Who Speaks for the Uninsured?

By John Ballard

Many of those individuals who would need a public health care option are those who are not likely to be able to take two hours out of their day to go to a public event like that town hall, They were too busy earning hourly wages and trying to keep roofs above their children's heads. Those voices are not going to be present in that discourse.

Kevin Motl, history professor at Ouachita Baptist University

That, in a nutshell, is why politics in America is dysfunctional in its handling of health care and insurance reform.. Next time an elected representative recites that old platitude about representing "ALL the people" remember the current display of fist-shaking, media extremism, public paranoia, viral emails and incivility making "news."

"Money is the mother's milk of politics."
--Jesse Unruh, Speaker of the California Assembly from 1961 to 1968.

Write that down.
Read, mark, learn and inwardly digest every word.
We all may be created equal in a philosophical sense, but our fortunes vary greatly in more than the financial sense of the word. Thomas Hobbs concluded three hundred fifty years ago that without a social contract (i.e. government) human existence is "solitary, poor, nasty, brutish, and short." We have sense learned that those conditions can survive both tyranny and democracy, even those with the best of intentions.

An echo of that "nasty, brutish and short" condition has been in a crescendo starting with the Reagan Revolution. This time it is a rising tide that will sink, not lift, all boats.

My opening quote by a history professor and the following from another historian at Princeton are from this morning's excellent NPR reporting.

National Republicans have targeted many of the Blue Dogs for defeat. But it's not clear that so many of them are vulnerable. Fifteen of the 52 Blue Dogs, including Ross, haven't had a tough race since at least 2002.

But Julian Zelizer, a historian at Princeton University, says that in modern politics, even a lawmaker with a safe seat usually does not feel comfortable going against the interests of the most reliable voters at home, and the most reliable donors in Washington.

"Ideally, some people think incumbency should allow members of Congress to act more like independent leaders," says Zelizer. "But it doesn't actually work that way, very often."

Get it?
Voters and donors.
That's how the system works. Lifestyles of the working poor include little money and few votes. The aftermaths of hurricanes Katrina and Rita showed the selfish underside of American wealth.
Likewise, an uninsured, unrepresented minority is now being disregarded in the same manner.

Today's Who's Representing the Uninsured on Capitol Hill? by Peter Overby includes an interactive national map as well as a short  voice report (four and a half minutes) aired on Morning Edition.
It's a shame that his measured approach will never be seen or heard by the right people.  Those who should be embarrassed are either indifferent or too busy kissing donor asses to be affected. 

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Ezra Klein's piece linked by David Anderson  makes excellent points but overlooks two important elements.

First is the variety of insurance "products" that overlap everyone. Not only do most people with health insurance have no idea what it costs until it's gone or they are forced to switch to COBRA, nearly everyone -- even the "uninsured" -- is insured most of the time by non-"health-care" insurance.  Automobile insurance, home-owners insurance, and product liability insurance cover accidents and negligence resulting in both medical and personal expenses. Workers compensation takes care of work-related injuries and disease. (Most people don't know, but even pre-existing conditions are covered, at least in Georgia, if a work environment or work related accident causes them to become worse.)  Many companies have life insurance policies on employees in addition to whatever pitiful amounts may be paid by worker's compensation in case some one is actually killed on the job. (That is, if the policies are unknown to the covered employees and are instead part of an executive compensation package.) And as every schoolboy and Republican knows, there's the always looming malpractice insurance producing fear in both health care professionals and patients alike, which combine to generate yet another generous revenue stream for the insurance industry, fed, of course, by premiums paid by physicians, passed on to patients in the form of higher charges.

There are more, I'm sure. The insurance industry is very imaginative in ways to collect money to cover risks,  real or imagined. Perhaps the most successful of them all is AFLAC whose ubiquitous, irresistibly cute, clever duck, has become better known than than Ronald McDonald. AFLAC does not sell insurance in the usual sense of the word, but a product that "supplements" insurance in the unfortunate event that a policy-holder becomes certifiably sick or injured to the point that they must be admitted to a hospital. Insurance agents know that they are not selling insurance in the financial sense. The real insurance product is peace of mind. And peace of mind sells best to the customer afflicted by fear and dread. That's why the "cancer policy" is so popular.

The second point overlooked by Klein is the most obvious: most people -- insured or not -- are not sick most of the time. With the exception of those with chronic conditions, most uninsured people neither need nor want to pay for insurance. Hell, if I'm not sick, why should I pay for what I don't need? That's a no-brainer. Besides, everyone knows that if you have an emergency the hospital is obliged to take care of you even without insurance.

Moreover, lots of people have discovered that if they are uninsured and are prepared to pay cash or work out terms with a clinic or physician, they can often get a discount. Sometimes the discount is shockingly good. I heard at an employee meeting at the hospital system where I was employed for five years that if someone was willing to pay cash at the ER they got a fifty percent discount on the spot. When I asked my that wasn't more widely known I was told by the employee that they didn't want that to "get out." Of course not. Why waste time and resources on someone with no insurance when the revenue potential from someone else is much better? Besides, the insured patient has to be sent for more tests and/or treatments (defensive medicine, you know, against malpractice suits) and by all means needs to be billed for a "follow-up" visit to the doctor, even if nothing is wrong. (Who knows, maybe we can find something else.)

My sister is one of those unfortunate self-employed people covered by one of those famous high-deductible plans, meaning that she expects to pay the first five thousand dollars of care to satisfy the deductible before anything is covered at all, even partly. (And of course there is also an upper limit on what will be covered in the even the charges get really high, which is how people graduate from medical bills to personal bankruptcy.) Shopping around for CT scans she discovered that by paying cash she can get one for under a few hundred dollars (instead of a thousand-plus) which includes a written report from a physician interpreting the results.

Last night's evening news had a compelling feature underscoring an epidemic of Alzheimer's Disease in our future. "Our" in this case means the entire world. As life expectancies increase so, too, does the expectation that Alzheimer's and other forms of dementia will become more of a problem. As far as I can tell, the issue of long-term care has not been mentioned in the current debate about health care. I forgot to mention long-term care insurance in the list above, but that is yet another "product" of the insurance people. My parents' experience made me aware of the economic impact of long term care but my guess is that most people are either ignorant or in denial about the prospect of long-term care that will touch every family sooner or later. A line at the end of the report mentioned that Alzheimer's Disease will cost something like twenty trillion dollars over the next two decades. That is a real challenge that remains unmentioned in current discussions about health care.

Pogo was correct. We have met the enemy and he is us.
But I don't fault us directly or even our politicians or leaders. I fault non-human creations superseding our humanity and political power. Science fiction fantasies about machines with artificial intelligence taking over the world make good entertainment, but already have a reality of corporate monsters without souls which eat individuals at one end and poop them out at the other with life sucked out. Our dependence on them has all the same qualities as the relationship between drug dealers and substance abusers. And we find ourselves helplessly in their grip. Yes, Blue Dogs, I'm talking about you.

The more I allow myself to think about how large corporations are subverting our politics and economy the more frustrated I become. Whether financial, agricultural, chemical, insurance, transportation or media... the big fish eat the little ones as we are witness the extinction of small banks, family farms, independent retail businesses and local newspapers. The last tax shelter for the common man, the family home, has proved to be an illusion as the real estate bubbles burst, both commercial and residential. It's enough to make me want to become a teabagger. It is no wonder they feel so helpless. They really are.