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Octavio Paz: Entre irse y quedarse/Between Going and Staying

Este poema de Octavio Paz, para mí, recuerda bien la naturaleza efímera y contradictoria  de la vida.   Es importante en estes días de Terri Schiavo.  The English translation follows.

Entre irse y quedarse

Entre irse y quedarse dude el día,
enamorado de su transparencia.

La tarde circular es ya bahía:
en su quieto vaivén se mece el munco.

Todo es visible y todo es elusivo,
todo está cerca y todo es intocable.

Los papeles, el libro, el vaso, el lápiz
reposan a la sombra de sus nombres

Latir del tiempo que en mi sien repite
la misma terca sílaba de sangre.

La luz hace del muro indiferente
un espectral teatro de reflejos.

En el centro de un ojo me descubro;
no me mira, me miro en su mirada.

Se disipa el instante.  Sin moverme,
yo me quedo y me voy: soy una pausa.

Between Going and Staying (Translated by Eliot Weinberger)

Between going and staying the day wavers,
in love with its own transparency.
The circular afternoon is now a bay
where the world in stillness rocks.

All is visible and all elusive,
all is near and can't be touched.

Paper, book, pencil, glass,
rest in the shade of their names.

Time throbbing in my temples repeats
the same unchanging syllable of blood.

The light turns the indifferent wall
into a ghostly theater of reflections.

I find myself in the middle of an eye,
watching myself in its blank stare.

The moment scatters.  Motionless,
I stay and go:  I am a pause.

Calling a Spade a Spade: A privatization advocate cuts the crap

Here is a summary of Peter Samuel's answers to the question of why private investors would do a better job with New York's bridges and tunnels that the City of New York would do. Samuel and Robert W. Poole of The Reason Public Policy Institute  had advocated privatization in an article in the NY Sun provoking questions from Rep. Jerrold Nadler, Dem NY. 

1. Samuel and Poole advocate selling the equity -- that is, the State should just sell the bridges and tunnels outright -- cash in.  Bonds, Samuel says, only get a fixed rate of return whereas equity just gives you straight profit.  AND you can sell it at a higher price than you got it for.  Just think of the equity in the Brooklyn Bridge!

2.  If you sell something outright, you aren't responsible for it any more.  If you sell bonds, then you have an obligation to service the debt.  This seems like apples and oranges.  You may have to service the debt, but you still own the bridge.  Compare this to home equity loans.  You could just sell your house outright instead of getting a loan, but then you wouldn't have your house!

3. Privatization of toll roads, bridges, tunnels and the like "is attractive to investors because it gives them the opportunity to benefit by managing the business to reduce costs and to enhance revenues, constrained only be the terms of the privatization contract.  They can hire their own employees, organize the way they see fit, maintain and operate differently.  The more freedom of operation the privatization contract gives them, the higher the bids you'll get."

Samuel wants to be clear about this.  He says,

Unfortunately some of the essential issues are clouded by the popular semantics of 'public private partnerships.'  This oozy-koozie fell-good term is used in such all-encompassing fashion it has little clear meaning.  But the PPP term is fashionable, apparently becauseit is seen as more politically palatable than 'privatization' and 'sale'.  Privatization is the clearest term.

Samuel discusses the Chicago Skyway where private interests lease the facility but have privatized the business of tolls.  Samuel sees no reason why facilities shouldn't be owned outright.  Just more efficient all around.  How about the John Hancock George Washington Bridge?

6. A transfer to private hands means you can bust the unions.  For instance, the private operators of the Chicago Skyway pay toll booth operators $12.00/hour vs. $20.00/ when the city had to pay union wages. This is the difference between a comfortable salary, though one that wouldn't allow a family a lot of extras salary -- and who would say people who have to spend their days, or maybe their nights, standing in toll booths don't deserve a comfortable salary -- vs. a very uncomfortable salary, one that a parent would be very hard-pressed to raise a family on in Chicago.

Among the core assumptions of Mr. Samuel and his cohorts:

1. The main, overriding reason to do anything is to make a profit.
2. Private businesses are always more efficient than any other organization
3. Especially when you mean by efficiency cutting costs as close to the bone as you possibly can to make as much profit as possible.
4. Profits and competition are the main drives/purposes of human life.

My questions:
1.  Where in the Bible does it say that we have to look for profits first, then consider whether the service being sold matters?
2. Where is the evidence that the thing provided is better because of an unfettered profit chase?
3. Under what circumstances is profit-seeking not efficient?
4. Which leads to...what do we mean by efficient? 
5. Where's the evidence that the free market is the best mechanism for providing everything?

If we start with a more basic problem-solving approach, it's easy to see that there are a number of ways to effectively handle various needs, often including but not confined to a free market approach.

If we assume that humans are more than simply "rational economic units" we can see that they have lots of needs besides for profit, lots of ways to express themselves, to meet needs, to innovate even when there is no big bang in bucks, lots of organizations that individually and in combination succeed in meeting needs.

We might also realize that the market depends now on creating a feeling of need where no need exists and that markets participate in exhausting us and our resources in an endless hunt for stuff we don't need and which are very inefficient in meeting actual needs and in caring for our world.

For instance

Bush and Friends, The Trans-Texas Corridor, The Texas Rangers, Fascism, Corporatism and all that

The Rant:
There is no unified Right Wing: The robber-barons are ruling the roost.  They've created an army of  business leaders, think tanks, politicians, government workers, academics, religious leaders and general zealots to do their dirty work.  These people -- leaders and followers -- hold some or all of the following dangerous beliefs: that free enterprise is holy; that the true core American values are that competition and private ownership of everything one can own is sacrosanct;  that what motivates people are profits and nothing comes close to profits as a motivational tool; that cost-cutting in the name of profits is a holy activity; that God is on their side; that wealth proves one's righteousness; that their success proves the worth of democracy and proves US democracy is just fine the way it is; that the United States is chosen specially by God; that Rapture is coming and they've got to get all Jews to Israel and while they're doing it, they can do whatever we want as saved Christians since they ARE saved since they've proclaimed Jesus their personal savior; having so declared, there's nothing they can do that is really going to get them in trouble with Jesus when he comes; that poor and suffering people have only themselves to blame; that therefore it's fine to perpetuate their problems; that the government should never interfere in the market if it's not in their interest for it to do but should when it is.

They imagine their own wealth or their own imagined salvation or both prove the truth of these beliefs. The beliefs gild tawdry unexamined motives: greed and power lust.  Humble as it may sound, being one of the guys may also be a motive.  These people socialize with each other all over the place.  And fear, too, may haunt some of them: fear of meaningless, emptiness, loss of prestige, who knows?  Maybe even fear of prison.  Maybe fear of damnation.

This army is organized from the top.  When the organization starts to slip, the army will start falling apart: anti-gay Christians will start noticing that there are gays in the Bush Administration.  Libertarians will see that their private enterprise friends have turned into the state and are actually intruding on their lives.  Small businesses will realize they have no power -- if they haven't already -- and that there is no such thing as competition: there are only alliances and payback schemes and cutthroat tactics. Superpatriots will realize that many of  the most powerful business interests are international and don't give a shit about whether the U.S. as a nation survives as long as they do.  Free enterprise folks will realize there's no such thing anymore.

How can we push them along the road to disintegration?  With the facts, among other things, and with some big efforts to draw them together and to present them and to yell about them and show how the facts betray the values and needs of the little people that the Republican Party so assiduously courts.

Here in Texas, we ourselves footsoldiers starting down the road of state and national fascism.

Fascist is a strong word to throw around and maybe not quite right.  Maybe corportist would be better.  But let's look at fascism for a minute.  According to the Columbia Encyclopedia, 2001 Edition,

Fascism, especially in its early stages, is obliged to be antitheoretical and frankly opportunistic in order to appeal to many diverse groups.  Nevertheless, a few key concepts are basic to it.  First and most important is the glorification of the state and the total subordination of the individual to it.

"Aha!" you say, but this is not just the United States of America, this is TEXAS we're talking about:  Texas, the heart of the home of individualism!  But just look around you...at the Ford trucks and the W stickers and the giant, glittering churches and the carefully cultivated drawls and the cowboy boots in the suburban Wal-Mart..  We wear the talismen of individualism to prove our membership in the state of mind of Texas.  The Encyclopedia continues:

A second ruling concept of fascism is embodied in the theory of social Darwinism.  The doctrine of survival of the fittest and necessity of struggle for life is applied by fascists to the the life of a nation state.  Peaceful, complacent nations are seen as doomed to fall before more dynamic nes, making struggle and aggressive militarism a leading characteristic of the fascists state.  Imperialism is a logical outcome of this dogma.

Now Texas is not an imperial power, but the drive to trample over decision-making processes and to insist on the rightness of things like true discussions of gigantic plans like the Trans Texas Corridor are justified by a belief in a very aggressive use of fear of "falling behind."  And you'll note it's in gigantic private-public profit.making projects that all this glitz is applied.  It's not applied to the needs of the people who actually live in the state, like children.  The Encyclopedia continues,

[Fascism's] essentially vague and emotional natue facilitates the development of unique national varieties whose leaders often deny indignantly that they are fascists at all. (All quotes from The Columbia Encyclopedia, Sixth Edition, 2001.

Texas state government is at this point in the hands of one party which is in control and partner to enormous business interests.  It's not just the corrupt good-old-boy network with dirty hands of a decade or so ago. Today, although lipservice is given to public participation, mechanisms for effective discussion are practically nonexistent. Texas practices are linked to national practices: they are the cutting edge, if you will (though obviously not because our leaders are progressive), the vanguard. 

A look at the development of the Trans Texas Corridor will prove this.  Before we hit the really big time, however, we will find the development of the Camino Colombia Toll Road outside of Laredo instructive.

A Final Article on Terri Schiavo

Below is a link to a lovely article written by Johann Christian Arnold of the Bruderhof Communities and The Daily Dig.  He is I would say a Christian of a conservative sort, but even for those of us who are not quite so inclined, his extraordinarily loving nature and insight are of great comfort and a lesson in the fact that Love is in the heart and can be shaped in many forms and can reach out beyond the confines of this or that particular structure of belief if only we can receive it. 

I wish Terri Shiavo's family -- both sides of it -- would read this article.

http://www.bruderhof.com/articles/jca/terri-schiavo.htm

Bush and Schiavo and my experience

You don't neeed your cerebral cortex to run your organs, but you need your cerebral cortex to be yourself -- to be a person.  I don't know how God deals with our soul, our alma, but for all practical purposes, our personhood, the part of us that lives in the material world, springs from our cerebral cortex.  When that is gone, we don't function as people anymore.  We can function as bundles of reflexes and respond as plants or primitive animals respond.  We are not there anymore.  I often fear that when  people are caught in such a state, their souls are stuck in a netherworld.  In Terri Schiavo's case, it is also important to remember that this is not a life that can continue on its own.  When a person can never again on her own ingest and digest food, that person is dependent on extraordinary measures.  The chronic use of such measures is sustaining a life that is pretty much over.

I have experience with vegetative states, two kinds.  I worked over a period of years with very severely retarded people -- people who had little or no cerebral functioning.  I saw them respond to heat, light, and more notably, to pain.  At that time, I was responsible for seeing that programs for such people were responsibly administered.  It was very depressing.  Various federal guidelines insisted that these people be "habilitated."  I never saw a more frustrated bunch of techs...spending weeks trying to achieve a teaching objective of tracking something for a few inches with their eyes, for instance, generally with no success.  These all were people we would not think of putting to death because they were not on life support of any sort.  They could swallow, though they couldn't do much of anything else: their limbs had to be moved for them, they had to have specially molded seats to keep them from discomfort while they were kept upright to look more "normal" during the day.  We were  most aware of them feeling, yes, pain, though they would also smile from time to time or open their eyes or appear to see you.  It often took years and sometimes it never happened that families could come to accept the situation of their children, children who grew from infancy in close to but not quite a vegetative state.  The people working with them came to know that there was no person inside.  They were gentle with these creatures, but out of hearing of the families would call them  slabs and plants.  They weren't speaking cruelly, only using a bit of black humor to keep their own wits about them.

Another experience was with my mother.  She had a massive stroke and was left in a persistent vegetative state for almost four years.  My father, a physician, had terribly conflicted feelings about the situation.  My mother had recently complained about severe and unusual headaches, but my father brushed them off.  Finally she was admitted to the hospital.  Nothing was found wrong, but before she was discharged, she had this stroke and was alive but was no more.  My father insisted on a ventilator.

Over almost fifty years of marriage, my parents had woven a particularly complicated marriage with threads of hate as strong as those of love which were also there.  They were both prickly, arrogant people who were especially unlikely to accept criticism.  Over the years, my father had fallen into being the first line of comments about my mother's medical complaints.  He was often not very sympathetic, though by this time they were both in their seventies and her complaints, especially since she continued to smoke heavily, were increasingly real.  My father himself had had a stroke at sixty, though he had recovered.  But he was the one with the history of high blood pressure, a history of high cholesterol.  She was supposed to live longer than he.

So when she had her stroke, his world came crashing down around him.  He blamed himself completely for not having listened to her complaints, for not having pushed testing further.  He took it upon himself to care for her as he never had cared for her in life.  He wove a warm-colored tapestry of a happy marriage and devoted husband.  He spent his days with her, reading to her, brushing her hair, putting perfume on her.  Nothing went untreated.  He insisted she was there and no one else could understand.

But I saw her and she wasn't there.  She lay on her back, her face looking much younger, smoothed of its wrinkles.  Sometimes she smiled, but not at my father though he thought it was at him.  You could get her to grip your finger the way an infant does.  She would make noises, gurgles and giggles it would seem.  My father would say, see, see, she's responding!  But to what?  With a huge stretch of the imagination I could only believe it was to some whisp of an internal image. 

Finally, my father could not visit her every day.  He had his own growing problems and could no longer keep a hawklike eye on her.  One day at work, her doctor called me.  She said, "I am sorry to have to tell you your mother has died."  The first words out of my mouth, even before the thought of them, were "Thank God."  The doctor's first words were, "I wish I'd known you felt this way." 

The cost of my father's efforts was not simply to the insurance companies but to the network of our family and friends.  People, including me, generally had mixed feelings about my mother: she was not exactly warm and snuggly.  But she was smart and witty and loved art and politics and took part in the community:  she was full of life, as they say.  She was definitely very autonomous and couldn't have stood people poking around her body and giving her no control.  If she was conscious.  IF she was not there, her conscious self would have railed against the expense and would have chosen to use the money for something like the local public library -- what that money could have done!  Or for art scholarships or for any number of celebrations of life.

For the Republicans and George W. to be advocating for Terri's parents is the ultimate in cynicism.  They are playing into the Schiavos' pain, not helping them let go of it. Medical authorities cannot say with 100% certainty that Terri the person is no longer there, but they can probably say with as much certainty as experts could say that it was O.J. Simpson's DNA  at his wife's murder site.  If Terri is not there anymore, to sustain her at great expense is to keep her parents trapped in a  destructive fantasy instead of letting them get on with their lives.  If she is there, which is extraordinarily unlikely, can she be content?

Respecting Autonomy: Would Terri Schiavo want to live?

This Terri Schiavo brouhaha -- absolute insanity.  Politicians cackling like a bunch of crazy chickens.   The press screeching like a Monty Python choir.  Congressmen slip-sliding around in the grease of their own unctiousness. Saturday Night Live couldn't do it better.  But it is a sad story.  It should be a private story.

The Terri Schiavo affair is, in the end, a troubled family's storm, the endless crashing thunder of a deeply troubled family.  The parents, blinded, are incapable of taking "no" for an answer. As in a bitter divorce where one party, enraged, rushes from one lawyer to the next to the next to the next in the hope of getting the impossible, these parents weep and wail and beseech in hope, maybe, of sating their neediness for --what? revenge? love? meaning?  Or maybe to save themselves from falling into an abyss -- shattering a brittle reality. So this family goes from lawyer to lawyer, doctor to doctor, court to court, reporter to reporter, to politician after politician.  The madness grows  helter-skelter, the loonies of our land feeding on it for attention and profit.

Frequently enough in this country, families come to the private decision to disconnect a family member, beloved or not, from life support.  Sometimes it is ventilator, sometimes a feeding tube, sometimes both.  These situations almost always cause anguish:  there is no easy way out.  This is, after all, life and death at its starkest. But most cases don't even make the local news.  The last thing most families want is to find themselves in the glare of the spotlight as they deal with their grief, their uncertainty, their ambivalence, their guilt, their secret wishes, their fears and longings.

In my experience, the noisier, more hysterical, more agonized, more public the family, the more likely they are to live in a deeply troubled private world.  Often they cannot look inside themselves. I suspect that this frantic grasping  to keep Terri Schiavo alive has more to do with whether or not her parents can face her death than it does with what Terri might or might not want.  What's going on in her parents' hearts?  Maybe she has, in her permanent vegetative state, become a fantasy daughter, the perfect child.  Maybe they can act out an idyllic family life they never had.  Maybe they think they can make up for her past pain.  Or maybe they feel, in their secret selves, that if Terri dies their lives will have no meaning.  Maybe Terri's dying will  mean the parents have to finally let Michael have his way.  Maybe he was in fact abusive: now it seems to them he is murdering her.  Maybe all the attention comforts them, like an audience comforts a lonely star.  Who knows?  She was an unhappy, chubby child and apparently a not-too-happy adult.  The irony of course in all of this is that eating issues continue to dominate what's left of her life.

This is all guessing, of course.  But I wonder if they might find a surprising bit of strength if they tried to put themselves in Terri's shoes, as Terri's shoes are today. 

They might ask  is it likely that the Terri they knew wouldn't mind being totally at the mercy of others for everything?

That she would not mind having no choice over who visited her and who didn't, who touched her, who cleaned her, who turned her, who changed her clothes?  Who cleaned her feeding tube, the sore where it's inserted?

That she would be happy having her mother speak for her, say what she cared about, what she liked, whether she was smiling or not, that she always loved it when they played  John Denver music for her?  What if she's sick of John Denver?

That she would like to spend twenty three out of twenty four hours a day alone and immobile, unable to choose for herself whether to have the blinds up or down? The sheets tucked under her chin or pulled all the way off? Her door open or shut?

That she would not mind that she could never decide what to eat,  what music to listen to? Whether to listen to it? That she wouldn't mind that she could never eat what she chose or go out to eat it?

That she didn't mind that she could express no opinions on anything...ever?  That maybe people were attributing a smile to her when in fact she was crying inside? That maybe she didn't like her mother reaching under her gown to straighten it? That maybe she wanted more privacy?

That she wouldn't mind never feeling the wind on her face, never sticking her toes in the sand at the beach, never confiding to her best friend or even her hairdresser?

What would she say about the money that has been spent on courts, on lawyers, on doctors, on the press, for the time of our august congressmen? Our President? If someone told her how much it all added up to it, how would she choose to spend it instead, if she could?

What if she wanted real peace?

These are questions the parents should ask themselves.   

Terri's may have been a troubled marriage. Her husband may have been a jerk.  Her parents may have been jerks.   Terri may have been anorexic.  She may or may not have said she never wanted life support, or maybe she said both.  That was then, this is now.

All we can do is to try to put ourselves in her shoes, not put her in ours.  If, on balance, with honest hearts, her parents can say she is content with the life she has now, that learning to swallow on her own would really fulfill her,  that she is fighting to stay alive,, then they should fight to have her live.  If they know in their heart of hearts that she would like to be set free, then, if they can shut out the noisy sycophants and parasitic press and hangers on and worst of all the self-righteous religious folks who would rather scream about right-to-life than admit this isn't a natural life, they can, with God's help, let her go.  If they cannot decide themselves, as has been suggested below (Peter A. Clark, S.J.) they can in all good conscience let go of the decision.  Her husband has the right to make it.  If they really fear his motives, they can  hand the decision not to her husband but to a guardian ad litem, someone truly outside this ugly, brutal storm, someone bound to make an ethical and compassionate decision.

NOTE: A good article, "Self-Determination and Selfhood" by Peter Suber of Earlham College can be found at www.earlham.edu/~peters/writing/emerson.htm

Peter A. Clark, S.J., a Catholic and an expert on medical ethics including end of life issues comments here: http://www.ascribe.org/cgi-bin/spew4th.pl?ascribeid=20031103.08

ABOUT issues of treating people in a persistent vegetative state:
Hallenbeck, J.ñ WSeissman, D., Fast Fact and Concept #10: Tube Feed or Not Tube Feed?

Nueva Rosita, Mexico

My husband and I just returned from a trip to Nueva Rosita in the state of Coahuila in Mexico.  We went with a group of delightful teenagers from our church's youth group.  Our task was to paint a small Episcopal church in the town.  A longer article will follow.

Here you can see part of Nueva Rosita away from the downtown, including hints of the coal mining which dominates the area.  In fact, the large area of Coahuila to the north of the state goes by the name región cabonifera or coal-bearing region.  We crossed the border into Mexico at Eagle Pass, Texas, my favorite crossing point.  The city on the other side of the border, Piedras Negras, is probably the pleasantest of the Mexico-Texas border cities and the one I would recommend if you don't have an opportunity to delve further into Mexico.

As has always been my experience in Mexico, people known and unknown were extraordinarily gracious and hospitable.  If only we offered, as a rule, the same welcoming treatment on the U.S. side of the border!  And yes, I do mean to undocumented workers, too.

Remember the falling dollar?

The Bush Administration has been depending on the falling dollar to boost American exports and dampen imports in an effort to moderate our huge national debt.  Remember, when the dollar falls, exports grow because our goods become cheaper overseas, and imports decline because imported goods become more expensive.  We sell more of our stuff and buy less of theirs.  The huge debt has been a cause of great concern among quite a number of non-politician economists because our government is paying daily expenses through indebtedness -- kind of like paying your rent and your utility bills on credit cards which you can't pay off every month.  The conservative stance has been to argue that it isn't really a problem because our dollar is so strong and we are so important that we can keep going like this for quite awhile.  The stance from The Other Sides has been that large indebtedness is okay periodically if it is used to stimulate the economy in down times, to build infrastructure which also would stimulate the economy, or to pay for time limited expenses like war (hopefully time-limited).  They have argued that if other countries start to lose confidence in the dollar and start to replace their dollar reserves with Euros, say, it would weaken the dollar to the point that we could start to have really serious problems with an unsound currency.  That is, for example, we would need more and more and more dollars to pay off other countries who now hold considerable quantitities of our debt.  China and Japan come to mind.  Under normal circumstances, or maybe we should say relatively stable circumstances, countries don't "call in" other supposedly economically sound countries' debt like repo men, but if they lost confidence in us, or for that matter they wanted to see us decline, they could.  An example on a small scale basis:  If you borrowd fifteen thousand dollars from someone in Europe six months ago, today you would owe her close to twenty thousand dollars.

Here is a link to today's New York Times which indicates that some players on the international scene are beginning to do just what economists on The Other Sides fear.  It also discusses the Administration's continuing failure to undertake problems that really matter and o make worse what was bad before.

Here is a link to an op-ed piece in the Times putting a  pin very close to the Alan Greenspan bubble -- the bubble in which live  Administration optimists.  http://www.nytimes.com/2005/03/10/opinion/10grant.html

Just West of San Antonio

It has been a rainy, gray winter here in South Central Texas.  This day in late February the sun came out and we saw the first  greening of spring.  You can look at the Sunday Drives in South Central Texas photo album for more pictures. 

Damning the Current Health Care System:Administrative Costs of Healthcare

The success of  The Right in damaging some of themselves and most of the rest of us can be seen in the strange situation we have with health care coverage. Here we have in one of the rich industrialized countries, a system of health care which many of us can't even afford and which many more of us access through expensive, cumbersome, inefficient, frustrating insurance plans.  Most of us will face hardship if we are faced with serious, ongoing health problems because we will have to start juggling our money to cover health costs.  Yet in most other industrialized countries, nobody considers that they will become poor because of health problems or that they will have more severe health problems because they are poor.  It's a no-brainer, but not for us.

You can take almost any aspect of medical care and single-payer systems do it better for less. Let's examine, for a start, administrative costs. 

Administrative costs of health care:

If in the United States we streamlined our administrative costs so that they matched Canadian levels,

• we would save $286 billion of the 1660.5 billion we spent in 2003.
• This would leave $6940 for each currently uninsured person in this country, quite enough more than is necessary for them to be covered.

How large a percentage of our bill are administrative costs?

• In 1999, administrative costs of health care in the United States were 31% of the total costs.  In Canada, they were 16.7%. 
• For US insurers themselves, overhead was the highest for investor-owned Blue-Cross/Blue-Shield plans (26.5%), second highest for commercial carriers (19.9%) and lowest for government-run Medicare (3.1%), the closest thing we have to a single payer system.

Our administrative costs are due to:

• the fact that we have more than 1200 private health insurers in the US which each have varying numbers of kinds of coverages.  This causes "fragmentation, inefficiency and dupicative bureaucracy" because hospitals, clinics and doctors offices have to sort through  thousands of different forms dealing with different amounts and types of coverage, different regulations on coverages, different requirements for documentation, different rules for eligibility, different copays, etc. etc.  A study cited in more than one article finds that in Seattle, 2000 patients with depression were covered by 189 different insurance plans and 755 different policies.
• Private insurance requires functions that are not necessary in a single-payer system:
  • Underwriters
  • Marketing
  • corporate incentives to increase profits by erecting hurdles to payment such as complicating and stalling payment so that companies can hold their money longer and so that some hospitals and clinical offices will give up trying to recover payments.
• Having to bill a multiplicity of insurance companies and institutions means that hospitals cannot pay a lump sum, and have massively complex accounting costs.

The   National Center for Policy Analysis, a Dallas-based think tank tightly tied to supporting The Right has tried to challenge the conclusions about bureaucratic costs attributable to our private system of insurance.  The Right's position is laid out in Twenty Myths about Single-Payer Health Insurance: International Evidence on the Effects of National Health Insurance in Countries around the World by John C. Goodman and D.M Herrick(see below) and elsewhere.  Goodman and Herrick say the conclusions of single-payer supporters are based on three false assumptions:

• That low costs are considered to be synomymous with effectiveness.
• That higher costs of private insurance bureaucracy result in worse outcomes.
• That the relatively low cost of bureaucracy results in better incomes.

Additionally, they claim that they assume that "administrative costs do not produce offsetting benefits.  Among the benefits of the plethora of private insurance providers, say Goodman and Herrick, are:

• the ability to appeal to different tastes and preferences among consumers for amenities such as varied levels of copayment, choice of physician network, limited waiting for physicians visits, etc.  (I have to interject here that I never thought of any of the above as amenities...more like juggling what I could afford.)
• the administrative use of a portion of the funds to ensure that "the remaining funds are spent wisely providing quick and convenient service."
• the control of "moral hazard (e.g. the tendency to overconsume when the service is perceived as being free rather than rely on the Canadian approach of using waiting lines as a method of rationing services.)" 
• According to Goodman and Herrick, we actually save bureaucratic costs because we don't have hidden administrative costs such as to cover the costs of "rationing by waiting," wasted resources because national health systems have "perverse incentives", the Canadian fee structure (and others for national health plans) makes patients make multiple, and therefore more expensive, visits.  (Incentives!!! Legitimate incentives for The Right are pretty much limited to the thrill of competition and profits.  These folks promote "entrepreneurial providers in an unfettered marketplace and direct access to specialists and specialty services based on the willingness to pay.")

In his article, Myths and Memes about Single-Payer Health Insurance in the United States:  a Rebuttal to Conservative Claims, (see below) John P. Geyman demolishes Goodman's and Herrick's "myths." After pointing out that they present data either from biased sources or no data, he presents the following comparison of specific adminstrative costs per capita in US dollars and provides the source, a study in The New England Journal of Medicine:

• Insurance overhead: U.S. 259, Canada    45
• Employer's cost to manage health benefits: US 57, Canada 8
• Hospital administration:  US 315, Canada 103
• Nursing home administration:  US 62, Canada 29
• Administrative costs of practitioners:  US 324, Canada 107
• Home care administration: US 42, Canada 13
  Total          US 1,059, Canada 307

Here I have only dealt with administrative costs.  I haven't touched the stuff that really matters: cost, availabilty and quality of medical care.  But it should be clear from just the examinationof administrative costs that many of them have to do with trying to maintain a multi-party private system of insurance based on competition and profits.  The trends indicated here continue throughout.

The two main sources I used:
Geyman, John P. Myths and Memes about Single-Payer Health Insurance in the United States: A Rebuttal to Conservative Claims, International JOurnal of Health Services, Volume 35, No. 1, pp 63-90, 2005.  It is available online for a fee at:
http://baywood.metapress.com/app/home/contribution.asp

Goodman, J.C. and Herrick, D.M., Twenty Myths about Single-Payer Health Insurance: International Evidence on the Effects of National Health Insurance in Countries around the World, National Center for Policy Analysis, Dallas, 2002.