This week the New York Times ran an article titled "Sparse Competition and Higher Premiums." If ever five words could sum up every broken aspect of American health care, those do it perfectly.

This week the New York Times ran an article titled "Sparse Competition and Higher Premiums." If ever five words could sum up every broken aspect of American health care, those do it perfectly.

The Times report on health insurance available through exchanges under the Affordable Care Act concludes: "While competition is intense in many populous regions, rural areas and small towns have far fewer carriers offering plans in the law’s online exchanges. Those places, many of them poor, are being asked to choose from some of the highest-priced plans in the 34 states where the federal government is running the health insurance marketplaces."

This deplorable detail highlights so many injustices, space permits delineation of just a few. First, there’s the persistent disparity between rich and poor. There is no health care crisis for the rich, save for the part where their premiums subsidize the care of people the health insurance industry has exiled — such a hardship that must be for the one percent.

Then there’s the equally persistent disparity between rural and urban insurance options. This too, is little more than Malthusian. It’s not as if most Americans’ insurance claims are actually serviced by an office anywhere near where they live.

The paucity of options for America’s rural population is, in a word, immoral. This immorality is the same kind of inequitable and usurious arrangement whereby sharecroppers and coal miners had to buy all their supplies from the company store. When you’re the only game in town you not only can set the rules, you can determine which pawns live and which pawns die. Nobody really cares about the pawns. There’ll always be plenty of them.

The Times goes on to present the most disquieting and vulgar disparity of all: Price. According to their research, a 50-year-old shopping for a mid-grade "silver" plan would pay at least $644 before federal subsidies if they lived in rural, Baker County, Ga., where there’s only one insurer.

By contrast, a 50-year-old in Atlanta, where there are four carriers, could pay just $320 for a comparable plan.

While it’s hard to put a price on a human life, the health insurance industry seems to have found a very efficient way. This then begs the question as to why this situation has happened. Here again, it’s pretty simple: The insurance industry, HMOs, hospitals, pharmaceutical companies and other industry actors have bankrolled a series of congressional cohorts into the worst kind of political prostitution. They are whores who think themselves princes.

In short, these corporate empires purchased the government they wanted, and we let them. More to the point, we paid them to do it. Just like the land owners and the mining companies before them, they found a way to make good people work, sweat, bleed and die in a system whose primary reward is stronger chains.

As the sharecropping and mining metaphor suggests, the final nefarious dimension of this situation is regional bias, and by extension, race.

The South is the biggest loser in this rigged game. It’s a region of hardworking, blue-collar people who are sadly used to being given the national scraps. As the Times reports, almost all the counties in Mississippi and Alabama are serviced by only one "provider."

Pundits and apologists will spin all of this in their obligatory shell game. It will somehow be explained as being "necessary." The only thing that’s "necessary" about this situation is to enact extremely strict price controls and mandate low, equalized premiums.

If the Affordable Care Act has one great flaw, it’s that it didn’t end health care as an instrument of profit.


Matthew Pate is a former law enforcement executive who holds a doctorate in criminal justice from the University of Albany and who has advised police agencies around the country. He writes from Pine Bluff, Ark. Contact him at