A healthcare story

The Pledge

About 1998 or so, I had a bit of blood in my stool. Having excellent health insurance paid through my employer, I scheduled a visit to have a colonoscopy. It went well, but all they found was a bit of irritated lining at the bend of my large intestine. The diagnosis? atypical ischemic colitis. What does that mean? They don’t know.

It turns out I was eating a lot of popcorn at the time, and whenever I’d have a lot of popcorn, there’d be blood in my stool 12–24 hrs later. So I decided that all of it was just “no worries”.

Fast forward to 2006. I make a career move that entails becoming an independent contractor, and so I have to buy health insurance for the first time on my own. In the application, you are required to list any hospital visits over the previous 10 yrs, so I list it. My application is denied for having a pre-existing condition.

So I start shopping other insurance providers- and getting denied insurance is apparently another condition that can get you denied health insurance. Never mind at this point I am less than 40 years old, have had top tier insurance all of my working life, and had coverage under my parents since birth.

Now I still had COBRA coverage from my previous employer, pricey at $800/mo for myself and spouse. But, because I moved from NJ to CA, they had the right to kick me off of my existing plan.

Terrified, I obtained some group insurance from the temp agency I got my gig with, still pricey but at $600/mo, more affordable (and tax free). Within months, I go back to being a full time employee, and elite status on healthcare.

Ten years on, once again I am an independent contractor, but have Platinum ACA coverage from Kaiser Permanente (the same elite coverage as I had as a full time employee) and pay ~$1100/mo for the two of us. I get no subsidies because I can afford it, but that’s the rate anyone would pay Kaiser, and was in line with what my employer paid for same pre-ACA (I paid about 15–20% of the premium pre-tax out of my paycheck when employed)

Having grown up in a blue-collar “look for the Union label” family (IBEW), having proper insurance was something you just did for your family. Life, health, auto, and not just the bare minimum, because when shit happens, your agent will be there for you.

To listen to the likes of Tom Price and his libertarian allies have a go at ACA, I’ve been an idiot. Turns out, I should have paid for my own with tax free healthcare dollars in a spending account funded by me, and all those years when I was not spending a dime (except for that one hospital stay and periodic checkups) could have been cash in my pocket. My employer would give me a raise equal to what they had been spending. All those years of paying premiums were suckered out of me by “leeches” who use “too much” healthcare.

There’s an interesting statistic posted there, quoted by Cathy Reisenwitz, that the average company paid $16,351/yr (thats $1300/month) per employee in 2013. Now, like many full time employees at big companies, I used to get a little reminder each year of exactly how much the company shells out for those so-called benefits in a “total compensation” statement, and I’m not sure I can believe that number. But because compensation is a company secret here in the USA, I’m violating my former employment contract just talking about what they may or may not have paid for any portion of my total pay, and because I can’t compare apples to apples with anyone (because I don’t know what tax credits the company got for those dollars, and because actual numbers are a secret seemingly treated like any other HIPAA medical record data, and what’s ironic about that name anyway…) I don’t have any idea whether or not I’ve been getting a benefit at all or being ripped off.

I take issue with a lot of Cathy’s so called “facts”, including the idea that a majority of prostatectomies are performed by remote-operated robots, or the laughable idea that typically radiation-averse doctors would willingly replace a single CT scan with 3 CT scans. She seems to think all that leftover money wasted on those 2 extra CT scans could be used to pay for bling fillings or Lasik, if I so wanted.

The Turn

What most people know is that I’m a big participant in the healthcare industry. My career has been largely funded by Big Pharma, so much so that when at a party someone introduced me after taking a breath from an anti-big-pharma tirade I actually introduced myself as Big Pharma. But I also participate in a number of anti-corporate and not-for-profit efforts as well, including Counter Culture Labs and the Omni Collective. I’m a big believer in the power of Democratic Socialism as a force for political good in the world.

I’m not in it to die with the largest number of toys- I believe that each day you have to look at what you do and the footprint you make, and what that costs. Believing in the power of capital-C Capital is not antithetical to socialist values, but aspiring to lead life to a Gini coefficient near 1 is. Things, and I mean strictly Things, are easier to understand if they have a value denomination in dollars or some other kind of fungible good.

Somewhere along the way, though, the idea that all Goods were fungible, and that one’s lifespan and lifestyle should be dictated by how much others keep their hands off of my stack, got mixed in there with Life Liberty and the Purfuit of Happineff.

Quite simply, that’s not how I was raised. Toys are more fun when you share them with others. It’s not pleasant to be the only person not allowed to play with the toys, and it’s silly to not play with someone just because they’re different.

I was also taught the difference between Management and Worker. Management decided what to do, and Workers were paid to do it. Here’s where it all went sideways, in my story. I’ve never really been the kind of person that tells people what to do, nor the kind of person that does what I am told to do. Turns out, that most people are kind of like me- they may have some aspects of their life that look like Management or Work but by and large they do something else. And things have been heading that way for a long time, certainly since I was merely a gleam in my parent’s eyes.

More and more, within corporations people who were once Workers started doing more for the company than simple labor. By and large, once someone is told what to do, they can keep doing it for a long time without being told to do it every day. Things like, be nice to customers, so they want to do business with us. Manage costs, because costs come out of profits, which pay wages.

Today the average Worker manages a dizzying array of complex Management-like tasks, like deciding how to invest a 401k instead of simply being paid a pension if you survived. Like choosing how to spend Healthcare Dollars, on a HMO, a PPO, a POS, or the like. Choosing to save for children, so that they are not forced to take up the same apparent shackle of Work as their parents, perhaps to become blessed as Management themselves one day. And, more and more, we are expected to make decisions on political referendums and bond issuances and school-board budgets as direct democracy puts less power in the hands of Kings, Leaders, and… Management.

But, a funny thing happened.

Once you could put a dollar value on Labor through Wages, and you could put a dollar value on time through interest rates, people figured out a way to figure out the course of a life in money. Insurance was a way to put a current dollar value on a potential future event. The assumption is that everybody gets old and tired, everybody isn’t going to be able or desire to work till they die, and so insurance was a way to take away some of the pain of things like death, illness, or exhaustion.

The magic happens when you are able to find large groups of people who collectively behave in a certain way- their outcomes appear vaguely similar, and can have a price put on them, a dollar value at some point, supported by paid premiums.

And, to some extent, these dollars could also change outcomes- you could pay for more education, and as a result you would earn more wages. And to some extent, the people who enabled these changed outcomes could argue that they have a right to a fraction of those increased wages. A doctor that prevented you from dying is performing a service that must be worth some ransom from your future earnings. An educator who installed knowledge performed a service that must be worth some ransom, as well. An adviser who helped you manage your 401k or your healthcare policy was also worth some ransom, too. Behind every life is hundreds of debts.

The Prestige

A debt, a ransom, is also a choice. Because we are bound by these hundreds of debts, though, we may not perceive that as a free choice; nonetheless, it is. One person might choose not to pay the ransom, or only pay a partial ransom. And, in exchange for another ransom, people might choose to hire another to either extract or abrogate the ransom by force of army or law.

Everyone can see the effects of this. We have become a society synonymous with pecuniary ends, yet behind it all is the effect of a change in position over time, the very definition of the physics of work. While the entity of work in physics is perfectly fungible after entropy deducts its tax, our attitudes and biases about the exchange rate of work when force multipliers are used hides this underlying exchange, leading to price insecurity and increasingly, unearned premiums. Rent seeking.

Moreover, the idea, the eventuality, the actuality that work can happen without management is increasingly self evident. Because most managers don’t have to tell workers how to do their work every day, they can leverage the work of more workers, and thus feel that they are, in turn, entitled to more of the ransom paid. When the last manager turns the lights off at the robot workplace, we experience a condition known as a singularity- a point where the actual value could be any number, it could be zero or infinity or any value whatsoever.

What a doctor does in providing healthcare, lifesaving and valuable healthcare, is follow a procedure. These are fairly intricate procedures, and they are constantly subject to change, and there are many hands that collect their ransoms along the path. But, because we have decided that there are procedures, we have already passed the singularity where the sum of those ransoms ceases to have meaning.

These singularities have increasingly perverse impacts. We pay billions of dollars for a central intelligence that is neither centralized, nor providing actual intelligence. We pay trillions for atomic and biological weapons to strike fear into those that may abrogate their debts, yet never use them on the largest abrogators of debts. Not only do we pay for imaginary ends, but we argue about how much should be paid to those who call the values of those imaginary ends. Who pays? Workers pay.

Ironically, the hero of libertarianism, Ayn Rand, suggested that when the true workers cease to be rewarded, they should go on strike. She envisioned a world in which management, somehow, did all the work, and that the John Galts and Dagny Taggarts of the world should simply go on strike to prove their worth. What a socialist concept, from such an anti-socialist mouthpiece…

What most people have never seen is how a democratic alliance of workers, the Union, decides to strike. It’s not an easy process, and it’s often clouded by fear of bankruptcy or violence at the hands of Management. Having seen and heard what actual union membership meant and felt like to someone like my father, it would be dishonest to say it’s as simple as voting, yes or no. Real democracy is the ugliest process, except for all the others. This thing you do, choosing Trump or Clinton, lobbying Hamilton Electors to a third way, endlessly recounting and recounting the same fouled pages as if this time, the result might be truer, is both infinitely valuable and infinitely worthless as any singularity moment in time.

What matters is what is left after the singularity unfolds. Don’t lose your shit over trivialities like who won or who influenced who. Don’t buy into unrestrained freedom, because unbounded denominators simply put us back in the realm of singularity. Move forward, and remember that everybody is going to have to share whatever’s left of the pie after the fighting ends.

Only social ends matter. Only Social Democracy matters.

Fuck Trump. Fuck Management. Only Workers matter. Not one single fuck do I give whether he was rightfully elected or not, he’s still obviously Management. The more those fuckers expect us to manage ourselves, the less value they have as managers. Take what is yours.

Putin, a communist? He’s fucking Management too.