Stop Calling It Insurance

People in Washington and other places are, right now, actually attempting to reform health care. It is time for anybody who cares about this to speak up, so here goes. There are really only two actions needed to lift from us all the fear of being the next person to die unattended in the emergency department waiting room. If these two conditions are met, then I do not care if the system is public or private, single or multiple, compulsory or voluntary. If we get these two things, we win.

One: stop calling the provisions we make for caring for our sick and dying, including ourselves, “health insurance.” If you want a detailed discussion of this, read “The Gamble,” back near the beginning of this very short blog. The insurance model does not work for health care. Insurance is a gamble based on the assumption that the bad thing insured against will happen to some people and not to others. But here’s the problem: everybody gets sick, and everybody dies. So, the only way that so-called health insurers can make money is by denying care to sick people. That way, they get to keep the money that we and our employers pay them as “insurance contributions.”

Insurers are not bad for us because they make a profit, as Michael Moore claimed in Sicko. They are bad for us because they make their profit by denying care to the sick. As human beings we cannot allow this to continue. So, first of all, take the insurance model out of the discussion.

You notice, I do not say the companies have to go. They may have skills to offer in the administration of large systems. They are more than welcome to continue to make money providing people with care. But the second thing that must happen is that we must stop them, right now, from denying people care. It is simply unacceptable to us as human beings who love our families and friends and even, sometimes, our neighbors. Anyone who is sick must be cared for. Period.

That’s it. If those two things could happen, maybe some of us could start breathing all the way down to the bottom of our lungs again. Imagine for a moment what it might be like not to be afraid of being bankrupted by the first major illness that will come, sooner or later. What would it be like not to fear a miserable and neglected old age? What would it be like not to have that little trove of health-care horror stories that run through your head when you wake up at three in the morning and cannot get back to sleep?

A friend read this blog and wrote to me about the title, Caring for Everyone. A friend of his, call her Jane, is a hypochondriac. She goes to the doctor about once a week and all her freinds think she is crazy. But, he said, about half the time, the doctors find something wrong, and she takes nine prescription drugs a day. Could “society” really care for her?

We hear this one a lot. People will ”overuse” health care, and if they can have as much of it as they want they’ll bankrupt the world. Do you really believe this? Half of the people I know avoid their doctors like, well, the plague. They do not want to face the fact that they are mortal until they really must. Most of us use only as much as we need. Most of us just want to know how to live as long and as happily as we can. The whole notion of “overuse” comes from the insurers, where the hypochondriac deprives the gamblers of their winnings.

If Jane’s doctors only had to think about Jane and finding out what was wrong with her, wouldn’t they figure her out?  I trust the doctors and nurse-practitioners and midwives and all the rest of those people who keep caring for the sick even under the most demeaning and depressing conditions imaginable. I would not last a day working in the emergency room I went to the day I had my first angina attack. Yet these people choose this work. I think we can trust them to keep Jane from bankrupting the system, and to take care of the rest of us.

So now is the time, folks. Write to your Congress-critters, and to anybody else who will listen. (1) Stop calling it insurance. (2) Stop denying people care. Care for everyone–it will be you someday. That’s all.

Medicare Part D-Minus and Jehovah

Dear Insurance Adivisor,

Thanks for reading!

Your assumption in your comment is that Medicare Part D was actually intended to help people. I do not believe that. I think everybody in Washington was just flailing away at the problem, maybe meaning well, maybe not, but ultimately lacking the gonads to do something the insurance industry would not like. The result was what you see. Of course it doesn’t help–it was not meant to help. It was meant to give the folks in Congress something they could wave at their constituents to say, “See, I’m fixing the health care system.”

The most important point I would like people to take from this blog is that the pyramid scheme we call health insurance is based on denying health care to sick people. That is how it functions. If it actually paid for health care for sick people on a regular basis, it would not make a profit for its shareholders. I covered that in “The Gamble” and “How We Got Here.”

It sounds like you have experience with Part D. Can you look at that thing and tell me with a straight face that it is about helping sick people? Very close to every human over the age of 50, much less 65, has at least one chronic health condition. Most of us have several. Part D pays a fraction of the yearly cost of standard drugs for most people with chronic conditions. Then it says, “Sorry, you’re on your own.” That’s the thing they call the Doughnut Hole. Then coverage kicks in again for people with truly catastrophic expenses.

Part D is designed not to cover most seniors’ drug costs. I do not see any other way of explaining the situation that makes sense. It is intended to pacify people, so that they think something is being done about their situation, while at the same time not actually paying for what people need. The intention is to keep people from building up enough outrage that they will lean on their so-called representatives to do something that endangers profits.

We have no example in this country of what it would be like to have a rational and compassionate health care system. As long as we allow the insurance industry to use our own fear of death to blind us, by threatening to take away what little we have, we cannot begin to develop something that would actually work. If we, individually and collectively, can take a deep breath and say, “Yes, I know I am going to die someday,” then the threat that the insurance industry is holding over our heads evaporates. Do you remember the character in Monty Python’s Life of Brian who was about to be stoned to death for saying the name of God? He’s giving John Cleese’s character a hard time, and John turns to him and tells him he had better stop saying the name of God or else. He replies, “What have I got to lose? Jehovah! Jehovah!” and starts dancing around the stoning-ground.

We can free up our imagination and come up with something we actually want. Maybe it will be a nationalized system, or maybe it will be some kind of public-private hybrid. For myself, I do not see anything wrong with people making a decent living providing health care. But whatever it is, the insurance model has simply got to go. Basic human decency requires it.

The Atheist in the Foxhole

Before I go any further into the notion that spiritual traditions, a.k.a. religions, might offer a way out of our health insurance mess, I have to address the assertion that there are no atheists in foxholes. In other words, that when faced with death, we all get religion. I do not think that is necessarily true. I do think, though, that when faced with death, we can be moved to be far better humans than we may have thought possible.

Atheism is trendy at the moment. The new books table at Cody’s, an independent bookstore near my home, has several books on atheism prominently displayed. But I do not think that being an atheist exempts anyone from being a good person. In fact, the people who write these books are moved partially by revulsion for the things that have been done in the name of religion. That is basic human goodness talking.

I will give you an example, the best one I have personally encountered, of how human goodness is intrinsic. It is the story of my one encounter with Noam Chomsky. I had the opportunity to meet him once, in a small group of about 20 people at the Graduate Theological Union in Berkeley, discussing the role of religion in public life. Because the group was so small, Chomsky insisted we sit in a circle rather than address him at the podium. The GTU folks were generally of the opinion that religion was necessary in order for people to have any standards by which to be good people. (I’m simplifying here, for the sake of brevity, but that was the gist.) Chomsky, as a good red-diaper baby, was having none of this. I was just a librarian at the GTU, but the forum was open, so I asked him, if religion is not what makes people good, kind, caring, what is? He replied (paraphrasing here) that we are good people like we have arms and legs. It’s inherent. We can rely on that. When I heard this, I had been a Buddhist for 15 years or so, and this is the teaching of basic human goodness, or primordial purity. I rocked back in my chair and just listened for the rest of the discussion.

Later, when I learned a little about his linguistics, I realized that his politics, in the case I just described, were actually of a piece with his science. As I understood it, and I’m sure someone will correct me if I’m wrong, the new thing he brought to the linguistics table was that language is an inherent capacity of humans. Just as the capacity to feel the suffering of others, and to care for them as one would care for oneself, is inherent.

I found him to be somewhat austere in an intellectual way, quite demanding in terms of the care people should give to working things out in their minds, but also genuinely humble and principled. I also found him to be a model of bravery in the Buddhist sense. That kind of atheist would do fine in a foxhole.

Us and Them

At first glance it seems that the hardest thing to change about the current situation is the deathgrip in which the health insurance con has trapped us all. The stupendous amount of money involved is a big contributor to that belief, I suppose. How exactly does one go about unwrapping people’s fingers from around such big piles of cash?

But I think that that problem can be solved if we can find away to solve the deeper problem of the denial of the impermanence of human existence: birth, old age, sickness, and death are how the story goes, along with life, youth, health, happiness, and enjoyment. It is a package. The health insurance con has been successful at least partially because the con men and women have been playing on our deep wish that we could have the good stuff and make the bad stuff go away. If there were a way to see through that, then the con would no longer have any kick to it.

In fact, most human cultures have aspects that do address the impermanence of existence and how we can live fully and richly in the light of that. All of the world’s religions of which I am aware offer their practitioners ways to understand and live with the inevitability of death. They offer ways of valuing life and living as good people in light of the fact that we will all die. It is not a coincidence that the last 200 years or so, when we have been seduced by science into hoping that maybe death will be overcome, have seen such stunning displays of human cruelty as those still going on today.

Maybe when we lose sight of the fact that we have things in common as human beings, one of them being the experience of age, illness, and death, we become more prone to separating people out into groups which are more or less worthy of our care. I have been struck over the last twenty years or so with the polarizing of people that has happened. I know people will say that this is a media artifact, and I think that is often true, but consider this. The U.S. is divided politically by something like 51% to 49%. But if you take one half of that divide, the Democratic party, and have two people run in a whole series of primaries, they wind up divided, again, by something like 51% to 49%. What is going on here?

I do not claim to have an answer to that question, but I do think that the fact that we have lost a spiritual sense of our common humanity is a big factor. We have divided ourselves into the fundamental duality, Us and Them. If I can convince myself that the man I know who died of a heart attack, died because he was at fault, because he ate the wrong things or was unable to make himself exercise enough, then I can maintain my belief that maybe it will not happen to me.

I know that religion is a bad word in some circles lately. I even understand that fact, given the atrocities that have been committed in the name of religion. But I think it’s possible to reclaim the gifts that the spiritual traditions of our various cultures have for us, and thus reclaim some moral compass in dealing with the human condition.

All or Nothing

At first glance, the hardest change to make would seem to be removing the insurance industry from health care. The people who have been running that long con have been making a massive amount of money at it for a very long time. We are all in on it, too. Take a close look at your mutual fund, your 401(k), or your pension plan if anyone out there still has one. I imagine you will find that they are all heavily invested in health insurance.

So, the health insurance companies will not go quietly. Michael Moore in 2007 posted to his e-mail list a memo from an insurance company P.R. person, in which the main talking point was that the rising cost of health care should be attributed to bad lifestyle choices by the evil Baby Boomers. I cannot find the letter, but I can paraphrase him or her as saying that it took us 50 years to get into this mess and it will take us just as long to get out of it. Those figures rather closely match the lifespan of the Baby Boom.

The plan? Blame the Baby Boom for its own aging, sickness, and death, give them as little care as possible, and sit tight until they all die.

Anyone who spends a moment thinking of someone they love being spoken of or treated that way would rebel. It is not acceptible to us as human beings. We cannot blame people for illness and old age as some kind of personal failure. Human beings care for the sick and we honor the dead. From what I have read, that is one of the ways anthropologists have defined as human the beings they encounter. They look not only at whether the hominids bury their dead, but at whether there are signs of people having been cared for when ill or injured.

There was a wonderful example of this in the press a few years back, which I have not been able to find again. If my description rings a bell for anyone, please write in with a reference. An anthropological dig turned up a skeleton of a male hominid who died in his thirties, about when people died in those days if they lived a long life. The striking thing about him was that his skeleton showed signs of a seriously broken bone that had healed. The injury had happened some years before the person died. The researcher wrote that the fact that the bone had healed meant this person had been cared for over a long recovery. Others had brought him food, kept him warm, and looked after his needs. This was surprising to the researchers because this particular dig came from a time when they thought the hominids were living a harsh existence, and they had assumed that the sick would have been left to die. This forced the researchers to re-consider their evaluation as to whether these hominids should be called human or at least proto-human.

The point of this story is that it is part of being human to care for the sick. We cannot let that be taken away from us. Does anyone really want to live in a world where they will be blamed for partaking in the human condition?

It suits the insurance industry to have us see this as an all or nothing proposition: either we go along with their little horror story or the financial house will come tumbling down. But the insurance industry can change. That massive infrastructure could be turned to administering health care rather than denying it. It only takes the removal of the insurance model to unleash a massive supply of medical knowledge, human compassion, and resources. The people who work for those companies will still have plenty of work to do.

The only people who would be harmed by this would be the people who have so far been making money on the gamble. But they are going to start losing soon anyway. The scheme is not scalable, as they say in the business world. It is also not supportable, and when people see what is actually involved in the plan the P.R. flack laid out, they will not stomach it. We can either let the insurance industry take us all down with them, or we can, as gently as possible, inform them that they are going to have to find another way to make money. They can take care of themselves, in fact they have few other skills. We as a human society must start caring for our sick and dying again.

Dear Mrs. Clinton

Hillary Clinton gave a great speech in New York last night, after winning the South Dakota primary. She asked people to write to her, on her website of course, and tell her what they thought she should do now. Since she has fought for universal health care for many years, and taken a stupendous amount of very personal grief for it, I felt compelled to respond.

I did this even though I wish she would not run for president and put us all through the torment of watching the Republicans eat her for breakfast. I address her as “Mrs. Clinton” because the belittling use of her first name by said Republicans, and the rest of the news media, makes me nauseous.

One of my readers asked me where I’m going with this blog. For those of you who are time challenged, the bullet points in this letter are my main arguments.

Dear Mrs. Clinton:

This is in bullet points because I know your time is valuable. 

• Whatever you decide, please devote your considerable personal capital to achieving universal health care
• Insurance assumes that the thing insured against will not happen to some people
• Everybody gets sick and everybody dies, so in fact insurance does not work for health care
• Insurance functions by denying care to people who need it
• Denying health care to people who need it is morally unacceptable
• Insurers have gotten the control they have because we are afraid to face the fact that we will get sick and die
• Insurers keep their power by using this fear and telling us that the people who do get sick and die are somehow to blame for that
• A huge amount of money and energy is going into this blame campaign so insurers can survive the upcoming old age and death of 70 million Boomers
• This blaming of the old and sick is also morally unacceptable.
• We need to look to our religious traditions, our ethical and philosophical traditions, and our common humanity and accept the fact that we all will get sick and die
• In light of our common humanity and common fate, we need to care for everyone
• Good luck, whatever you decide.

Love,

Nora

How we got here

The Insurance Gamble approach to health care has worked for a while. Specifically, it has functioned well enough since World War II, when it was invented to keep people well enough to work in war factories. But the fact that this scheme has managed to work for a while was mainly a matter of timing. There was a revolution in medicine after World War II, featuring the discovery of antibiotics and the further develoment of public health and sanitation measures from the early part of the 20th century. As a result, many more children born in the post-war euphoria of the late 1940s and 50s survived childhood than would have been the case a generation earlier. Fewer of their mothers died in childbirth. Fewer of their grandparents died of the heart attacks and cancer that killed people in their 40s and 50s a generation earlier.

So, the gamble worked for a while. The sheer numbers of young and healthy people alive from 1960 to 1990 meant that insurance companies could make money without denying care too obviously.

The same factors fed the development of a culture in the U.S. that glorifies youth and health and denies that sickness and death are a normal part of human life. It was possible for a child like me, born in 1953, to reach adulthood without ever having seen a family member or friend die. There were many parents like mine who thought it best to shelter their children from the very existence of death, so that when family members did die, the children were kept away from the funerals and other aspects of the process. Families lived separated from each other by greater distances than in previous generations, so it was possible to hide very large things behind the emotional furniture.

One has only to read a sampling of what is available in the mainstream media on human health to see this culture in action. The ugly outcome of it is that when a person gets sick and eventually falls prey to the human condition, the person is blamed for it. The blame can be subtle or blatant, but there has to be an explanation for such a thing happening, because the assumption is that it should not happen.

This is also attributable to the roots of U.S. culture in Protestantism and especially Puritanism, which held as part of its creed that the quality of your life was a direct indication of how much God did or did not like you. If you were poor or sick or miserable, it was a sign of God’s disfavor. While fewer people believe in that sort of God today, you do not have to look far to find the assumption that sickness is the result of something the sick person has done wrong.  The fact that everyone gets sick must forgotten, or else someone might notice that there is no way to get it right, and the entire structure of guilt, blame, and self-criticism might collapse like the house of cards it is.

That structure has made a small number of people a great deal of money. But, as everyone who has not been locked up in a cave for the past ten years knows, the jig is up. All those young and healthy people who held up the walls and roof of the insurance industry’s pyramid scheme and the culture’s self-deception are getting old and getting sick. If we are to avert a collapse that could take a lot of us along with it, there are going to have to be systemic changes.

1) The insurance model must be removed from the process of caring for the sick.

2) The culture as a whole must allow the existence of illness and death back into the light of day.

3) The culture as a whole must recover the basic human capacity for love and care in the face of imperfection.

The Gamble

Insurance is fundamentally a gamble. When I insure my car, I give the insurance company my money and I bet that an accident will happen that will damage my car. The insurance company bets that nothing will happen. If I win, the insurance company pays. If I lose, I pay, in that I have paid my premiums and I have never gotten any money back.

This works with a car or a house or a diamond ring because not every one of those items is damaged or stolen. Many drivers do not have accidents. So insurance companies can make this bet and win often enough to make a somewhat honest profit, if you think that money made gambling can be honest.

But everyone gets sick and everyone dies. There are no exceptions. It is a definition of life in a human body. The condition is one hundred percent fatal.

So it is not possible for health care companies operating on the insurance model to make an honest profit. They can only make money by denying health care to people when they need it. Since part of the gamble is that if I win (that is, I get sick), the company pays (because they lost the bet), then the insurance companies’ profit is not honest. The entire structure is built on a lie, that the insurance company will pay, and a massive societal self-deception, that maybe I will not get sick and die.

So it is not just that making a profit from caring for the sick, the old, and the dying is immoral.  That point could be argued by well-meaning people and often is. But the Insurance Gamble model is completely dysfunctional. It makes money because people who are sick, old, and dying are routinely denied care. They are denied care directly, by companies refusing to pay, and they are denied care indirectly, by companies making the process so difficult that the sick person, who is not in a state to be able to deal with it, gives up. This is not accidental, it is deliberate; and it is not morally acceptable.

Both of the two foundations of this mess, the outright lie and the self-deception, need to be addressed. We are facing a massive financial train wreck. We are also facing a loss of our common humanity if we are forced to condone some people not being cared for when they are sick. A great deal of Western culture, particularly U.S. culture, is complicit in the situation. Our culture is built on denying the impermanence of human life. From any sane spiritual worldview, the fact that we have allowed ourselves to be backed into the current corner regarding health care is a case in point.

” . . . Until I am compelled to believe differently”

It has been almost a year since Michael Moore’s film, Sicko, came out, and it seems to have finally turned at least some people’s attention to what I have always seen as the source of the crisis in health care in the U.S. It is not doctors charging too much, hospitals overpaying their executives, or patients going to the doctor every time they stub their toes. The crisis is rooted in the insurance industry that controls the flow of money, and, of course, keeps some of the money as it rushes by.

Sicko does seem to have turned attention toward the insurance industry. But to me, there is still a missing piece. Moore demonstrates repeatedly that the reason why insurance companies are such a corrupting influence is that they are in business primarily to make a profit for their shareholders, not to care for the sick and dying. If caring for sick people conflicts with making a profit, the sick people lose.

While this is true and also despicable, it does not solve anything. It does no good to point a finger at people and say, “You’re just in this to make money and that’s evil.” It does no good, even though it could certainly be argued that, for instance, allowing the woman with whom I worked to die at 40 of a blood clot in her lungs, because you would not spend the money to diagnose her back pain, is evil incarnate. It is hard to think of a better definition of evil, when I think of how much she suffered in her last week. All of us know stories like hers. We did not need Michael Moore to tell us this.

But, if this were just evil, we would have no chance against it. Walk up to a business person tomorrow and say to him or her, “You are evil, because you make a profit at the expense of others.” That person will have a strong and passionate defense of his or her choices. Take that basic self-justification and inflate it with a revenue stream that is approaching ten percent of the U.S. economy. The insurance industry has a lot of muscle with which to shout back, “No, we’re not evil.” It can make lots of soft and fuzzy commercials full of smiling children and puppy dogs and lots of commercials with worried faces and threatening voices. “Government control!” “We care!” “Thrive!”

The problem is not just that insurance companies are in business to make money. The problem is the attempt to apply the insurance model itself to human health.  People have only been funding health care this way since the mid 1940s, or about sixty years, the lifespan of the oldest members of the baby boom. Things went along smoothly enough for a while as the U. S. economy basked in the relative ease of that great money machine. First the parents of those 70 million people made and spent money raising them. Then they entered the workforce and fuelled an unprecedented time of prosperity. They paid income taxes, Social Security taxes, and health insurance premiums far in excess of their use of services. But now they are getting old and they are getting sick. The level plains are past and a large mountain range has appeared on the horizon. The insurance industry would like to believe it can continue just as it has done, just as Meriwether Lewis did when he first saw the Rocky Mountains ahead of him. He wrote in his journal that night, “I will believe it a good comfortable road until I am compelled to believe differently.” Six months later he and his men were starving in the snow.