and accused AHIP of trying to pull the wool over journalists' eyes.

    "AHIP's focus on profit margins is misleading and designed to protect their massive income by shifting attention away from their return on equity -- a key measure of profits as a percentage of the amount invested," HCAN's executive director, Ethan Rome, wrote.

    "That return is a phenomenal 16.1 percent as of today. By that measure, health insurers are ranked fourth highest of the 16 industries in the health care sector. The health insurance industry has a higher return for investors than cell phone companies, beer companies, mortgage companies, life insurance companies, TV broadcasters, drug store companies, or grocery stores."

    -- from here:

    I know I know, if Moore published it it must be wrong.

  16. cont'd

    Medicare, at least the non-privatized bits, and prior to Bush "reforms" required of health providers a hell of a lot less paperwork and admin expense than most for profit health insurance companies did. So perhaps I believe that we should "end" regulation by simply not having for profit health insurance companies at all. Have a gov't run single payer system, which will result in far less % of GDP spent on health care, with quality of care increasing for the aggregate of Americans, and allow non-profit health insurance groups who want something in addition to the single payer state run system.

    But as for this notion that health insurance companies would be more willing to insure marginal cases if they had more dynamic situations on the other end - I will never understand how you can have such faith in humanity here, but yet assert that you cannot hold other economic and political positions because it requires too much faith in humanity. Health insurance companies have made killer profits and still routinely denied care to any and every case they could get away with. Under our current ordo they have one goal - to make as much money for their shareholders as possible. Given that goal, why would they ever be motivated to pay out for a patient like Neal if they could find any means of getting out of it? Why would they not be motivated to set up contracts and administrative systems which result in as high a percentage as possible of claims they do not end up paying? There is a social phenomenon that must be spoken to here as well, which economists like Krugman have noted - with the advent of new trading technologies in the 70s, which made rapid trading possible between regions and different markets and thus increased the speed of economic transactions exponentially, there has been on the part of investors a demand for certain levels of profit margins, on a routine basis, than were ever expected before for a period as sustained as we have seen it (roughly a generation now). With the health care industry the current demand for both high profit margins and increasing profit margins demands, necessarily, that companies find creative means to deny claims. This has far more to do with the problem of people in America getting the health care they need than any regulation, including the many regulations the companies had custom written for them.


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