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.