One of the most infuriating things about healthcare in the United States is that not only is it viciously expensive, the private insurance system is a deliberately confusing labyrinth filled with tricks and traps designed to maximize profit both for the insurance companies and for healthcare providers.

Prices for care vary widely not only from place to place, but also depending on who’s actually paying. The overwhelming majority of transactions in our day to day lives deal with fixed prices. The price one person pays is the same as the one everyone else pays, and things like haggling are not even an option. You pay the asking price, or you don’t buy that product.

That means that when we get a bill for hundreds or thousands of dollars for something related to health care, we tend to assume that’s just the cost, and seeing the size of some of those bills, it’s not hard to understand why people would be willing to pay hundreds or even thousands of dollars per month to avoid a bill of tens or hundreds of thousands of dollars for accident or illness. A good health insurance plan can make a huge difference in the life of a U.S. resident.

For example, when I spent a semester in Tanzania, I took the anti-malarial drug Malarone. It was the best option available, particularly because the alternatives had common side effects like intense, usually unpleasant dreams, or increased sensitivity to solar radiation. For a northerner visiting the tropics, it’s generally a bad idea to do things that make sunburns more likely.

The problem is that Malarone is more expensive. It’s a daily pill, and at the time I  believe it cost $5USD per pill. Nowadays the same supply would cost a little over $7USD per pill. For a four month trip, that’s around $600, on top of any other expenses. The insurance I had at the time, through my father’s work, covered it entirely.

That’s not the actual cost to make the pills though- not even close. It’s also probably not what the insurance company paid for them.

The relationship between patient and insurer is very adversarial, resulting in the aforementioned labyrinth, but beyond that, the bills patients see are almost never what insurance companies pay. They negotiate better rates and prices, and then try to push the costs they can’t negotiate away onto the patient, with the kinds of results David Pakman discusses in this clip:

I can’t help but feel that the extortionate “asking price” helps push people into paying so much for insurance, to avoid medical bankruptcy.

My own experiences include a plan in 2008 and 2009 that wouldn’t cover any emergency rooms within about 10 miles of where I lived, spending months and countless hours trying to confirm that the coverage I was paying for in 2018 and 2019 was active, and on trying to find a doctor that would even accept it, getting charged $200 out of pocket for a 10 minute consultation with a doctor when it turned out the card I had been paying $600 per month to get wasn’t working, and many other delightful experiences.

I took a fall on my bicycle in 2009 that cracked my helmet in half, and decided to hope no serious damage had been done rather than pay for the emergency room. I was hit by a car while commuting on my bike in 2013 (the driver’s fault), and had to turn down the ambulance ride and avoid getting my injuries checked out for the same reason. In both cases, I got lucky.

The entire world is subjected to relentless propaganda about how the United States is “the greatest country in the world”, but much of that is just incidental exposure to messaging aimed at American citizens, designed apparently to keep us from realizing the degree to which we are mistreated by our country and its ruling class.

I sometimes see people from Europe wondering why Americans don’t take to the streets over things like the healthcare situation, poor wages and inadequate safety nets, and so much more. A lot of it is things like this. Protesters risk arrest. Many companies reserve the right to fire employees who get arrested, or who miss work because they got arrested, or who miss work for a protest or a strike. Losing work isn’t just losing a paycheck, for many it’s also losing access to healthcare.

Protesting for any change in a left-wing direction can result in brutal attacks by police with kinetic and chemical weapons, which can result in massive medical bills. Rioting even more so (though police often try to turn peaceful protests into riots).

The reality of the United States is that it has found ways to repress its citizenry far beyond what you might think is happening based on what the law says. Rather than direct government control, corporations set the conditions under which people can have a stable, healthy life, and the government only has to prevent you from getting around the obstacles created by the corporations.

Health insurance companies levy heavy taxes for access to medicine, the government just ensures that there’s no better alternative than paying, and that same pattern exists throughout the system.

That’s why so much activism now includes efforts to help protesters avoid the steep penalties for exercising their right to protest, and it’s also why I ended up settling on my favoured approach to working for change.

This same dynamic exists to various extents in all capitalist countries. It is not the only form of repression, but despite all the talk about the “free” nature of capitalism, it is still a form of repression, and from what I can tell, it’s only getting worse.

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