(continued from Russians, was Bakunin and Marx...)
Anyway as a daily fact of life about only place I see much like what you describe is in some of the wilder, poorer, and mostly black and hispanic neighborhoods in SF and O-town---where there is a deep sort of dismissle of all authority, especially white political-police authority. This authority is seen as completely irrelevant bullshit---created mainly to hassel people. While not the same, there is a sort of similar dialectical swing between crack down and liberalism, police squads and social reformers, turns toward crime/irresponsibility and turns toward heightened social awareness---class conscieousness.
Maybe the similarities are a matter of a similarily of living in chaos, because that is what poverty or at least desparate economic circumstances look like from the outside. Chaos. Because money is always low and irregular everything in life is thrown into uncertainty---work, bills, rent, food, transportation. It is almost impossible to plan anything because you never know what's going to happen between now and then. Toss a wheelchair and/or a couple of kids in the mix and you have a real mess on your hands.
Seen from below, welfare and social services are essentially a socio-political extension of the police-state and criminal justice system that rules the political economy of poverty with a hard, arbitrary, and iron fist.
Since I am part of this welfare-prison-political-economy of poverty, I am constantly debating myself on what to do for who. Technically, that is by the rules of my job, I shouldn't be doing anything for anyone except tell people what they can't have. My job has become a welfare cop enforcing medicare and private insurance policies which have been created to not provide any service at all. So these are rules made to be broken. My inner spirit says oh fuck you, and do everything for everybody and then lie about it on paper.
But the boss is going broke and threatens to close the business, so I have to be selective about what I do. It's just complete bullshit. I sympathize deeply with any form of defiance I see around me.
I've got to see Moore's Sicko, but I am afraid I am going to be tremendously disappointed. He was not filming in the neighborhoods I work so he and the film can not show the true vastness of misery this so-called healthcare system has spawned and how it intersects with the whole corporate state system of oppression.
One of the key problems that also reveals the profound complicity of business and government in creating this cultural of poverty, is that Medicare and its policies lead the field in its race to the bottom---spending vast sums on everything except actually treating health problems and providing medical services. The much hated HMOs and private insurance companies follow Medicare guidelines, and then add a few twists of their own. Unless you pay for policy coverage you basically can't afford, then you are simply buying the worst coverage possible which is usually worse than Medicare.
Here's a nice thing to consider. Medicare and the insurance industry change their rules and policies all the time. What was covered last week, may or may not be covered or considered a `benefit' this week. So lowly businesses like the one I work for never know in advance what they will be paid on a claim. And furthermore, claims are not paid all at once, but are often defferred, or paid in installments. This creats a similar form of chaos issuing from a completely inconsistant cash flow for the service providers which in turn, turns my life into a potential chaos.
The latest scam in the insurance industry is to re-sell their policies to another company and dump their least `cost-effective' policies on an even nastier company who is now free to squeeze harder. So there is a great shuffling act going on. The new company who now owns your healthcare policy is free to establish its own rules on what is covered and how much it is covered. For example, my health insurance policy at work was turned over to another company who just decided that prescription drug claims would now not be paid, until my two thousand dollar deductible was met. Previously, the policy had a drug benefit that was paid at paultry 20% of the retail price. My co-pay was 80%. Now that 20% is added to the deductible until the magic two thousand dollar limit is reached. This means effectively I have no drug benefit---if you follow all that bullshit.
Of course the two thousand dollar deductible is ludicious in the first place. Only three times in my life have I ever had a medical bill over about a hundred dollars which is the now standard office visit to an MD. Once I was in traffic accident on my bicycle and had to sue the driver's insurance company to pay the ambulance ride, paramedic triage, and ER bill. The other two times were severe lung complications from a very bad flue.
In any event, the whole political debate over healthcare is a farce. We don't need universal access to health insurance. We need cradle to grave medical services paid by the government out of taxes.
But we also need to establish a whole system of political control over such a system so that it can not be turned into what Medicare has become---a cost cutting death machine run by a completely unaccountable (to the people) independent federal agency.
In other words we need direct, public access and oversight of policies. Additionally, we need an administrative law body for individual cases---so that people can go before a legal authority and change rules, get findings and have independent decisions handed down---with appeal rights to the federal court system. Public access and independent legal review are essential because I certainly don't trust a government agency to fairly decide who or what is covered under a universal healthcare system. And that's just the patient side. The medical care provider system needs a similar and well coordinated overhaul of its own.
The provider system or service delivery system which is where I am in this equation is trapped between two economic anatagonists, the manufacturer/suppliers and the benefit/billing system of the government agencies/insurance industry.
The manufacturers, suppliers, pharmaceudical industries, etc. all raise their prices like clock work, while the claims systems systematically cut their payment schedules. Hospitals, rehab centers, community clinics, nursing home industry, doctors, nurses, aides, para-professionals and allied trades like mine---the whole medical service delivery system is caught between the same two antagonists. The way it works is typical of the US neoliberal economy. Deny, underrate, or otherwise medigate the underlying human need (healthcare), punish the medical service delivery workers, and reward the biggest capitalists or best lobbied whenever possible.
What is going now is a collapse of the service delivery system driven by these two large antagonists. Changing just the billing/claims system to a single payer system might help, but it is not really a secure long term answer. Sooner or later the medical-industrial-complex has to be overhauled through heavy regulation. So in order for a tax based, government administered single payer system to work, there has to be an equal effort made to regulate the industries that feed into this system. Otherwise the government budget will just become the giant feeding trough for the biggest capitalists---just another subsidize the rich plan.
While none of the above reforms are going to happen, the fact is we need to figure out what should be the scope and goal of such reforms. We need to know in advance what various plans mean and don't mean, we need arguments to shutdown the farce of current political debate, and we need to know what we want, what it means and how to build it.
CG