This Unholy Mess


The Best of Scams

As a scam artist, the president has been a disappointment. His lying has always been more about quantity than quality. Inauguration crowd size, three million illegal votes, a Mexican-financed border wall, Obama wiretapping Trump Tower, less expensive health care that will cover everyone—these have all been interesting, but none of them managed to achieve any real traction in the world. They were debunked almost as fast as he could twitter them. They lacked the critical quality of durability.
So for a refreshing turn away from the cheap stuff, let’s have a look at a truly great American scam. One that is breathtaking in scope and visionary in concept. A scam that has touched every American, over many decades, and only now shows faint signs of slowing up.
It’s the brilliant, elegantly simple notion of putting together the two words “health” and “insurance.” Sheer genius. A measure of its success is the fact that the phrase “health insurance” is now a commonplace. You might even be reading this and saying, “Sure. Health insurance. Everyone knows what that is.” To which, in praise of this scam’s creators, I reply: Bravo!
Because health care is not, and has never been, about insurance. Not in the normal sense.
What is insurance, after all? It is a financial hedge against relatively rare disaster. If your home is the one in 50,000 that burns to the ground, for example, or is flooded out, there is a pool of money available to settle your claim, because lots of homes are insured but never burn down. It is the 49,999 owners’ premium payments that allow insurance companies to cover those homes that do burn. And create fat profits, too, of course.
This is clearly not what happens with health care. In fact, my painstaking research shows that, out of 50,000 random individuals, the percentage that will require health care—a lot of it, sooner or later–is…let me see…oh yes, here it is: 100%.
So when we talk about supplying health care to our citizens, the vehicle that makes it available might be called a “health care system” or “health care services” or even “Medicine 4 U.” But it is emphatically not “insurance.”
Still, you can understand why the insurance industry clings to this nomenclature, and to their sweet, completely unnecessary participation in health care delivery. Where else do they get such a captive, broad customer base to feast on? Where else do they find so much latitude in pricing, so much opacity in administration, so much subsidy money flowing directly from the government (i.e., you and me) into their coffers? It’s a gold mine! Company executives complain bitterly these days about losing money, yet they seem oh-so committed to staying in the industry. I’m confident they still manage to cover their country club dues and make their yacht payments.
How do they keep it going, these geniuses? Are they all PhDs from Trump University? Well, one excellent answer comes to us from Thomas Pynchon, in his classic 1974 novel, “Gravity’s Rainbow.” And I quote: “If you can get people asking the wrong questions, you won’t have to worry about answers.” As soon as we are roped into talking about “health insurance,” suddenly we’re talking about things like policies, premiums, and deductibles, as if we were discussing your car or your home and not your well-being and your life. We’re off and running—in the wrong direction.
This is what makes Congress’s latest elaborate minuet about health care so poignant and tragi-comic. Paul Ryan strikes a pose, sleeves rolled up, doing the hard work of making a jumble of jargon sound sensible. He carries on manfully about risk pools and tax credits, all the while ignoring the fact that as long as the insurance industry takes 20 or 30 cents of every health care dollar, and big pharma continues, with his blessing, to maintain budget-breaking prices for drugs that sell for much less in other countries, he will never have his cherished replacement for Obamacare. Or if he does get it, it will involve either (a) huge “premiums,” untenable for most people, (b) massive additions to the national debt, or (c) supplying 30-50 million Americans with the policy called “Emergency Room and/or Death”.
To those who don’t like the idea of the government running some form of single-payer health system (Damn government can’t do anything right!), I would reply: you trust it to defend the nation, to maintain our courts, to protect our food supply and the quality of our air and water, so it is odd that you find it so hard to see government administering the nation’s health care, rather than allowing mammoth corporations to make profits from people’s suffering while their mailers tell us, “Your health is important to us!”

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