By Michael Tyler, EJS Poet in Residence
The most gripping news story seizing headlines, dominating air time and galvanizing the opinion-making fervor of the general public, is the sidewalk execution of UnitedHealthcare CEO Brian Thompson. That such a patently bold and graphic slaying took place on a street at the start of the day, in the nation’s most populous and famous metropolis, in and of itself was newsworthy, internationally. That it was not committed by the ”usual suspect” has become the domestic flashpoint of a disturbing, sociological juxtaposition. The alleged gunman, Luigi Mangione, a young, Ivy League-educated, affluent, White American son of a prominent family is archetypically representative of the standard bearer of privilege in the United States. But in the shockmongering era of social media, he is increasingly being lionized with folkloric heroism, championed as a vigilante surrogate of retribution for millions of people contemptuous of one of the most despised corporate cartels in the country — the health insurance industry.
In the immediate aftermath of the murder, personal narratives have been forthcoming about the financial devastation, life hardships, physical suffering and even deaths people view as the real premiums paid to the industry. Last year, health insurance companies made $25 billion in profit and hospitals took in $90 billion, while costs and denied claims have created a financial reality where medical bills now account for half of all credit card debt. Regardless of region, race or politics such testimonials reveal what is felt to be a systemic disregard as callous and inhumane, as the most notorious street gangs terrorizing communities across the country.
Currently, 69% of the world’s population has universal health care coverage, as a basic human right. The United States stands alone as the only high-income, developed nation — the World Bank classifies 86 nations as such, that does not provide this for its citizens. There are 195 recognized nations in the world. Recently, during the pandemic, the inequities and inequalities that are structurally built into the health care system were once again spotlighted, and once again shown to be disproportionately evidenced as racial and gender disparities.
Typically, the industry’s explanations for these imbalances, and the many other problems related to the cartel’s practices, are the particular peculiarities of culture, the scapegoating pressures of inflation, the lack of uniformity in state regulations, the cost impact of collective bargaining, and the incentivizing tax considerations given to employer-sponsored health insurance. As other factors, industry analysts also cite the tremendous imbalance between administrative costs and care costs, that doctors are paid for procedures and not outcomes, the private equity takeover of hospitals and medical practices, skyrocketing prescription costs and the mystery of health care pricing.
A more forensic examination yields evidence of a darker, more diabolical and despicable reason our nation has yet to provide effective, efficient and equitable universal health care for its citizens. It is a reason, when looking through the broader lens of social remedy, that brings greater focus to the enormously complex, comprehensive and interconnected issue of reparations for African Americans, in this country. Yes, even this Gordian predicament is also knotted by racism.
Frederick L. Hoffman. That is a name most people have never heard of before. But if ever any one individual was more deserving of having the nation point its collective finger of blame for the calculating cruelty that is our health insurance reality, it is this man. First, some needed context.
Following the Civil War, relative to their white counterparts, newly emancipated African Americans suffered extremely high mortality rates. Most were living in temporary campsites that were isolated from White populations. Poor nutrition and squalid living conditions led to the outbreak of many diseases. Smallpox was a particular scourge. It had already been demonstrated, during the Civil War, that quarantines and vaccinations could halt the spread of the disease. But neither the government nor military officials cared to offer any intervention or prevention.
However, the White population still needed the newly freed labor force to continue working its plantations. This created an unnerving concern. An emancipated and healthy population of African Americans could pose a threat to White authority and land ownership. This led to the disingenuous enactment of policies, programs and facilities in response to the health dilemma but they were all intentionally underfunded, understaffed and under equipped, leading to most of them being ineffective and discontinued shortly after they began.
White resentment towards subsidizing health care for African Americans grew and engendered a self-exonerating backlash resentment, which postulated that any assistance to freed slaves would only foster their dependency on White benevolence, and that only hard work (What could be harder than slavery?) would lead to their resiliency and better health. This thinking mutated to the contemptuous conclusion expressed by Samuel Cox, a congressman from Ohio: “No charitable black scheme can wash out the color of the Negro, change his inferior nature or save him from his inevitable fate.” That fate: extinction. This then set forth what became known as “the Negro problem”.
Now, back to Hoffman. At age 26, he was a German immigrant who worked as a statistician for Prudential Life Insurance. In 1896, three decades after the Civil War, he published a seminal work entitled, Race Traits and Tendencies of the American Negro. It was a 330-page article (later became a book) published in the very influential and respected Publications of the American Economic Association. Prudential commissioned the work, in response to several state legislative initiatives being proposed to prohibit discrimination against African Americans, for obtaining life and health insurance.
Hoffman’s work was so widely championed by politicians, academicians and business leaders that it soon became the primer for the entire insurance industry. Under the guise of scientific methodology and edited by his unsympathetic beliefs in white supremacy and eugenics, Hoffman evaluated and compiled data to demonstrate that the American Negro was incredibly prone to disease and thus, “uninsurable”. He postulated that not only were race minorities, Negroes most notably, biologically inferior but they also constituted a hindrance to the future advancement and progress of the nation — a revolting irony given that the enslaved labor of Negroes allowed this nation to progress and advance faster than any other in history. Despite its reception for being hailed as a work of genius, Race Traits was heavily criticized by some in the academic world for using dubious sources, employing flawed mathematics and embedding racial dogma as facts into the actuarial process.
However, Hoffman’s statistical prowess distinguished him in his field, enabling him to have tremendous input and influence over public health, for years to come. He also became the third vice president for Prudential. Hoffman published similarly exhaustive works on malaria, lead poisoning and cancer, the latter of which made him the first to link diet and tobacco to cancer. He helped found both the American Cancer Society and the National Tuberculosis Association, which later became the American Lung Association. Given the indoctrination of racism of the entire nation, Hoffman was lauded for being objective and humane rather than maligned for bigotry, as evidenced by his stigmatizing treatise against the American Negro. But it was Hoffman’s conclusion, and thus the conclusion of many others in academia, government and business that by not insuring Negroes, the Negro problem would eventually, quite literally die out.
Consequently, the health care industry developed to support this end, with a Byzantine practice of profitizing insurance with barriers to access and an ever expanding ability to override the recommendations of physicians for needed care. Given that this could not be so overtly applied to demonstrate a direct and intentional bias against African Americans, such practices became the standards for the entire health care system and the health insurance industry. From causality to consequence, we’ve gone from smallpox to sidewalk execution.
Years ago, in 1998, while discussing the need for reparations with a White American sociologist, I stated that what most White Americans fail to comprehend and connect is that we all have an interconnected reality, and therefore an interconnected destiny. But racism permits White Americans a perspective of primacy, which not only leads to a physical segregation of existence, but also a philosophical one of destiny. Consequently, White perspective only considers our intersections from the value added singularity of its enhancement, which is why slavery was able to exist and why Black exertion, be it for labor or entertainment, is something White appreciation can exist for. The inverse of that, however, is that what White Americans perceive as being only African American problems will, in fact, become national burdens and episodic crises because we are indivisibly linked. I pointed out that no less than the proto-libertarian Ayn Rand once opined, “You can ignore the reality, but you cannot ignore the consequences of ignoring the reality.”
I also shared that it has been said by many, and in many different ways, that African Americans are the conscience of the nation. I offered for his consideration, this passage from essayist, novelist and short-story writer Richrd Wright:
“We black folk, our history and our present being, are a mirror of all the
manifold experiences of America. What we want, what we represent, what
we endure is what America is. If we Black folk perish, America will perish.”
It was at the end of that discussion twenty-six years ago, that I first said to anyone, “When you think of the word reparation, you must begin to hear the words repair the nation.” Until the auditory nerve of our national conscience can be aided to hear that, we will all continue to bear the devastations, hardships, sufferings and deaths of being deaf to our interconnected humanity — and we’ll resign our collective fate to a greater woe, for the health care of the nation.
From the author: I intentionally wrote this piece with the symbolic significance of having precisely 1619 words.