Uninsured in America: First Thoughts

I've just started reading Uninsured in America (by Susan Starr Sered and Rushika Fernandopulle, Univ. of Ca. Press, 2005), and I'm concerned. While the book is a much needed look at the working poor, and it promises to provide me with facts and stories I'll be quoting at cocktail parties for months to come, I'm worried that it won't make a lick of practical difference.

The point of the book seems to be to chronicle how working hard and playing by the rules is often not enough to let individuals and families meet crushing health care costs, and to shine a light on the often devastating consequences. It's a good reason to write a book. The potential problem lies in the presentation. Like most liberals, I already believe that if you work hard and exercise some minimal level of good judgment in managing your life affairs, a wealthy and powerful nation should be able to see to it that the necessities for health and happiness are available to you.

If this book is to make a direct change, then, it has to be aimed at the other side: people who believe (wrongly) that we do take care of our own; people who believe that because they are making it through, anyone can; and people who just don't give a shit as long as the market is humming. And by page 26, I've begun to worry that this book won't make a dent in that crowd.

My concern centers around the authors' apparent unwillingness to scrutinize their own opinions and assumptions.

Here's an example of an unnecessary over-simplification that detracts from an essentially valid point [from page 26, emphasis mine]:

In recent decades, a fundamental paradox inherent in the [American] dream has surfaced ever more clearly: although both employers and workers may share the vision of the American dream and may even share a belief that it can best be achieved when all pitch in for a common goal, the reality is that the means to attain that dream comes from one finite pot—company revenues. Gains on the part of workers come at the expense of profits for employers; labor compensation (wages, benefits, and other costs) makes up a large percentage of company expenses. Thus, as health care costs have soared over the past decades, many employers have come to see providing health insurance to employees as a burden.

Sure, if at the end of each quarter you took the total revenues and divvied them up amongst operating costs, covering capital outlay, worker pay and benefits, executive compensation, etc., then everyone is fighting over the same pieces of pie. But that's not how companies work. Companies often spend borrowed money. What's good for one area of the company may be bad for others in the short run but lead to overall improvement for all involved, and the inverse may be true as well. Does this mean that the authors are wrong? Not necessarily. It's true that employers can increase profits by shortchanging employees, but that's hardly an inherent paradox.

An analogy: A parent could trim his monthly budget by cutting his kids back to one meal a day—does that mean there's a paradox at the heart of the parent-child relationship? Of course not. If you saw someone treating his children this way, you would say that that particular relationship was sick, improper. You would say that the members of that family need help, and perhaps that the father ought to be punished. You'd say that he should be monitored in the future. You might want to make sure that there's system in place to deal with this kind of neglect. But is this reason to be suspicious of all parent-child relationships? No.

Why does this matter? Because it weakens the point the authors are trying to make in this section. Instead of saying that we live in society that has allowed large companies to shirk their social responsibilities, instead of pointing out bad actors and bad actions, Sered and Fernandopulle alledge that the American dream is built on an inescapable contradiction. I don't happen to agree, and I wonder why they would have taken a stance that is far more broad and absolute than necessary to make their point. I wonder why they would take a swipe at the foundational ideals of American capitalism without more than a few paragraphs to support the argument.

I suspect it's because the book is written for those who already agree with the authors. That's a shame, because the stories in the book deserve a wider audience.

So that's a harsh indictment of a book for only having read 25 or so pages. I'll be back in the comments over the next few days to update, focus, and, if it's called for, apologize.


A novel approach to book reviewing . . .

but an interesting concept: Serial reviews.

It makes sense from the point of view that in my older age I'm starting a lot more books than I finish. Sometimes the author just pisses me off. Sometimes the writing is just flat-out shoddy. Sometimes there are typos. Sometimes I'm just bored. If the book doesn't keep me engaged, it doesn't do its first job.

That said, I sometimes have fundamental doubts about the stability and integrity of the capitalist model. When growth in shareholder value is the single measure of success, growth for growth's sake becomes the driver of everything else. This seems to me to be patently unsustainable and also undesirable.

Some new age biz schools are toying with the idea of triple bottom lines where shareholder value is only one of three variables of interest. (I can't remember what the other two are, something about the environment/sustainability and something about the workforce?) I don't think the concept will stick though, because the measurements are too tricky and greed becomes less of a motivator.

Which is where the government must come in. If the markets themselves won't manage environmental responsibility without exposing civilization to unnecessary risk, then government must act. The same with social risk (e.g., health insurance). It's time to get over the illusion that markets can effectively deal with all the needs of a society. That myth is dead, except in little pockets like the Puppetshow.

PS to Lance

Good to see you out and about again! I've missed your blogging self.

A, Thanks

When you say "this is where government comes in," you're absolutely right. Corporations play the role and have the powers that we as a citizenry allow them to have. Sears could probably increase profits for shareholders by branching into the heroin trade, but they don't because we don't allow it.

Capitalism is dead!

or, better: "Capitalism is a bankrupt concept!"

We can run weekly articles on our new manifesto along with Womb Wednesdays and Freaky Eco-Fridays. Okay, my concepts need work. I admit it. But it's more "elevated" than yesterday's discussion of body parts!
“All the world's a stage,
And all the men and women merely players.”
So enjoy the Drama.

Maybe the authors didn't intend

to sway those who disagreed. Perhaps books aimed in that direction don't sell as well . . . I assume their publisher's goal is to maximize profitability?

I would think that most non-fiction writers have a good idea about their intentions long before the first word is written. Even if the research sends them away from their initial concept, it's not like they are unaware. I would think that if they'd intended it to change minds, it would be obvious. (Unless their collaboration became problematical and they're just happy to have gotten through it.)

Maybe they assume anyone who doesn't agree with them wouldn't read the book anyway. So, they just wanted to be an inspiration and information source to the like-minded.

It's weird, isn't it, how many people work so hard on projects that seemed to be so obviously flawed from the get-go?
“All the world's a stage,
And all the men and women merely players.”
So enjoy the Drama.

well, gee, yeah, I was,

I really was. Duh.
“All the world's a stage,
And all the men and women merely players.”
So enjoy the Drama.

Uninsured in America

Speaking for the 45+ million. I lost my insurance about 3 yrs ago after being laid off. I'm now making some cash, but as a contract worker, i.e., no bennies. So do I attempt to get private insurance at premium rates? What if I'm denied due to some preexisting condition (you're screwed), or I can, but at rates I will not be able to bear during the next out-of-work stint? Heck, I don't have time even to fill out the four-page medical history, I'm working such long hours. (You know, doing that responsible citizen thing.) Welcome to Bushworld.

The corporate-based model for health care is irredeemable. The corporation looks out for the coropration. Period.

When are Dems gonna start reminding voters that we believe we are all in this together, that America is only as strong as the weakest link, that alone we are, each and every one, one illness away from ruin. There, but for the grace of God, etc.

Why do we celebrate the soldier's ethic of "You watch my back; I watch yours" in films, but dismiss it as socialism in the civilian sector?

Why do Republican politicians like the president tell voters that digitizing medical records could shave 20% off the cost of the average person's medical care, yet they put their weight behind tort reform that experts say might save less than 1%?

They favor the 1% solution because they are the party of the 1% and not of the rest of us.


watching each other's backs

isn't just a military value. It's supposedly a Christian one.

I, too, have gone long years without health insurance. The system is broken.
“All the world's a stage,
And all the men and women merely players.”
So enjoy the Drama.