Health for profit

Ever since the fatal shooting of United Health CEO Brian Thompson, the whole issue of the ridiculous unaffordability of health care and the capricious, cavalier attitudes of health insurers has been much on people's minds here in the United States.  Around ten percent of Americans have no health insurance at all, meaning they are one health crisis from bankruptcy -- and very likely to forego medical care completely for anything that isn't immediately life-threatening.  Many others are woefully underinsured.

Of the twenty-five wealthiest nations in the world, only three -- Qatar, Saudi Arabia, and the United States -- do not have some form of government-paid health care for all citizens.  With regards to human rights, not really the company we want to be keeping, is it?

As far as the other wealthy nations go -- well, allow me to cite just one example.

My writer friend Andrew Butters, who lives in Canada (and has given me permission to relate this story), went through the agonizing experience of having his daughter develop a devastating medical condition -- progressive scoliosis.  The disorder was inevitably leading toward debility, nerve and organ damage, and ultimately would have been fatal without significant (and urgent) medical intervention.  Eventually she required twelve hours of surgery, a long hospital stay, and extensive care for months afterward, but made a complete recovery and is now a healthy and happy adult.

The family paid less than $2,000 out of pocket total.  In fact, out of gratitude to the Canadian health care system, Andrew wrote a book about the experience called Bent But Not Broken (highly recommended reading, it's incredibly inspiring) and is able to donate every cent of the proceeds to charities helping other parents in similar situations.

In the United States?  Even with health insurance, this exact same situation would have created massive medical debt they'd be paying off for decades.  For many families, it would have permanently destroyed them financially.

The fact that the other twenty-two wealthiest countries in the world are making health care for all work, and we're not, seems to indicate that we could be doing this, but we just don't want to.  So why is that?  How did all the others come to look upon health care as a right, not a privilege restricted to the rich, and we didn't?

Well, allow me to introduce you to Frederick Ludwig Hoffman.

Hoffman in 1909 [Image is in the Public Domain]

Hoffman was born in 1865 in the town of Varel, Oldenburg, Germany.  His performance in school was rather dismal, and ultimately he realized he wasn't going to make a decent living in Germany, so he emigrated to the United States in 1884, where shortly afterward he was hired as a statistician for the Prudential Insurance Company of America.

He was also a raving racist.

Around this time, African Americans were gaining ground in terms of rights and opportunities, and Hoffman thought this was just terrible.  He was convinced that Blacks were genetically inferior -- not only less intelligent and more prone to crime, but had shorter life spans and more health problems.  That the last-mentioned had to do with mistreatment, poverty, poor nutrition, and lack of access to medical care, didn't seem to occur to him.  But he saw other countries moving toward considering good-quality medical care to be a right; in fact, his native Germany instituted a national health care program in 1885.  Despite the inherent immorality of forcing sick people to pay, as if becoming ill was somehow their fault (or a choice at all), Hoffman was appalled at the thought of this becoming policy in the United States.  He realized that if this happened here, wealthy White people would be shouldering the financial burden of paying for the health care of poor Blacks.

And we couldn't have that.

He wrote a book called Race Traits and Tendencies of the American Negro which was a mishmash of huge amounts of statistics on illness and death rates, along with a heaping helping of racist tropes, eugenics, arguments against miscegenation, and deliberate avoidance of any mention of the role of social status and environment in human health.  Of course, it played right into the panicky bigotry of the time, not to mention the greed über alles attitudes of the people in charge (remember, this is the era of the Robber Barons).  So rake in the profits and simultaneously make life miserable for Blacks?

Prudential, and other insurance companies, said, "Hell yeah, sign me up!"

Megan Wolff, in the journal Public Health Reports (link provided above), writes:

Insurance is a highly lucrative business, and in the latter 19th century it factored among the biggest, fastest-growing, and most aggressive corporate entities in existence.  Between 1860 and 1870 alone, the number of policies active in New York State jumped from 50,000 to 650,000; by 1868 the sum of insurance throughout the nation exceeded the national debt.  Cutthroat business practices guided corporate policy.  By the mid 1870s, the three largest companies—Metropolitan Life, the Equitable, and Mutual Life—had expanded into a corporate oligopoly that dominated sales in the cities of the northeast United States and maintained an impressive reputation worldwide...

The relatively equal access of African Americans to main-line industrial policies came to a halt... when Prudential announced a decision to reduce life benefits to African Americans by a third, though they would continue to pay the same premiums.  Citing elevated mortality rates among Blacks, the company insisted that its decision was “equitable” and based “solely on the basis of facts.”  Some evidence suggests, however, that the prospect of Black policyholders simply had not occurred to commercial insurers when they launched their industrial policies—at least not in the volumes with which African Americans applied for coverage—and the reduction of benefits was a response to an unanticipated and socially undesirable demand.

There was some effort by states to institute anti-discrimination laws regarding insurance, but Prudential trotted out Hoffman, who was happy to explain his reasoning (backed up, of course, by plenty of statistics).  Few White lawmakers felt all that inclined to argue on the behalf of poor Blacks, who after all had no legal clout, and in fact very little say in anything.

Hoffman, on the other hand, became an overnight celebrity.  In 1901 Prudential started its Department of Statistics -- what we would now call the actuarial department -- with Hoffman at its head.  There's some evidence that his views softened toward the end of his life (he died in 1946), and that he eventually acknowledged the role of social stratification in Blacks' lower life expectancy and higher rate of health problems, but by that time the damage was done.  The corporate control of medical care in the United States was already set in stone, and that was largely due to Hoffman's tireless efforts to prevent African Americans from having health and life insurance.

And as we've seen over and over, once the corporations see a profit to be made, there's no power on Earth that can stop them from doing whatever it takes to achieve it, even if they leave thousands of dead bodies in their wake.  In what kind of crazy, bass-ackwards system can your doctor say, "You must have this treatment or you won't recover," and the insurance company gets to say, "Nah, you don't really need that"?

There's some truth to the fact that looking at the roots of an issue doesn't necessarily inform you about what the issue is now.  That the lack of universal health care in the United States was inspired by racism is less important than what's motivating it in the present.  (After all, during the Civil War and Reconstruction Periods, the Democrats were more often the racists and the Republicans the anti-racists, and that's hardly the case today.)  

But it's at least instructive to consider that the current situation -- where the wealthy have unlimited access to the best medical care, and the the poor are one surgery from bankruptcy -- has its roots in a fundamentally immoral stance, that somehow certain people are deserving of good health and others aren't, and that the greed of corporate leaders should trump any considerations of fairness.  And this kind of built-in social inequity can't go on forever.  While I don't condone Luigi Mangione's actions, I certainly understand them.  As the noblemen and women of pre-Revolutionary France found out, you can't keep taking advantage of people indefinitely and expect them not to react.

So whatever the origin of the insurance industry's motives, right now what they're doing is profiting off the misfortune of others.  For all of the health insurance companies' cheerful slogans about how they're "your partner for good health," the fact remains that the only ones they're actually partners with are their stockholders.

Not that it's likely to improve under the incoming administration, which puts corporate profit above anything else.  So we've got at least another four years of poor people going broke because they had the audacity to get sick at the wrong time.

And it all traces back to the specious research of a racist German statistician who told the insurance companies and other business leaders exactly what they wanted to hear.  The wealthy then twisted the arms of the elected officials -- as they still do -- and the result is an inherently unfair pay-or-die system that is nearly unique amongst industrialized countries.

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Reaping the whirlwind

Back in 1980, I came up with an idea for a novel.

Ronald Reagan had just been elected president, and many of us were alarmed at what seemed like a lurch toward far-right populism -- anti-regulation, pro-corporate policy that was marketed as somehow being beneficial to the working class.  The buzzwords were "trickle-down economics," the idea that if you gave big tax breaks to the rich, the benefits would "trickle down" to you and me and the rest of the working stiffs.  It was bolstered by a belief that the rich were actually concerned about lifting the working class out of poverty; that it was possible, in the society as it was, for a poor person to become wealthy.

That, to quote Steinbeck, the poor were just "temporarily embarrassed millionaires."

It didn't work.  The rich got richer (as intended) and the working class reaped exactly zero benefits from it.  And it generated deep resentment, as corporate profits soared, CEOs raked in unimaginable amounts of cash -- and workers' salaries stagnated.

And I thought: this can't go on forever.  At some point, people are going to get fed up, decide they have nothing to lose, and pull the whole superstructure down.

This was the genesis of my novel In the Midst of Lions.

The title comes from a line from Psalm 56: "Have pity on me, O God, have pity on me... for I lie prostrate in the midst of lions that devour men."  The story is set in Seattle, and centers around five completely ordinary people who are caught up in the collapse.  The attacks are precipitated by a shadowy worldwide organization of violent anarchists called the Lackland Liberation Authority; the "Lacklanders" are people who lost their property from corporate buy-ups of land for industrial agriculture and mining, and because price increases made home ownership out of reach.  Threatening LLA graffiti, in their trademark red spray paint, begins showing up on walls.  

Then the attacks start.  At first, they're scattered and sporadic, targeting a few of the most egregious offenders; but when that doesn't work, they strike hard, and simultaneously, at governmental and business leaders across the world.

The result is spiraling chaos.

Back in 1980 I wrote a few chapters of it, but somehow sensed that I didn't have the background, knowledge, or writing skill to pull off something this big, so I tabled the project.  It was in the back of my mind -- for forty years.  In 2020 I finally decided to tackle it, and wrote it and two sequels (The Scattering Winds and The Chains of Orion), which I published in 2023.  

The reason this comes up is that there's a passage from In the Midst of Lions that's been on my mind for the last couple of days:

“But there’s one thing I don’t understand,” Soren said.  “If they had this coordinated, worldwide plot, planned well in advance, there has to have been communication between different places.  By destroying the telecommunication hubs, they’ve cut themselves off along with the rest of us.  It’s sawing off the tree branch you’re sitting on.”

“I doubt they care.” Cassandra’s lips tightened, the only display of emotion she revealed.  “I’ve read some of the Lacklanders’ manifestos.  They’re no different than the suicide bombers in the Middle East back during the Gulf Wars.  The point is to destroy the power structure they despise.  If they can take down the corporate-capitalist overlords, they still count it as a success even if they go down along with them.”

“That makes no sense at all,” Mary said.

“I didn’t say it was rational.”

The deadly attack on UnitedHealth CEO Brian Thompson comes from this same desperation.  UnitedHealth is in first place amongst American health insurance companies for percentage of claims turned down -- estimates are around a 32% denial rate.  "Deny, Defend, Depose" was written on the bullet casings -- and the disingenuous media is still saying, "Gee, I wonder what the murderer's motive was?"  Instead of outrage at the violent act, the result has been an outpouring of anger against health insurance companies -- and by extension, ultra-wealthy corporate CEOs everywhere -- coupled with a complete lack of sympathy for Thompson and a celebration of his killer (who, at the time of this writing, remains unidentified and at large).  A Facebook post by UnitedHealth asking for "understanding in this difficult time" got almost a hundred thousand responses -- 77,000 of which were laugh emojis.  

But what gave me the biggest shiver up the spine was the following image of graffiti I saw on Facebook.

In red spray paint.  In Seattle.

I said to a friend -- and I was only half joking -- "I didn't think I'd have to move In the Midst of Lions to the non-fiction shelf quite this soon."

Thompson's murder, and the glee that followed, isn't laudable, but it is understandable.  And it definitely isn't one pundit's characterization of "a sign of the deep moral and ethical corrosion of America."  It's a result of something that we've seen over and over again in history, from the American and French Revolutions to what's happening right now in Syria; if you push people long enough and hard enough, profit off their struggle, empower corrupt oligarchs and expect the working class simply to play along, eventually the whole tower of cards collapses.  People will then take action by whatever means they can to put an end to it -- legally or illegally, ethically or unethically, peacefully or violently.

Something Donald Trump and his ultra-wealthy corporate capitalist cronies might want to keep in mind.

Stephen King wrote, in his book The Stand, "The effective half-life of evil is always relatively short."  It's a line that's stuck with me since I first read it, perhaps thirty years ago.  The power-hungry and super-wealthy -- who are, of course, usually one and the same -- think their riches will protect them.  That's what King Louis XVI thought; so did Napoleon, Jean-Claude Duvalier, Jean-Bédel Bokassa, Idi Amin, Benito Mussolini, Pol Pot, Ferdinand Marcos, and Muammar Gaddafi.  

All of them were wrong, and several of them paid for that error with their lives.

The problem with all this is that the result of the downfall of dictators is often chaos, destroying economy, infrastructure... and the ordinary people who only wanted to be able to feed their families and have a roof over their heads.  In In the Midst of Lions, it's not just the corporate oligarchs who end up suffering, it's everyone.

I'd like to hope that the people in charge will recognize where we're headed before it's too late, but unfortunately, we have a very poor track record of learning from history.  (Or from cautionary fiction, for that matter.)  The overweening arrogance that comes with wealth and power tends to make them say, "Oh, sure, it may have happened to all those people in history... but it won't happen to me."

It all reminds me of another biblical quote, this one from the Book of Hosea: "Who sows the wind, reaps the whirlwind."

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Mental health priorities

What do you hear about more on the news, homicides in the United States, or suicides in the United States?

Unless you're watching drastically different news media than I do, you answered "homicide."  The media, and many people in the government, harp continuously on how dangerous our cities are, how we're all terribly vulnerable, and how you need to protect yourself.  This, of course, plays right into the narrative of groups like the NRA, whose bread and butter is convincing people they're unsafe.

Now, don't get me wrong; there are dangerous places in the United States and elsewhere.  And I'm not arguing against -- hell, I'm not even addressing -- the whole issue of gun ownership and a person's right to defend him or herself.  But the sense in this country that homicide is a huge problem and suicide is largely invisible reflects a fundamental untruth.

Because in the United States, suicide is almost three times more common than homicide.  The most recent statistics on homicide is that there are 5.3 homicides per 100,000 people.  Not only is this lower than the global average (which in 2016 was 7.3 violent deaths per 100,000 people), it has been declining steadily since 1990.

Suicide, on the other hand?  The current rate is 13.0 suicides per 100,000 people, and unlike homicide, the rate has been steadily increasing.  Between 1999 and 2014, the suicide rate in the United States went up by 24%.

It's appalling that most Americans don't know this.  A study released this week by researchers at the University of Washington, Northeastern University, and Harvard University showed that the vast majority of United States citizens rank homicide as a far higher risk than suicide.

"This research indicates that in the scope of violent death, the majority of U.S. adults don't know how people are dying," said Erin Morgan, lead author and doctoral student in the Department of Epidemiology at the University of Washington School of Public Health.  "Knowing that the presence of a firearm increases the risk for suicide, and that firearm suicide is substantially more common than firearm homicide, may lead people to think twice about whether or not firearm ownership and their storage practices are really the safest options for them and their household...  The relative frequencies that respondents reported didn't match up with the state's data when we compared them to vital statistics.  The inconsistency between the true causes and what the public perceives to be frequent causes of death indicates a gap in knowledge."

[Image licensed under the Creative Commons Wildengamuld, Free Depression Stock Image, CC BY-SA 4.0]

This further highlights the absurdity of our abysmal track record for mental health care.  Political careers are made over stances on crime reduction.  How many politicians even mention mental health policy as part of their platform?

The result is that even a lot of people who have health insurance have lousy coverage for mental health services.  Medications like antipsychotics and anxiolytics are expensive and often not covered, or only are partially covered.  I have a friend who has delayed getting on (much-needed) antidepressants for years -- mostly because of the difficulty of finding a qualified psychiatrist who can prescribe them, the fact that his health insurance has piss-poor mental health coverage, and the high co-pay on the medication itself.

No wonder the suicide rate is climbing.  Dealing with mental health is simply not a national priority.

It's time to turn this around.  Phone your local, state, and federal representatives.  My guess is that at least some part of the inaction is not deliberate; I'll bet that just as few of them know the statistics on suicide and homicide as the rest of the populace.

But once we know, it's time to act.  As study co-author Erin Morgan put it, "We know that this is a mixture of mass and individual communication, but what really leads people to draw the conclusions that they do?  If people think that the rate of homicide is really high because that's what is shown on the news and on fictional TV shows, then these are opportunities to start to portray a more realistic picture of what's happening."

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This week's Skeptophilia book recommendation is a wonderful read -- The Immortal Life of Henrietta Lacks by Rebecca Skloot.  Henrietta Lacks was the wife of a poor farmer who was diagnosed with cervical cancer in 1951, and underwent an operation to remove the tumor.  The operation was unsuccessful, and Lacks died later that year.

Her tumor cells are still alive.

The doctor who removed the tumor realized their potential for cancer research, and patented them, calling them HeLa cells.  It is no exaggeration to say they've been used in every medical research lab in the world.  The book not only puts a face on the woman whose cells were taken and used without her permission, but considers difficult questions about patient privacy and rights -- and it makes for a fascinating, sometimes disturbing, read.

[If you purchase the book from Amazon using the image/link below, part of the proceeds goes to supporting Skeptophilia!]