Roving thoughts and provocations

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Health Care: The New American Sadism

Max Beckmann: Night, 1918

The good man understands what is right,
the bad man understands profit.
                                         —Confucius

You may have already read or heard about Steven Brill’s excellent, long article in Time magazine, called “Bitter Pill: Why Medical Bills Are Killing Us.” If you think it doesn’t concern you, don’t be so sure. Brill documents how a trip to the emergency room for chest pains that turn out to be indigestion can exceed the cost of a semester of college, how simple lab work done during a few days in a hospital can be more expensive than a new car, and how a drug that requires $300 to make and that the manufacturer sells to a hospital for $3,000–3,500, can cost the patient to whom it is prescribed $13,702. He looks closely at the outrageous prices on itemized hospital bills and finds that individual services listed on them have been priced at double and triple what those same services cost separately—for reasons neither the patient understands nor the hospital can explain. And he recounts the horror stories of people reduced to penury after a brief hospital stay, even though they had some health insurance, money in the bank, and suffered from only minor ailments.

Put simply, Brill says, these bills tell us there’s no free market in our healthcare system, that hospitals set their rates knowing that someone in pain or in fear for his or her life is not going to ask to see the price list first before agreeing to some test or treatment. It’s no wonder that 60 percent of our fellow Americans who file for personal bankruptcy each year do so because of medical costs.

Of course, if you have Medicare or an expensive health insurance policy, your costs are going to be lower, since hospitals are forced to give you a discount and insurance companies themselves are able to negotiate much lower prices for services. If, however, you have no or insufficient insurance, you’ll be charged top rates. In any case, drug companies, medical device makers, hospitals, and labs are assured of profit; it just depends how big—and that’s really what all those who want to take the government out of healthcare are screaming about. They want no restraints placed on profits of medical industry, or for that matter, anywhere else.

Today, when the acquisition of wealth, quickly and in large amounts, is admired above any other human endeavor, every medical emergency or catastrophic illness is seen as an opportunity for some to enrich themselves beyond their wildest dreams. It’s no wonder that our healthcare is so much more expensive than that of every other developed country in the world, where the costs are not only much lower, but people also live longer than we do. Unlike us, other countries have the peculiar notion that profit has no place in any situation in which the basic decencies that human beings owe to one another ought to be the first consideration, and for that reason regulate the cost of lifesaving drugs and operations. In other words, they are less greedy than we are and far more humane.

That may sound harsh. But Brill’s article makes one comprehend not just the talk in Washington about the supposed absolute necessity of replacing Medicare and Medicaid with “market-oriented” health care, but also the full human cost such a change would bring. If the elderly and the poor are stripped of the few protections these government programs give them, they’ll be left at the mercy of a medical industry and insurance companies whose already huge profits, so they imagine, will then get even bigger. Despite the claims that these are high-minded proposals that will fix our national debt, and despite their veneration as such by the political establishment and the media, what is being offered to the American people is nothing more than thinly-disguised money-making scams.

In the past, even the most venal among our politicians would now and then show that they have hearts. No more. Now that money rules politics more than ever before and those for whom private gain outweighs public good every time fill the coffers of both political parties, any mention of the plight of the sick, the homeless, and the old borders on political suicide. Polls show that most Americans do not quite share the callousness of our political class to the suffering of the less fortunate members of our society. But some do. We all remember, I hope, the cheers that went up in the audience during the GOP’s presidential debate last spring in Tampa when Ron Paul, the libertarian candidate and former doctor, stated that he would let an uninsured man lying in a coma die without lifting a finger. “That’s what freedom is all about, taking your own risk,” he said. “This whole idea that you have to compare and take care of everybody…” at which point, a few members of the audience shouted “Yeah,” cutting off the congressman in mid-sentence.

This is the new face of American sadism: the unconcealed burst of joy at the thought that pain is going to be inflicted on someone weak and helpless. Its viciousness, I believe, is symptomatic of the way our society is changing. Everything from the healthcare industry, payday loans, and for-profit prisons to the trading in so-called derivatives, privatization of public education, outsourcing of jobs, war profiteering, and hundreds of other ongoing rackets all have that same predatory quality. It’s as if this were not their own country, but some place they’ve invaded in order to loot its wealth and fleece its population without caring what happens to that population tomorrow. The only interest these profit-seekers have in us is as cheap labor, cannon fodder for wars, and suckers to be parted with our money. If we ever have a police state here, I’ve been thinking, it won’t be because we’ve become fascists overnight, but because rounding up people and locking them up will be seen as just another way to get rich. If the hell that Jonathan Edwards and other Puritan divines described in such gruesome and graphic detail is still up and running, I hope that’s where many of them are headed for.

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