The fight to reform health care in this country has many parallels to an earlier struggle in our nation's history, the struggle to abolish slavery. In both cases, a heavily entrenched minority tries to maintain a sizeable economic interest in an immoral enterprise, causing great suffering in a large segment of the U.S. population. The moral footing of the private health insurance companies is arguably as bad as that of the Southern plantation owners. It remains to be seen whether today’s struggle will end as violently as the older one.
As a first point of comparison, let us consider the amounts of money involved in these two enterprises. How much did the Southern slaveholders stand to lose if their peculiar institution was abolished? One figure would be the value of all the slaves that would be freed, i.e. the total value of the “property” that the slave owners stood to lose. In 1860 the combined value of all the slaves of the South is estimated at $4 billion. We could also consider the costs of replacing the slave labor with paid labor, but for the sake of argument let’s just use the straightforward $4 billion figure as an estimate of the size of the Southern plantation owners’ economic interest in slavery. In today’s dollars (using an index that compares the average wages of an unskilled worker), that equals $645 billion.
For the size of the health insurance industry’s economic interest, let us use the difference between today's inefficient private health insurance system and an efficient single-payer system. That difference is estimated at $350 billion a year. This money’s only purpose is to support the private health insurance industry, and produces no additional value for the consumer.
As you can see the amounts of money involved in slavery and private health insurance are comparable. The exact figures are not important. What I want to illustrate is that the sizes of the economic interest in both cases is very large, and we should assume the stakeholders will fight to keep their money with equal ferocity. More on this later.
But what of the moral issues? Are they comparable? No modern person should find slavery anything but morally repugnant. But is the moral footing of the health insurance companies as bad as that of the slaveholders? Just what are the crimes of these companies?
The first, less serious, offense is extortion. We are forced to pay these companies $350 billion a year, or 30% more, for nothing but a worser product. A small group of people have worked themselves into a position of power and have levied a tariff on the healthcare costs of most Americans. We have no choice but to pay this tariff, since the vast majority of Americans must purchase health insurance, and there is no competitive non-profit or public option.
Health is the most basic necessity of life. How would we feel if there was this tariff on other necessities? Suppose when you wrote your $1000 rent check to the landlord, you also had to include a $300 check for a “rent processing company” whose only job was to pass the first check from you to your landlord? Or what if you spend $100 at the grocery store, and on the way out you have to give a burly goon $30 in order to reach the parking lot? Would you stand for it?
Even worse morally is that the price of this basic necessity, health, has become beyond the ability of so many of our fellow citizens to pay. How would we react if food became so expensive in this country that it became a luxury? Would we allow these poor unfortunates who can't afford bread to just die? I should hope not.
But that's what we allow to happen to 45,000 people a year who die for lack of sufficient health insurance. To put it in perspective, that's the equivalent of a 9/11 happening in our country every month, year after year, with no end in sight. Why aren’t more people appalled by this figure? Is it because the deaths of these people are not as dramatic as those of 9/11? The deaths of the uninsured happen on the streets, in hovels, in inner-city hospital ERs, and wherever else the poor go to die. The government has spent trillions of dollars trying to avert another 9/11, and yet this monthly 9/11, preventable by a comparatively smaller outlay of money, is allowed to happen.
The insurance companies are only partially culpable for this travesty, to the extent that they drive up prices. We, too, must bear responsibility, since we have not yet forced our government to provide universal health care coverage.
But the insurance companies can be held solely responsible another crime, for denying coverage and treatments in the interests of maintaining their profit margins. Here they descend to the vile moral level of the slaveholder. In the eyes of a slaveholder and an insurance company, a human being is reduced to a mere accounting entity. The slave had an initial cost and was expected to pay out more in labor over the course of his or her lifetime. We, the insured, pay in premiums over the course of our lifetimes, and we damn well better not receive more payouts, in the form of actual health care, than what we put in. If we do, the insurance company will do whatever it can to cut loose “the dogs,” even to the point of cancelling product lines across a state.
This is evil. Truly, no different than the evil of slavery. In both cases, you have a rich, powerful person exerting complete control over another human being’s life, solely for the purpose of enriching themselves.
Slavery did not pass easily from the face of this nation. The Southern plantation owners would not give up their slaves, and their huge economic interest, without a violent struggle.
How will this evil of private health insurance, and the meting out of life necessities to only those who can afford it, be purged from our nation? Will it be purged? Will this evil pass peacefully via mutual action and legislation? Or, like slavery, will this stain on our nation require blood to be removed?
I fear the worst. The current system asks that 45,000 people a year not question the reason why they are denied health care, and just die quietly. Many of them may be poor and old and unable to fight, but as the current system gets more and more expensive, the number of the uninsured will grow to the point that there will be enough able-bodied among them to refuse to just die, and to fight back.
Coincidentally, the number of slaves at the peak in 1860, 3.9 million people, or 12% of the U.S. population, is about the same number as the uninsured today, 45 million, or 15% of the total. The slaves never succeeded in insurrection, but some tried. Do we want to keep pushing the poor in this country to the point that they, too, have no choice but to revolt?
Why should this struggle play out differently today than it did 150 years ago? Are we better or smarter than we were back then? That's doubtful. Arguably, the average Southern plantation owner was better educated morally than the average health insurance executive today, to the extent that the church was a more powerful institution back then. And yet the plantation owner still managed to find the elaborate justifications for maintaining their grip on their property.
By what mechanism can this power be wrested from these entrenched interests? Via popular expressions of distaste with the insurance company's actions? These can be ignored. By legislation? The vast majority of the Congress has been purchased by the insurance industry. At least in the slavery debate, there was a significant minority of congressmen who actively deplored the institution of slavery. These days, nearly uniformly, the Congress is in support of whatever corporations choose to do.
In our nation’s history, has any industry the size of the health insurance industry ever been coerced by the government to significantly change its ways? And yet here we are asking a $350 billion industry to just go away.
I will continue to work peacefully against the evil of today’s system, but I do so with little hope of success. I dread the bloody purgation of this evil, but fear that it will come. I hope the more naturally optimistic among you are right and I am wrong.
