The S-Word and Dr. Kevorkian's
Accountant

Health care Rx from my socialist fire
department

Thursday 15 October 2009
by: Greg Palast, t r u t h
o u t | Op-Ed

Tell me where it hurts,
Mr. President.

What's killing you, Barack, is what's killing us
all: an evil germ called "Medical Loss Ratio."

"Medical Loss Ratio"
[MLR] is the fancy term used by health insurance companies for their slice,
their take-out, their pound of flesh, their gross - very gross - profit.

The "MLR" is the difference between what you pay an insurance company
and what that insurer pays out to doctors, hospitals and pharmacists for your
medical care.

I've totted it up from the raw stats: The "MLR," insurance
companies' margins, is about to top - holy mama! - a quarter
trillion dollars a year. That's $2.7 trillion over the next decade.

Until the 1990's, insurers skimmed only about a nickel on the dollar for
their "service," Wendell Potter told me. Potter is the CIGNA insurance company
PR man who came in from the cold to tell us about what goes down inside the
health insurance gold mine. Today, Potter notes (and I've checked his accuracy),
porky operators like AIG have kicked up their Loss Ratio by nearly 500 percent.

The industries' slice is growing to nearly a quarter of your insurance
bill. All of it just paperwork and profiteering.

President Obama is
never going to pull the insurance company piggies from a trough this big,
especially when the industry has made room for Congressional snouts.

So what's the Rx? Easy: Kill the pigs and call the fire
department.

The only solution to Loss Ratio piggery is to kill the
pigs: eliminate health insurers from the health industry entirely.

We
can't cure our ills, as our president has attempted, by attacking the problem
ass-backwards. No, Mr. Obama, we don't need HEALTH INSURANCE for
everyone, we need HEALTH CARE for everyone. There's a giant difference.
Instead of concentrating on PAYMENT, we need to focus solely on providing
the health SERVICE.

From my London days writing for The Guardian,
I can tell you the British do NOT have national health insurance. They have a
National Health Service.

The government builds hospitals, hires
doctors and, when you need the service, you just go and get it. It's kind of
like the fire department. When your house is on fire, you don't call your fire
insurance company, you call THE FIRE DEPARTMENT. We care first about the
service, not the payment.

The British government hires the
doctors, like firemen, and Brits use them, like firemen, as they need them.

It works. My mother-in-law, a nurse, on a visit to England, was stunned
at the speed, quality and absence of mad paperwork to fix her broken arm.

But, you might say, that's, that's SOCIALISM! Well, yes, it is.
And I'm not afraid to use the S-word: Socialized Medicine. Just like America's
Socialized Fire Departments. (Fun fact: socialized, i.e. publicly funded, fire
departments were 'invented' by the revolutionary Ben Franklin.)

And
Yes We Can get socialized medicine passed into law.

Really.
It's simple: we sneak it in with the kids.

We can learn from Lyndon
Johnson's sale of Socialist Medicare. Johnson knew that no one could argue that
Granny do without a doctor. Can the "Pro-Life" Republicans now tell us that
pregnant moms and children ages 0 to 3 should be denied care? Therefore, to the
Medicare program for those 65-or-older, we simply add "Kiddie Care," for those
from Negative 9 months through age 3.

But instead of the wallet-busting
Medicare system, in which doctors and hospitals are paid for each suture, bag of
blood and pat on the head, Kiddie Care will be provided by Kiddie Care Service
salaried doctors.

How do we get doctors (who now AVERAGE $240,575 a
year) to take well-paid, but not pig-paid, posts? We grab'm while they're young.
We pay doctors the full cost of their medical education; and we treat them as
humans during internship, not as in the current system where interns are treated
as medi-slaves. In return for the public paying for their medical education, the
public gets the young doctors' ten-year commitment to work for the health
service at a reasonable salary.

That's not my invention. The
free-education idea for staffing a national health service had long ago been
proposed by that wily old dog Ted Kennedy. (Damn, we miss him.)

Once the
first wave of three-year-olds are about to turn four and their families face
having to buy them health insurance, these millions of parents will become an
unstoppable army of lobbyists screaming for the extension of Kiddie Care to age
four, then to age five, then to age six and so on. Get it?

Yes, Mr.
Limbaugh, I am another bleeding heart trying to sneak socialized medicine into
America. Yes, I am trying to rid us of the "free-market" insurers who are
causing the bleeding. Health insurers are as useful to our health care system as
a bicycle is useful to a goldfish.

Free-Market Fantasia

There ain't no such thing as a "free market" in medical care, as there
is a free market in food. You can eat peanut butter instead of dining at
Maxime's. But you can't tell the surgeon, "No thanks, I can't afford a new
kidney this week - I'll just have a broken arm."

A free-market
for-profit insurance system means that, when you need a new pancreas, your fate
is left to an insurance company computer programmed by Franz Kafka, Dr.
Kevorkian and his accountant. It's you versus the Medical Loss Ratio. Good luck.

In olden days, doctors would attach leeches to suck a patient's blood.
Today, we have insurance companies' Medical Loss Ratio. Both can kill you. If
Obama and America want to end this sickness in the body politic, start with Dr.
Kennedy's sure-fire cure: a national health service for kids - and get rid of
the bloodsuckers.

***

I Quit: A Personal Note

I
learned of the Kiddie Care solution during my brief and ill-starred tenure at
the Center for Hospital Administration Studies at the University of Chicago
"Billings" Hospital. I couldn't make up that name. Years later, they hired
Michelle Obama as their vice president for community affairs.

In my
time, three decades ago, "Billings" handled the affairs of that poor community
by shipping the uninsured, sometimes bleeding, to poor-folks hospitals. One
wounded patient died on the poverty shuttle.

I quit, and swore that one
day I'd write about it. I just did.

*********************

Forensic economist Greg Palast is author of the New York Times
bestseller, "The Best Democracy Money Can Buy." His investigations for BBC TV
and Democracy Now! can be seen by subscribing to Palast's reports at www.GregPalast.com. Hear Wendell Potter
tell Greg Palast about health insurers' dirty secret here.

The hoariest and most oft-repeated cliche in American politics may
be that America is the greatest country in the world. Every politician,
Democrat and Republican, seems duty bound to pander to this idea of
American exceptionalism, and woe unto him who hints otherwise. This
country is "the last, best hope of mankind,'' or the "shining city on
the hill,'' or the "great social experiment.'' As if this weren't
enough, Jimmy Carter upped the fawning ante 30 years ago by uttering
arguably the most damning words in modern American politics. He called
for a "government as good as the American people,'' thus taking
national greatness and investing it in each and every one of us.

Carter was speaking when Watergate was fresh, and government had
been disgraced, but still. The fact of the matter is that whenever
anything really significant has been accomplished by our government, it
is precisely because it was better than the American people.

Think of World War II, America's entrance into which was strenuously
resisted by the populace until Franklin Roosevelt carefully laid the
groundwork and Pearl Harbor made it inevitable. Think of civil rights,
which Lyndon Johnson pressed despite widescale opposition, and not just
in the South. Even then it took more than 100 years. Or think of the
current health care debate in which Americans seem to desire some sort
of reform, just not a reform that would significantly help people in
dire need, while the Obama administration is pushing to provide that
assistance. In the end, government has inspired Americans far more than
Americans have inspired their government. They are too busy boasting.

There is nothing wrong with self-satisfaction or national pride. But
the incessant trumpeting of our national superiority to every other
country in the world is more than just off-putting and insulting. It is
infantile, like the vaunting of a schoolyard bully that his Dad is
better than your Dad. It is wrong. And it might be dangerous both to
ourselves and to the rest of the world.

Consider what it means. By what standard is one nation any greater
than any other nation? Yes, the United States has vast material
resources - we rank eighth in gross domestic product per capita - but
we also have, according to the Organisation for Economic Cooperation
and Development, the "highest inequality and poverty rate'' in the
world, outside of Mexico and Turkey, and things are getting worse.
Nothing to boast of there.

Yes, we have a relatively high median income, but our standard of
living as measured by the Human Development Index of the United Nations
ranks us only 15th in the world, behind, among others, Norway, France,
Canada, and Australia. Are they better than we are? Even our home
ownership rate trails that of the citizens of Canada, Belgium, Spain,
Norway, and even Portugal.

Yes, the United States has the best system of higher education in
the world, but, according to an Educational Policy Institute report, we
rank 13th in the affordability of that education, and we are much less
successful with lower education - 11th in the percentage of the 25 to
34 population with a high school diploma and 22d in science education.

And though Americans love to crow about the "best health care'' in
the world, the fact is that according to the World Health Organization
Index, we actually rank 37th in the quality of our health care. And we
are still the only industrialized country in the world without a
national health care system.

Even when one considers anecdotal evidence - "If this isn't the
greatest country then why do so many people want to come here?'' - the
case isn't particularly persuasive. Mexicans cross the border to the
United States for economic opportunity. Turks go to Germany, Indians
and Pakistanis to Great Britain, Arabs to France. This isn't a sign of
our special greatness, just a sign that desperate people seek a more
powerful economy for their betterment.

The point of all this isn't that America doesn't have a lot to be proud of. It does. The point is that just about every country
has a lot to be proud of, and America has no more right to assume it is
the greatest nation in the world than does France, Switzerland, China,
or Russia.

None of this would make much difference if the self-congratulation
was just harmless bragging. But there are consequences. A country that
believes it is the greatest in the world is also less likely to be
constrained by that world. One could argue that the Iraq war was a
direct result of a sense of national infallibility. So was our
willingness to torture, our reluctance to admit our mistakes in
Afghanistan, our culpability in the global recession, and our
foot-dragging on global warming. Such a nation is also less likely to
introspect or to strive for true greatness because it believes its
greatness has already arrived.

There is something bizarre about a country whose leaders have
constantly to toady to their constituents and in which any criticism is
tantamount to a lack of patriotism, but that describes America today.
Every politician feels compelled to ape Jimmy Carter's old words to the
point where our alleged greatness has also become our national mantra.

It seems eons ago when Bobby Kennedy, a politician who didn't like
to stroke even his own supporters, actually scolded a rally for booing
Lyndon Johnson because, Kennedy said, Johnson couldn't have done what
he did in Vietnam if he didn't have the American people, including
Kennedy's audience, as his facilitators.

We aren't going to hear that sort of honesty from political leaders
any more because the American people are too thin-skinned and arrogant
to tolerate it. Arrogance in an individual is unbecoming. It is no more
becoming for a nation. The Greeks understood that the gods punished
mortals for their hubris - for feeling that they were godlike. They
knew that overweening pride preceded a fall. One suspects that nations
are no more immune to punishment than individuals. A nation that brooks
no criticism, a nation that feels it is always better than any other, a
nation that has to be endlessly flattered and won't face the truth, a
nation whose people think they possess some special moral exemption and
wisdom, a nation without humility is a nation spoiling for calamity.

We've been living in a fool's paradise. The result may be a government that is as good as the American people, which is something that should concern everyone.