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Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
Americans, who are getting sicker, sadder, and ever more anxious, are so often unable to access necessities like healthcare because all too many legislators, judges, and administration officials refuse to hold large companies accountable.
One thing our government doesn’t like doing is challenging the greed of health insurance companies. I can speak with some authority about holes in the ever-fraying safety net of our healthcare system, including Tricare, the military health insurance plan used by most troops, veterans, and their families; other employer-sponsored health insurance; state-sponsored care like Medicare and Medicaid; and individually purchased plans. After all, I’m the spouse of a veteran who uses military healthcare and a clinical social worker. I serve military families that rely on a variety of health insurance plans to pay for their care and believe me, it’s only getting harder.
To take one example: At least in my state, Maryland, Tricare, if it pays at all, compensates clinicians like me far less for mental healthcare than Medicaid (government medical assistance for low-income Americans). It also misleads military patients by referring them to me even after Tricare has acknowledged that I’m unable to take more of them. Other healthcare plans serving Americans go months without reimbursing me for services they authorized.
For me, as a therapist, wife, and mother, nowhere is the relationship between corporations and everyday life more impactful than in the ways our government allows health insurance companies of every kind to avoid truly paying for the care Americans need
Over the years, I’ve written for TomDispatch about many things that military families go through—most similar to what other Americans experience, although almost invariably a little more so. That includes the struggle to feed their families and stay out of debt, the search for childcare, a growing sense of loneliness and pain, and, of course (to mention something so many other Americans haven’t experienced) exposure to the violence of war and its weaponry.
Private companies—and not just medical ones—shape the contours of American life in so many ways, even if we don’t know those companies’ names. Take arms contractors who have contributed so much to the spillover of military-grade weaponry into the hands of civilian killers. Just as all too many Americans, including schoolchildren, have found themselves forced to stare into the barrel of an AR-15 rifle, so have distressed soldiers stared into the “barrels” of companies few of us have heard of that can decide whether they’ll ever get the opportunity for therapy.
Sadly, in my world, greed all too often shapes how we live, just as it’s shaped the world of… yes, the Supreme Court. And for that you can thank the magnates who so generously gifted lavish trips and perks to Justices Clarence Thomas and Samuel Alito while they handed down morally devastating decisions on so many issues, gun control and abortion among them, that will determine the nature of life and death in this country.
In a moment, I’ll tell you a bit about my own experiences as a clinician. But let me start by saying that, for me, as a therapist, wife, and mother, nowhere is the relationship between corporations and everyday life more impactful than in the ways our government allows health insurance companies of every kind to avoid truly paying for the care Americans need. (Ask me, for instance, whether Tricare paid for my family to get flu shots this year. I’ll bet you can guess the answer to that one.)
Americans, who are getting sicker, sadder, and ever more anxious, are so often unable to access necessities like healthcare because all too many legislators, judges, and administration officials refuse to hold large companies accountable to the rule of la—when, that is, significant laws related to such corporations even exist.
As a therapist, I accept most major insurance plans in the Washington, D.C. area, where I operate a small private practice out of my rural home. I set out to make care accessible to middle- and lower-income Americans, particularly those who fought in America’s wars, were impacted by them, or grew up in a military family—groups where suicide rates are significantly higher than in the general population and where depression, anxiety, and violence are rampant.
I have a social science PhD that has helped me figure out how complicated systems work, yet our insurance system (if it can even be called that) confounds me. I find myself turning away dozens of people every month because I can’t afford to lose more time and income dealing with the complications of their insurance.
A country of wealthy healthcare corporations enabled by the government, who let clinicians choose between volunteer work or turning sick people away, is its own kind of banana republic.
My standard line for those who come to me seeking care is too often: “I’m so sorry, I wish I could help, but I’m unable to take any new patients with [insert here major healthcare plan, most of them state-sponsored or, in the case of Carefirst, D.C.’s version of Blue Cross Blue Shield, contracted by the federal government for its employees].” I then wonder what will happen to that suicidal three-times-deployed Afghanistan and Iraq veteran with young kids at home, who’s been referred to me by this country’s downsized, on-base healthcare system; or the single mother whose State Department job is supposed to offer her an insurance plan to help her manage the stress of aid work in combat zones; or unnerved asylum seekers from Russia, Ukraine, and so on (and on and on and on).
Meanwhile, in a separate area of my mind, I’m starting to try to lay the groundwork for a time when my own ability to support my family won’t suddenly be thwarted because one link in some part of our country’s fragile chain of companies that finance healthcare breaks for months on end.
Most people I talk to around my affluent town aren’t aware that, in late February of this year, the U.S. healthcare system suffered a major setback: BlackCat, a ransomware group, hacked into Change Healthcare, a subsidiary of the corporate behemoth UnitedHealth Corporation, which (until recently at least) processed about 40% of the nation’s healthcare claims annually, including from therapists. For months after that, some major insurance companies lacked a clear route to receive medical claims from providers like me. They also lacked a way to transfer money from their own banks to doctors. Other claims payment systems take weeks or months to establish, because you have to make sure they’re in sync with the chain of companies you work with in healthcare (if you accept insurance). There’s your encrypted patient data system, your payment-processing system, the insurance company itself, and maybe a company you hire to help you with your billing. In short, the Change outage left many providers like me without a way to get paid for what we do.
Nationally, over these months, more than 90% of hospitals and many group practices (especially smaller ones) lost money—to the tune of somewhere between hundreds of millions of dollars and $1 billion daily. Tens of millions of dollars in insurance payments to providers were delayed indefinitely. Doctors, nurses, and therapists were forced to close their doors, cut staff, forego needed supplies such as chemotherapy drugs, for example, or stop seeing patients. A survey by the American Medical Association of 1,400 medical practices found that 80% had lost revenue, 55% had to use their own personal funds to cover practice expenses, and about a third were unable to pay staff. Eighty-five percent of those practices had to commit extra time to the revenue cycle. The only reason I was able to see patients is because I have a spouse with a job that covers some of our bills (as well as our mounting credit card debt).
UnitedHealth went months without paying me for therapy I did with several of its members because I wrote the number “11,” not “10,” on claim forms to indicate that I saw patients online.
I had a particularly difficult time getting the insurance companies that are supposed to cover the healthcare of our troops to cough up funds. Tricare took three months to begin paying me because the requirements of its subcontractor, Humana, Inc., to enroll with a new payment system were opaque even for my professional biller. Then, it took weeks more after they figured it out for Tricare to formally approve the new arrangement.
Johns Hopkins Family Health Plan, another insurance plan for military families sponsored by the Department of Defense, didn’t start paying me the thousands of dollars it owed me in backpay until late June. Maryland Medicaid went weeks or even months without covering services for three of my patients. (Lest anyone think this is unrelated to the way we treat our military families, note that Medicaid serves millions of troops, in addition to many other populations.) The only reason those patients of mine continued to receive care was because I volunteered to do it, a choice that a medical professional living in the largest economy on Earth shouldn’t have to make. A country of wealthy healthcare corporations enabled by the government, who let clinicians choose between volunteer work or turning sick people away, is its own kind of banana republic.
Should we be surprised? Not in a for-profit healthcare system, where companies stand to gain by hoarding premiums long enough to garner yet more interest on them. Why would any of them feel compelled to fix such an outage in a timely fashion unless someone made them do it?—and no one did.
After the Change Healthcare outage, UnitedHealth’s CEO Andrew Witty testified before Congress for the first time in 15 years—a noteworthy (if insufficient) first step in raising public awareness and pressuring companies to improve their data security and prevent disruptions to healthcare. What I didn’t see was any significant discussion of why Americans need little-known companies like Change to begin with.
Change’s role is essentially to take the notes saying what we did that therapists and doctors like me write after we see patients and pass them on to insurance companies like Tricare/Humana, Medicaid/Optum, or D.C. Medicare (administered by the Pennsylvania-based Novitas, Inc.) in a format those payers are most likely to accept. If you ask me, were Change the character in the 1990s parody Office Space asked by downsizing consultants, “What would you say you do here?,” instead of responding, “I deal with the customers so the engineers don’t have to,” it might say, “I deal with the insurance companies so the providers don’t have to.” Essentially, Change takes my notes and sends them to the computer systems of insurers, which then (maybe) pay me. For a company that electronically dispatches healthcare claims from providers to payers, it’s done remarkably well. It was the most profitable of UnitedHealth’s thousands of subsidiaries, and UnitedHealth was itself one of the Fortune 500’s top 25 companies in 2023.
Maybe before something akin to another January 6 happens in America, more people should begin to question the assumption that private is better, that billionaires are the embodiment of the American dream, and that government, on principle, is not to be trusted
So many cooks in the kitchen amount to confusion and lack of accountability for providers like me.
Prior to the Change outage, the reasons companies didn’t pay out to medical workers were often as arbitrary and unrelated to healthcare as you could imagine. UnitedHealth went months without paying me for therapy I did with several of its members because I wrote the number “11,” not “10,” on claim forms to indicate that I saw patients online. No matter that both numbers stood for the same thing. Worse yet, its representatives refused to tell me that this was the problem until government officials intervened on my behalf. Honestly, I don’t think we live in a “deep state” as much as in (and yes, I would capitalize it!) Deep Corporate America.
Much is said these days by folks on the far right about the “deep state” and Donald Trump’s plans to gut it should he return to the White House in 2025. Speaking from the bowels of the healthcare industry, I’d say that what we have on our hands are many layers of companies (like those beneath Tricare, Medicaid, and Medicare) that decide whether and how to administer funds in ways too complicated and inhuman to truly explain. Consider it an irony then that, in 2022, the healthcare version of all of that was deepened by—yes!—a Trump-appointed judge who struck down a Justice Department lawsuit attempting to prevent UnitedHealth from acquiring Change.
Many failed states rot from the inside before they collapse, when people get so fed up with not having their basic needs met that they take to the streets. Maybe before something akin to another January 6 happens in America, more people should begin to question the assumption that private is better, that billionaires are the embodiment of the American dream, and that government, on principle, is not to be trusted. Instead, isn’t it time to hold the feet of government officials to the fire and begin a genuine crackdown on corporate greed in this country?
If that doesn’t happen, our healthcare system will prove to be just one disastrous layer in a genuine American house of cards. Unless our public officials begin to place our human rights and the rule of law first, count on one thing: Somewhere along the line that house of cards, medical or otherwise, is headed for collapse.
Airman Larry Hebert, who began a hunger strike at the White House on Easter Sunday, says he was inspired by the self-immolation of active-duty Airman Aaron Bushnell.
An active-duty Air Force airman is on a hunger strike in front of the White House, in solidarity with the children of Gaza, who are being deliberately starved to death.
Larry Hebert, a senior airman with six years in the Air Force, began his hunger strike at the White House on Easter Sunday. He says he will be present at the White House from 10:00 am to 3:00 pm, April 1-6, and will then move to the House of Representatives, beginning Monday, April 8, when Congress is back in session.
Airman Hebert, who recently joined the organization Veterans For Peace, says he was inspired by the self-immolation of active-duty Airman Aaron Bushnell.
"When Aaron Bushnell took his own life at the Israeli Embassy for the people of Gaza, that had a profound impact on me. I felt and resonated exactly with how he was feeling, and so that was really powerful and influential," Hebert said. "But what really infuriated me was the response afterward. Leadership within the military and within our government were just silent. There was utter silence surrounding Aaron Bushnell and what he did."
"We anticipate that other active-duty military and veterans will be following his example."
"I knew I had to raise my voice in opposition to the U.S. government supplying Israel the bombs and rockets to commit genocide in Gaza," said Hebert. "Active-duty members are afraid to speak out, and I hope my example and that of others, like Aaron, can change that."
In mid-March, Hebert, from rural New Hampshire, took an authorized leave from his assignment at Naval Station Rota, Spain. Since then he has participated in demonstrations demanding a permanent cease-fire in Gaza and visited several congressional offices to press for an end to U.S. weapons shipments to Israel, which violate several U.S. laws.
Hebert is standing outside the White House this week with a sign that reads "Active-duty airman refuses to eat while Gaza starves."
He is not wearing a military uniform, which might be considered a violation of military regulations.
"I am on Day 4 of my hunger strike in solidarity with the civilians that are being deliberately starved in Gaza," said Hebert on Wednesday.
Hebert told
Task and Purpose that he currently works as an avionics technician assigned to Naval Station Rota, Spain. The NAVSTA base provides cargo, fuel, and logistics support to military units in the region and supports U.S. and NATO ships with three active piers.
Hebert plans to continue the hunger strike—limiting himself to water and a juice supplement—for as long as he physically can.
He toldMilitary.com, "I don't have a stop or an end for it right now. I'm going to go until my body cannot go any longer or we get the cease-fire and the end of unconditional aid to Israel."
Hebert joins many hundreds of current and retired military and civilian government officials urging U.S. leaders to stop fueling Israel's war that has killed over 32,000 Palestinians, nearly half of whom are children. Starvation and disease are rapidly becoming as deadly as the war itself throughout Gaza, where Israel has bombed hospitals, mosques, and residential neighborhoods to rubble.
"We applaud and wholeheartedly support the courageous action of this young Airman," said Mike Ferner, national director of Veterans For Peace. "We hope he will inspire other military personnel and veterans to take similar actions."
Veterans For Peace supports military personnel who act in good conscience and refuse to participate in genocide, war crimes, and crimes against humanity, whether directly or in support roles. For example, orders to load or transport U.S. weapons to Israel are illegal, under both U.S. and international law.
Veterans For Peace recommends that military personnel who want more information about their legal rights, or who wish to be discharged from the military, contact the GI Rights Hotline.
Airman Hebert's protest is gaining national and international notice. On Tuesday alone, he was interviewed by Democracy Now,The New York Times, The Guardian, Voice of America, Al Jazeera, WMUR-New Hampshire, and The Katie Halpern Show on YouTube.
"Larry Hebert's bold action is having an impact," said Ferner of Veterans For Peace. "We anticipate that other active-duty military and veterans will be following his example."
For active-duty members of the U.S. military considering following in Herbert's footsteps, or anyone who seeks more information, here are some of the laws the U.S. is currently breaking. In a February 12 letter to the U.S. State Department inspector-general, Veterans For Peace detailed the U.S. laws currently being violated by U.S. officials every time weapons shipments to Israel are authorized to include:
We need green military technology to kill one another sustainably.
You probably have never read the 2015, "An Ecomodernist Manifesto." Good for you! That missed experience leaves you a little more brain space to recall who won the 1967 World Series, which brothers played sax and drums on "Papa's Got A Brand New Bag" (Maceo and Melvin Parker), and who wrote the trilogy, Molloy, Malone Dies, and The Unnamable (if you guessed Samuel Beckett, congratulations). Having a finite brain, I maintain only a sustainable body of knowledge.
So why even bring up a hoary old movement that seldom enters the news cycle? Who cares about a manifesto written at the end of President Barack Obama's last term?
Our political culture rolls the dice on climate change, with a strategy of doing absolutely nothing, and ecomodernism provides the rhetorical inspiration for inaction. We ought to trot out the manifesto on sweltering hot days just to pay homage to the authors of a document that uplifts us with the rallying cry that “future help is on the way.” If ecomodernists have become the de facto architects of environmental policy, shouldn't we spend a couple of minutes considering their virtues?
With an economy growing with clean, safe nuclear energy, carbon capture, GMOs, and desalination we need a fighting force keeping pace—with space lasers, magnifying glasses the size of football stadiums, solar drones, and clean nukes.
Ecomodernism is sort of the love child of Ayn Rand and John Muir, or the mutant offspring of Rachel Carson and Tony Robbins, or even, god forbid, the living flesh melded from Emily Dickinson and John D. Rockefeller. If you attempt to intertwine the most predatory icons of free market thinking with random champions of pristine woods, you come up with a utopia of unlimited luxury and unspoiled nature. This is the best "have your cake and eat it too" philosophy ever. The ecomodernists even have a word to describe this unlikely splicing of mass consumption and ecologism—"decoupling."
Decoupling (take a deep breath) means that economic growth and the fate of the natural world can—by virtue of future technical achievements—be entirely separated. The rabid faith in free markets, future technology, and human expansion drives the economic fundamentalism of ecomodernists. You can have a hypertrophied economy the size of fucking Betelgeuse juxtaposed with flourishing redwood forests and twittering finches (carefully cultivated by human designs)—or so the ecomodernists tell us. It's like thinking that you can eat 20,000 daily calories of bacon, butter, and ice cream (while sitting on the couch all day flicking through YouTube shorts) and be as shredded as Bruce Lee—you merely have to decouple your diet and lifestyle from your health.
This wonderful world bursts forth from a foundation of three great shibboleths—clean, safe nuclear energy, desalination, and carbon capture. Oh, and GMO driven industrial farming—four shibboleths. In ecomodernist fantasies we can just keep doing what we are doing—burning coal, fracking, drilling, etc. and be confident that a befouled world can be saved by future innovations. Count me in! Who doesn't want a world crammed with cheap stuff—a mandate for greed decoupled from consequences?
The one tiny issue that the ecomodernists have yet to consider is decoupled military spending and warfare. If the economy can be decoupled from the environment, then so too, we need to imagine a future utopia in which we can blow up cities and eviscerate enemy civilians while preserving the sanctity of nature. I spent a full 12 minutes on The Breakthrough Institute website and did not see a single blog comment on green military hardware. I should mention that The Breakthrough Institute is the flagship of ecomodernism—the place to read a hundred or more bits about decoupling. It might be that there are musings about environmentally responsible weapons of mass destruction at The Breakthrough, and I just failed to find them. You would think that ecomodernists have thought about such things—obviously, in an infinite growth economy there will be infinite military spending. Or, I should say, continued infinite military spending.
The ecomodernist weltanschauung appears to embrace the idea that any technological invention that can be imagined will inevitably come to fruition. If this is correct, why are ecomodernists unable to imagine the future of clean weaponry? Even a less than shining light—Rep. Marjorie Taylor Greene (R-Ga.)—imagined Jewish space lasers. A weapon that can vaporize people and property from a remote orbit in space has to be far more deferential to ecosystems than the usual fighter bomber delivered explosives. In the spirit of decoupling we need space lasers from all spiritual denominations—not just Jewish ones.
Every evil child knows about the pleasures of committing ant genocide with a magnifying glass. This solar driven means of mass death should be a natural idea for ecomodernist thinkers. Think of the James Webb telescope built, not to explore remote galaxies shortly after the big bang, but designed to redirect and concentrate deadly sunbeams to crush those enemy strongholds that advocate growth-impeding ideology. Modern warfare since Guernica has centered on bombing civilian populations to a pulp. In an ecomodernist world, we ought to obliterate unwanted people with the most sustainable technology that money can buy.
What about solar powered robotic drones armed with razor sharp titanium blades? How about clean nuclear bombs? It is rumored that the nuclear industry funds The Breakthrough Institute—that makes nuclear warfare into an ecomodernist prerogative.
In a world full of free markets, war, and genocide we cannot continue to destroy human life on industrial scales with old-fashioned fossil fuel driven armies. The U.S. military uses, annually, more fossil fuels than the country of Portugal. That is fine for now, but we will need an even bigger military in the future—a fighting force with the exponential potential to match capitalist expansion. With an economy growing with clean, safe nuclear energy, carbon capture, GMOs, and desalination we need a fighting force keeping pace—with space lasers, magnifying glasses the size of football stadiums, solar drones, and clean nukes.
Ecomodernists talk about building a "good Anthropocene"—an Anthropocene bursting to the gills with gadgets, fashion, entertainment, 70-hour work weeks, and fast cars. We can't have all the stuff we need to keep the emptiness of the Anthropocene at bay, unless we can force the Global South to hand over the extracted rare materials we need to make an ass kicking, rocking Anthropocene. We need The Breakthrough Institute to grow a pair and say the quiet part out loud.