THE WEEK IN GREED #9: Triumph of the Ill


Ten years ago, in the midst of a lengthy depression, I found a lump in my lower forty and decided, with the help of my depression, that I had cancer. This explained why I felt tired all the time, why I had trouble peeing, why I woke every morning embalmed in dread.

I didn’t have health insurance. My employers had always supplied that and when I left journalism to write depressing short stories, it disappeared. Nor did I think to purchase insurance for myself, because insurance was a useless expense, something for old people to worry about.

Now I had cancer, or thought I did, and my friend Evan, who was a doctor but refused, quite sensibly, to feel my lump (and in fact correctly diagnosed me as a self-pity addict) warned that even if I were sick I wouldn’t be able to purchase insurance. My cancer would be considered “a pre-existing condition.”

I was going to die.

I did not die. I didn’t even have cancer, though when I finally saw a doctor he referred me to a urologist named Koo who suspected I had “a urethral stricture” and, without so much as buying me dinner or a drink, proceeded to insert a camera all the way up my urethra and into my bladder. I wound up paying Dr. Koo $1900 for this procedure.

He never sent flowers.


Yesterday, the Supreme Court of the United States upheld the health care reform law that President Obama spent his first two years in office pushing through. The immediate effects of this decision are moral. It will remain a little easier for poor and middle class people to secure treatment, and a little harder for insurance companies to ration care based on greed.

The central provisions of the Affordable Care Act (ACA) are as follows.

Forbids insurance companies from denying coverage to those with pre-existing conditions.

Allows children to remain on their parents’ insurance until age 26.

Extends Medicaid coverage to those living in or near poverty.

Makes several common preventive medical services free.

Punishes insurance companies for spending less than 80 percent of your money on patient care.

Provides discounts to Medicare recipients for prescription drugs.

The ACA also requires those citizens without health care insurance who are capable of buying it to do so, and provides subsidies to help them.


This is not some arcane piece of legislation. The measures cited above matter. To you—the person reading this column. Unless you are an insurance executive or an extremely rich person, the ACA will save you (and your loved ones) thousands of dollars.

My in-laws, who watch Fox News religiously and therefore—while knowing virtually nothing about it—oppose the law, will save hundred of dollars every month.


If the law had been around a decade ago, it not only would have guaranteed that I could buy insurance, but required me to do so.

The economic reason for this requirement is obvious: when you force insurance companies to enroll the sick, they hike premiums. But if you require otherwise healthy people to purchase insurance, the risk is spread across a larger pool and rates remain affordable.

When he was a centrist governor, Mitt Romney imposed this mandate on the residents of my state, Massachusetts. It was a conservative idea back then, a way of shifting the onus for health insurance from companies to individuals. Here’s what he had to say: “With regards to the individual mandate, the individual responsibility program that I proposed, I was very pleased that the compromise between the two houses includes the personal responsibility mandate. That is essential for bringing the health care costs down for everyone and getting everyone the health insurance they need.”


Those of us who view health care as a moral imperative rather than another branch of the capitalist endeavor looked upon the ACA as a shabby compromise. Any sane democracy, examining the world’s various health care systems, would recognize at once that nations with socialized medicine provide the best and cheapest care.

But we live in America, where big industries such as insurance and pharmaceuticals spend billions of dollars to prevent an outbreak of common sense. And thus Obama—for reasons that appear in retrospect profoundly masochistic—opted not for a single payer system that would have forced private industry to drop rates and improve service, but an odd patchwork.


On the eve of the Supreme Court ruling, a reporter asked White House spokesman Jay Carney why the administration had failed to convince the American people that the ACA was a good thing.

“Well,” Carney replied, “as you know, most of the provisions in the law are wildly popular with the public, so if you asswipes in the media had actually reported on them, rather interviewing lunatics and shills about mythical death panels, maybe it would be more popular.”


Actually, check that. Here’s what he actually said:

“Well, Kristen, that is a great question. I think we’ve discussed this on a number of occasions over the months and years. There was excellent reporting recently, I think on the sheer volume in the millions and millions and millions of dollars that was spent in an effort to discredit the Affordable Care Act (ACA). The differential in money spent was, I think eye-opening, but I think reflects the challenge that we have faced.”

I’m not sure I’ve ever read a statement that so thoroughly captures the rhetorical timidity of the Obama regime.


But of course, Obama himself is to blame for this failure. Put simply: he’s a lousy narrator. He has yet to understand that great leaders must also be great storytellers, and that all great stories are animated not by sensible platitudes but by heroes and villains.

In the case of health care reform, he had only to tell Americans what they already knew: that sickness was not a business opportunity, but a human crisis. That our system for healing had become corrupted by greed. That insurance and drug companies were preying on decades of political inertia, charging too much, providing too little, ruining lives and crippling the economy. That he’d watched his own mother battle insurance companies even as she succumbed to cancer at the age of 53.

He should have traveled the country telling that story, listing exactly what was in his bill, over and over, and demanding that his opponents explain why they were siding with insurance companies over sick people.


As it is, he will now be left to do this on the campaign trail, while Mitt Romney attempts to explain why he was for the individual mandate before he was against it.

One provision Obama would be wise to highlight is the rule requiring insurance companies to send rebate checks to their customers if they spend less than 80 percent of their premiums on patient care. In Massachusetts, these checks will average $140 per family. In other words, thanks to the ACA, insurers who spend too much on administrative overhead or lobbyists or CEO bonuses must now pay their customers back.

If this constitutes a government takeover of the health care system, I’m pretty sure most people are onboard.


As for the Supreme Court itself, I stopped regarding them as a legitimate institution at the precise moment they awarded George W. Bush an office he did not earn from voters. They were despicable and without principle then. They remain so now.

That Chief Justice John Roberts decided to allow the ACA to stand, on a technicality, is a function not of his legal intellect or conscience, but his vanity. The Roberts Court has done irreparable damage to our democracy by erasing the vestiges of finance reform. Never has an American judicial body sought to promote so brazenly the interests of obscene wealth.

If there is a remedy to the sickness they represent, it will come about only when citizens awaken to the fact that their passivity has privileged the motives of corporations over their own rights.

Steve Almond's most recent book, Against Football, was a New York Times bestseller for at least three seconds. More from this author →