On Managed Care

Want to hear my definitions of "insurance fraud"?
I'll tell you anyway.

Insurance fraud is when an HMO sells you a policy at an exorbitant rate
and then finds all manner of ways to frustrate your pursuit of
benefits.

Insurance fraud is when an HMO impedes access to procedures and
specialists by requiring further "review" or "investigation."

Insurance fraud is when an HMO denies coverage for pre-existing
conditions.

Insurance fraud is when, to demolish any chance one might have of
effectively communicating requests or complaints, an HMO deliberately
hires morons to staff its customer service department.

Finally, insurance fraud is when an HMO not only plays these games but
also joins with other HMOs to mount lobbying and advertising campaigns
against the development of alternative health insurance systems.

A subversive I may be, but I've never been of the militant variety.
When the SDS was blowing up banks in the early '70s,
I was expressing my displeasure with the
establishment by intentionally omitting zip
codes-that'll jam their gears!

And, however grudgingly, I've come over time to accept capitalism as a
permanent reality. A given.

But this managed care business, which is to say, capitalism of a
blatantly predatory stripe, is making me ponder actions way off my
normal spectrum.

I'm finding it increasingly difficult to sit still for a category of
capitalism in which people demonstrably unqualified to participate in a
free market economy-for whom capitalism is too heady a system-routinely
commit what amount to acts of violence against their customers.
(Messing as they are with other people's very lives, you have to wonder
how these HMO creeps were brought up, what kind of parents they
had.)

Of course, much as I'd like to, I could never dispatch each and every
HMO administrator to his local ICU all by myself. I'd need help, and on
a broad scale. But the prospect of getting such help is dim. The vast
majority of us, after all, are reluctant to so much as question, let
alone rise against, even the ugliest manifestations of a broader system
that promises every American a piece of the serious action-and this
despite how false that promise is for all but a relatively few, or how
destructive may be the indignities our belief in it obliges us to
suffer. Most of us remain willfully stupid in this regard (which, in
another context is one of the reasons the Enron scumbags who amputated
their employees' futures are still alive).

In fact, most Americans (including the majority of the 41 million who
go without insurance because they can't afford the premiums), disdain
even the civilized alternative of a not-for-profit, government-operated
health care system. It apparently hasn't occurred to them that there's
no significant risk to capitalism in this solution. We've already got
"socialized" institutions in this country-police and fire departments,
for example-that hardly infringe on our freedom to take advantage of
one another. Even a few more would still leave us with plenty of
opportunities to put one over on our fellow man. (And the notion that
dealing with a government bureaucracy would somehow be more brutal than
dealing with Aetna, Prudential or Oxford, well, that's a joke, isn't
it?)

So what's left to do when revolt is no more in the offing than
government intervention is?

Unfortunately, beyond fantasizing that our growing population of serial
killers (folks who've made it clear that accumulating money isn't their
first priority) will develop a sense of civic responsibility to go with
their skills and proclivity, I haven't come up with much. Certainly
nothing that promises more than the smallest of rewards at the price of
considerable personal sacrifice.

I'm speaking of getting sick a lot; using, you know, the hell out of my
policy. By constantly contracting illnesses that require extended
hospitalization, frequent doctor visits and enormous quantities of
pharmaceuticals, I'd have the satisfaction of at least putting a dent
in an HMO's profits.

Yeah, I know. But I like the pharmaceuticals part and it
would be a step up from omitting zip codes.