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