Wednesday, April 5, 2017

Racket of Rackets

By James Howard Kunstler and originally published at kunstler.com
If you thought banking in our time was a miserable racket — which it is, of course, and by “racket” I mean a criminal enterprise — then so-called health care has it beat by a country mile, with an added layer of sadism and cruelty built into its operations. Lots of people willingly sign onto mortgages and car loans they wouldn’t qualify for in an ethically sound society, but the interest rates and payments are generally spelled out on paper. They know what they’re signing on for, even if the contract is reckless and stupid on the parts of both borrower and lender. Pension funds and insurance companies foolishly bought bundled mortgage bonds of this crap concocted in the housing bubble. They did it out of greed and desperation, but a little due diligence would have clued them into the fraud being served up by the likes of Goldman Sachs.
Medicine is utterly opaque cost-wise, and that is the heart of the issue. Nobody in the system will say what anything costs and nobody wants to because it would break the spell that they work in an honest, legit business. There is no rational scheme for the cost of any service from one “provider” to the next or even one patient to the next. Anyway, the costs are obscenely inflated and concealed in so many deliberately deceptive coding schemes that even actuaries and professors of economics are confounded by their bills. The services are provided when the customer is under the utmost duress, often life-threatening, and the outcome even in a successful recovery from illness is financial ruin that leaves a lot of people better off dead.
It is a hostage racket, in plain English, a disgrace to the profession that has adopted it, and an insult to the nation. All the idiotic negotiations in congress around the role of insurance companies are a grand dodge to avoid acknowledging the essential racketeering of the “providers” — doctors and hospitals. We are never going to reform it in its current incarnation. For all his personality deformities, President Trump is right in saying that ObamaCare is going to implode. It is only a carbuncle on the gangrenous body of the US medical establishment. The whole system will go down with it.
The New York Times departed from its usual obsessions with Russian turpitude and transgender life last week to publish a valuable briefing on this aspect of the health care racket: Those Indecipherable Medical Bills? They’re One Reason Health Care Costs So Much by Elisabeth Rosenthal. Much of this covers ground exposed in the now famous March 4, 2013 Time Magazine cover story (it took up the whole issue): Bitter Pill: Why Medical Bills Are Killing Us, by Steven Brill. The American public and its government have been adequately informed about the gross and lawless chiseling rampant in every quarter of medicine. The system is one of engineered criminality. It is inflicting ruin on millions. It is really a wonder that the public has not stormed the hospitals with pitchforks and flaming brands to string up that gang in the parking lots high above their Beemers and Lexuses.
There are only two plausible arcs to this story. One is that the nation might face the facts and resort to the Single Payer system found in virtually every other nation that affects to be civilized. There is no other way to eliminate the deliberate racketeering. The other outcome would be the inevitable collapse of the system and its eventual re-set to a much less complex, cash-on-the-barrelhead, local clinic-based model with far less heroic high-tech interventions available for the broad public, but much more affordable basic care. Both outcomes would require jettisoning the immense overburden of administrative dross that clutters up the current model, with its absurd tug-of-war between the price-gouging hospital “Chargemaster” clerks and the sadistic insurance company monitors bent on denying treatment to their sick and hapless “customers” (hostages). Be warned: these represent tens of thousands of supposedly “good” jobs. Of course, they are “good” because they pay middle class wages, of which there are fewer and fewer elsewhere in the economy. But, they are well-paid because of the grotesquely profitable racket they serve. They’ve turned an entire generation of office workers into servants of criminal enterprise. Imagine the damage this does to the soul of our culture.
My suggestion for real reform of the medical racket looks to historical precedent:
In 1932 (before the election of FDR, by the way), the US Senate formed a commission to look into the causes of the 1929 Wall Street Crash and recommend corrections in banking regulation to obviate future episodes like it. It is known to history as the Pecora Commission, after its chief counsel Ferdinand Pecora, an assistant Manhattan DA, who performed gallantly in his role. The commission ran for two years. Its hearings led to prison terms for many bankers and ultimately to the Glass-Steagall Act of 1932, which kept banking relatively honest and stable until its nefarious repeal in 1999 under President Bill Clinton — which led rapidly to a new age of Wall Street malfeasance, still underway.
The US Senate needs to set up an equivalent of the Pecora Commission to thoroughly expose the cost racketeering in medicine, enable the prosecution of the people driving it, and propose a Single Payer remedy for flushing it away. The Department of Justice can certainly apply the RICO anti-racketeering statutes against the big health care conglomerates and their executives personally. I don’t know why it has not done so already — except for the obvious conclusion that our elected officials have been fully complicit in the medical rackets, which is surely the case of new Secretary of Health and Human Services, Tom Price, a former surgeon and congressman who trafficked in medical stocks during his years representing his suburban Atlanta district. A new commission could bypass this unprincipled clown altogether.
It is getting to the point where we have to ask ourselves if we are even capable of being a serious people anymore. Medicine is now a catastrophe every bit as pernicious as the illnesses it is supposed to treat, and a grave threat to a nation that we’re supposed to care about. What party, extant or waiting to be born, will get behind this cleanup operation?