Inconvenient News,
       by smintheus

Thursday, November 20, 2008

  The health insurance reform carnival

Health insurers have announced that they'll support a new requirement that they must accept all applicants, including those who are ill or disabled, as long as everybody is required to purchase health insurance. In other words, while acknowledging the intense public pressure for real health care reform, they're advancing a scheme to insure universal employment for health insurers.

The insurers do not however support a flat rate for both healthy and sick applicants - without which their apparent concession really is just another ploy coming out of the industry's bottomless bag of tricks.

What they're aiming for is a health insurance 'reform' bill that will allow them to continue to turn away high-risk applicants (in the future by the simple device of making such premiums unaffordable), while milking the healthier population by means of a new line of legally mandated insurance. The latter probably would include a substantial amount of junk insurance designed to give the appearance of health coverage but carrying minimal benefits. Insurers already do a tidy business in selling junk health insurance, but with legal mandates their profits in this sector could soar.

So this cynical announcement is emblematic of what is most wrong with our current health care system enterprise.

Let's face it, we don't have anything like a system in the US for delivering health care. We have a crazy patchwork of overlapping devices, none of which properly functions in itself or on its own. Even worse, at the core of this enterprise is a for-profit insurance industry that by design works at odds with the goal of providing health care. It exists to extract the maximum of money in exchange for the minimum of health care. The problem is not that the machine needs to be fine-tuned. The real problem is that it's a Rube Goldberg contraption.

This mess has grown and thrived because, regrettably, in the US we don't like to call a spade a spade. Or rather, the more severe a problem the more the traditional media and the DC political establishment refuse to acknowledge it. The evidence of elite denial is all around us.

We've just finished a campaign in which the Republicans nominated an absurdly and frighteningly ignorant vice-presidential candidate. Many voters figured that out pretty darn quickly. But how often did you see the political or media elite acknowledge publicly that Sarah Palin was a ridiculous nominee before voters had rejected her? After Election Day, sure, some put their fingers to the wind and decided it was safe to state the obvious. But until then, the important thing was to pretend that the selection of a patently unqualified candidate presented no problem of any significance. She was packaged as a serious candidate, therefore the only thing to do was pretend she be taken seriously.

The same has occurred with every major problem the country has faced in recent years. The invasion of Iraq? There was transparently no need for it once weapons inspectors were admitted into Iraq. Anyway the evidence presented by the Bush administration simply didn't stack up. But how many establishment types dared to say the obvious? Much better just to get along by going along with the fantasy of seriousness being peddled.

The mortgage mess? For more than a dozen years it was clear to anybody acquainted with the housing market that house prices in many areas were inflating at ridiculous and unsustainable rates, and that lenders had thrown caution to the winds in pushing money at virtually anybody who inquired about buying the overvalued property, no matter their credit-worthiness. It was also clear that ARMs and other bizarre mortgage plans lenders pushed, along with a flood of unnecessary home equity loans, were going to create high default rates. When we first started to look at buying a house a decade ago, I recoiled in horror at the mortgage practices I saw. How many establishment types addressed this looming catastrophe until the house of cards actually began folding?

The meltdown of Wall Street financial institutions? That has been in the works since the 1980s when Depression-era regulations were swept aside, replaced by the 1920s ethos of anything-goes. Anybody willing to look candidly at what modern financial securities actually were predicated on could see that Wall Street's apparent success was built on nothing more than a pyramid scheme. Even insiders acknowledge shock at the willingness of just about everybody to pretend that the inherent flaws didn't so much as exist.

How often does Congress address well-known problems forthrightly, before they become urgent? What do you expect more from the traditional media, candor or timidity? A cynic might conclude that showing you're perfectly able to ignore looming disaster is a prerequisite to acquiring a position of prominence in politics or the traditional media in the US.

In any case, we can expect that nobody of influence is ever going to want to admit that the American health care 'system' is a broken and ridiculous contraption, or that adding any number of further levers, tensioning devices, mirrors, and spring-loaded squirrel ramps won't ever fix what is wrong with it. That would be revolutionary admission, after all, requiring some discussion of how a genuine health care system ought to be designed.

The establishment in the US is unwilling to concede that we have a health care carnival rather than a free market. There's no way that they're prepared to acknowledge that a health care 'system' dependent upon private insurance can never work properly because it's not designed to work. There can be no discussion of the plain fact that it's designed to extract the maximum of money in exchange for the minimum of health care.

It's a carnival, and the health insurance industry spokesman is the carnival barker. His job is to maintain the illusion that what we rubes need and want is an ideal health insurance package, and that he'll help us find it somewhere along that arcade if we just take his advice.

What we really need of course isn't in that arcade. It's universal health care, without the middlemen, without the con-artists.

But what it looks like we'll get from Congress, instead, is mandated con-artistry at semi-regulated rates of flim-flammery. Universal health insurance is not reform. It's an inoculation against actual reform. If that's what the 'reform' movement interjects this time around, it could be yet another 60 years before Americans finally get the universal health care that the rest of the developed world has long enjoyed.

crossposted at

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