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The Bureaucracy
Citizen, are your papers in order?

by Bryan Zepp Jamieson
August 2, 2009

Imagine a government agency that ran with 40% administrative overhead. In reality, even the Pentagon doesn't run that sloppily, and it's usually the worst when it comes to bungled bureaucratic messes. There's no bureaucracy quite like a military bureaucracy, especially in peacetime when nothing it does particularly matters. It's famous for sending suntan lotion to Thule, in northern Greenland, or parkas to troops in places like Vietnam, where it rarely gets below 80 degrees. In the military, there is a form for everything, and for everything there is a form, in triplicate, please print clearly, forever and ever, amen.

The country of Egypt is reputed to have the worst bureaucracy in the world. Just to get a permit to have a cab might involve hundreds of trips to dozens of agencies, countless hours filling out forms, all wanting to know the same things but asking in slightly different ways and on different colored paper and – most importantly – with different code numbers along the bottom. The procedure can cost hundreds in fees for the license and for applications, in time wasted dealing with this administrative mess, and, being Egypt, thousands more in bribes. Nobody likes to do business in Egypt as a result, and only those with the clout to bypass the bureaucracy even try.

A bumper sticker popular some years back read: “Bureaucracy: the science of turning energy into solid waste.”

Nobody likes bureaucracies, least of all the people who work in them. I know people who are in the middle layers of such monsters (the “maw”, if you will) and they routinely tell horror stories of waste, mismanagement, and pure idiocy. Franz Kafka knew and understood bureaucracies.

The only thing worse than one huge bureaucracy is hundreds of small bureaucracies that are usually mildly antagonistic, each to the other. In a large bureaucracy, feuding and gamesmanship breaks out between departments, but there's usually a way available to force a solution, if upper management desires. When you have entirely different bureaucracies that WANT to interfere, each one with the other, then you have a real mess, and take pity on all who are trapped in that particular Rube Goldberg version of administration.

Now, imagine that all these little bureaucracies, not fiefdoms but independent kingdoms, all have a common purpose, which is to maximize the amount of money coming in, and to minimize the amount of useful activity going out. Some would say that bureaucracies gravitate toward that anyway, and that's true, but it's a tendency. We're talking about a MANDATE. Maximize money coming in, and minimize useful activity going out, to the point where bureaucrats are actually rewarded for successfully denying something to an applicant that he or she was actually entitled to have! Suppose that such a vile and malevolent system ate up nearly 5% of an entire society's production to favor just a few idle rich.

If you are thinking that no society would tolerate such a thing, imagine all those little bureaucracies banding together to spend billions of dollars a year (financed by the people they've cheated) to assure the public that they are the protectors of that public, and hundreds of millions more to ensure that the government protected them, not just from the law, not just from competition, but from the very people they purport to serve. Imagine they even managed to get the government to agree to let them set their own prices and forbid any competitive bidding from outside their own vast cabal.

At this point, you are wondering why such a society isn't in open revolt, dragging members of these bureaucracies and the legislators who support them out into the street and tar-and-feathering them. Even with billions spent on propaganda, the people can only be fooled for so long, right?

Welcome to the role of insurance companies in the American health system.

Hundreds of insurance companies, big and small.

All interested in providing coverage for health. At a profit. The biggest profit possible, in fact.

Each with its own sets of forms, regulations, rules, demands, and schedules. Collectively, a daunting nightmare of paperwork and conflicting and often irrational demands made on medical practitioners and patients.

Each devoted to bringing in the most money, and allowing the least money out.

Each loudly insisting that they are there only for the benefit of the people who are being cheated by such a system.

Each so empowered that it has become easy for them to dictate to doctors – including YOUR doctor – what approaches and methods are suitable for treatment of anything that might ail you.

Each busily looking for any loophole whereby they can deny you coverage, preferably in a way that doesn't violate America's lax insurance laws, but illegally if they can get away with it.

And they can get away with it, because they have a loophole that effectively takes away your right to a day in court. All medical insurance policies include a waiver, promising not to sue, but instead to take any dispute to a arbitration panel, and that panel is to be chosen by the insurance company. You probably won't be surprised to learn the the insurance companies win 95% of such claims. Indeed, it's startling that they even lose 5%, but part of that is because in California, there is a law explicitly forbidding gag orders on arbitration. So we get to see the results, if not the individual specifics of cases, in California. In the other 49 states, the loser faces severe legal penalties if he or she discusses anything concerning the arbitration. So it may well be that 100% of cases go to the insurance companies there.

Did I mention you aren't allowed to have a lawyer in such proceedings? Hooray for tort reform! Serving insurance clients in much the same way that Bernie Madoff served his investors!

So: insurance companies can dictate to your doctor, and they can dictate to you, and nobody, but nobody, can hold them accountable, because the only recourse available is in their paws, and in nearly all cases, kept out of public sight. Good luck arguing with your insurance company if they deny coverage for a ludicrous reason, or no reason at all. Some don't even bother with a rationale, but prefer to make the client spend lots of time and money trying to find out why the insurer cheated them.

An article today in Truthout showed the extent this cabal will go to to protect those hundreds of billions in profits. Michael Winship wrote “the Center for Responsive Politics reported that in the second quarter of this year alone, the pharmaceuticals and health product industries spent $67,959,095 on lobbying, and the insurance industry $39,760,477. Another $25,552,088 was spent by lobbyists for hospitals and nursing homes. That's a total of $133,271,660 in just three months, and that's not even counting the lobbying money spent to fight health care reform by professional associations like the US Chamber of Commerce.”

One hundred and thirty three million, and that was before any bill reached the House. And it wasn't a case of fighting against being abolished by a single-payer system like the excellent one Canadians enjoy, no. It was just to prevent the so-called “public option,” the ability of clients to opt into a not-for-profit insurance program instead of one of theirs. All that money, just to avoid having to actually compete with a health care system they insist is inferior.

That was just lobbyists. The insurance companies have spent billions more on advertising, assuring everyone that the public option will turn America into a bleak, grey Soviet state and medical care into a horror story from Ivan Denisovich. Billions more of invisible spending takes place in the realm of the right wing echo machine, where Faux News and the Moonie Times and all the rest of the pseudo-journalists and think tanks will chorus that public option is bad and socialistic and results in euthanasia of older folks, rationed health care, and inefficiencies.

It's a pack of lies, but they are extremely well-funded lies, because the insurance companies know that if ANY option is offered beside what they have, they are doomed.

Frankly, I often wonder why we don't see CEOs of major insurance companies hanging from lamp posts. Maybe they have insurance policies against that sort of thing.

But if you are hearing all the lies and scare tactics from the insurance companies and their servants on the far right, and wondering if a public option is wise, reread this essay, and ask yourself how it could possibly be any worse than what America has now.

And then consider the Canadian system. Talk to Canadians. You're on line, it's not hard to find Canadian chat groups. They'll be happy to tell you all that's good and bad about their system. Then talk to Americans, and compare the results.

Then support the public option, and press in the future for single payer.

Posted: August 3, 2009

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