The murder of a heath insurance CEO is much in the news. This act, like all murder, is deeply abhorrent. That said, this heinous act was intended ‘pour décourager les autres’ and may affect policy decisions in the health insurance industry, but only very marginally. It would be very marginally, because the roles of private actors in our entire system of public policy making is arcane and highly scripted. What comes down as policy is the result of processes so highly diffuse that it is near impossible to assign accountability. When it comes to government, especially, this is intentional and such lack of accountability lies at the heart of animus toward the deep state, which is the entire state. Also said, must be some facts about health insurance particularly and how coverage policies are arrived at. As with the rest of our present chaotic society, these are complex and multi-faceted matters; they are misunderstood by the general public, which misunderstanding is fostered and inflamed from various quarters - especially those who seek to influence public/political attitudes toward health financing, generally. Their ultimate goal is to force system failure and ensure a single (government) payer.
Let us begin with a basic mechanical fact governing health insurance: most private insurance decisions in the US devolve to a significant extent from - where else? - the federal government. That omnipresent, putatively omniscient entity actually makes most or all the major coverage decisions via Medicare and Medicaid rules, which constitute what amounts to the steering mechanism for the entire aircraft carrier battle group that is the US health industry apparatus. This allusion to warfare is not unintentional. It derives from one of the fundamental - so thoroughly groomed - public misunderstandings of the very definition of what insurance actually is. This is no small matter! Therein, we will find the seeds of the execution which sprouted (as in “let a thousand flowers bloom”) on a street in NYC. In passing, profit margins in the health insurance industry are low - 3 - 6%; compare that with Apple Computer.
Insurance is, at base, a contract - an enforceable (ultimately via the powers of the state) agreement between parties to perform certain duties set forth in writing, for contracts like these. Disagreements as to the exact meaning of any of the particular elements of contracts are (usually) state matters, rather than federal. This is since most contracts fall within the jurisdiction of state law; a term of any contract may, however, obligate the parties to take disputes, to a particular jurisdiction or to an arbitration process for resolution. In the case of private health insurance (i.e., NOT Medicare or Medicaid, which mostly cover only individuals), the parties may be an individual or a group (as with employee group insurance ’fringe benefits’, which cover the majority of employees and their families) on one side and a corporate health insurance company on the other. Groups with many (healthy enough to work!) subscribers are significant revenue sources for insurance companies and the parties negotiate the coverage and the premiums to be paid.
Here lies one of the big problems with the public’s misunderstanding. Ask the average person what is health insurance and you will learn they (sic) believe it means “someone else pays all or most all of my health care costs (after deductibles and coinsurance = even more complexity). “Don’t look to me for payment” (in fact, many deductibles and coinsurance legitimately owed are never collected). Though the actual numbers are difficult to tease out, it appears that around 40% of the billed and legitimate ‘out-of-pocket’ expenses go unpaid annually - to the tune of $200 million. Of course, the payers (public and private) know this going in and it factors in to the negotiated (private) and “take it or leave it” (public) premiums charged.
This, too, is a long and complex story. For purposes here, however, let’s say it is called ‘cost shifting’, (forget baseball; this is the real American pastime) whereby those who do pay their bills wind up subsidizing those who do not - generally by paying higher premiums than they otherwise would. This practice is quite sophisticated and has been going on since the government first entered the health insurance “market” (it is nothing of the sort, rather a mostly top-down command economy, managing to combine the worst of all economic worlds, with what amount to a ‘whack-a-mole’ payment system, which evolves mostly according to which victim group cries loudest and most politically effectively at any given time). An insurance anthropologist would surely unearth interesting layers, should they (sic) manage to rip off top layers of band-aids over health insurance payments, promulgated as solutions over many years.
OK, back to the insurance contract. “Insurance” generally, is a contract of indemnity - that is, it is supposed to indemnify against the actual occurrence of one or more risks to one’s health. That means it is designed to make the subscriber economically whole for costs incurred following the occurrence of one of the agreed to risks, which causes the subscriber quantifiable economic harm, as stated in the policy. When fruition of a risk occurs, which was not agreed to in the contract, dispute inevitably arises. This is a major source of anger and resentment toward insurance companies. Again, it is worth repeating that the general public has a deeply held and erroneous belief that any service concerning “health” means that (s)he should have zero financial obligation for any service received. Unfortunately, the flames of this unsustainable belief are fanned by the usual suspects promoting an entitled, completely unaccountable, infantile, anything goes, and “I’m the victim” society.
Another highly pertinent fact obtains as to the function of insurance. It’s very design is to indemnify against risk, not pay for known and regularly-occurring costs. When it comes to health care, there is a good bit of costly “routine care” which health insurance winds up paying for. Thus, we have added the cost burden of not only indemnifying for losses due to the occurrence of risks, but also for the costs of routine care - like screening tests and annual physical exam and blood tests. This would be like buying auto insurance and requiring it to cover not only accidents, but routine maintenance, fuel, and regular wash & wax. In sum, ‘routine’ care of either autos or our selves adds an infinitely expansile demand for services, while resources which may be allocated to paying premiums, are obviously not elastic.
An acquaintance is a well-known economist, specializing in health insurance. he has several down-to-earth anecdotes to illustrate the limits of coverage, even when possible risks do, in fact, materialize. In discussing limits of coverage, he has a particularly clarifying example. Suppose a subscriber has a rare disease, for which there is no known treatment. However, animal experiments have raised the possibility that a prolonged exposure to weightlessness - in Earth orbit - would likely stop progression or possibly even cure the symptoms. So, the question arises: is either the state or a private insurance company then obliged to launch the patient into orbit and do everything required to sustain him/her there? The entitlement mentality is so deeply rooted that there are likely those who would argue (loudly and even threateningly) that “someone” must pay for this extreme remedy; after all it’s for ‘health’.
Of course, the vast majority of arguable coverage situations are much closer calls. Such decisions go straight to the bottom line of every insurance company due to the nature of actuarial cost estimates based on a particular panel of covered services. What risks can it cover and remain financially solvent? Even though many such companies are not-for-profit, these, too, cannot continue in existence if revenue does not cover expenditures. Given the ethos of our society (and its consequent laws), bankruptcy of an insurance company leaves the government (state or federal) as payer of last resort. This has the effect of shifting costs of failure to the government - as with banks.
Most citizens (subjects?) fail to understand that even the state and federal governments lack infinite resources. They ultimately tax to obtain all their resources (or take on unprecedented amount of debt) and it typically does so in sneaky ways. Example: “tax the corporations!” is a frequent cry. Great, but where do corporations get their money? Answer: from ordinary taxpayers who buy their goods/services. All tax on corporations ultimately “passes through” to their customers, so taxing corporations is yet another stealthy way to tax ordinary people, who then resent the corporation which provides desirable products at a cost which inevitably factors in tax expenses. (The extent to which the state is THE major beneficiary of for-profit corporate activities is, in fact, stunning! It is beyond the scope of this essay, however. See here).
Earlier I introduced the idea that government sets the pace for the entire health insurance industry when it comes to what health problems are covered and which are not. It also largely commands premiums allowed (as well as co-pays & deductibles). Surely, (behind closed doors) it meets with company (and its own for Medicare and Medicaid) economists and lawyers to actuarially determine the company’s costs and revenue. Such things may be reasonably well statistically predicted. These are then agreed to, knowing all the essential but unmentionable facts in operation sub rosa. The coup de grace when it comes to going forward rationally, however, is that entitlement mentality of the general public, which always shouts: “It’s health! somebody else must pay, not me”! Is NOT countered with education and explanation by the government.
Rather, such attitudes are affirmed, amplified and given oblique de jure status courtesy of the socialists with state power. “No surprise” laws are in force, which (with malice aforethought) only strengthen the all-but-universal belief there should be zero out-of-pocket costs for any health service. As I said as best I can determine, 40% of totally legitimate co-pays and deductibles go unpaid by the entitled, and still outraged public. I am surprised that there has been only one public execution to date, of someone who merely played his part in the kabuki theatre which passes for the enacting of health policy in the US.
Discerning Maoist products of our elite universities are likely cognizant of the many parallels operant when it comes to policy making; it is the same in virtually all industries in our American brand of new-and-improved fascism. Make no mistake - this is the very definition of fascism, not as it is used to tar hated conservatives by the MSM. The fusion of state and corporation is so complete it is no longer possible to ascertain who has captured whom in these unholy unions.
The present assassin, ineligible for martyrdom for want of the death penalty, will nonetheless qualify for revolutionary sanctification, not least for declaring open season on the minions of despised avatars (the many faceless executives, administrators, jurists, etc.) of administrative/corporate power. President Trump is categorically different, as open season was declared on him by the left/MSM during his first campaign in 2016. Now, no one in the any sector of society’s power structure is immune. Were I an administrator, a CEO, a judge, a legislator, indeed anyone deemed to have said ‘NO’, or even having the power to do so, to anyone in the ‘entitled’ class, I would understand that I may become a target without notice.
The seething anger in America, a nation (barely) which has abandoned all limits on behavior (at least for members of heretofore politically favored groups), has reached pandemic proportions. Any remaining civility represents a shrinking reservoir of the hard-won freedoms - enshrined in the Constitution - based on self-restraint learned over thousands of years of historical evolution of human societies. Those on the left, intent on coercing society into a Marxist utopia (again!), demand absolute power, as exhibited in there endless attempts to excise the Bill of Rights and and erase the Constitution. They have not been shy in announcing they will proceed “by any means necessary”. Maybe Trump’s re-election signals that some numbers of the population have realized these people mean what they say and have been about the business of doing it!
The “progress” they promise now includes despising even words expressed by anyone who disagrees with their self-righteous revealed wisdom. The present murder, from the left, was predictable and inevitable, a matter of only ‘when’ not ‘if’. It was aimed at what was mistakenly perceived as a vestige of old corporate power. It was, in fact, the new power of American fascism, ironically the left’s favorite epithet for any disagreement whatsoever - however mildly asserted or rational. The entire ethos of today’s American left is objectively totalitarian. It is also exemplary of the left’s constant tactic projection: accusing others of trying to do precisely what they are boldly doing themselves.
This in-your-face denial of reality is an obvious effort to instill anger and resentment in anyone on the receiving end. The left has been hoping (they do not pray) those on the right would respond with violence. They fact this has not happened - that virtually every act of violence from the ’60’s onward, has been on the left - speaks volumes as to the character and motivations of those of us on the right; our goal is individual liberty lived by responsible, social individuals who voluntarily choose to live peaceably with their fellows. This happens mostly by working out our differences personally, with words.
The underlying question - if we are to ever even begin to ameliorate society’s many critical ills - is how can we govern ourselves once again in a system where decision makers are accountable for the consequences of their actions. In a cynical, stealthy manner - quite at odds with the Constitutional ideal - American leadership in every institution has incrementally insulated itself from all accountability. This malignant strategy has been practiced in government in all branches and in corporate structures at all levels, preceding the Founding.
This grand effort to diffuse accountability is at the root of every societal dysfunction; its roots are in our human nature - in the lust for power; the ancient and lethal sin of pride. After all, to the extent one is unaccountable, one’s power rests fully assured. I suspect the science of psychology is capable of clearly articulating this mechanism and demonstrating its present effectiveness. In passing, since God has been dead, leftist rubrics demand reverence for only The State. The only recognized sins, the only limitations of behavior are those derogatory to The State. Totality consists in that “everything not compulsory is forbidden”.
The practical import of answering the question of accountability is obvious. Given the complexities of post-modern society, it will be difficult - and maybe impossible - to create a novel system of governance whereby the citizenry are actual (and not pro forma) participants in their own governance. Otherwise, they devolve to mere subjects of some sovereign - either a singular dictator or a diffuse technocracy with plenary power. The latter seems to describe our present plight, with a hybrid contribution of elements of limited (so far) and intermittent Presidential rule by fiat.
Given the novelties created by new technologies and their combination with severely reduced capacities of individuals to restrain their own behavior (and society’s unwillingness to morally stigmatize most anything), I find myself unable to envision a new means of governance which is sorely needed. I think a fair reading of human history reveals that progress in governance can be described as a series of successful efforts to constrain power of leaders and establish limits on the behavior of individuals. It seems in the early 21st century, we are at a point where both these longstanding efforts have been abandoned; where the state seeks to exercise unlimited power and individuals believe they may act as they wish without consequences.
One foreseeable result of this state of affairs is the present fascist governance we enjoy. The other is violence rather than meaningful individual civic participation. The recent assassination, in this context, then, was baked into the confection, unavoidable. It is clear we are at an inflection point of history. Assuming - in the wisdom of our unaccountable leaders - we don’t provoke nuclear annihilation over Ukraine and mankind still has a future, unless we find a new way, violence and assassinations will become merely banal.
Somehow, we must find a new way to participate meaningfully in our own governance. God knows how. Alternatively, we must accommodate ourselves to immersion in a hive-mind type affair; high-tech totalitarian surveillance and control system with mandatory emotion (or at least mouthing the words) along with ‘bread and circuses’ to soften the despair. If we make no real progress in this endeavor, we can expect to live in chaos punctuated by violent outbursts of the kind which has just so captured, briefly, the national attention. This individual, in his putative writings, indicated he wished to spare “innocents”. Recognition that “innocents” even exist is absent from many politically motivated individuals and especially groups, whose aim is political impact. For these, unfortunately, their own measure of success is in units of body count. The present perpetrator may be a footnote in history as one of the lesser evils which has befallen our successors.