Why health care fails in the USA

Most of the opposition to universal health care in America is based on our longstanding traditions of greed and double crossing.

The colonies that became the United States were founded as business ventures. Religious dissenters may have been used to staff some of them, but that was because they provided a substantial number of people willing to relocate far, far away. Along with their conscientious convictions, they had obligations to provide returns to their investors. As far as the investors were concerned, the obligations were all that mattered. This was the leading edge of capitalist expansion.

Business thrives on a certain amount of deceit. Profit is itself the amount that a business is able to overcharge for goods and services, in order to have funds to invest in things like other ventures, and the egotistical indulgences of people in charge. We put up with a little of it. The businesses push for a little more. Various forces push back if they can. But between nations, and against indigenous peoples, the deceit includes frequent signing -- and then violation -- of treaties. As the colonies became the nation and the nation developed, deals were struck in back rooms, palms were greased, and history written to show that the good guys always won.

Time and again the little guys have been reminded that the big guys look out for themselves first, and the rabble a distant second. We're conditioned to expect to be double crossed if we're not paying constant attention to how the cards are being dealt. It's almost a point of pride.

We do have our traditional belief in honesty and integrity, truth and justice, freedom and equality. But little of that was reflected in the period when robber barons amassed legendary fortunes to set the contemptible standard of wealth that still afflicts us.

All this conditions us to expect that any system will be gamed, and that cheaters will abound at the top and the bottom. What do you hear most often from people carping about social programs? They hate paying for freeloaders. And the second most common thing? They fear that the system will be inefficient and corrupt. It does not matter to them that the current system is already inefficient and corrupt. They assume, from historical precedent, that the government and corporate interests will collude to fix prices to the advantage of rich investors, and that the users of the programs will most likely be goldbricking slackers.

There is more support for the first contention than for the second. Most Americans work as hard a they can. Some strivers are fortunate enough to be able to find enough jobs to work way more than the 40-hour week we were once led to believe was a reasonable standard. Others fail to connect as well with virtuous toil,  and end up living with their parents for a few decades, or falling onto public assistance. And yes, there are goldbricking slackers, but to assume that the person you see using food stamps or lining up for unemployment is just a loser with low morals looks through a pretty distorted lens. Most people have dreams and hopes. Unrealistic though many of them may be, they're generally innocent enough.

When it comes to health care, I often hear that objectors to a universal system don't want to pay for someone else's health care.

You pay for someone else's health care whenever you do business with a company that provides benefits for its employees. You pay for someone else's health care whenever you pay your own insurance premium. You pay for someone else's health care whenever you pay your taxes. By inserting the overhead costs and profit desires of insurance companies into a haphazard agglomeration of risk pools, we jack our own costs higher and higher. The idea that you are not paying for someone else's problems is a dangerous illusion. We all pay for other people's problems, and we always will. Even in libertarian anarchy we would pay dearly for other people's problems, as they acted them out without restraint for as far as they could extend their influence.

Accepting for the moment that we will believe in the innocence and integrity of most clients of a universal health care system, that still leaves the cheaters on the supply side. Only the unwavering resolve of a citizen government will restrain that. Raising children with better ethics will help keep such a government going. Abandon the unrealistic expectation that anyone can become filthy rich and that it's perfectly fine to try.

The social contract becomes complicated when it depends on the good faith and responsible behavior of large numbers of people, but the only alternatives are authoritarianism or anarchy. Put the unruly mob under an iron heel, or pull off all the controls and let the forces of nature bring tides of slaughter, interrupted by brief respites of exhaustion. Breed without restraint, planning on the deaths of many. Become less attached to specific people, places and things, because all will be in danger. Let most of civilization go. It's too expensive and complicated to maintain.

Reproduction is a controversial issue. The compulsion is basic and powerful. On the one hand, I can imagine a thoughtful society replenished by small families with carefully raised children. On the other hand, who knows where the next great mind might come from? The fruitfully multiplying crowd says to replicate early and often. On yet another hand, each generation uses the ideas that are born near it and within it to interpret and shape the world in which they find themselves. You never know to miss what you never had. So controlling the inflow to population seems much better than speeding up the outflow to maintain sustainable levels. Otherwise, any social system will be overwhelmed.

A democratic government, even on a republican model, requires educated, informed citizens asking good questions and focusing on the balance between the desires and needs of individuals and the best interests of the group. That seems to be falling apart, as the desires of individuals and sub-groups supersede the national interest. And that national interest has to acknowledge that the nation exists on a finite planet with other people on it. Conquest has not been possible, nor should it be. All we are left with is cooperation or annihilation. Didn't someone we revere once say "Join or Die?"

It goes beyond the borders of 13 colonies or 50 states now. We don't have to like each other. But we are stuck with each other. We have to figure out how to make it work.

Health insurance is an enemy of freedom

In a comment on Senator Jeanne Shaheen's Facebook page, I reported that I could not afford insurance under the ACA:

Senator Jeanne, due to peculiarities in my circumstances, I am unable to afford coverage under the ACA. Health insurance is not health care. And at this point I have neither one anyway. Last month, I had to pass a kidney stone alone at home and then go to work the next day, business as usual. My retirement plan consists of various scenarios for suicide when I can no longer take care of myself. I guess this makes me the ideal citizen, as far as the conservatives are concerned. Work 'em 'til they drop.

Another commenter suggested this:

Really maybe you need to find a better job. personally I have never had a job that didn't offer insur(ance). (Actual post had a typo in the last word.)

I answered:

Forcing people's career choices in search of insurance is not freedom. It indicates a country run for the benefit of insurance companies.

Isn't that pretty obvious? Along with getting people to use the terms health insurance and health care interchangeably, we've conditioned ourselves to seek "benefits" as a survival need, in a wilderness where we have to grub for every resource. Those who control the wealth determine how it is doled out, even if that means working for the destructive economy or choosing to live at risk for the sake of what you believe in. We are all soldiers facing death for a cause, even if we conscientiously avoid using combat for conflict resolution. I happen to have ended up in a place where the job that suited many of my abilities and needs only briefly provided "benefits," regardless of my usefulness to the business or that business's service to the community. Society at large benefits from the unheralded life and death of numerous benefactors for whom no public buildings are ever named.

With a system of universal care, rather than profiteering schemes of insurance, freedom of movement, choice, and work will make our society more innovative and our citizens more free. By making health insurance a marketed commodity, we actually hurt many other aspects of the free market economy. If you want unfettered freedom, live in anarchy now and take whatever happens to you. If you want a reasonably free society with well-maintained infrastructure and civilized amenities, accept that some things cannot be turned to profit. Some things are autonomic functions of society, that need to run quietly in the background. These include health care and energy production. If either of those intrudes on the peace and progress of the human species, we're doing something wrong. Right now, those intrusions make up most of the news. The rest of it hinges on inanities like what color we want our neighbors to be.

Evolution exemption

The debate over abortion rights and birth control stems from our most basic instincts, filtered through our language and thought processes.

The hardest hard core opposes all abortion and birth control. You copulate, you live with the consequences. That is a very naturalistic viewpoint, albeit frequently espoused by people who claim that dominion over all of nature was granted to us by a deity. We can selectively breed any species but our own. Our own species must proliferate without restraint, to be selectively killed in arguments over esoteric points of philosophy, or conflict over possession of natural resources.

A debatable theory that the use of cesarean section births has already shaped physical evolution points out that pregnancy and childbirth would be fatal to some women. In the naturalistic view, these deaths are necessary to purge those defective genes. If God had meant those women to survive, He would have given them wider pelvises.

From a practical standpoint, if we develop a significant population that can only give birth surgically, we have created a dependent group that will die out if they are cut off from medical facilities at the wrong time. This can happen in a number of ways, not least of which is by cutting health care in a developed nation, or by the collapse of civilization in general as a result of an overblown argument about esoteric points of philosophy, or conflict over possession of natural resources.

Fertility is destiny in a world without birth control. Conceive and be replicated, or conceive and be eliminated. The so-called sexual revolution granted control over fertility to those most affected by it. Horny people, mostly men, hoped that this would lead to lots of recreational copulation. Control-freak prudes seize on that aspect alone to excoriate it as the foulest sin. In all the smoke and chaos of that debate, the fact that fertility control gives women the freedom to live productive non-sexual lives is submerged in the swinging melee of religious symbols and insults.

The control freaks say that a woman who wants to live a non-sexual life can simply refuse to participate in sex. No other mitigation is necessary. Reality constantly refutes this.

Everything that affects birth and death shapes evolution. Because humans react to ideas, not just to the passage of genetic material and the survival of better or worse hunters and gatherers, social and political choices shape whether the species of tomorrow goes upward and outward on intellectual advancement or devolves into superstitious hunters and gatherers again.

Our instincts constantly speak to our intellect in ancient, wordless ways we often do not recognize as the primitive promptings that they are. We call this the subconscious. Sometimes the subconscious draws on intellectual concepts running subroutines, but more often you can find the biological prompting that predates the invention of words. The ancient world called. It wants its species back.

Collected thoughts

Just a few snippets from social media posts

If corporations are people, what gender are they? And should that affect their right to merge?

In case anyone still thinks that term limits would fix anything, look at what Trump has done in the first 10 days of his first term in the only elective office for which he has ever run.

Authoritarian conservatism is a system of selectively breeding for obedience. It's remarkable how they bait the trap by saying they're protecting liberty.

I vastly prefer people who remind me to be peaceful over those who try to solicit my aggression.

There are two kinds of people in this world: the ones who realize that we're all in this together and the ones who are wrong.

With all the heartwarming support for climate change awareness and opposition to pipelines and fracking, how much are you doing as a consumer to reduce fossil fuel use? No corporate behemoth will waste money on a product that is not selling. For all that we need to stand up for regulation and oversight, those will never win as long as we keep supporting the social model that made the problems in the first place. By the way, I realize this is hopeless.

Just the fact that health care is referred to as an industry tells you everything you need to know about America's attitude toward human suffering. The health care industry is highly rated as an investment these days. That means lots of return for shareholders.

Getting people to use "health insurance" and "health care" as interchangeable terms has been one of the biggest propaganda victories of the last couple of decades.

When the result is millions of people turned into cannon fodder on both sides, you have to wonder whether titanic clashes of good and evil serve either side very well.

Who knew that the some of the people you can fool all of the time would turn out to be such a significant voting bloc?

I'm sure we can all agree that there is no issue on which we can all agree.

A country that threatens other countries with its nuclear arsenal is a hostage-taking suicide bomber.

Human race informed that they will not get their security deposit back as they depart from Earth to find a new planet.

In 2017, millions of people in the developed world followed through on their resolution to get rid of the clutter and excess possessions in their homes. Suddenly, everyone was living in airy spaciousness and marvelous simplicity! It was also the first year in which you could walk across the Pacific Ocean on the mat of trash and discarded possessions.

If you try to challenge and refute every ignorant assertion with well-reasoned, fact-based arguments, you will spend your time doing only that, until you die of exhaustion. On the other hand, unchallenged ignorant assertions often become accepted as truths because they sound snappy and no one has publicly blown them up.

I got in touch with my emotions. They seemed pissed off that I had found their hideout.

What would you do? Way beyond Quinones

As we enter what could be a period of violent upheaval in this country, you might want to think about how you would react in various scenarios.

The ABC show "What Would You Do?" plays with light versions of social issues, but the legitimization of white nationalism, sexism, LGBTQ-phobia and strong-arm tactics in general coming out of the recent presidential campaign has already spawned incidents of violence.

The wonderful Women's Marches all over the country and in the world in general made a commendable display of peaceful protest. However, the climate in authoritarian circles, and in the right wing, is not at all receptive to protest demonstrations.

What would you do if law enforcement covering a demonstration opened fire with automatic weapons? Would you back down immediately, take cover, and run? Or would you march forward to be mowed down, as a rebuke to the vestiges of conscience left in the world? If you fled on the first day, would you come back for a second day? If you fled on the first day, would you begin to organize for civil war?

What would you do if you saw a group of white people beating up a brown person? A non-heterosexual person? A Jewish person? What would you do? How would you intervene, if at all?

What would you do if Jewish businesses were vandalized and ransacked in your town? What about Muslim businesses?

What would you do if lynching began again, law enforcement did not investigate, and district attorneys did not prosecute? What would you do if perpetrators who did face token trials always went free?

The current administration drew heavily on the influence of paranoia and hatred to build momentum for their campaign. They used voters disenfranchised by corporate influence, economically burdened by overpopulation and by technological advancement, feeding the popular myths about poor people, dark people, unfamiliar religions, and government conspiracies to advance the real conspiracy, which is corporate dominance of political, social, and economic life.

What would you do if oligarchy took over your country and you still had to look the word up every time you heard it, or just ignore it and hope it goes away?

It will start so slowly that you can easily tell yourself it's going nowhere. And it may really simmer down. But if it doesn't, you should have some idea what you would do.

Get in the aisle

I hate primary elections.

I have not joined a political party because I don't want either one to take me for granted. A political party is exactly like a religion: if you spend enough time looking and listening, things will get weird. As a party loyalist, you have to take the weird with whatever attracted you in the first place. As a true party loyalist, maybe the weird was what attracted you in the first place.

No solution for an entire town, county, state, or nation should belong to one party. Human problems should be solved in heterogeneous gatherings focused on solving civilization's problems, not advancing a narrow agenda to claim victory for a specific team. Humans like to form teams. Solutions may originate deep within one team or another. Using those solutions to claim a greater value for the team as a whole is good advertising, but poor public relations. Yes, the two can exist simultaneously. The good advertising reaches a susceptible demographic while excluding and alienating a whole spectrum of the rest of the population.

Politicians often speak of reaching across the aisle, working across the aisle, describing their willingness to cooperate with the other team to get important things done. The strength of the political party comes from its committed loyalists -- and its deep-pocketed donors -- to form opposing forces that come together in tenuous truces.

I'd like to see both parties small enough to drown in a bathtub. Most of us should stand in the aisle and make the hard core partisans come to us. That's not to say that every solution plows down the middle of every issue, diluting every effort into a slurry that's half gravy and half sewage. Sometimes you have to steer hard left or right to negotiate a particular challenge. No subdivision of political belief should be able to claim that vindication in one instance endows it with automatic credibility in any future situation.

People tend to look for others who think the same way. Like-minded individuals will form groups. Out of these can come great synergy. Ultimately, however, decisions made on behalf of all people need to be vetted by as many of all the people as possible. If most of us are in the aisle, that's where the like-minded will have to come to sell their idea.

When America falls

Contemplating the looming collapse of the United States of America, I reflected that the Vietnam War was the death blow. The civil rights movement contributed, because of endemic racism, but the Vietnam War really shattered trust in the government that had been painstakingly built through the mid to late 1930s.

We had come out of World War II feeling pretty good about ourselves. The Cold War set up a climate of constant anxiety that gave the military-industrial complex a huge boost, but it was Us against Them. McCarthyism cast doubt on loyalties within our country, but still fell short of discrediting our entire government in the broader public eye.

Vietnam was the turning point. We've been on the long slide ever since.

The Soviet invasion of Afghanistan, and the protracted war that followed, was referred to at times as the USSR's Vietnam. It was cited as a contributing factor to the collapse of the Soviet Union.

Russia emerged from the wreckage of the USSR in pretty rough shape, but has now managed to make itself a threat as a strong-willed and well armed world power. Russia existed before the Soviet Union. It exists after the Soviet Union. The Soviet Union was in many ways just a rebranding of the Russian Empire. It was good while it lasted, but not vital. You could say we won our Vietnam War because it has taken us so much longer to crumble from the structural damage. But Russia has regrouped and regained power. It has even regained some territory.

After the United States collapses, we have no mighty former identity we can resume. Everything was tied up in the myth of the Land of the Free, the exceptional nation composed of immigrant land thieves pushing a wave of genocide from coast to coast, and then settling in to be the tech nerds and cowboys to the world. It's a giant bullshit souffle that has stayed up a remarkably long time, considering that it depends entirely on hot air.

An uncharitable view? Ungrateful to my forebears? Change very few things and I never exist. Now that I DO exist, I want to avoid pain and misery. Do I owe anything to future generations? I can only take my best guess as to what humanity will need -- aside from mass sterilization -- to enjoy life in The Future.

We developed our national identity at a time when humans could believe that a winner really could take all. I'm sure realistically deep thinkers realized that such a victory, if ever it came to pass, would be short lived. Aside from the ponderous difficulty of conquering every square inch and keeping subdued areas under control while the tyrant's forces moved on to the next target, even when all was under the despotic thumb, little wigglers would be slithering out to bite the hand that grips them.

The idea of a big winner persisted into the latter part of the 20th Century. For a time, the United States looked like it. But of course we weren't, and didn't really claim to be. Sure, we were the last superpower (Don't look at China! No fair looking at China!), but we were nice guys. We were basically your big, strong, older brother, who will slap you upside the head if you get out of line, but otherwise is looking out for you against the real bullies.

Thing is, we aren't the older brother. We are a work of fiction, a creation of philosophy, rather than tribal boundaries blended with evolved concepts of nationalism.

To a large extent, every nation is a work of fiction. When humans grouped by clan on hunting and farming lands they had evolved on for longer than they had language to describe it, their identity as creatures of their piece of Earth had some merit. As language and the ability to dissemble evolved, government and group identity became more cerebral, even though the effects are concrete, and can be deadly.

There are younger nations than the United States. None of them have been -- or likely will be -- superpowers. Indeed, what is a superpower? It must be both an economic and a military powerhouse. But a military powerhouse is not a land of free people. But we have to defend our freedom from the outsiders who would take it. So we must be a military powerhouse. But a military powerhouse alone does not guarantee a vibrant economy, unless your power is so much greater than anyone else's that they pay tribute to your nation rather than face your wrath.

That still doesn't sound like the Land of the Free. It sounds like a crazy man sitting on a powder keg. Nobody wants to rile him up, but no one is happy or serene, either. Is that the best we can do? Maybe so. It's worth considering. Is the challenge of the pursuit of happiness that we have to do it under threat of annihilation by the forces of paranoia? As it was in the beginning, is now and ever shall be?

Every living thing faces its eventual death, so you could say we already pursue our happiness under that considerable handicap. As far as I'm concerned, that does not excuse the aggressors who threaten anyone they don't like.

We're going down, arguing bitterly about the right of ordinary citizens to own high-powered firearms, the right of corporate titans to buy government, and the full acceptance of the wonderful and terrifying diversity that our founding documents have unleashed.

We've run beyond the simple idea that merely requiring every young adult to put on a uniform and be trained as a soldier will miraculously produce the kind of national unity that will propel us and our species forward into what could have been a relatively comfortable and entertaining future. That's still the winner take all mentality. We have to force ourselves to evolve beyond killing each other. A large percentage of people believe that is impossible. They may be right.

As far as the future is concerned, everything is optional. That means anything is disposable. Winning that mess could look a lot like losing.