Expose’ 2 Of 3: Scalping And Sponging In Healthcare

Prologue: For the first time NWS readers come across an expose’ of our healthcare system that is sick of cancer caused by insatiable greed.

The written piece is presented in progression, i.e. headlined Part 1 that the public is reading about a week now, and parts 2 & 3 that the public is about to read.

These three-some tiers of incredible information regarding our healthcare system ravaged by the cancer of greed, are based on the author’s research and study … affordable Healthcare being one of the hottest issues that could break or elect a candidate for president, barely four months from now. Right now we are fighting over healthcare as one of the most important issues for a nationwide debate while we approach the critical moment to elect the next president of the United States.

The value of this editorial effort the author and NWS had collaborated to present to the readers cannot be overemphasized. Challenged by this expose’ are the concerns of politicians and millions of their followers, as well as the interest of political scientists, social and healthcare specialists, business people, the academe, especially a huge number of students across the country, not to speak of the multitude of researchers with various interests that would definitely benefit from it.

The author is an award winning journalist. He just received another similar award – Excellence Award in Journalism and Community Service – from San Diego’s humanitarian foundation on June 21, 2008.

There is something unique about how the expose’ is written – actually the author’s signature in writing. This satirical essay is rich in imagery, where euphemism and metaphor are skillfully used as tools to challenge the readers’ understanding and perception of the real danger we face. Yet it is meant to attract the sophisticated readers and to capture the attention of ordinary Americans because of the simplicity it was written, and the layman’s language used.

The ultimate aim is to influence Americans to become intelligent voters when they make a critical decision to elect the next president this November. They must know what is, and what is not, by all means.

[NWS in consultation with the author – July 18, 2008.]


Public apathy breeds its own bloodsuckers. That leeches spawn in our healthcare system is beyond dispute.

Das Kapital registers a damning point. And so did Karl Marx’s political adherents operating in American soil.

When left swingers – the enemy within – argue that profit gluttons feed on public gullibility, greed in our capitalist healthcare system is indefensible!

On top of it, there is a leechlike partnership between our healthcare industry and the government. This macabre alliance hits us like a falling ton of bricks from the angry sky!

As carriers of the ideological virus of revolutionary socialism and extreme radicalism disguised as libertarian patriots, Karl Marx and his leftist American disciples that walk the plank of protest against imperialism, celebrate with total abandon their I-told-you so bite of the capitalist world in this country.

For example, the misguided wrapped in American flag claim that 9/11 was not the dirty work of Al Qaeda but of imperialist America, and that Americans deserve to die in the hands of terrorists. When we hear this battle cry for change from the radicals in the academe and from the candidate for president of the United States, we know that capitalism is badly snake-bitten.

It is the likes of our gravely diseased healthcare system that light the fire of the activists’ campaign against this imagined evil American Empire, thus calling the citizens to arms – meaning to revolt is a philosophy of violence for change — to kill, to destroy and to burn down our democratic way of life so that like the proverbial Phoenix, Bolshevik socialism will rise from the ashes and take over. Surf the Web and you will know they are here.

In our Western democracy, we often ask ourselves in front of the mirror where we fail as a free society. In this instance – in this ugly story of our healthcare — our jaws drop in utter disbelief. For, here we stand witnesses to the murder of our trust in government – a government supposedly of the people, for the people and by the people — but unfortunately run by midnight politicians in this era of darkness and gloom.

Just think about it … the proud yet sterile government under the stewardship of negotiating and negotiable politicians – in short, bribed politicians — is just standing there with arms akimbo while the healthcare industry skins innocent consumers dry and hard to the bone. We are painfully shaken, and in an excruciating agony, hearts are so broken we could drop to our knees and cry while the Left celebrates.

Celebrants swing their ax relentlessly to cut down America and in the wild that politics is, howler with joyful glee … T I M B E R r r r …! They are political lumberjacks — cutters and fellers of our standing democratic institutions long erected by our forebears, and transporters of our 9/11 dead bodies for lumber down the river. Some of them are disguised as Democrats if not revolutionary Libertarians disguised as pseudo-Republicans.

One of them a Democrat who is running for president, is swinging his ax to change America. Another, a pseudo-Republican aspiring to be a presidential nominee, bloodied the nose of Americans, both dead and alive, by blaming America for 9/11 like how Osama bin Laden and Al Qaeda abused, attacked and torture this land of the free.

The sad truth behind this severe healthcare anomaly is that the government is not there to protect the insured patients captured by the healthcare industry, but there to protect their captors. Karl Marx’s I-told-you-so ideology, scores a damning point.

As clear as the blue sky in summer, healthcare scalping is a protected undertaking of hit-and-run profiteers in our midst. We know for a fact that health insurance hardly uses its own invested capital to shoulder the cost of medicine and medical services the patients badly need. The money it spends for the patient who is in dire need of medical help plus overhead expenses, is the money of the insured in an insurance pool, not the money of the insurance.

This “pool fund” of the insured is hardly spent for the sick either. It goes somewhere else. The industry makes a business out of it by investing the fund in a scalping reinsurance scheme or in a “float” to earn more profit.

This space is not big enough for me to explain the technical aspect of this rip-off. To do the task is no different from writing a book. But this wounding truth resides in public libraries for anyone interested to pay a visit. A shocker awaits a curious visitor who will be greeted with stomach-turning information that in fact patients can die for all the insurance people care. Conscience? Nada, not even flowers for funerals!

The insurance turns philosophical when its greed and vulgar indifference are challenged: Insurance buffs normally defend themselves by saying that there is nothing personal in the whole operation – it is just strictly business.

In other words, insured patients can die due to unaffordable healthcare, but their tragic death has nothing to do with insurance business.

Thanks to the government that is not there to protect patients captured by the industry, but there to protect their captors.

Let’s not forget the bond that solidifies the interest of politicians who run the government and the industry’s reciprocal interest, not to speak of the mean-spiritedness of the ungodly alliance [Expose’ 1].

Since those industry-subsidized politicians are the ones running the government, the insurance industry and the government are at liberty to perpetuate this parasitical sponging, this leechlike partnership scalping the innocent consumers, instead of protecting them from powerful scalpers.

Let’s examine the arguments that the eerie wind blows from the dark side: While it is true that there are some philanthropic projects here and there sponsored by the moneyed in the insurance business – and some are even put up with contributory government funding — it is also equally true that in return, the corporate catch is more, i.e., tax deductions, tax cut or rebates in favor of the donor for whatever amount donated, and the profit-sponging corporation gains more, in addition to publicity derived from shedding crocodile tears for the socially disadvantaged, thereby tremendously bolstering a positive image before the eyes of the awestruck and/or systematically captivated American public.

It is also true – thus the argument goes further — that some of us drumbeat being saved by health insurance. But saving one’s life is merely incidental. The insurer did not go into this business to save lives. The health insurance in this country is not a salvation army. Insurers are not there for humanitarian reasons. As hardcore capitalists, they are there to make great revenues, profit being their only excuse for being. Ergo, profit is ranked No. 1 in their unholy existence, while saving someone’s life is only ranked second if it is in fact ranked at all.

The notion that insurance is there only for the purpose of saving lives, is where the business secretes its modus operandi and hides its killings. Insurance advertisements to this effect become the opium of innocently hooked Americans whose trust in the system is unknowingly betrayed.

With this peeling off editorial, it is a wake up call for America and to all good Americans. Again back to the lead statements of this serialized expose’ — that the industry is neither there for the benefit of patients nor for the interest of the consumers but only for its own corporate interest.

It is important to understand this even more carefully with the hope that presidential candidates McCain and Obama may know so that when any of their kind gets elected president they should do something about it: In this country’s free market system, the insurance industry’s health coverage planners are themselves the ones drawing the rules for exemptions or non-covered benefits which anyone once insured is forced to accept and/or either obligated to follow or without health insurance, destined to die.

That’s the payback authority that politicians in Congress give to the industry in return for the lobby gifts received – unrestrained power of the lords of the industry to decide what insurance benefits to cover and pay — which results in insurance paying only cheap benefits — and toss the more expensive cost to the consumers.

Technicians of the industry inundate the public with statistics showing the risk they undertake and the losses they sustain, to cover up their gains. In the book that this author is currently writing, this subterfuge is aptly described as a cheap cephalopod tactic.

Exposing this shoddy squid tactic is one way of saying that talking about the insurance’s actuarial mumbo-jumbo serves no useful purpose because it only justifies, more than just mollifies, systemic rip-offs for profit. Besides, that would be warping towards technicalities from the simplest form of explanation when doing it in that complicated way would just amount to the same thing.

It would be suspiciously too conspicuous to depart from a simple clarification that our short-stacked candidates for president should have indulged in – simple, perfectly honest and straightforward explanation the American public so richly deserves — like how this piece is written to be, using a layman’s language for the easy understanding of the ordinary American.

For, to confuse is to confiscate the gift of knowledge from the less sophisticated which most of the country’s indigents seeking medical attention are, and here I am really sad to say it without blinking an eye … to state this anomaly right here in black and white, without any iota of trickery and pretension.

And with this exposure of the truth that in journalistic parlance the bad and the ugly wanted to kill, the underlying question is: Can McCain or Obama disclose the industry’s pilfering and profiteering if not larceny, to the public? Do they have the courage to say in public that their political donors are parasites that worm their way into the patients’ pocket?

In a calculated response to this question, I want to repeat hammering on this undying truth one more time to secure this very important point: To opportunist politicians who know which side of the bread is buttered, to discuss in public this parasitical relationship with the backhanding industry to which they are symbiotically attached, would definitely be a political hara-kiri.

The other way of saying it is that the moment any indictment of sponsors and political benefactors comes out of the politicians’ mouth in public, they are, in politics, dead cucumbers left out in the cold. Recall that McCain has been jettisoned from the Republicans’ running campaign bandwagon. Left out in the cold, the Arizona Senator earned the name “Maverick” before losing the Republican presidential nomination four years ago. The Senator did not earn that wayward “honor” for nothing.

Lie-bleeding to death this contrived cover so that the truth will come out and live for all Americans to behold starts from insurance rules that put consumers in straightjackets. Those rules drawn by the industry itself, are for the insurer’s benefit, never even in a dream that those rules have been crafted for the benefit of the consumers or the patients. This notion that it is, is another sloppy and knobby belief of the general public that should be corrected right here using the simplest terms and logic possible.

Under those industry self-serving rules, the patients’ claims for high cost medicine and medical treatment even when covered by insurance, are generally questioned or objected to or if not, subjected to labyrinthine procedures for approval. Except in extreme cases that come like a drop of rain in the desert, a shortcut is conditionally – not even absolutely or freely — allowed.

Insurance rules that the lords of the industry were authorized by Congress to promulgate for their own protection against payment of high-cost benefits to the patients, saw to it that the insured has to undergo layers of exhaustion of administrative remedies before the insuring company or HMO approves a costly life-saving treatment.

When the medical treatment is expensive and therefore hardly affordable, the poor patient runs to insurance for help. But help isn’t coming. The insurance contract and the implementing rules have this coverage-exit clause giving the company absolute discretion to decide whether or not the expensive medical treatment the patient chose as a matter of right under the law, is “experimental”.

Medical treatments that are “experimental” are not covered. The rub is, what is “experimental”, lies only inside the head of the insurer who made the rules. It is a toss-coin no-win enigma to the patient while to the insurance it is an absolute win-win situation – tail I win, head you lose!

Reports indicate that some very ill patients have died while requests for treatment they chose as a matter of right under the law, were opposed and awaiting a resolution through a maze of grievance procedures that when patient-contested and resorted to for relief, the patient doesn’t have even a Chinaman’s chance to win against the insurance.

And here’s the added insult to injury: The insurance money that could have otherwise saved the dying patient goes to the pocket of the greedy after the insured on hold, withered in the vine so to speak, and just passed away. A chunk of this accumulated money is distributed to health service providers in the form of an annual incentives or bonus – like a reward for denying treatment or for recommending cheap medical services to the patient that result in company savings.

One gets traumatized even just to think about this animalist scalping and sponging with absolute contempt, indignation and sickening revulsion.

We often times are confronted with tremendous publicity blitz of the great tasks the industry engaged itself in, supposedly for the good of society. But one must be from another planet to believe that the insurance system has been established by law as an act of compassion for humankind.

There is no charity in the world of insurance business, and there is no humanity and compassion to find anywhere within the confines of this scalping and sponging business.

The accessory Media and insurance profiteers, who whistle blissfully while counting their loot on the way to the bank, are involved in a blatant conspiracy to dupe the public into believing that insurance is a manna from heaven for the poor who needs medical help. Nothing is more twisted farther away from the hideous truth than this cruel deception from Hell that in the final analysis, incinerates the human soul without mercy.

If one has academically traveled into this discipline, he/she will know that social theoreticians are always correct in the book about insurance benefit theories, but terribly wrong in practice. Most of these experts if not part of the hooded scheme or sponging conspiracy are a million miles far removed from reality.

Scrounging politicians and the kind of parasitical politics they play also raise the imponderables of insurance cost that from the patients’ perspective, what they are made to believe are actually not what they are as in the case of the cost of frequently reported misdiagnosis, and overcharging.

We have a sad example why Medicare still remains such a freak legislation up to now. As earlier stated, the industry controls Congress that passed the Medicare law. Politicians owe the likes of Safeway conglomerate campaign fund raisers politicians must repay by protecting corporate interests through legislation, at the expense of dying patients in particular, and the gypped community in general.

Let’s not also talk about legal remedies. Of course these are available to all victimized patients under our laws and justice system. But that is not the point. A managed healthcare should mean that the patient should not have to go to court first before they can get their medical treatment. They already have paid for in advance through payroll deductions, the medical safety net they needed from the time they chose to be insured.

Otherwise, what is the point of having this whole insurance business when it only makes patients feel more sick, embarrasses America, throws mud into the system and soil the image of our free enterprise society?

We win the wealth-generating argument in capitalism. Unquestionably, we in the free world are comparatively rich, but Karl Marx and the Left are winning the moral argument, especially in healthcare capitalism. State control to eradicate greed and to make free healthcare an absolute reward to the laboring class, was to me the center of Karl Marx’s argument in Das Kapital.

Obviously, the enemy in the gate, celebrates the triumph of the spirit, and uses it to destroy this country from within.

And the reason for this is so simple yet so complex to comprehend: That greed in our system is indefensible!. #

© Copyright Edwin A. Sumcad. NWS access July 18, 2008.

The writer is an award-winning journalist. Go to NWS homepage, click on the columnist button to know more about the author or you may e-mail your comment at ed.superx722@yahoo.com.sg

[Read the concluding part of this special editorial report on Healthcare.]

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