Rest assured, nothing is going to be done about this, but the news is still worth some cogitation. The new figures are out, and they show that almost 44 million people are without health insurance.
It’s what you might expect when health insurance for a family costs $9,000 a year and is expected to top the $10,000 mark next year. The average family income is — just to put things in perspective — $27,000 per year, so unless an employer is picking up a healthy (no pun intended) chunk of the insurance bill, there is little choice but to do without this form of protection.
A shrinking percentage of employers is able to offer employees even partially-paid-for health insurance. They can’t afford it, either, and when they have to go up against foreign companies who have no health-insurance costs — because they are based in societies where the costs are socialized — the price of insurance becomes ruinous.
Wal-Mart manages to offer health insurance to half a million employees at the cost of about $3,500 each, but it is hardly dream coverage. It is no coverage at all for retirees, and new hourly-wage hires have to wait half a year for the benefits to kick in; when they do, there is still a $1,000 deductible, and the kids’ flu shots aren’t covered anyway. Nevertheless, it’s better than the nothing that the nation’s 44 million uninsured are stuck with. Given Wal-Mart’s ferocious competition in general merchandise and groceries and whatever else they’re into, other companies will have to cut their health-insurance coverage to trim costs or go lower than Wal-Mart.
If employment picks up, will health-care coverage pick up also? Possibly less than you might expect, because rather than saddle themselves with the nightmare of squeezing something like a decent price out of the health-insurance industry, for many companies it makes more sense to attract workers by raising the hourly wage and letting them try to find something that they can afford. (That’ll be the day.)
This little complaint and larger, noisier ones will have the same effect on the course of future events as spitting in the ocean has on sea levels. The cost of insurance, the cost of drugs, the cost and quality of every kind of medical care is the subject of louder clamor every year, but nothing much will be done, and what is done and offered as a reform or an improvement will turn out to be a charade, a cheat and a fraud.
Howard Dean, an M.D. himself, has been reminding people at campaign stops that Harry Truman was asking Congress for a socialized medicine bill half a century ago. The call for action is even older. In 1929, Forbes magazine carried an article entitled “Gouged by Doctors: Hospital Costs Far Too High for Patients of Moderate Means — The Need for Business Leaders to Step in.” Another Forbes article, called “When Medical Gougers Exploit the Sick,” tells the story of a man who had to come up with $150 in cash before the doctor would perform an emergency appendectomy. The man in the latter article was able to borrow half the money for the operation from a neighbor. We are still staging neighborhood yard sales to pay for operations on small children in desperate medical and financial circumstances. As they say, the more it doesn’t change, the more it doesn’t change.
What an unholy mess!
People forced to buy prescription drugs of uncertain quality on the Internet. People declaring bankruptcy because they can’t pay their medical bills. Hospitals turning people away. Hospitals siccing wolfish debt collectors on dying cancer patients. Old people hoisting themselves onto buses to buy inexpensive drugs in Canada, and the American government — ever the stooge of the big drug companies — trying to stop the old people, who have to choose between taking their heart medicine and eating all seven days of the week.
My doctor — and probably yours, too, if you have one any more — has a full-time person who does nothing but fill out forms for the private medical-insurance industry. In the old days, when people got sick, their relatives nursed them and took care of them. Nowadays, the relatives don’t have time because they have to spend it filling out the sick person’s insurance forms, and calling back (and back, and back, and back) because the insurance company got one digit wrong and is too inefficient or indifferent to correct it. Private medical insurance is slower, stupider, more corrupt and less useful than any part of the federal bureaucracy. It exists because of greed, and it supplies nothing but the martyrdom of the sick and dying to free-market dogma, which doesn’t work.
It is a commonplace that no significant improvement in the health-care set-up can be hoped for because the politicians have been bribed by the insurance industry, the hospital industry, the nursing-home industry, the drug industry, the trial-lawyer industry and so forth. Campaign contributions — to give the bribes their polite name — rule.
This is another thing that will not change. For a century, Congress has fitfully and periodically passed what are called campaign-finance laws. Not one of them has been effective. Lawyers, with the connivance of their friends on the bench, have contrived at great expense to their clients to destroy these laws as fast as they have been passed. The new one, the McCain-Feingold bill, is before the Supreme Court, which will in the next few weeks come down with a decision that will begin the process of gutting it.
No effective campaign-finance law will ever be passed by Congress, as matters stand now. There is just too much money on the other side; any candidate with itchy fingers can easily skip around the federal public-finance scheme. The only candidates to use it are those who cannot raise any money to speak of. Winners don’t. George W. Bush doesn’t.
During the Republican primary in 2000, John McCain came out of nowhere and, without big money behind him, raised enough from small contributors to give Mr. Bush and the big-money boys a brief scare. This year, Howard Dean is pulling in small contributions on such a scale that he, like Mr. Bush, may find it makes sense for him to spurn federal money. This phenomenon has caused The Washington Post to report that while “other candidates focus on their humble roots or heroic feats, Dean inverts the telescope: He talks about the voters. He tells them they’re okay. Instead of trying to get them to love him, he tells them to love themselves.”
Let’s hope that in addition to telling us to love ourselves (something few of us Americans really need to hear), he will also tell us that if the broad middle class continues to let the big rich — corporate and individual — pay for American politics, they are going to continue getting the shaft. It is possible that middle-class Republicans enjoy the feeling they get when their much-higher-income brethren administer their political pessaries, although there must be days when they, too, have their doubts. The Democratic middle class cannot be happy with the sale of their party on the political eBay to celebrities, AIPAC, trial lawyers, etc. Since nothing else is going to succeed, the people will have to buy back the political system and make it their own.
The middle classes — say those making between $40,000 and $150,000 a year collectively — can do it if they cultivate the habit of giving $200 or $300 every year, and some years even a little more. Aggregated, that makes the ordinary people competitive with the extraordinarily rich. Think of the donations as the rich people do — as bribes, as payoffs on getting the $10,000 insurance tab cut. You are buying “access,” as the K Street fixers do. Once we get this going, we can give tax credits for small political contributions and gradually reintroduce into politics men and women who have something else in mind besides where they are going to snatch the next dollar.
The American political system cannot be redeemed, but it can be repurchased.