Tuesday, March 23, 2010

Consumers, Commodities and "Reform"

A month ago, I responded to a NYTimes article by criticizing the tendency in their "analysis" to presuppose that we should think of ourselves as consumers in the context of health care "reform":
The entire way that this "issue" is thought about and discussed in mainstream outlets reeks of deeply-seated ideological distortions. The most obvious example of this distortion lies in the fact that we are continually prodded to think of ourselves primarily as consumers. In the health care "debate", we are asked to assume the role of consumer, and then to think about what creative institutional reforms we could implement that might help make our object of consumption, health care, less expensive. In this way, the entire debate is reduced to technocratic price tinkering.

We are continually encouraged to focus our attention solely on consumption; but we never reflect back on the conditions of production. Thus, the realm of circulation rather than the control of the means of production are the subject of scrutiny. The result is the sterile debate about how to remedy "soaring health care prices", where the real underlying economic issues are not even considered. The basic configuration of power in our current system remains uncriticized.
Now, check this out. Before, I responded to what I took to be an implicit injunction to think in consumer-product terms... now the NYTimes has switched to an explicit deployment of that ideological set of concepts.

If you yell "consumer" at people enough, and they learn to respond in kind, you've already accomplished a good deal, ideologically speaking. In the health care context, in effect, you rule out institutional reforms like single-payer, where all residents of the US (i.e. not just the right consumers) would be unconditionally covered. In the case of single-payer, the consumer-product relation drops out completely, because we would no longer be purchasing a commodity for a market price at all under such a system.

Under single-payer, the service would be distributed according to human need and the price would be determined by one's ability to pay (i.e. via a graduated income tax), which is precisely not the way that market prices function: in a "free" market your access is strictly limited according to how much money you have, and the flat-rate, one-size-fits-all prices are set by the demands of profitability for owners of the insurance companies. And they can yank them up any time they please, in order to ensure profitability is sufficiently cushy.

Anything worthy of being called health care reform, would have to challenge the idea that private, for-profit companies are to provide "consumers" with a "commodity" (in principle exchangeable with any other) that is sold on a market of some kind. At least the public option, however tepid and problematic it was, purported to challenge this state of affairs in some way (although it left much intact). But the present bill actually takes all of this for granted. It cements and further funds and institutionalizes the for-profit, market-based consumer mentality.

And what's worse, Obama and Co. conceded even the ability to regulate these fuckers at the Federal level. So, we're being forced, on pain of legal penalty, to purchase the products of a for-profit industry... and our "progressive", "visionary" leaders in Congress couldn't even bother to push for the ability to regulate this industry who've now got a captive market of consumers.

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