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

[vsign]

"MEDICARE FOR ALL"
The health care system is so confusing, we feel hopeless. If we can't unclutter our minds, we can't see an answer. It might be harder for all those opposing any change to resist if we would talk about "medicare for all". They talk about socialism or taxes or the economy and get us confused and debating instead of finding an answer. It was easier 100 years ago to get health care!

[ronnieponnie]

Barbara, if I may call you that, thank you, thank you, thank you!!! You have become one of my very favorites. You have given me hope (well, at least a little).

[margesimpson]

I like the way you think. If only I could believe that Dennis Kucinich could get elected.We may have to groundswell the people's movement while Hilary is president. MMMMMM.... could work.....

[Aunt Shecky]

Ms. Ehrenreich has the quality of a good writer: the ability to take a dry, "boring" topic and make it interesting.
But I ask again: why are the costs of medical care so high to begin with?

[Doofus]

(To begin with, US physicians earn a lot, according to the Bureau of Labor Statistics.)

http://www.bls.gov/oco/ocos074.htm#earnings

Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association’s Physician Compensation and Production Survey, median total compensation for physicians in 2004 varied by specialty, as shown (below). Total compensation for physicians reflects the amount reported as direct compensation for tax purposes, plus all voluntary salary reductions. Salary, bonus and/or incentive payments, research stipends, honoraria, and distribution of profits were included in total compensation.

Median total compensation of physicians by specialty, 2004
.......... Less than 2 years in specialty - More than 1 year in specialty
Anesthesiology $259,948 - $321,686
Surgery: General $228,839 - $282,504
Obstetrics/gynecology: General $203,270 - $247,348
Psychiatry: General $173,922 - $180,000
Internal medicine: General $141,912 - $166,420
Pediatrics: General $132,953 - $161,331
Family practice (w/o obstetrics) $137,119 - $156,010

[Doofus]

And if you don't like 'government figures' have a look at these...

http://www.physicianssearch.com/physician/salary2.html

[THP]

Barbara, You mentioned private insurers like Aetna. What is the deal with Blue Cross and Blue Shield who say they are officially not for profit companies?

[maddogbitesback]

The enemy is the government which bows to all corporations regardless of the needs of the people. Until corporate America stops putting in people such as Reagan and the Bushes, America will continue to sink and fall further and further behind. The war is a hostile corporate take over funded by American taxpayers and paid for with American blood and the ceaseless hatred of billions. The cost of 18000 American lives is "a small price" compared to what the Iraqi's have suffered. It is the price of getting cheap gas and cheap clothes. You get what you pay for. And you ain't paying for government health care or infrastructure.

[prochange]

When are people going to wake up?
When are they going to protest in the streets and stop paying any insurance premiums?
It is not only health insurers who specialize in denying all claims. Nowadays you need a lawyer for any claim you may have against any insurer, which makes insurance premiums even more expensive because you have to pay the lawyer.
Ask the people who suffered through Katrina. Ask anybody, who had a car accident.
If you dare to have a claim against an insurance company be prepared to be penalized, investigated and eventually dropped.
Health insurances only take you if you are healthy. Car insurances raise their premiums because of what is going on in your neighborhood, not because of your driving record. You are penalized because people are allowed to drive and text message and gangs of illegal immigrants drive without insurance and steal cars by the thousands.
Pay your house insurance for decades and then you have a claim, they deny you, raise your premium or drop you.
And why do these people, who work for insurance companies, denying claims, think they will be treated differently, if they have a claim? If people do no start to think more compassionately, we will soon have a society of a few very wealthy people and the rest is just slaves. Oh wait, we already have!! We are going back to the Middle Ages. Any progress society made in the past is slowly dissolving, people are just not realizing it because they are sleepschooled that the only purpose of life is to buy crap, eat as much fast food as possible and follow every move of any drugged and desperate celebrity.

[sa]

for the price of one week in iraq we could extinguish all these "healthcare" companies. they are wealthcare companies. their own wealth. their wealth at the expense of other people's health. our genius president was able to delay the healthcare CONVERSATION, by a little thing called iraq - it was win/win/win all the way around for him and them - the terrible money grubber, greed mongerers in every corner of america's vast capitalistic rapefest.

so yeah, instead of iraq (for one week) let's bomb and destroy all health maintenance organizations - kill everyone invoved with such an evil enterprise. and then with the money of one month in iraq - let's insure ALL americans health coverage. everyone. and then with a year in iraq, lets educate our citizens (college access for everyone deserving) so that our society is vigorous and whole - not lopsided and corrupt. good ideas, good people, good inventions. it will pay for itself in significant enterprise and commerce.


and then with another month of iraq's wages, let's fix our infrastructure so that the sky doesn't fall on us at any given moment.

and then with a decade of iraq's war expense - let's devote money to an alternative fuel source that includes converting present and past cars to that mechanical/chemical/technological conversion. and let's also feed all the world's unfed, and cure aids - all this from a decade's wages in iraq, spent on killing and bombing and making the world hate america, so that we can orchestrate a good climate for oil trade.

but yeah, first off, let's bomb and kill everybody involved with HMO's.


p.s. huffington post - i dare you to publish
this truth.

p.s.s. don't taze me bro!

[Shortyfuse]

Yes, at a time when they should have been hitting the drug companies over the head about prices, our leaders were draining the social security funds with drug policies.
Let's not forget the influence the insurance companies have on laws. If they have to pay to much in certain areas they push for laws that help them with their cases in court. ( seat belt laws ). Many of these laws would just have been a public service announcement in the past.

[lastams]

… While the Health-care Industry is making ungodly profits (as much as 20 times higher than other fortune 500 companies), employing over 700 lobbyists in DC alone and basically writing our health-care legislation, this administration is able to depict the Democratic Party (and their big-government ways) as more threatening than being victimized by these greedy vultures.
The number one cause of personal bankruptcies has become health care debt … thank God that this administration was able to rewrite the bankruptcy laws so as to squeeze every last penny out of the dying!…
Yet, seniors deciding between food and medicine (some with as much as a 20,000 percent markup), seem more worried about “socialized” medicine than their own health.
So to the question as to why the Congress is so scared of the insurance companies; it’s the money stupid.
The swollen coffers of the health-care industry can dole out contributions like candy, offer lucrative post-government employment, and influence public opinion though mass media.
Perhaps a better question would be why are the American people so gullible, and when will they stop drinking the Kool-Aid.

[margesimpson]

managed health care and health insurance companies gave $48.9 million from 1989 to 2007 with 59% to Republicans and 41% TO Dems. Clean elections would be a great start to wrench the influence money has away from our elections and on our policies.

[ponderman]

The insurance industry is nothing more (or less) than a glorified protection racket. It's success in mind-conditioning the American public with every fear tactic in the book is obvious.

There is one simple solution...expose it for what it is, and get everybody to cancel their policies. Fat chance of that happening.

[InsaneDisabled]

Yup. They're saying it. "Let them eat cake."

What else is requiring everybody to have health insurance? We can't afford it, so make us buy it. Ta da!

What is "The Simple Life" but playing shepherdess at the Petit Trianon? The extreme luxury and conspicuous overconsumption of the wealthy class is now being televised. How long before the poor just break?

Where do you suppose the guillotine will go? Times Square? The Mall in Washington?

[llamajockey]

The corporatist DNC/DLC power structure seems determined to force the nomination of a candidate solely based on the most superficial of criteria, image, name recognition and personality. The 2008 campaign will be completely devoid of goals, issues and principles.

Yet come Fall 2008, the few remaining long suffering GOTV Democratic activists will be left trying to promote a candidate who has nothing to offer the independent voters but the Democratic base as well.

All the Democratic candidates want to greatly expand job and wage destroying middle class "nonimmigrant" work visas like the H1-B and L1.
That alone means millions of Americans loosing both their jobs and health insurance.

Nor are any of the Candidates demanding a revisting of NAFTA, China PNTR, GATT, WTO, the "FREE TRADE" insanity that is wiping out the working class and our manufacturing base. At the very best Edwards at least talks about what is wrong with "Free Trade". But, he fails to call it what it really is Global Labor Arbitrage and demand a viable solution. Hillary and Obama on the other hand are out to lunch.

Likewise none of the leading candidates is willing to back Single Payer Health Insurance. In affect they are willing to completely ignore the public outcry in the wake of Michael Moore's outstanding film SICKO. This means taking off the table the one absolutedly killer populist issue the Democrats had going for them.

So ask yourself why should folks show up and vote Democratic in 2004 or 2006??? In the last two elections folks showed up inorder to vote against Dubya and the Iraq War. In fall 2008 Bush will not be on the ticket.

If the Democrats face a Republicans who takes a populist stand against the Open Borders and the unsustainable immigration insanity and makes vaque promises to end the Iraq War like Eisenhower did for Korea, the Democrats, especially Hillary will be luck to get 45% of the vote.

[duboisist]

It all comes down to magic words. Bush uses them all the time.
Are you killing Iraqis? Say the magic word “terrorist” and now you’re “defeating the enemy.”
Democrats do it too. Are there people who make money selling their access to decision makers? Say the magic word “lobbyist” and it’s only wrong when “lobbyists’ make donations to candidates because they might gain access to decision makers and everyone ignores the fact that people become lobbyist BECAUSE THEY ALREADY HAVE ACCESS TO DECISION MAKERS. Most of them are former decision makers themselves or former members of their staffs.

The media never demands a definition of these magic words. I guess they are afraid to admit they don’t see “the emperor’s new clothes” so they act as if the magic words had whatever definition they imagine it might. The candidates’ advisors go back and forth between candidates and the media the way generals go between the military and industry.

The last two day is prime evidence that it is all about magic words. The same Senate that would vote for measures that could help end the war because some members were UNCOMFORTABLE WITH THE LANGUAGE or restore the right to HABEUS CORPUS voted to condemn a NEWSPAPER AD.
The American people have to stop electing people who are AFRAID OF WORDS and we all need to stop listening to the people who misuse them.

[emsique]

I am self employed and pay a lot of money each month to a major HMO for a high deductible policy for me and my family. A lot of employers do the same thing for their employees. It goes up a lot each year. I KNOW that a medicare type program for all would cost a hell of a lot less in taxes, fees and copays than what we as a nation pay now.
It is depressing to see how half assed everyone's health care proposals are, except for Kucinich. If health care and getting out of Iraq are so important to Democrats, why are the "top tier" still on top? Are we so shallow that we go for rock star politicians instead of issue candidates? Come on, people, if we really want change, then let's support the candidates that represent change. Oh, and here is a hint: Being "not Bush" is not enough to qualify you as representing change.