The Screwtape Letters (Satiric IP Version)

(With apologies to CS Lewis and “The Screwtape Letters”)

My dearest Wormwood,

I bring you great felicitations from the High Command of the Infernal Insurance Conclave. Your sterling efforts in beguiling the masses and policy wonks have caught the eyes of our Dark Lords there. In particular, the pronouncement that IP policies, (in no small part due to your powers of subterfuge and persuasion) will not be fully portable has gained us valuable breathing space and time.

High Command has given me the most pleasant task of informing you that you have been promoted within the Conclave Lower Ranks to Senior Beguiler Class 2. Our whole family is proud of you, and we are at this very present moment celebrating this news with a salubrious portion of a dead (and unsuccessful insurance claim) policyholder’s flesh and a generous pour of a physician’s blood, toil, tears and sweat. As you can see, even in hell, there can be moments of mirth. And greater mirth there will be, when you return from the frontlines battling those damned policyholders and physicians, while keeping the policy wonks on your side. The 3Ps: Policy Wonks, Policyholders and Physicians. Just keep the Policy Wonks on your side, and you will be fine against the piteous Policyholders and the pathetic Physicians.

By IPs remaining non-portable, we stay immune to the forces of competition and the free market once the unsuspecting customer has bought a policy and has developed pre-existing diseases. It is said that healthcare is an example of market failure. Post-sale IP without portability, and hence competition-proof, is proof of this adage. And yet they still fell right into it. Please forgive me if I sound uncharacteristically gleeful.

We must now press our advantage with our potent miasmatic concoction of deceit and duplicity. On one hand, we will continue our sorrowful and specious tale of not being successful or sustainable as a business, which will gain us much unmerited sympathy from all the silly people in high places.

On the other hand, and with some luck, we will continue to have a low claims ratio, while paying ourselves more and more in the form of management expenses and distribution costs (i.e. commissions). Our ostensibly pitiful tale will be bolstered by the fog of “change in reserves and other expenses”, which will vary a lot from year to year and which nobody can explain clearly why this is so.

Our self-gratifying efforts in terms of ever-increasing management expenses and distribution costs can only be thwarted internally – when those morons on the investment side fail miserably to deliver any returns on their investment activities, and even, Our Father Below forbid, make losses.

But this is only half of the equation. It is imperative that you continue to bring legions of souls to feed the all-consuming IP behemoth that in turns funds our lavish lives. We do this by exposing our multitudinous targets to the coalface of their insecurities and fears, knowing fully well that in the end, half of them who have bought IPs will never make a claim, even when they fall sick in the hospitals. They still opt for the subsidised care funded by public monies, which in turn are mined off the bent backs of our burnt-out taxpayers.

This beauteous state of affairs can only be sustained by ensuring that their fear of not having access to subsidised care after discharge from private care remains palpably intimidating if not paralyzing.

Nearly 70% of the population have bought IPs. Can we do better? 80%? 90%? Delirious joy awaits us if we can hit these higher numbers, which will lead to more and more remuneration and commissions for ourselves.

However, it is my duty to remind you, my dear nephew, that you must never confuse the Policyholder with the Patient. For indeed, while they are physically the same being, the two cannot be more different. The IP Policyholder is a prey that has been captured; a resource that can feed our ravenous appetites for material gratification as long as he pays his insurance premiums every year, while the Patient is someone who has fallen ill and will do exactly the opposite as the Policyholder. The Patient will consume the very same monies that we have so successfully leeched out of the Policyholder. We compete for policyholders. We do NOT compete for patients. Policyholders are good news until they become patients, because patients are bad news. We have great affection for the would-be or pre-policyholder, but we have no mercy for the patient. That is why the Dark Lords of the High Command of the Conclave always publicly say “Our first responsibility is to the Policyholder”. Nobody talks about Responsibility to the Patient.

We must stay the course of limiting access to those pesky physicians. Once again, I recall with great pride and fondness my classmate in the Abyss Academy, Slubgob’s role (now Lord Slubgob) in introducing the idea of preferred physician panels. What genius! This was a turning point in our battle with the Forces of Light. The only thing “preferred” about these panels is that we prefer them to be as small as possible. Indeed, the policy wonks did put pressure on us to increase the size of these panels slightly initially after they were introduced and we did so to superficially appease them. But as long as these panels remain, we have all the aces in the game of limiting access. We also continue to increase the friction in gaining access to these panels for physicians, and obscure our true intent by remaining completely opaque on the criteria that we use to bestow (with that obligatory whiff of sovereign disdain) on a physician a place on our panels. (If truth be known, sometimes we just flip a coin and let the Fates decide). Do remember, that you must make sure a physician knows it in his bones that he exists on our panels at our whim and fancy. If need be, sometimes he must be made to grovel to keep his status as a panel doctor. Like patients, show no mercy to them either. For panel physicians who show no less than perfect obeisance, drop them.

The true power of panels is that they scythe through that most hated and oft-quoted construct called the patient-doctor relationship. The Conclave doesn’t say so publicly, but it finds the concept of the patient-doctor relationship abhorrent and gnaws at the core of what the Conclave stands for, which is lucre.

With panels, we can dismantle old patient-doctor relationships and replace them with transactional claims and disbursements between policyholders and physicians that are completely controlled by us. With panels, we, the intercalators, have surreptitiously become more powerful than whatever detestable direct bond that physicians thought they had with their patients. With panels, we march on with our plans to obstruct and obfuscate.

Finally, we have to stay alert to the powers of the regulators. Fortuitously, they remain somnolent and oblivious to the cries for regulation with regard to the clinical aspects of IPs. We must keep up with our veneer of commitment to participating in whatever mediation or remedial processes the policy wonks have come up with, as long as our participation remains discretionary.

We must once again use our powers of deception and misdirection to keep the current state of non-regulation under the shroud of pseudo-adjudicatory forums. For once we are compelled to participate and follow decisions made by external parties on matters concerning what is appropriate clinical care that should and must be funded by us, we are then regulated, and in truth, quite done for. However, it would be remiss of me not to remind you that we must also keep up the illusion of sincerity and guise of congeniality by participating in some cases which we are most likely to win the debate, while refusing to take part in those many cases where the facts are patently against us.

Please give me an update next month on your continued training in the field of regulatory capture and your masters dissertation on this same subject. Until then, I remain,

Your affectionate uncle,

Screwtape

Hobbitsma’s note:

For the avoidance of doubt, this is satire. All characters mentioned in this post are fictional.

CS Lewis (1898 to 1963) was an Oxford professor in English Literature. He wrote many books, including The Chronicles of Narnia. The Screwtape Letters is a Christian Apologetics fictional novel written by him and dedicated to JRR Tolkien (his contemporary and good friend from Oxford, who wrote Lord of the Rings) and it is written in a satirical and epistolary style.

“First published in February 1942, the story takes the form of a series of letters from a senior devil, Screwtape to his nephew, Wormwood, a junior tempter. The uncle’s mentorship pertains to the nephew’s responsibility in securing the damnation of a British man known only as “the Patient”.

By 1999, the novel had 26 English and 15 German editions, with around half a million copies sold.” (https://en.wikipedia.org/wiki/Screwtape)