Weekend at Uncle Sam’s

A sizable chunk of the American population is rationally checked out of politics and has been for a great part of their lives. Every few years earnest youngsters, political junkies and civic scolds give them flack, but it’s easy enough to ignore them. Politically active means keeping up with the Sunday morning talk shows, knowing what the latest political scandal is and who the key players are, and yanking a lever every few years, maybe some jury duty. Across some lines it does not do to cross, as any Twittering anarchist holed up in his hotel with a stack of Buffy DVDs well knows. The earnest and respectable know to get into barbed wire ringed free speech corrals.

A superficial intellectual awareness coupled with emotional distance is a rational approach for all of us. To assume by default that we are getting screwed by both parties, that government is inherently bumbling and wasteful (compared to private enterprise, which as everyone reading blogs, email and celebrity news all day in their cubicle knows is a model of efficiency), and tune out is to pretty much get it right without having to expend any time or energy tracking specifics and trivia. Who gives a shit what this election or that mid-term referendum means for the Democrats or Republicans as a party, or the current head (actual topic seen on the gym television at approximately 4:30 AM this morning.) To paraphrase a poet, you don’t need Morning Joe or Brit Hume to know which way the wind blows.

The catch is that we are getting screwed and have been for some time, you can be pissed, sure, but what are you gonna do? Bitch about it to your friends and plod along in life, things aren’t so bad here - unless you lose your job, and then shortly thereafter your friends, possessions and then it’s a mad scramble for personal survival.

A small part of me wonders if the health care reform underway may eventually be seen as an inflection point. Most days our government’s actions, as horrific and controversial as they are, do not affect us directly, it is mostly someone else’s kid dying in Iraq or Afghanistan, someone else’s country getting blown to shit – or it’s your grandchildren paying for today’s largesse. The point is that as pissed as many may be, most remain far enough removed that it makes more sense to register vague hope, anger, maybe attend a protest, and move on than to risk personal or financial health taking some ill-fated action. The long cons are largely invisible from everyday life – I’m talking about each person’s daily routine now - like the bailout and Wall Street’s ongoing gouging of the public (see Sachs, Goldman) – there is sense of feeling jobbed, but the tax bill is not in the here and now, and what is there to do really as long as we still have bread on the table and whatever on the tube?

Health care is different because it affects a lot of people and on a short time line; we are not talking about your grandchildren’s future, or your neighbor’s kid in Iraq, but your health care. Couple this with the national anxiety over losing your job and insurance, and this is an issue that directly affects almost every conceivable demographic group immediately. Even the most rationally checked out is paying attention to this. And how exactly have things gone down?

What this issue has revealed for all to see is that the propped up corpse of American Democracy, which many mistook for a sick old man, is, in fact, dead. The debate has hewed so closely to the corporate agenda as to beggar belief even for the cynically uninformed who know intuitively that the government is officially fucked up. The rationally checked out have it easier than the ideologically committed and indoctrinated intellectuals who follow politics closely; for them this has been confusing and disappointing to the nth degree. Those political party true believers are faced with just how shut out they (and most everyone else) really are; they have seen the nickel’s worth of difference and are at a loss, probably feel betrayed. Don't worry, they will get over it, they always do.

In a functioning democracy with a government for the people, by the people and of the people, is there any doubt that health insurance companies would be nationalized or abolished altogether? Their main purpose at this date is to suck as much money out of the system as possible. Paying the bills and negotiating prices with care providers is their value added proposition, but the obvious economic incentive for insurance companies is to minimize how much they pay out – and this has led to rescission, denial of coverage, and sky rocketing rates.

I happen to work in health care on the R&D side. Yesterday we had a meeting to discuss what third party vendor we would contract with to secure payment from insurance companies and individuals paying out of pocket. As a start up with a new product coming to market, we have to establish a history of payment with insurance companies because there is no price point yet. A consultant advised us that the best strategy with insurance companies is to find the quickest path to ‘no payment’, their default position, so we can begin appealing, which creates costly paperwork for the insurance company. The name of the game is to inflict enough economic attrition with appeals to settle a price they will pay. No wonder the U.S. health care system is 21% of excess spending on administrative costs (McKinsey Global Institute).

A government not captured and owned by business interests; beholden to voter concerns instead, would abolish these anachronistic companies, the failed experiment of health insurance, and dramatically redraw the profit lines of health care. The entire debate thus far (and we are nearing the end game) has accepted the profits of insurance companies and pharmaceuticals as an unquestionable feature of the health care system. A widespread recognition in corporate America that health expenses, left unchecked, would eventually drown the American economy is what prompted this debate and reform; this is remarkable given their usual track record of going headlong into long term disaster while pursuing quarterly earnings. I have to give credit for that, at least.

The Democrats have worked an extremely business friendly plan with a few minor concessions for the sick who insurance companies would, quite rationally, rather dump than payout on. The Republicans have offered a joke of a counter reform, implicitly allowing practices like rescission to continue, allowing insurance companies to dump the insured if they determine that the insured misled them about existing conditions. (This means that if you get sick without insurance, or change jobs, or lose your job, then you are not likely to ever get and keep health coverage if you need it.) I am not going through the rest of the particulars of either bill as relayed in the press because that is not the point of what I am driving at here, but background and necessary context. What I am getting at is that the degree to which our government is willing to screw us on behalf of their wealthy patrons can no longer be a vague or distant proposition for the masses – health care is close to almost everyone in this country. The slide towards serfdom is not likely to be well met by a population jacked on amphetamines, MMA, football, violence and porn.

The bailouts for Wall Street and the banking sector exposed the lies of American capitalism and welfare at once; it ain’t the poor living large on the public dime and it ain’t the rich competing in a dog eat dog fight. Even if most people are reading articles like Matt Taibbi’s seminal Rolling Stone pieces, there has been a widespread recognition that this game is rigged to greater degree than previously suspected. This was the setup, because even watching this go down only did so much.

People are not going to take to the streets over health reform, but it could well be the moment when the widespread recognition of just how rotten and corrupt our government has become, how captured by business, just how false the choice between or two parties is, how hollow our civics courses are in school, just how nominal our nominal voices are heard becomes the new understanding (the bailouts, as bald a scam as they were, could be compartmentalized as one-off emergency measures, a hold your nose moment in the face of global meltdown.) I’d guess that no matter how cynical, cranky and half informed people were before now, many had no idea how bad it is; and as the socialized capitalist animal continues devouring itself, inevitably more and more muddling Americans are drawn closer to its teeth and claws – and its fast becoming an us against them, everyday, everyone type conflict.