The Shape of Things to Come


In a time of crisis and supposed national sacrifice, it's oddly comforting, in a perverse sort of way, to know that some are sacrificing more than others. It suggests that things are gradually getting back to normal, and in George W. Bush's America, normal means that although we're all equal, some are more equal than others. The rich and the corporations are on track to get their latest tax cut, if the GOP can just sell it in the name of patriotism and economic stimulation; a few things never change.

There are other, more mundane signs of resurgent normalcy, however. One concerns the struggling airline industry. In November, after it became obvious that deregulated air travel in the post-Sept. 11 era would evolve from merely difficult to nightmarish, an American company announced a new concept to deal with looming airport gridlock. Aeritas Inc., billed as a "leading innovator in mobile commercial technology," launched FreedomPass, a wireless check-in system purportedly aimed at improving security and reducing congestion at the nation's airline hubs, but chiefly intended to enhance industry profitability through lowered screening costs and perquisites to preferred passengers.

FreedomPass would operate on the principle of a special barcode-based boarding pass linked to a passenger's photo ID and interacting with voiceprint verification. A voiceprint match would verify the traveler's identity prior to his reaching the airport, and the barcode would be checked against his stored photo ID at the passenger gate. Sounds like an interesting, if overly techie, solution to long lines and screening delays, but it's not for everyone. In fact, the fully automated system is intended only for a favored few, the frequent business flyers whom the airlines consider their most valued customers. It's vital not to unduly annoy or inconvenience these important folks, whose time is more valuable than that of ordinary, run-of-the-mill passengers.

The problem with air travel, you see, lies not with deregulation and the glaring security problems it has created; it lies instead with the fact that we've never had a proper two-tiered system for processing travelers, a system that recognizes class differences and operates accordingly. As an Aeritas press release explained it, the FreedomPass approach targets those individuals most essential to the airlines' financial success, a "low-risk, highly identifiable set of passengers that could bypass check-in lines and pass more rapidly through security checkpoints." By implementing it, as they are in the process of doing, airlines hope to solidify the patronage of those monied, first-class passengers who want to board immediately and avoid the routine hassles encountered by lesser travelers. So, the next time you're standing in line at Delta or United while others are settling comfortably into their cushioned seats, remember that it's all for the good of the nation's air-transportation system ó or, more accurately, those for whom it primarily exists.

Another dubious sign of business as usual in George W.'s America concerns the health system. Now that private managed care, the domain of impersonal HMOs and heartless insurance companies, has been judged a colossal failure, the public is casting about for an alternative. Some Americans, those with money, appear to have found one, but again, it's only for the fortunate few. The approach, based on special, individualized care for those able and willing to pay for it, has been dubbed "concierge care."

According to an Associated Press report, the trend began in those bastions of advanced medicine, Seattle, Washington and Boca Raton, Florida, with the formation of primary-care practices carrying fashionably mod names like MD2 and MDVIP. Patients with the wherewithal ó dot-com executives in Seattle or rich retirees in Boca ó pay medical entrepreneurs anywhere from $1,500 to $20,000 a year above and beyond standard insurance coverage to cater to their needs. For their money, annual subscribers get home or office visits, doctors who are on call daily around the clock, prompt testing and lab results, longer, more personal examinations from physicians, and quick, often preferential referrals to specialists.

This trend toward two-tiered health care is moving nationwide via franchising arrangements, and the doctors involved appear enthusiastic. In addition to making a bundle, they get to serve fewer people; one Seattle physician claims to have less than 100 patients and to treat only one or two per day. Presumably, he spends the rest of his time golfing or tending to his investments. Not all of the health profession is so sanguine, however. Even the conservative American Medical Association has questioned the propriety of discriminatory Cadillac services and their adverse effects on communities as a whole. In a time of limited health resources, better care for the few invariably means lesser care for the many. But participating physicians interviewed by the AP were unrepentant; said one, "None of these doctors is Mother Teresa."

There is a better way, but it entails the recognition that in medical care, as in the battle against terrorism, we're all in it together. That's what citizens of Portland, Maine, concluded last fall, when they voted in referendum for a universal, single-payer health-care system to be established in their municipality. The vote was non-binding and amounted to an advisory resolution directed at members of the city council, but it sent a clear message to Maine's state legislators, who have begun considering a statewide, government-run health system.

An especially encouraging sign is that Blue Cross and Blue Shield of Maine, the former nonprofit recently absorbed by for-profit giant Anthem Insurance of Indianapolis, pumped $382,000 into the effort to defeat the single-payer proposal (outspending proponents 25 to 1) and lost anyway. Maybe the present definition of what's "normal" can be changed after all. Maybe a two-tiered America, one for the economic Èlite and one for everyone else, is not an inevitability. Maybe special preferences, whether in medicine, air travel, or any other area of life really can be reversed; they are a product, after all, of the 1990s boom economy working in tandem with a deregulated environment and a worshipful belief in the marketplace.

But the boom is over, deregulation is in disarray, and the market looks less and less appealing as an all-purpose arbiter for society. The time would appear ripe for a resurgence of economic democracy and social equality. If sacrifice is to be the national watchword for the foreseeable future, we should demand nothing less.

Wayne O'Leary is a writer in Orono, Maine.

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