So, of course you should go read Steven Brill’s excellent article on health care price gouging. Or maybe you shouldn’t. It’s very long. Not everybody has to be a fucking policy intellectual, or even au courant in the “public affairs” covered by Time. You don’t have to read much (or, God forbid, write) about policy to be a good person and a good citizen.
But citizenship does carry burdens. Like this:
By the time Steven D. died at his home in Northern California the following November, he had lived for an additional 11 months. And Alice had collected bills totaling $902,452. The family’s first bill — for $348,000 — which arrived when Steven got home from the Seton Medical Center in Daly City, Calif., was full of all the usual chargemaster profit grabs: $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85; $24 each for 19 niacin pills that are sold in drugstores for about a nickel apiece. There were also four boxes of sterile gauze pads for $77 each. None of that was considered part of what was provided in return for Seton’s facility charge for the intensive-care unit for two days at $13,225 a day, 12 days in the critical unit at $7,315 a day and one day in a standard room (all of which totaled $120,116 over 15 days). There was also $20,886 for CT scans and $24,251 for lab work.
Does Alice have neighbors? Does she have friends? Where were they, what did they — and by that I mean we in some earnest and patronizing way — do about this?
The burden of citizenship is to share in, and hold people to account for, the injustices experienced by our neighbors. Alice was fucking ripped off to the tune of any semblance of economic and financial security she might ever have had at the very moment that her husband was dying of cancer. This is beyond awful. This is mortal sin in any religion worth the name. This is pure evil.
Our problem is not a matter of shitty policy arrangements. We have plenty of those. Whatever. Policy is a third-order pile of bullshit. Our problem is that it is a sick excuse for a society when this sort of ass-rape is relegated by custom and practice into the sphere of the “private”, the sort of bureaucratic struggle one quietly hires professionals to deal with and hides as much as possible from friends and coworkers. Ass-rape of the more literal sort is also a private affair, in the first order. We insist upon it being public, because a society whose customs tolerated the maintenance of its first-order privacy would be a miserable, detestable place in which the powerful quietly ass-raped the powerless and were never held to account. The difference between literal ass-rape and what happened to Alice and Steven D. is not that ass-rape is criminal while health-care price-gouging, although regrettable, is not. To say that is to confuse cause for effect. Literal ass-rape is criminal because we-the-people as a broad-based mass are disgusted by it and insist upon it being a public and criminal matter rather than a quiet tragedy and struggle. When we hear about a Joe Paterno who overlooks this requirement, we literally hound the motherfucker to death. Perhaps unfairly, in any particular case — pitchforks are simultaneously sharp and blunt instruments! The sheer fear of which is why the powerful create laws. But where laws aren’t there, the pitchforks must always be. A society that expects laws to substitute for, rather than channel, public outrage, is a society not long for this world in any form worthy of the name. Outrage and shame are primary.
As soon as you delve into the policy wonkery in cases like this, you are submitting to a conspiracy by the powerful against the many. The greater the sphere of disagreeable things that are “complicated”, the more it is possible to construct intricate and inscrutable bureaucracies to “arbitrate”. There will be think-tanks and policy papers, funded by people who are well-meaning (in a narrow, idiotically un-self-aware way) but very rich and powerful. The conclusions of which will be earnest and carefully researched but confined to a window not very upsetting to the very rich and powerful. Undoing the ability of plutocrat hospital “CEOs”, or bankers or lobbyists or whatever, to continue the sort of ass-rape to which their lifestyles have grown accustomed will not be on the table. A good society depends on an active public, first and foremost. A society that has allowed the predations of the powerful to become purely private matters mediated via “markets”, courts, academies, and bureaucracies, that has delegated “activism” to a mostly protected professional class, is nothing more than a herd hoping that today it is somebody else who will be slaughtered.
Is that who we are?
- 22-Feb-2012, 8:50 p.m. PST: “
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