Code Bill: The Health of the Nation


I can’t recall Dr. Walther’s first name; I’m not sure I ever heard it spoken in my presence. Donald, I believe, though I can’t be certain.

But other details about him I remember in surprising detail. He was my pediatrician from the time that I was a toddler until just before I went to high school. He was a youthful looking man, with an open, pleasant smile. I remember the leather grain of the black bag he brought to my house, the smell of unscented soap on his immaculately groomed fingers, the fine dark hair revealed on his forearms when he’d roll his shirt sleeves up before washing his hands in the bathroom, the look of attentiveness as he listened to the stethoscope pressed against my chest, his gently reassuring manner. He was the doctor who saw me through the mumps, measles, and chicken pox; who administered the polio vaccine when it finally appeared during those tense postwar years of epidemic and Cold War fears; he was in attendance in the operating room at St. Clair’s Hospital when I had my tonsils removed, and he was the doctor who came to my hospital room later to give me my post-operative checkup.

While I suspect my father – an engineer and salesman for a die-casting manufacturer – carried some kind of major medical insurance, I imagine he paid for most of Dr. Walther’s good ministrations on a fee-for-service basis, an arrangement as quaint now as the Doctor’s black leather bag and home visits or the wire mesh mask placed over my nose and mouth then smothered with an ether soaked gauze the day I had my tonsillectomy.

There are, of course, still physicians practicing in the mold of Dr. Walther. My current general practitioner is a fine example. A good listener, he manages to mix professionalism with a personable manner even while operating in the assembly line of the HMO era. But as health care in this country has become increasingly corporatized, doctors are more and more treated like employees rather than professionals who have devoted the better part of a decade to complete the training that is a prerequisite just to enter the field.

So pity poor William McGuire, CEO and chair of the very unquaint UnitedHealth Group, the giant private health care company headquartered in Minnetonka. Dr. William McGuire that is, for he is an erstwhile physician turned, by way of a Colorado medical practice he helped transform into one of the country’s first for-profit HMOs, into a corporate executive. Perhaps if he’d continued practicing, rather than merely profiting, from medicine, he might have avoided his current embarrassment. Of course, he’d still have to work on his bedside manner. Less corporate, Bill. More human.

After accumulating nearly $2 billion in total compensation for running UHG – a sum that could cover several warehouses full of black leather bags – McGuire has been forced by a combination of shareholder ire and growing public scrutiny in this time of soaring health care costs to push himself away, however reluctantly, however incrementally, from the corporate trough where he and his fellow UHG board members and directors have fed themselves so lavishly at a time when almost 50 million Americans – about 25 percent of them children – cannot even afford health insurance.

Not only has McGuire’s unseemly avarice been entitled “obscene” by a shareholder at the company’s most recent annual meeting, but the investment boards of a number of states – including UHG’s host state, Minnesota – have decided not to invest pension and other public monies into the company because its executive compensation policy has been deemed excessive. It would appear that questions are also being raised about the propriety – even the legality – of UHG’s practice of backdating the issuance of stock options bestowed on McGuire and others to times when the company’s stocks were trading low, the better to plump up the profits McGuire can realize when he decides to sell high. All this unusual degree of transparency and accountability – unusual at least in the world of Corporate America during the reign of King George – has forced UnitedHealth’s board to undergo the humiliating ritual of renouncing future stock option and other sweetheart perks they’ve been dealing themselves lo, this past decade or so, such as (and this is my fave) reimbursing Bill and other UHG poobahs for expenses incurred for their private use of company jets.

And so on.

Now in all fairness, it has been argued that McGuire’s compensation has been just a just award for the sterling performance of UHG’s stock, which has realized a 70 fold increase in the price of individual shares since McGuire came on board in 1991.

Yes, indeed, UHG has performed well. But given that health care costs in the past five years alone have risen more than 70 percent without an appreciable rise in productivity or service, it’s difficult to see how any company in the field could fail to perform well. That kind of gratuitous price hike is, in fact, typical of industries dominated by monopolies, or near-monopolies. Dr. McGuire may be some of kind business genius but frankly, it would take someone possessed of another kind of genius – the sort of reverse Midas touch possessed by our MBA Commander-in-Chief – for UHG to have not turned in booming performances on the equity exchange during the time he’s been at the helm.

Meanwhile, though UHG’s fortunes have prospered, the same cannot be said for the nation’s health. Not only are nearly 50 million Americans trying to get along without health insurance, but a high percentage of personal bankruptcies are driven by the financial ruin caused by sky-high medical expenses.

To make matters even worse, all that money and angst aren’t even yielding as much as you might expect. A brand new study of the comparative health of white (insured) Americans and white members of the British population has discovered that, across the board, Americans suffer much higher rates of cancer, heart disease, stroke, hypertension, and diabetes than do their British counterparts, even though the English have a greater propensity to smoke and drink to excess and still labor under what we’ve been told is an inefficient, state-run healthcare system – “socialized medicine,” as I’m sure the boys at UHG might call it. How to explain this striking discovery is not yet known, though perhaps stress caused by the rising cost of everything in America, especially health insurance, might play a role.

In trying to peer into the soul of privateers like McGuire (and does it come as any surprise that he and his posse of fellow board members have all been big financial backers of Dubya, who came to power promising to run the White House like a corporation, apparently meaning that he intended to turn the country over to corporate interests?) I find a scene in Key Largo probably offers the best insight. One of characters trapped in the movie’s hurricane-lashed hotel turns to the gangster played by Edward G. Robinson and asks, “What do you want?” When a stammering Robinson fails to come up with an answer, Humphrey Bogart provides one. “I know what he wants,” Bogie says contemptuously. “More.”

“More” has also been the driving, though unacknowledged, force behind the massive transfer of wealth from the bottom 99 percent of our society to the top 1 percent that is the true legacy of the so-called Reagan Revolution. Since Dutch came to power and genially declared war on the New Deal, welfare “queens,” and all those other mortal impediments to American ingenuity and know-how, the top 1 percent of Americans have gone from owning about 40 percent of the total wealth of the country to owning more than 70 percent.

This upward transfer of wealth – the greatest ever to have occurred peacefully in the history of the world, which is to say not as the result of foreign conquest – is no unforeseen consequence, but the actual goal of the Reagan Revolution, the Contract with America and, now the Bush agenda. By whatever name – deregulation, privatization, etc. – the policies pursued by the American government since the 1980s (and here, I do not exclude the Clinton Administration) have constituted at heart a Tory project aimed at a wholesale reordering of American society to make it less eqalitarian, more like a Third World economy. The rise and, I predict, pending fall of Bill McGuire—indeed the whole health care crisis in which we find ourselves – can not be understand unless placed within the context of this larger transfer of wealth.

The days of Dr. Walther are long gone, never to return. But that does not mean we can’t restore some measure of sanity into our collective lives. The spectacle of soulless plutocrats like Dr. Bill McGuire may be precisely the sort of bitter medicine we need to help us recover our senses enough not merely to find the moral umbrage and political will to fashion a program offering universal healhcare but also to put a halt to the shameless – and very unhealthy – corporate takeover of America.