Magazine | July 1, 2013, Issue

Leviathan’s Subcontractors

It took me years of living in the United States before I acclimated to certain uniquely American rituals. I noticed early, standing in the pick-up line at CVS or Rite Aid, that it took more time to collect a prescription than in any other country I’ve ever needed a bottle of pills in. But it was a while longer before I was sufficiently bored to start following the conversations of those two or three places ahead of me in line, as they argued over 78-cent co-pays, or suggested the clerk had perhaps transposed two of the insurance numbers, or explained that the problem might be due to their employer having recently switched from Blue Cross to Cigna . . . Filling a prescription in America is like going to a very fashionable nightclub: You can never be entirely certain the doorman will let you in.

It happened to a friend of mine the other day. Her monthly refill was denied late on a Friday afternoon so she had the weekend to prepare herself for the Monday-morning bad news that her health insurance had been canceled, without notification, and its cancellation backdated a couple of months just to add to the fun. Long story. They all are. Too long for this column, or indeed the average novella. Also very complicated. That’s one of the advantages of the system. I confess, as a guest host for Rush Limbaugh on the radio, that my heart sinks a little whenever a caller wishes to explain the particular indignities heaped upon him by his health-care “provider,” because generally it takes a good 20 minutes just to lay out the facts of the case, and even then it doesn’t really make sense. I don’t like to think I’m a total idiot. When an ISI guy from Islamabad expounds on the ever shifting tribal allegiances of North Waziristan, I’m on top of every nuance. When a London tax expert explains money laundering by Russian oligarchs through Guernsey and Nevis via Ireland and Cyprus, I can pretty much keep up. But when a victim of American health care starts trying to fill me in, round about 40 minutes in I have a strange urge to stab forks in my eyeballs. Except then, of course, I’d have to go to an American hospital.

Foreigners can’t understand a word of an Obamacare conversation. The problem with health care in most countries is that they’re third-party systems, which are by definition economically inefficient, whether the third party is government or private insurance. But that would be too obvious for us. So in America there’s the patient and there’s the doctor, and there’s the insurer, who is provided through the employer, who outsources it to an employee-benefits-management company. By my count, that’s a fifth-party system, on top of which Obamacare adds a sixth.

And if, somewhere between the party of the fifth part and the party of the fourth part, things come apart, well, good luck with that. As my friend was told, over and over, by the robot in customer service, “I’m just applying the new federal rules.”

#page#You hear that a lot these days. Unable to sleep the other night, I found myself reading the 2011 Federal Reserve rule “amending Regulation Z (Truth in Lending) to implement amendments to the Truth in Lending Act (TILA) made by the Dodd Frank Wall Street Reform and Consumer Protection Act”: 

The Board’s proposed rule provides flexibility in underwriting standards so that creditors may adapt their underwriting processes to a consumer’s particular circumstances, such as to the needs of self-employed consumers and consumers heavily dependent on bonuses and commissions, consistent with the Board’s 2008 HOEPA Final Rule. See 73 FR 44522, 44547, July 30, 2008.

Sure, it sounds boring, but wait till you see Amending Regulation Z — The Musical. But here’s the thing: Why should it be the job of a Federal Reserve “rule” to “provide flexibility in underwriting standards”? In a supposedly private banking system, shouldn’t the guy sitting across the desk from the customers be allowed to evaluate his customers as individuals? Ah, but, as readers will have noticed, you can take your credit application to the First National Bank of Dead Moose, the First National Bank of West Dead Moose, and the First National Bank of Dead Moose Junction, and they’ll all give you the same answer. They can compete on debit-card design and check-wallet color but ever less on banking services. For most Americans, there are many banks with different names, but increasingly, like the “private” health system, they’re uniform enforcers of the federal rules: From the customer’s point of view, it’s a government bank in all but name.

Most countries decay into statism through nationalization: Britain nationalized health care in the late Forties, France nationalized the banks in the early Eighties. But that’s not the American way. So the veneer of a private sector is maintained as an ever more implausible façade for a hyper-regulated statism: Big Government at one remove, subcontracted to nominally private paperwork shufflers across the land. In health care, banking, homeownership, college tuition, Americans now enjoy considerably less freedom of movement than citizens of openly statist nations in Europe.

As it happens, these are all the areas of life the prudent man is enjoined to take care of: Save for the future. Get an education. Buy property. Look after your health. Remorseless governmentalization of all four sectors is part of the ever greater sclerosis in America — and immensely time-consuming. My friend may well get her health care back, after weeks of effort. But so much of life is like that now, isn’t it? Not the rough-and-tumble of a free society or the homogenized mediocrity of socialism, but just the vast diversion of so much American energy into shuffling around the regulatory obstacles to daily life.

– Mr. Steyn blogs at SteynOnline (

Mark Steyn — Mark Steyn is an international bestselling author, a Top 41 recording artist, and a leading Canadian human-rights activist. That’s to say, his latest book, After America (2011), is a top-five bestseller in ...

In This Issue


Politics & Policy

Bureaucratic Rot

‘The fish rots from the head down” is a popular saying these days, mostly among people who do not fish and who, apparently, have never met a fish. “The fish rots ...
Politics & Policy

The debate over Internet sales taxes, when all distractions are stripped away, isn’t about the Internet or taxes. It is about federalism. Confusion over what federalism means explains the conservative ...
Politics & Policy

The Cincinnati Myth

When news broke that the Internal Revenue Service had, over the course of nearly two years, actively discriminated against conservative groups applying for tax exemption, subjecting them to intrusive questions ...
Politics & Policy

One-Party Taxmen

What if I were to tell you that the IRS tea-party-targeting scandal all started with the great 19th-century railroads? Or with the conscience of a largely inconsequential, ornately mustachioed Gilded ...


Politics & Policy

Men’s Rising Earnings

Assessing the severity of economic problems often requires choosing between different sets of analyses that reach disparate conclusions. While much lip service is paid to “evidence-based policymaking,” all too often ...

Books, Arts & Manners

Politics & Policy

Epic of a Nation

From Boethius to Bonhoeffer, many authors have written their most famous books in prison. In rare individuals down the ages, the predicament of incarceration seems to have unleashed great creativity. ...
Politics & Policy

Genius for Friendship

Someone should tell the story of this odd couple, because many today would find it hard to believe. Politics often feels like an ideological blood-sport, with pundits mercilessly bludgeoning one ...
Politics & Policy

No Green Light

The Bling Ring, the latest film from Sofia Coppola, marks something of a departure for its director. After several movies that have looked at the celebrity lifestyle from the inside ...


The Long View

G-Mail Inbox

GMAIL INBOX Hi! Totally weird coincidence! You and I were in the same homeroom sophomore year! I was the quiet kid in the back? Tyler? Do you remember? Probably not. You were ...
Politics & Policy


HEELS UPON THE TILE When I consider your devoted eyes, devoid of any vice I could reject, alive with avid interest, subtly flecked, and focused on my face with slight surprise, it seems as though ...
Politics & Policy


The Thousand Years’ Twilight Victor Davis Hanson has added intriguing and refreshing historical references to the pages of NR for a number of years. As Michael Knox Beran implies at the ...
Politics & Policy

The Week

‐ The good news: The NSA doesn’t know you’re reading this. The bad news: The IRS does. ‐ The latest Republican fashion on immigration is to declare broad support for the ...

Most Popular


Holy Week with Saint Paul

Just the other day, I ordered a replacement copy of The Passion of the Christ -- it can be so impactful for Holy Week meditation. In the years since its release, it’s become something of required Lenten viewing for me. But this year, there is a new movie to help with prayer, Paul, Apostle of Christ, released ... Read More

Heckuva Job, Paul and Mitch

As Thursday's editorial makes clear, the omnibus spending bill is a disgrace. That may be why about 40 percent of Republicans (and 40 percent of Democrats) voted against it. Apart from the absence of a DACA/Dream amnesty, the immigration portions represent a comprehensive victory by the anti-enforcement crowd. ... Read More
Politics & Policy

California’s Pro-Nuclear Renegade

If California’s upcoming gubernatorial race gets decided solely by money, Michael Shellenberger doesn’t have a chance. The latest campaign filings show that Shellenberger, an environmentalist from Berkeley, has about $37,000 in cash on hand. The frontrunner in the June 5 California primary, Lieutenant ... Read More
Politics & Policy

The Sliming of Bari Weiss

If you follow at all the ideological war that’s erupted around the New York Times editorial page, then you know Bari Weiss. It’s too much to call Bari conservative. A better description might be heterodox. On some issues, particularly social issues and immigration, she’s a woman of the Left. On others — ... Read More