A Preview of Alpha Status: A Non-fiction Novel
Excerpt From Chapter 18: The Fate Cursed Man
From a letter written by the book's primary antagonist to his billionare twin:
If you’ll indulge me in this much-needed distraction, let us study the sordid history of America’s medical woes. We can start by looking at the early years of this century, where we find a 2004 Harvard study that unveils the tragic fact that “about two million men, women and children were swept through the bankruptcy system in the fallout of a medical problem. Good educations, decent jobs, and health insurance were no guarantee that a person wouldn’t be wiped out by an illness or an accident.”311 Dr. Steffie Woolhandler, a co-author and an associate professor of medicine at Harvard Medical School, said, “Our study is fairly shocking…We found that, too often, private health insurance is an umbrella that melts in the rain.”312 But that was only an appetizer for the medical turmoil that plagued our nation in the years to come.
In 2009, the same Harvard researchers followed up their initial study with the stunning claim that 62.1% (!) of all American bankruptcies in 2007 could be attributed to medical bills.313 And in the second study, the Harvard authors made reference to a Yale study which showed that, as recently as the early 1980s, families filing for bankruptcy in the aftermath of a serious medical problem was only 8%.314 What the hell happened between the 1980s and the 2000s?
But the situation only worsened in the 2010s, in the wake of the Great Recession. The passage of the Affordable Care Act, despite being a necessary step forward in American healthcare, did not seem to alleviate the financial pain. If anything, the ACA was tantamount to putting a Band-Aid on a severed limb in an effort to stop the bleeding. If we return to the work of the Harvard researchers, the rates continued to climb even after the passage of the ACA. Between 2013 and 2016, the share of American bankruptcies attributed to medical costs had jumped to 67.5%, compared to 65.5% just before the passage of the bill, and the aforementioned 62.1% in 2007.315
Again, how did this happen? What occurred between our generation and Becca’s?
Naturally, the explanation is multifactorial, and there are many things one could point to. One is the fact that medical expenses have simply outpaced the growth in income, and it is one of many reasons why the American middle class has been decimated during our lifetimes. It is a point of mind-boggling irrational pride that we live in a country that practically brags about criminally high healthcare costs.
Another set of reasons is in how insurance companies have evolved to continue exploiting their customers, trading health and well-being for the right to make a buck at their customers’ expense. Despite the push for wider coverage and industry standardization, private health insurance companies still largely set their own rules, and most insured people are blissfully unaware that their polices have payout limits or onerous restrictions as to where their customers can receive care. Moreover, there are still an overwhelming number of reasons that companies can deny claims or cancel coverage outright. When private companies make their money specifically by denying their customers services, rather than providing services, there will always be a way to exploit them for profit. It’s a fundamental failure of incentive structure in the healthcare and insurance economies.
Understood more broadly, it speaks to the nature of capitalism, and where the lack of individual agency resides in the equation. In most healthcare instances, a single person is trapped between the infinitely more powerful and deep-pocketed healthcare provider and insurance company. The people receiving the healthcare are—ironically and tragically—the least empowered party in the healthcare experience. As Dr. David Himmelstein of the Harvard studies grimly notes, “Unless you’re Jeff Bezos, people don’t have very good alternatives, because the insurance that is available and affordable to people, or that most people’s employers provide them, is not adequate protection if you’re sick.”316
If we dig deeper into the normative assumptions made in the disgustingly capitalist society of ours, we find yet another failure of the market-based economic system. Capitalist economies are built on certain assumptions for the marketplace, including choice and optionality. In fact, choice and optionality are arguably the most essential factors for making a capitalist economy possible. For example, if one is considering buying a television, or a car, or a phone, or virtually any other consumer product, the prospective buyer is provided a variety of brands and models to choose from. Or even more empowering, the prospective buyer is given the ultimate consumer’s right of choosing not to buy the product at all. The optionality provided by choice—the choice of what, where, or how to buy a product, or whether or not to purchase the product at all—is the ultimate arbiter in determining economic equilibrium, and thus the end price.
But healthcare is a unique product in an economy. Health, as a universal human need, defies the normative assumption of choice in the marketplace. Nobody wishes for bad health, and no sane person wishes to die from a treatable illness. When one’s life is at stake, the “choice” of whether or not to purchase healthcare is no choice at all—it is an illusion which has been presented to us under the guise of a capitalist “freedom.” We are forced by threat of death to buy healthcare at whatever the cost. And the healthcare industry has taken full advantage of that fact by charging ever higher rates for their services. For most, if the only alternative to death is bankruptcy, then it’s an easy choice to make.
While healthcare costs and the related bankruptcies inexorably rise, Americans have been struggling to find ways around this disgraceful failing of our country. One emergent strategy—I kid you not—has been to feign a bank robbery so that a sick person can be sent to prison, where the ill person can receive medical care without the burden of usurious costs. To wit, in 2011, 59-year-old James Verone of Gastonia, North Carolina, peacefully robbed a bank for $1 so he could be incarcerated for healthcare. On the day he decided he could no longer survive without medical attention, Mr. Verone calmly handed a bank teller a note demanding money, claiming that he had a gun. Then he peacefully said, “I’ll be sitting right over here, on the chair, waiting for the police.”317 His desire to go to prison was so he could receive treatment for a growth in his chest and two ruptured discs, which he could not afford to treat. As Mr. Verone told reporters, “I’m sort of a logical person and that was my logic…If it is called manipulation, then out of necessity because I need medical care, then I guess I am manipulating the courts to get medical care.”318
Mr. Verone’s logic seemed to resonate with others, because two years later, a man named Timothy Alsip from Portland, Oregon, attempted a nearly identical bank robbery in exchange for a prison sentence and the healthcare that came with it. Mr. Alsip, suffering undisclosed medical problems which he could not afford to treat, scrawled a note that read: “This is a holdup. Give me a dollar.” He then handed the note to a Bank of America teller, received a dollar, and then calmly took a seat in the lobby until the police arrived to arrest him.319
Yet for some, the thought of bankruptcy or a prison sentence is too shameful, and they make the alternate choice. For Brian S. Jones, a man living outside of Seattle in 2019, the best option seemed to be death. So around 8:30 a.m. on a quiet summer morning, Mr. Jones called 911 saying he planned to commit suicide by shooting himself.320 Deputies rushed to his home and a crisis negotiator pleaded over a loudspeaker for nearly an hour to try and rescue the distraught man, but to no avail. After the failed pleas, the deputies entered the house and not only found Mr. Jones dead inside, but his wife, Patricia A. Whitney-Jones, dead as well. The case was ruled a murder-suicide. The sheriff’s department later stated, “Several notes were left citing severe ongoing medical problems with the wife and expressing concerns that the couple did not have sufficient resources to pay for medical care.”321 It was an unthinkable end to yet another medical tragedy in this country. But it was far from the last.
In 2020, the cracks in our healthcare system broke wide open with the arrival of the SARS-CoV-2 “coronavirus” pandemic. Not only was our country woefully unprepared for dealing with such a crisis, but our response was predictably atrocious. Despite being the wealthiest nation in the world, we could not adequately supply our country with the necessary personal protective equipment (PPE), like masks, gowns, face shields, and hand sanitizer. As the Centers for Disease Control and Prevention noted at the time, “PPE shortages are currently posing a tremendous challenge to the US healthcare system.”322 That “tremendous challenge” resulted in massive and unnecessary loss of life. As New York physician Dr. Calvin Sun said after being forced to use his ski goggles and ski jacket as makeshift PPE to treat sick and dying patients, the shortage of equipment and broader failure of our healthcare system was like witnessing an “evolution of chaos.”323
The coronavirus’s effect on our backwards country was perhaps best illustrated with Michael Flor, a Seattle resident who had become badly infected. Believing that he was terminally ill, a night-shift nurse held a phone to Mr. Flor’s ear so he could hear his final goodbyes from his wife and children. Miraculously, however, Mr. Flor survived, and was applauded by healthcare workers upon release from the Swedish Issaquah hospital. And shortly thereafter, his survival was celebrated with a 181-page long hospital bill that totaled over $1.1 million dollars.324 I can’t express how shocked and appalled my European colleagues were when that story broke. Such blatant profiting from someone’s near-death experience during a pandemic was ineffably unconscionable to them. Yet, for us Americans, it has become standard practice.
There were more widespread economic ramifications to the 2020 pandemic, all of which took an additional and unnecessarily harsh toll on the health of our citizens. Millions of Americans lost their jobs as unemployment levels skyrocketed to the highest levels since the 1930s. And with the job loss, many lost their health insurance too. America’s decision to tie health insurance to employment was one of the stupidest ideas our country has ever had, and the pandemic exploited and killed us for it. Combined with our nationwide “cult of ignorance,” our irrational disdain for experts, and our suicidal rejection of authority, it was no wonder that through 2020 we recorded the highest death count in the world.325
I can only stew in abject despondency as I recall how a virus enveloped the globe, millions became infected and ill, and untold thousands of our fellow citizens died in an agonizing fashion which has been described as “slowly drowning in your own lungs.”326 Put in more relative terms, the American death count from a single year of the coronavirus pandemic exceeded all the US military deaths from World War II to the present. Eight decades of nearly constant warfare had a lower death count than the first twelve months of a pandemic. I find that astounding in the worst possible way.
In our infinite stupidity and infuriating incompetence, with a backward healthcare system and a perverted sense of capitalism, we succumbed to the disease like no other developed nation on Earth. In addition to the panic that gripped the nation, the sickness and death that we had to endure, and the steep biological and emotional toll the virus took, we Americans were also forced to worry about co-pays, deductibles, and clinging to whatever heinously low levels of healthcare coverage we could get.
Pray tell, what kind of country do we live in? What depraved system of chronic suffering perpetuates the exploitation of its citizens to such a ruthless and inhumane degree? In what twisted and iniquitous world does the moral balance skew so egregiously toward making a dollar while simultaneously bankrupting, imprisoning, and killing one’s own sick and desperate people?
The answer, of course, is American’s uniquely cruel brand of capitalism. We live in a maddening society where people are forced to live in healthcare servitude—or to rob banks, or to murder their spouses and kill themselves, or to drown in their own lungs—because of an inability to receive adequate medical care. Intentional suffering is the blind eye through which the American capitalist chooses to view the world.
And we are supposed to believe that this is the best we can do?
Even the Economist—a venerable pro-business, pro-capitalism publication—rightly describes America as a global outlier, the only large rich country without universal healthcare.327 Guided by our cultish obsession with a depraved form of capitalism, and perpetuated by ideological demagogues in expensive suits spewing malicious rhetoric, we have foolishly believed for far too long that the private sector can solve our healthcare woes. We already spend more money and receive worse healthcare outcomes than virtually any other OECD country. Despite spending nearly twice as much on healthcare as the other member nations, we boast the lowest life expectancy, the highest suicide rate, the highest chronic disease burden, nearly double the obesity rate, the highest number of hospitalizations from preventable causes, and the highest rate of avoidable deaths.328 American exceptionalism indeed.
With more urgency than I can ever express, we need to right the ship and create a nationalized healthcare program. The current situation has been far too tragic for far too long.
In fact, the demand for a socialized healthcare system has already been implemented in a shadow-economy. The failure of the broader capitalist market in healthcare created a burgeoning form of socialized medicine in the form of crowdsourced financial campaigns. Gofundme, the website initially created for entrepreneurial fundraising, has evolved to become a de facto source of socialized medical payments. Leading up to 2020, the site boasted over 250,000 public fundraising campaigns for healthcare needs, with more than $650 million raised annually.329 The imperative of socialized medicine is already here, and the resistance to creating it is a political and moral failing of the democratic experiment that America has attempted.
Even hardcore libertarians like yourself can admit that there are parts of our nation that cannot and should not be governed by the private sector. Broad swaths of the country, under the umbrella of the greater public good, are clearly best run by public institutions. The military, police departments, fire departments, the public-school system, National Parks and National Forest, and many other institutions all fall under the broad umbrella of insuring the long-term health of our country. These are all things we have discovered in previous centuries to be better solved by taxation and responsible government.
But now in this twenty-first century, through repeated trial and error, and the dangerous social experiments played out on massive scales, we have found more flaws to capitalism. But the resistance to fixing them is both confusing and infuriating. For too many, capitalism exists not as a malleable economic system that can be shaped for the broadest public good by a responsible government, but a fundamentalist religion that has been etched in stone and burned into the sclerotic minds of fanatic apostles.
So, to challenge some core tenets of postmodern capitalist dogma, it is worth reviewing two items: the actual application of socialized policies, and the failure of our democracy which spawned the Frankensteinian version of capitalism we suffer today.
The first task is to challenge the popular yet misguided notion that socialism means people are getting something for nothing. Americans assume that socialist polices imply “free” healthcare, or “free” college, or other “free” goods and services. That is nonsense—everything granted to citizens only happens because there’s a system of taxes which pays for them. Nothing is free! We all pay for the benefits collectively. The irony in labeling universal healthcare a “free” (but implicitly undeserved) service, but never describing our military as a “free” (but somehow entirely deserved) service is lost on too many Americans. Both fulfill the most basic functions of a government by protecting the health and well-being of its citizens. Yet one is vilified and the other is celebrated. It’s a maddening double standard.
If we accept the premise that the fundamental services that protect citizens and foster their well-being are never “free,” and that they’re funded by the taxes that we all pay, then it’s only logical to study the system of taxes that everyone pays into. Or to be more accurate, perhaps I should say the system of taxes we all SHOULD pay into. The unfortunate truth, as you have exemplified in your own life, is that the wealthiest people and most powerful corporations in our country have all found ways to flout the tax system and pay nothing into it, despite extracting tremendous amounts of goods, services, subsidies, and infrastructure benefits from the system to enhance their own wealth. Two well-known examples are how billionaire Warren Buffett pays a lower tax rate than his secretary, and how Amazon, a trillion-dollar company, finds a way to pay $0 in US federal income tax.330 Meanwhile, the working class of America finds themselves robbed of the prosperity seen at the top of the economy as they suffer stagnating wages and low or negative growth in real income. Even worse, the deleterious effect on the middle and lower socioeconomic classes has been compounded because the effective tax rate has been found by some economists to be essentially flat, and not nearly as progressive as once thought. 331 In other words, the poor and middle classes are forced to pay much larger shares of their earnings toward taxes, which contributes to our collective good, while the rich have systematically found ways to avoid higher taxation rates and shirk their civic duty.
If there are leeches on the system who are receiving something for nothing, then it’s not the poor or middle class; it’s the kings of capitalism. The American rich already enjoy “get-something-for-nothing” socialism, and it’s the rest of us who live in the cruel world of capitalism. As the former US Secretary of Labor Robert Reich wrote, “most Americans are subject to an increasingly harsh and arbitrary capitalism in which they’re working harder but getting nowhere, and have less security than ever. They need thicker safety nets and deserve a bigger piece of the economic pie. If you want to call this socialism, fine. I call it fair.”332
Or perhaps the immortal words of Kurt Vonnegut captured the situation best, all the way back in 1965.333
Thus did a handful of rapacious citizens come to control all that was worth controlling in America. Thus was the savage and stupid and entirely inappropriate and unnecessary and humorless American class system created. Honest, industrious, peaceful citizens were classed as bloodsuckers, if they asked to be paid a living wage. And they saw that praise was reserved henceforth for those who devised means of getting paid enormously for committing crimes against which no laws had been passed. Thus the American dream turned belly up, turned green, bobbed to the scummy surface of cupidity unlimited, filled with gas, went bang in the noonday sun.
We have seen it time and time again, where the rich are afforded government-sanctioned economic advantages which propel them inexorably upwards, while the rest of us get trapped in cycles of despair and ruin. And when things turn sour, as they inevitably do from time to time, the first in line to receive their socialized government handouts are the richest and the wealthiest. From the corporate bailouts that started in the 1970s and which metastasized with each successive economic calamity, including the multi-trillion-dollar stimulus packages following the COVID-19 pandemic, we have witnessed the unfolding of a system which only served to increase the wealth of the rich and to bury the poor farther underground.
I suppose one could argue that capitalism has actually been long dead in America. For the rich and wealthy, we have quietly socialized their losses and privatized their gains. It’s a rigged system, and it speaks to the larger failing of our democracy. If the people’s desires were truly reflected in our government, then we wouldn’t suffer from the broken system of representation in which we languish. Consider the facts: money has been allowed to corrupt our election process with unlimited funding, citizens are repeatedly disenfranchised and systematically discouraged from voting, odiously gerrymandered districts skew the electorate, and our “winner take all” form of elections makes political power a zero-sum game. But perhaps worst of all, the value of a single American vote has been diluted from James Madison’s original intention of “one Representative for every fifty thousand persons” into the contemporary ratio of one representative for over 740,000 citizens. 334 In fact, if one looks at only the last metric—the ratio of elected representatives in the national government’s lower legislative chamber to the number of citizens—we Americans get to brag about another ignominious title among OECD countries: The USA has the most diluted democracy by stultifying margins (275% less representative than the next closest nation, Japan, and over 13,500% more diluted than Iceland).335 Not only has our version of capitalism been perverted beyond recognition, but the underlying system of democracy which should be able to amend the situation has itself been broken too.
How do we describe the pitiful state of our country? Is our nation a “festival of kleptocratic impunity,” where the rich only get richer and the poor only get poorer? 336 Is our lifetime defined by the “Alice in Wonderland moment of elite buoyancy and mass despair,” where meritocracy and work ethic have been cast aside in favor of cronyism and stagnant social mobility? 337 Are we a reincarnation of 1800’s economies, in what Thomas Piketty calls “patrimonial capitalism,” where inherited wealth and accumulation of assets are not only the primary causes of wealth, but the barriers which keep others locked in their cycle of poverty? Or are we a nation that Nobel Peace Prize winner and former US President Jimmy Carter described as “an oligarchy with unlimited political bribery,” a society that embraces a system which “violates the essence of what made America a great country?”338
From my perspective on the social ladder, I would say that America is a gilded wasteland. We are a country of ostentatious window dressing that has been meticulously applied to a home with crumbling foundations. When looking beyond the country club veneer and the Hollywood glamour, we find a core of a country which has started to rot. The twin pillars of capitalism and democracy have mutated into gross caricatures of their original selves. The vibrant, egalitarian, and opportunity-laden country of the previous century has given way to greed, inequality, and painful desperation. And our stubborn brand of infallible self-righteousness and hopelessly misdirected patriotism serves to perpetuate our failing American institutions, rather than fix them.
The first step toward rectifying our collective malaise is to tax more effectively. End the loopholes, chase down the tax-dodging corporations and billionaires, and make the scoundrels pay their fair share. (If it were up to me, I would reinstitute the tax rates of the 1950s, where the top federal income tax rate was 90% or more, and economic inequality was low, and America boasted a strong middle class.) We also need to incorporate a wealth tax to help alleviate inequality, as Spain, Norway, Belgium, and even your beloved Switzerland do.
Step two is to distribute the taxes more effectively and according to the people’s will, which means having to reinvigorate the democratic process so Americans’ voices are better heard. We could use the German model, where citizens are automatically given a voting ID card when they reach 18. Or we could look at Australia, which mandates a compulsory preferential system of voting. Other measures, such as making voting a national holiday, reversing gerrymandered districts, increasing political representation, and limiting money’s influence on the electoral process could all be adopted to strengthen the democratic process. But I fear such a progressive evolution is too far removed from reality, and we will only continue to watch our country crumble into nationwide spasms of pain, desperation, and death.
I could go on, but I fear I have once again rambled into areas that have lost your interest. For me, contemplating the deeper causes of our nation’s collective misfortune is the one worthwhile distraction in my life. While you spend your Sunday doing whatever hedonistic billionaire things suit your fancy, I spend my Sunday not playing with my children at a park in the sunshine, but sitting next to my dying daughter in a hospital, wondering how I can afford her medical bills.
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