Sick of Health!

I suspect the next year or two of domestic politics, if not longer, will be increasingly preoccupied with the crisis in the “health care delivery system,” which is about as screwed up a non-system as you can imagine. We held our latest Talk at CounterPULSE on this theme last Wednesday night, and will soon post a podcast of that online. (Also we are now up and running with our weekly half-hour radio show at 10:30 pm Thursdays on KUSF, 90.3 FM, current and next shows from last Spring’s Talk on “Can San Francisco Feed Itself?”) My friend Adrienne Pine works for the California Nurses Assn. and she gave a machine-gun-fast blistering account of the dysfunctionality of the medical industry, with a surprisingly detailed deconstruction of Schwarzenegger’s convoluted proposal. She made many worthy points, but one to emphasize is that we already have a “universal” health care system… it’s the emergency rooms in hospitals everywhere that cannot legally turn anyone away. A more wasteful and dumb way to take care of our health would be hard to design, let alone implement. But if the Massachusetts or proposed California systems are any indication, maybe we CAN make it worse!

In summary, these so-called “universal health care” systems are designed to make sure we are individually forced to buy private insurance, unless we’re so poor as determined by a needs-assessment by state bureaucrats that we get subsidized private insurance. The whole impossible edifice of administrative for-profit waste not only is not chopped down, but expanded by law! Ted Rall, writing on Common Dreams the other day, nails the problems:

In 2006, insurance premiums for an employer-sponsored health plan for a family of four averaged $11,500, more than the net annual salary of a full-time employee who earns $8 per hour. Americans pay over $2 trillion per year–four times the federal defense budget–on a healthcare system that sucks. And the cost keeps going up, two to three times faster than inflation…

It’s obviously outrageous that tens of millions of citizens of the wealthiest country to have ever existed in human history are one cluster of metastasizing cells away from bankruptcy. Did you know that 25 percent of mortgage foreclosures result from high medical bills?

But there’s a second, even bigger healthcare scandal that no one ever talks about. There are 250 million other Americans–those of us “lucky” enough to have health insurance–who aren’t much better off than the uninsured.

Workers and employers pay an average of $465 per month each to insurance companies who use every shady trick in the book to avoid paying out claims. Pre-existing condition? Not covered. Don’t want to drive hours to see a doctor who belongs to your plan? Pay out of pocket. Suffering from an unusual condition that requires the expertise of a high-priced specialist? Denied. You might think a chronic condition calls for long-term care, but to a claims analyst it’s merely another excuse to refuse to pay up.

Every now and then, you luck out. Odds are, however, that your deductible will eat up your payout.

When an insurance company hack can’t invent a legitimate excuse to turn down a claim they do it anyway. They play the odds, assuming that most petitioners, baffled by Byzantine voicemail trees, impenetrable websites and endless wait times, will be too discouraged to pursue appeals to rejections of their rightful claims. They want you to simply go away.

Let’s not even talk about vision or dental plans, which have become rare benefits offered by fewer and fewer employers. Hey, it’s not like eyes or teeth are important…

The unbridled greed of corporatized healthcare is breathtaking. United HealthGroup, currently listed as #37 on the Fortune 500, earned $3.3 billion in net profits in 2006–up 28 percent from the year before. Wellpoint made a whopping $2.5 billion, a 157 percent increase. When is the last time you got a 28 percent raise? 157 percent? It’s blood money, pure and simple. How much profit is generated by the death of an uninsured or undertreated American?

These rapacious entities are even worse than the oil companies.

I hate the argument that “greed” is the cause here, because the phenomenon is much more structural than psychological. These private companies are bidden to make profits. That’s what they do and to expect anything else without social pressure to restrict that basic purpose is naive at best. They do not exist to do anything useful or nice or helpful. If a company meets any actual human needs during its existence, it’s an accident, a mere side effect of its single-minded pursuit of profit.

The most common lefty solution to this mess is to propose a government-run single-payer system. Like Medicare, but for everyone (and it’s pointed out that Medicare only spends 3% on administration, compared to about 30% by the rest of the ass-backwards sickness industry). That would probably be better in general. But another piece of the problem that doesn’t come up much is what we tried to touch on in our Talk last Wednesday, the idea of the “therapy society” wherein more and more of our lives are medicalized… as Adrienne put it, childhood is now a disease that must be treated with Ritalin, pregnancy requires medical specialization, even menstruation is increasingly being framed as a “treatable condition.” The disconnection between life and nature proceeds apace, and this kind of alienated distancing imposed by medicalization is an ignored part of it. Even the alternative paradigms fail to address this problem adequately, since everyone from body workers to acupuncturists need steady clients and income… Not to say that most of us don’t feel like there’s a lot going wrong, from body pain and ailments to persistent nagging depression and a profound sense that things aren’t right. But treating it with professional services or drugs, our most common non-“solutions”, might be recipes for ongoing dependence and profound misapprehension of what’s really wrong with our lives.

We got to talking about stress later in the evening, that odd category that is both a diagnosable condition (hypertension) but is more or less what passes for normal in most people’s lives. Just talking about how fucked up the medical industry is, is a great recipe for feeling stress! The precariousness of employment, health insurance, love, community, security, et al, just naturally leads to stress. Hearing about friends getting cancer (or worse, dying, as another friend did a week ago from an OD, and he was a needle-exchange/naloxen activist!) is almost always seen in individual terms, as a twist of horrible fate for the person who goes down. Our ability to conceive of and address these issues as social issues, as shared dramas of our culture, is ever weaker. Obviously there are big economic powers who benefit enormously from this insanity, whether the big polluters who have toxified our environment to the point that a cancer epidemic for the rest of our born days is assured, or the big insurers, medical equipment manufacturers, hospital builders, Big Pharma, etc., who literally profit from sickness and death and add untold dollars to the GNP as they help their markets grow!

Brother! Time for a deep shift, a turning upside down of this madhouse… Talking and reporting and arguing is the first step, since as the AIDS activists who completely altered the paradigm of treatment and advocacy around that epidemic put it bluntly: Silence = Death. Fighting for a single-payer system is a worthy reformist goal, but we have a larger social project to reconceptualize health and sickness, to properly frame social causes and effects beyond an individualized pathology. Like so much else in our lives, reproducing our isolation and individualized ways of coping are only to keep us stuck in the predicament we’re trying to unravel…

P.S. A couple of related links popped up in the day since I posted this. My pal Jon Christensen has written a smart review of what appears to be a very smart book, “Inescapable Ecologies: A History of Environment, Disease and Knowledge” By Linda Nash. The other is a very clear opinion piece in the SF Bay Guardian called “Why Insurers Love The New Health Plan” by Zenei Cortez. If you’re involved in discussing the Schwarzenegger plan, you’ll get some helpful ammo from this piece.