American Healthcare: American Genocide

November, 2009


"But he isn't wearing anything."
From The Emperor's New Clothes by Hans Christian Andersen

"Perception is reality. It doesn't matter what the facts are. We don't have time for the facts. We're going to do it the way people think it's best to do it."

My boss wasn't kidding. I had just presented him the research I had prepared that proved a plan he wanted me to implement would cost the department more not save funds as he had previously announced to his faculty. He was up for faculty review. The "plan" was popular among the faculty. If he implemented it, he would be viewed as responsive to their ideas. Educating them would be time-consuming, confusing, and might be misunderstood. I complied with his directive, of course, because, I, too, wanted to keep my job. The facts bore out. The plan cost more money, but rather than concede the plan was the problem, we invented another excuse for the outcome and then spent even more funds addressing the "problem" we had invented.

The term "genocide" did not exist before 1944. It is a very specific term, coined by the U.N. and refers to violent crimes committed against groups with the intent to destroy the existence of the group. Human rights, as laid out in the U.S. Bill of Rights or the 1948 United Nations Universal Declaration of Human Rights, concern the rights of individuals.

On December 9, 1948, in the shadow of the Holocaust, the United Nations approved the Convention on the Prevention and Punishment of the Crime of Genocide. This convention establishes "genocide” as an international crime, which signatory nations “undertake to prevent and punish.” It defines genocide as:

“Genocide means any of the following acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group, as such:’
“(a) Killing members of the group;
“(b) Causing serious bodily or mental harm to members of the group;’
“(c) Deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part;’
“(d) Imposing measures intended to prevent births within the group;’
“(e) Forcibly transferring children of the group to another group.”

It is important to note in this definition (see letter "c") that negligence that leads to loss of life qualifies as genocide, as well as direct slaughter.

There is a related term of relevance, namely "Crime against Humanity." A Crime against Humanity consists of certain acts when committed as part of a widespread or systematic attack directed against any civilian population, in pursuit of a state or organizational objective.

Still, there is often scholarly quibbling about whether it is one or the other when massive death in a specific population is driven more by political expediency than by hatred of the group. The number of deaths to qualify as genocide is also a quibble, but generally a million deaths hit the mark. Deaths due to lack of access to healthcare will reach that mark, if we start counting them this year, by about 2015.

Some historians maintain it is still genocide if a group is targeted out of political ambition rather than a constructed hatred of the group or a comprehensive intent to eliminate all members of the targeted group. E.g. the actions of Joseph Stalin leading to the deaths of about seven million Ukrainians is considered genocide by some scholars and not by others. In 1932-33 the former leader of the Soviet Union caused a famine in the Ukraine because the people there were seeking independence.

The difference of opinion also persists when considering the slower elimination of about fifty million Native Americans following the European invasion of North America in the fifteenth century, since the objective wasn't necessarily to kill all native people but to occupy and appropriate their land.
Even more controversial has been the claim the U.S. response to AIDS/HIV in the 1980s was genocide. Proponents of defining it as genocide point to the fact that more than 20,000 gay men had died before there was any state response to the epidemic and that a response only was triggered when a significant number of members of the dominant culture (heterosexual people) were infected by the virus. In fact, religious leaders like Jerry Falwell fiercely resisted any response to the epidemic calling it "God's way of weeding his garden." And, while Falwell's comment seems more outrageous today, at that time it was considered a simple difference of opinion to which Falwell was entitled.

The change in how remarks like this are viewed is relevant toward how genocide is defined. That is, massive loss of life among a targeted group is more apt to be deemed genocide years, if not centuries, after the incident even though it was not at the time.

In any case, the primary prerequisite test to qualify as genocide must include evidence that "dehumanization" of the targeted group has taken place. To begin the claim of genocide it must be established there have methodical and intentional schemes to cast members of the targeted group as less human or less worthy of survival than members of the dominant culture.

A case can be made—and likely will be made at some point in the future—that the contemporary practice of healthcare in the United States, if allowed to persist unstopped, is genocide. As many as 100,000 people die annually because they cannot afford healthcare. About half die because they do not have health insurance, and the other half die because their health insurance provider will not pay for the care they need to survive. The apartheid of healthcare access in America is glaringly obvious. The healthcare one receives in the U.S. depends on the healthcare one can afford. The wealthy have no fear whatsoever that they will receive the best health available. The targeted group includes those who cannot afford the healthcare they need to survive. Comprised primarily of the working poor, the size of the targeted group is increasingly exponentially and proportionately to the greed and political ambition of those who benefit from health insurance company profits.

These deaths are not caused by a lack of fiscal or natural resources. Everyone in the nation could have access to healthcare for less cost to taxpayers if corporate profit was eliminated from the equation, and few knowledgeable people deny this. These deaths persist because corporations wield more national power than those whose lives are lost.

None of the incarnations of legislation seriously considered by the 111th Congress ever intended to stop a significant portion, let alone all, of these deaths, even though it was entirely within the scope and resources of Congress to do so. Indeed those lives that will still be sacrificed to the god of profiteering were never acknowledged nor mourned nor even given a moment of silence when Nancy Pelosi cheered at the passage HR3962 even though she knew this legislation would effectively still allow many to die.

Even though legislation had been introduced and reintroduced since 2003 (HR676) that would have covered everyone by eliminating insurance profiteering, this legislation was not only not taken up, it was blocked from even mere discussion by the Speaker of the House and the White House at every turn. Even the president said at one point, regarding healthcare reform summits, "Everything is on the table. Well, everything but HR676."

"Why was HR676 blacked out?" This is a salient question and adds evidence that allowing thousands to die was an intentional act by the State. Undoubtedly the motivation by the State and the Health Insurance Industry which essentially owns and controls the State, was to avoid what they knew would be a public outcry for HR676 if the public learned the bill's merits.
Merely asking this question, however, not only pricked the ire of the State, a.k.a, the corporate control to which it yielded, but also vexed those whom one might assume would have been natural allies.

Healthcare forums sponsored by "progressive" Democrats didn’t merely exclude HR676 from their line-up. Across the country, they banned and even had arrested activists who tried to expose the cover-up.

"We're all for HR676," progressive Democrats sometimes claimed, "but there's not the political will to pass it now."

When pressed, some, like Iowa State Senator Jack Hatch, admitted at an Iowa healthcare forum last March (at which the keynote speaker was Blue Cross Blue Shield representative and Republican former Iowa Governor Robert Ray) that "political will" was not lack of public support, which by most polls was overwhelming for such a bill. "Political will" was the lack of support of healthcare corporations who bankrolled too many Democratic election bids .

Or, as U.S. Senator Tom Harkin (D-Iowa) said at an AARP healthcare forum in late summer, "Just because most Americans want something doesn't mean Congress will do it."

Partisan loyalty took precedence over human life. And many political progressive groups whose prestige and/or paychecks required party loyalty capitulated. Groups like Move-On.Org, Health Care for America Now (HCAN) and HCAN's Iowa affiliate Iowa Citizen Action Network (ICAN) advocated any legislation that Nancy Pelosi said to support.

For example despite the fact that ICAN had distributed petitions since March for a "Public Option" that would give Americans the ability to drop their private insurance if they so chose, their party loyalty did not waver when they issued invitations to two events with the purpose of thanking U.S. Congressman Leonard Boswell for voting for HR 3962. They did this even though HR 3962 didn't merely fall short but was completely contrary to what they had promised the thousands who signed their petitions that legislation they supported would include.

HR 3962, in fact, rendered Americans with not more, but less choice, than they'd had before. Rather than being able to drop expensive private health insurance for a "public option," Americans would now be required by law to keep paying those premiums. Further, those who had opted to stay uninsured rather than pay high private insurance premiums would now be forced by law to buy private insurance whether they wanted to or not. "Affordability" would no longer be determined by the budgetary needs of families but by the State with the determination heavily administered by private health insurance companies. Additionally, rather than helping "all," the bill's authors admitted HR 3962 would still leave twenty million people without access to healthcare, an estimate it is reasonable to believe will be far less than reality. (The Senate bill is even worse and will not—because it cannot—improve this.)

When this betrayal was pointed out, ICAN conceded in an email that, "While we may wish that the house bill provided even more relief, it currently includes provisions that will make real improvements in the lives of Americans that may compare with the passage of Medicare and Social Security."

How the word "may" was intended in this statement is hard to know. Suffice it to say that ICAN did not, because it could not, specify what these "real improvements" were. Certainly the faulty analogy made between HR 3962 and the Medicare and Social Security quickly falls apart under even superficial scrutiny, if for no other reason than that neither of the latter two acts required Americans to enroll in either program, let alone forced them to be consumers of any private industry. What was clearer in this statement was the implication that to "wish" for something more, i.e. to save those lives that would be lost under this legislation, was idealist and even frivolous, like wanting more frosting on an already delicious cake.

When all else failed, Democrats pulled out their most tired clichés and canards. Phrases like "politics is the art of compromise" and "crafting legislation is like watching sausage made" were regurgitated ad nauseum as if they had justifiable meaning. "Incremental change" morphed into an ethic that was held higher than committing what could be morally if not legally described as the negligent homicide of thousands. The problem is that genocide and crimes against humanity can't be stopped with incremental change. How do we decide who still dies?

Perhaps the most cynical scam pulled on the American public was that there ever was a real struggle for the passage of HR3962. The evidence for this was apparent from the beginning when Senators Max Baucus (D-Montana) and Chuck Grassley (R-Iowa) were named chairs of the Finance Committee forums on healthcare reform. Both are among the top-three Senate recipients of campaign contributions from health insurance companies. The obvious conflict of interest in this was not particularly challenged by many "progressives" who remained inclined to give the new administration "a chance." Consequently the bulk of the legislation crafted in the House and the Senate was written by health insurance industry staff, making sure every provision ultimately included a strong financial benefit for the companies they represented. The predestined and accomplished goal was anything that happened was to be a windfall for the insurance companies.

Meanwhile a faux public battle was waged with a handful of "tea-baggers" (the instigating ones likely hired by private insurance) and given ridiculously overblown coverage by national news media that was undoubtedly capitulating to the millions it received from the health insurance industry in advertising revenues. (Not coincidentally, the hundreds to thousands who demonstrated and rallied for HR676—including the more than 200 who were arrested at these actions—were never given a moment of air-time by national media.) Concurrently, Organizing for America (OFA), Obama's grass roots group, staged events to "stand up to big insurance" by supporting the Obama Plan, while behind the scenes the White House was arm-twisting reluctant legislators to give-in to health insurance company demands. What was portrayed as a "win-lose" struggle for the American People was never more than a win-win game for private insurance, with insurance company executives chortling all the way to the bank, knowing they would make out like the bandits they are either way. In the end House Representatives mostly voted according to their roles in this theatrical performance. It should not be considered a coincidence that the outcome that most financially benefitted private insurance was the one that won.

Another pocket of resistance to exposing all of this came from anarchists and even a few Catholic Workers who worried, among other worries, that HR 676 gave too much power to the State. Even though HR 676 significantly diminished State power over access to healthcare (in that the only State involvement was to appropriate funds to pay medical bills) compared to the current practice and that both had far less State intrusion than the legislation the 111th Congress advanced, they balked at being perceived to support any legislation offered by the State. The suggestion that U.S. healthcare practices were inextricably tied to war (because war funding and healthcare corporations are themselves inextricable) was met with particular skepticism, as if how people were killed and where they were killed for corporate profit made them any less dead. These concerns remain inchoate and beg further discussion and questions. How can one call for Congress to use war spending for healthcare and resist legislation that does that? Can anarchists sometimes step aside from fundamentalist ideology when a State act saves life and liberty—such as the Emancipation Proclamation, the Martin Luther King-driven Civil Rights Act, or the enfranchisement of women?

Still, the influence of Catholic Workers was ubiquitous in the resistance to Congressional lies regarding healthcare reform. Nearly every organized action included a current or former Catholic Worker. The first resistance action before a health insurance company was organized by the Des Moines Catholic Worker community and led to the arrest of nine at Wellmark Blue Cross Blue Shield in Des Moines. Hundreds followed their lead and 183 were arrested at sit-ins at other insurance companies throughout the nation. Those arrested included Sam Pullen, a member of the Center for the Working Poor Catholic Worker community in Los Angeles. Sam's witness included refusing bail, remaining in jail, and a hunger strike to draw attention to those who suffer and die because they are denied healthcare.

Their efforts were not completely in vain and pushed two amendments toward consideration that would have at least ameliorated the viciousness of HR 3962. One, an amendment put forward by Anthony Weiner of New York replaced the entire bill with a single-payer provision. While certainly doomed to fail, the amendment would have at least identified with some surety which House Representatives really did support HR 676 and which did not. This "is you is or is you ain't my baby" hope was stripped by none other than President Obama himself, who personally strong-armed Weiner into dropping the amendment late on the night before the vote.


Capitalism is most insidiously evil when it commodifies and restricts access to resources human beings need in order to survive. Accomplishing this first requires diminishing and dehumanizing those who will not or cannot comply. Human beings are reduced to their value as consumers, financial contributors or investors. Human beings that cannot provide capital gain—the poor and unemployed or under-employed or those who decline to be cannon fodder in wars for profit—are not worth saving. They are in fact a barrier to profit growth, and so, the dominant culture or the culture that dominates, (the wealthy, corporate owners and shareholders) inflict conditions that allow them to die. Rather than shown compassion, the dead and suffering are blamed for conditions over which they have no power and are shamed as irresponsible, lazy, or unpatriotic.
Perception is not reality. Reality is reality. Pretending something is other than it is doesn’t position us to change what it is. Still when the word “genocide” is used in connection with healthcare, some take umbrage, as if somehow suggesting an atrocity in these intentional deaths somehow diminishes lives lost in other atrocities.

It may be this umbrage that is the best evidence for such consideration. It is the lack of intense populist outrage that proves our collective acceptance of the dehumanization of those who will die. The seamless accomplishment of this by itself stands as justification for investigating healthcare practice in the U.S. as pending genocide. History has certainly and repeatedly shown powers and populace choosing to ignore or minimize infamous acts of genocide at their nascence. And history, has shamed us later when we knew the massive body count could have been much less if we’d not called early critics “reactionary” or “extremist.” It only gets serious when it’s our child, parent, spouse, or friend.

This column is a prologue begging for such consideration. Perhaps this time we can interrupt the mounting body count before such an ascription is undeniable. The longer we delay this rather than demand an end to our ghoulish national practice in healthcare, an ever-increasing share of us will be added to the targeted group of disposable humanity.

The Empire does not need a wardrobe adjustment. The Empire is naked and naked with the shame of this inhumanity to man. Those of us who care must, at the very least, call it what it is.