The Great Uninsured -

National Review ^ | April 8, 2005 | Florence King

[UnklGene]

The Great Uninsured -

A meditation on the covereds and the uncovereds, and other things

FLORENCE KING

America has a new persecuted minority. The Great Unwashed have been replaced by the Great Uninsured.

The word “uninsured” has taken on the freighted tonality of “unemployed,” “deadbeat,” “indigent,” and even “homeless.” The next time you hear someone confess to having no health coverage, check out the ever-so-slight pause in his listener’s voice. Watch for the slow blink, the quick wiping clean of alarmed features back to bland American acceptance. We’re good at this; nobody can do the pause-blink-wipe number like an American.

There are as yet no generally known anti-uninsured slurs, but if I know anything about the Greatest Country on the Face of the Earth they are bound to emerge. Maybe we will call them “sickniks”; maybe we will call them “toddies” for the hot lemonade and whiskey they take for double pneumonia; or maybe “branders” after those characters in westerns who cauterize their own wounds.

The slur that comes closest to describing how Americans view the uninsured is “poor white trash,” but we have been so worked over by the goons of political correctness that we are now in the grip of a terrified need to make everything we say sound inclusive, even slurs. “Poor white trash” would have to be tarted up to “poor white trash of all races and classes” before anyone would touch it, so if you want to take out inclusion coverage before you run down the Great Uninsured, it’s best to stick with Marie Antoinette’s “them.”

The uninsured always were “them.” What we are dealing with here are reincarnated attitudes that go further back than most people now alive can remember. But I do remember them, and that’s what got me started on the subject of insurance.

Rest assured that I am not going to write about insurance per se. That requires a natural ear for droning that I lack; a numbers cruncher’s visceral need to drizzle “%” signs all over the page; and, of course, the technical knowledge to criticize HillaryCare and BushCare. I can’t do that. As Samuel Johnson said of the plot of Cymbeline, “It is impossible to criticize unresisting imbecility.”

I leave “deductibles” and “co-payments” and all the rest of it to the panicky-eyed patients milling around the doctor’s checkout desk while his shattered nurse waits on hold to find out who pays for the first three hemorrhoids. What interests me is the place of insurance in the American psyche and how it has affected our health-care crisis.

Back before most people had bank accounts, they had insurance policies. They were always for life insurance — the average man had nothing else to insure — and on them rested his sense of self-worth and his reputation among his peers. Having insurance divided the responsible from the shiftless, the dependable from the flighty. It established a young man as “good husband material,” while an older man who had a paid-up policy was the prototype of steadiness. Their widows and orphans would never end up in what was then called the poorhouse.

Insurance also answered the powerful emotional need for a “decent burial.” This comes out in A Tree Grows in Brooklyn. For years Katie Nolan has paid a dime a week for her own policy and a nickel each for her two children’s. No matter how hard up the Nolans were, she always made sure she had “the insurance money” when the agent came round, keeping it in a tin-can bank hidden in the farthest corner of the closet, nailed to the floor.

But the day comes when Katie is destitute. She tells the agent she can’t pay the premiums; she will have to let the policies lapse. Instead he advises her to cash in the children’s policies so that she can keep up her own, and have a decent burial for their sakes.

She understands. “I wouldn’t want to be buried as a pauper in Potter’s Field. That’s something they could never rise above; neither they, nor their children, nor their children’s children.”

It is not necessary to have known people like this in order to be influenced by them. If you were raised by somebody who was raised by somebody who remembered them, you remember them too. This is why stock characters in movies are perennial favorites. The doctor who made house calls, the lawyer who worshiped justice, and the reliable husbands and decent burials of that old-time insurance live on in our collective national memory long after they have left the stage.

When medical insurance got going after World War Two, it was called “hospitalization,” or, interchangeably, “Blue Cross,” after the pioneer. It was a fortunate name, with a built-in reverent hush, like Prudential. Saying “I have Blue Cross” sounded old and established. Many continued to say it even after coverage was expanded to include doctor bills and the name was changed to Blue Cross & Blue Shield. As competition mounted and other companies got into the business, “group health,” as it was by then known, became America’s new old-time insurance. The decent burial was replaced by the decent complete physical, and the definition of “good husband material” was now a man with “fringe benefits” coming out of his ears. As the matchmakers said, he was “covered.”

It was the Age of the Great Insured. Early group health covered everybody for everything. The premiums were so reasonable they made hardly a dent in your paycheck. When I worked on the Raleigh News & Observer in the ’60s, I paid three dollars a week for such generous coverage that I half-resented being healthy. I used it for the usual tests and shots, but otherwise I made no claims.

Millions of others did. Now that health care was “free,” human nature kicked in. People began running to the doctor for the least little thing. Ask them why and they would recite the usual maxims about an ounce of prevention, but it was never long before the truth compulsively popped out: “I hate to waste my insurance.”

There it was, right out in the open: Eat every mouthful of insurance on that plate! Insurance is good for you. Insurance makes you a better person. If you don’t go to the doctor, people will think you have no insurance. Whatever is wrong with you, insurance will kiss it and make it well.

These were the cultural hypochondriacs. Others, with a dormant tendency toward the real thing, blossomed into full-flowering nightshade in the rich soil of full coverage. Anyone who worked in an office during these halcyon years probably remembers a monster of self-diagnosis just down the hall. He would have been perfectly all right if he had not overdosed on health insurance, but now he kept a blood-pressure cuff in his desk and believed that the pothole he drove over jarred loose his pancreas, causing what he christened “Errant Gland” during his coffee-break phone call to the doctor.

HalcyonCare couldn’t possibly last. Whenever we insure something its price goes up, as do waste and fraudulent claims. Medical science kept devising new and increasingly expensive treatments, technology, and pharmaceuticals, forcing Halcyon to raise premiums even more, until companies could no longer afford to provide HalcyonCare to their employees. And the employees, languishing now in their HMOs, could not believe what had happened: Insurance, once a symbol of stability, was now a symbol of chaos.

The honeymoon was over but the honeymoon mindset remained. “It worked fine at first,” people said, reminiscing about HalcyonCare while filling out their stack of forms in the doctor’s waiting room. Of course it did. Everything works fine at first — credit cards, public schools, feminism — because human nature has not been kicking in long enough. The trouble starts when we try to make a basically good idea work for everybody, everywhere, all the time, until the good idea crumbles under the weight put on it and becomes a bad idea.

In the years before World War One, Henry Ford astounded the nation when he announced that he would pay his workers five dollars a day, a munificent wage for the time. His intention was to attract and keep the cream of loyal hard workers. It worked fine at first, until the unions reasoned that if bosses would volunteer to pay high wages, think what could be gotten out of them by force. To that end they upped their demands to outrageous levels over the years; more and more raises, benefits, overtime, holidays, rest periods, and bonuses, until the American autoworker was the envy of the blue-collar world. Now he works at Wal-Mart because he priced himself out of the market.

So now we are going to “fix Health Care,” as the current locution has it. We always seem to be “fixing” something — Social Security, the border, levees — but fix is an unfortunate choice of words for the tasks at hand. Too cavalier, too likely to be in the same sentence as “a lick and a promise,” or “a little dab’ll do ya.”

Fix is Dagwood with a hammer and a mouthful of nails, trotting off to do what Blondie has been nagging him to do for ages. We all know how that’s going to turn out, so don’t be surprised if, some day in the not too distant future, the Statue of Liberty’s torch is replaced with a sign reading “It Worked Fine at First.”

Florence King’s National Review columns are collected in STET, Damnit!: The Misanthrope’s Corner, 1991 to 2002.

[JoeGar]

To sum-up the healthcare debate: "EVERYBODY WANTS SOMEBODY ELSE TO PAY FOR HIS HEALTH CARE."

[spikeytx86]

True, but you would think that people could understand that if someone else pays the bills they are going to want to call the shots as well. I call it willful ignorance.

[speekinout]

I don't think people understand that. We've had over 40 years of the mantra that "gov't pays". And we can vote for the benefits we want.

I really do think that most people don't have the time or information to understand how it works.

[ridesthemiles]

I had no health insurance for over 10 years, as a self-employed person. They priced it right off my plate, and I told them so.

I paid at the clinic for whatever I needed, and I paid for more expensive stuff when I needed.

I wasn't homeless. I wasn't unemployed. I took care of myself. I didn't contribute to the closing of trauma centers and hospitals that were forced to close from treating so many non-paying patients.