Yes, it does. And this was noted by the Left during the health care bill debates, but it seemed to fall on deaf ears. Of course, the GOP is seizing on the $500 billion number to try to make themselves look good. The fact that they can even credibly posture as a defender of Medicare speaks to the disorienting, confused nonsense that passes for political discourse in the corporate media. But this much is clear: Medicare is an extremely popular program, so much so that even the Right has to posture as a fan of it. Of course, the Democrats too want to posture as fans of Medicare. Neither party wants to take the blame for slashing it, but, in the end, both of them would like to do it. Apologists for Obama seem to have forgotten the recommendations put forward by the bipartisan committee appointed by the President to draft up a plan to make punishing cuts to social programs.
One other thing- check out the WaPo link provided above. In the "facts" section (loaded with Democrat apologetics), after some waffling on whether not the it's true that $500 billion will be cut, we read the following: "These spending reductions presumably would be a good thing, since virtually everyone agrees that Medicare spending is out of control." Really? That's funny, I don't remember agreeing to that. I would, however, say that health insurance profits are out of control. I would say that the premiums charged by the profit-driven insurance agencies are out of control. I'd also add the number of uninsured Americans as well as the number of unnecessary deaths caused by our system are out of control as well. I don't even know what it means to say that Medicare spending is "out of control".
Sooner or later, re-election obsessed Democrat apologists will begin to trot out putative accomplishments of Obama. They will claim that the health care bill is one of them, and they'll surely want to set aside uncomfortable facts (like the above). Don't buy it. The health care bill was written by the very industry who is the source of the health care crisis in this country. It doesn't even include the meager, inadequate "public option". It expands and consolidates the role that profiteers play in our health care system. It isn't a small step toward single-payer, it is a newly minted roadblock to further progressive reform.
Tuesday, August 2, 2011
Does "Obamacare" Cut $500 billion from Medicare?
Thursday, January 6, 2011
What would we lose?
House Republicans are already talking about repealing ObamaCare. Now, as any reader of this blog is well aware, I am a staunch advocate of single payer. So I ask you: if you really care about genuine health care reform, what do we stand to lose if ObamaCare is repealed?
What will we have lost if the Republicans have their way? Why should progressives be disturbed about the repeal of a bill that did more in the way of disorienting the Left than it did in fulfilling progressive ideals?
Sunday, January 2, 2011
From the Archives: Private Interests Masquerading as Universal
From 2009:
Imagine if the U.S. Chamber of Commerce had said the following about why they uncompromisingly opposed the EFCA ("the card check"):
"We the U.S. Chamber of Commerce, represent the interests of a small group of financial and business elites who own large capitalist enterprises. We care, first and foremost, that we are earning as much money as possible. Take note of the "we" in the last sentence, for if someone else were to reap the returns of the institutions we own and control, this would be unacceptable.If they had said this, most people likely would have said: "Shove it, you rich assholes."
Now it seems to us that if the EFCA passes Congress there is a very good chance that more workers will form unions, which means that we will have to cede some of our profits because unions will require that we pay better wages, benefits, pensions and so forth. Moreover, they will curtail our ability to most efficiently manipulate workers (e.g. arbitrarily terminate employees or downsize to maintain profit margins) in our quest to maximize our profits.
At the end of the day, we as extremely wealthy and powerful capitalists will lose measures of our wealth and power if this bill passes. Hence our uncompromising hatred for the bill."
So of course, they cannot simply assert their narrow interests as capitalists in making a public argument about policy. To be heard, they have to make up some story about how their interests are in fact not really their interests, per se, but universal interests. That is, generalizable interests that at least appear to have some relevance to the lives of the 99% majority of the population who aren't part of the ownership of a massive private corporation. Hence all of the endless drivel about 'secret ballots' and so on.
Now fast-forward to the "health care debate" that's ensuing over the so-called "public option".
Anyone familiar with the AMA's history, recalls that they pulled every stop out in the late 1940s and early 1960s when health care reform was on the table. That is, they went apeshit and started babbling about 'totalitarianism' and employed Ronald Reagan to do commercials claiming that Stalin was coming to eat America's babies. This is what they said about Harry Truman's post-WWII plan to institute single-payer:
"all forms of security, compulsory security, even against old age and unemployment, represent a beginning invasion by the state into the personal life of the individual, represent a taking away of individual responsibility, a weakening of national caliber, a definite step toward either communism or totalitarianism"Who is the AMA? They are a large, influential political organization who represents the interests of the most powerful, wealthy and politically-connected doctors in America. They do not represent all doctors. See, for example Physicians for a National Health Program, who see the interests of the private insurance industry as fundamentally opposed to the role doctors ought to serve in a just society. They are staunch supporters of Single-Payer.
Now its not hard to see what the AMA wants. This organization, as the representatives of the most powerful and wealthy doctors, exists primarily to defend the power and high earnings of those whom it represents. So, its not difficult to take them seriously when they come out and say that they don't like paying Medicare rates (they can exploit markets to get even higher rates, so why should they settle for such lackluster earnings?).
But we would be making a seriously obtuse mistake if we thought that the AMA sincerely cared about things like:
-Whether our health-care system is well-ordered and just
-Whether profiteers run insurance institutions and routinely deny claims
-Whether everyone is getting the care they need
-Whether access is universal or guaranteed
-Whether everyone can afford healthcare
-etc.
We have no reason to think that they care for anything of these things in themselves. And, as Ezra Klein points out, we have very strong reasons to think that they would oppose any of these considerations if they conflicted with the material interests of wealthy and powerful doctors. The class dynamics underwriting their Association notwithstanding, the history of the AMA's political interventions speaks for itself.
So what role does the AMA play in public debates? Of course they can't make public interventions that lay bare their narrow, strategic interest in manipulating discourse so that they can maximize their earnings. So they have to say stuff like this:
“The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”Interestingly, they opened this statement by saying that care ought only to be "provided through private markets, as it is currently." Can anyone say 'dogmatic'? If they really cared about "the best way to expand health insurance coverage" why all the whining about the need to have "private markets" and "private insurers" front and center?
My, these business types are so big on the rhetoric of "choice". You can choose to be either insured by some moronic for-profit institution, or you can choose some other such firm of the same ilk. Or you can fucking wither and die. You pick!
To bring this post to a close, I want to tie this thought about narrow, stategic private interests into recent discussions of the 'power plays' being made in the debate over the "public option" bill in Congress. I sometimes hear, as on this Ezra Klein vs. Libertarian 'blogging heads' thing, that "the Democrats really want single payer, but..." or that "liberals really want SP but...". Nevermind the question of who these 'liberals' are and where one finds them. But if the Democrats, i.e. the party who has control of both chambers of Congress and the White House and has trounced the opposition party in the last two elections, want single-payer I find it hard to see what's stopping them.
But let's entertain the fantasy of liberal bloggers about how our government works for a moment. Let's say that the Democrats really do, deep down, get all warm and fuzzy when they think about single-payer. Why can't they just get it done? The answer can't be that the Republicans will oppose it. They already oppose the current reform. They opposed Obama in the last major election. They suck, that's why they keep getting hammered at the ballot box. So the answer can't be that the Democrats just don't have the votes.
What, then, is the holdup? Well it can't be, as Ezra Klein claims it is, that the problem is just that there is "status-quo bias" and "people don't want to lose the health insurance plan they have". That may be some small part of it. But this ignores the 50 million Americans without any insurance; surely they aren't biased towards the current situation. Moreover, this 'status quo bias' hypothesis contradicts Klein's frequently-made (and correct, in my view) point that "health insurance corporations are among the most hated institutions in America".
The pink elephant in the room here has got to be the entrenched, extremely profitable, powerful private health insurance industry who would cease to exist under a single-payer plan. The powerful class in charge of (and profiting from) these massive institutions are the biggest reason why reform would be so difficult to achieve. They aren't going to go down without a fight. They aren't ever going to play nice without being forced to. And we know they aren't going to put their eggs all in one electoral basket; they're going to hedge their bets. That's why the give millions to Democratic members of congress.
In short, we can't ever forget that these industrial giants uncompromisingly hate single payer, since they wouldn't be industrial giants any longer if the plan were adopted.
So why isn't this obvious fact ever discussed in the 'public debate'? Why is it so hard to believe that if the narrow interests of those who profit from the status-quo were nakedly asserted in the public sphere, most people would balk? Why not simply discuss, incessantly, the amount of money these assholes make a year? Why not place our moronic system in a global context and rank our performance against virtually every other major industrial capitalist country in the world (all of whom do not have profit-driven commodified insurance the way we do)? Why not ask why it is that people in those countries would NEVER accept the insecurity, uncertainty, and inhumanity of the sort of system we have?
Tuesday, December 14, 2010
The apologetics roll in
See here.
The basic argument is that the ruling against the mandate is part of one "tradition" of views about U.S. economy, whereas the defense of the mandate represents another. The first "tradition" is laissez faire. The second is a reformist and progressive. The author of the article would have us believe that ObamaCare is part of the reformist tradition of ideas that lend support to Medicare and Social Security.
The facts suggest otherwise. ObamaCare is not a reformist push against the entrenched power of elites... it is a further entrenchment of the power of those very elites. Rather than tampering with capitalism, ObamaCare expands and institutionalizes the for-profit insurance industry and, at the same time, mandates that all Americans purchase their products or face a penalty. Medicare, on the other hand, is an ambitious program that actually displaced private interests for the public good by guaranteeing seniors access to health care.
So, it is just false that we must either defend the individual mandate put into law by ObamaCare, on the one hand, or concede defeat to the laissez faire lunatics on the Right. Putting the point that way obscures what's at stake by making Obama appear as a progressive facing down conservative opposition. In reality, he's basically a conservative defending a conservative idea against conservative opportunists that happen to be in a different faction of the single pro-business party which monopolizes the political process.
It hardly needs to be said that this notion of "two traditions of thought" is basically bullshit for at least two different reasons. First of all, from the perspective of pure intellectual history, these two "traditions" are neither perennially competing nor coherent paradigms unto themselves. The notion of "laissez faire" obscures more than it explains in the real world. It is mere ideology (in the pejorative sense). It is but one idea, marshaled in certain circumstances when others weren't so effective, used to legitimate certain unjust social arrangements. Capitalist economies have never really operated on the basis of "laissez faire", nor could they. Defenders of the inequalities of capitalism have been far more creative and dynamic than the facile idea of a "tradition of laissez faire" suggests. And the supposedly competing "progressive" paradigm is no better. Speaking purely in terms of ideas, views as different as the technocratic reformism of Keynesian economics, the agrarian radicalism of the populists, and the socialist egalitarianism of the early labor movement could all potentially be the referent of such a "paradigm". It is no help to subsume them all under one heading and claim that they were all after a "social minimum" or "safety net".
Second, it's unclear that we should think of the political struggles over reforms in purely ideational terms. We must also talk about material conditions, unexpected historical or economic shifts, organization and struggle, changes in configurations of power, etc. etc. In short, it won't do us any good to talk about the historical change a series of passages from one idea to the next. We forget at our own peril that the dominant ideas in a capitalist society are not the outcome of a free rational discussion open to all; they are often the congealed effects of a certain configuration of power. Marx's sociological way of putting the point is that the ideas of the ruling class are often the ruling ideas. That means that if you control the means of production and distribution of information, you're likely to have a strong impact on the currency of ideas.
Thus, the entire framework of analysis posited in this article is obfuscatory and ideological. Even worse, it misapplies it's own ideological framework and attempts to incorporate ObamaCare into a contrived paradigm to which ObamaCare does not belong.
Mandates, ObamaCare and Social Justice
A U.S. District Judge in Virginia, Henry E. Hudson, has recently ruled that the individual mandate in Obama's health care bill is unconstitutional. When I first read this, I was ambivalent. On the one hand, I've got no love for the Republican boneheads for whom this is a way of trying to assault the entire idea of health care reform. But on the other, I've long felt that the individual mandate is an oppressive, basically conservative idea.
No wonder, then, that the individual mandate was an idea hatched by the Right. As I've noted elsewhere, it emerged as an idea in the early 1970s from Richard Nixon as a response to Ted Kennedy's push for single-payer. As Ezra Klein notes:
The individual mandate began life as a Republican idea. Its earliest appearances in legislation were in the Republican alternatives to the Clinton health-care bill, where it was co-sponsored by such GOP stalwarts as Bob Dole, Orrin G. Hatch and Charles E. Grassley. Later on, it was the centerpiece of then-Gov. Mitt Romney’s health-reform plan in Massachusetts, and then it was included in the Wyden-Bennett bill, which many Republicans signed on to.So, before sympathizing with apologists for Obama and the Dems who will, no doubt, jump to the defense of ObamaCare against the recent ruling (by a conservative, Bush-appointed judge), it's important to understand what's at stake.It was only when the individual mandate appeared in President Obama’s legislation that it became so polarizing on the right. The political logic was clear enough: The individual mandate was the most unpopular piece of the bill (you might remember that Obama’s 2008 campaign plan omitted it, and he frequently attacked Hillary Clinton for endorsing it in her proposal). But as a policy choice, it might prove disastrous.
The individual mandate was created by conservatives who realized that it was the only way to get universal coverage into the private market. Otherwise, insurers turn away the sick, public anger rises, and, eventually, you get some kind of government-run, single-payer system, much as they did in Europe, and much as we have with Medicare.
The range of choices before us is not either (a) Republican non-sense, or (b) whatever Obama puts forward. No, on the contrary, justice itself recommends certain health care ideas and impugns others, regardless of what Obama does or says. Contrary to the beliefs of some of his apologists, he's not God and we're not theistic voluntarists.
Everyone who has spent any time considering the issue of health care can see that single-payer is the most rational and just arrangement. Why, then, should we shed a tear at the demise of a mandate that forces everyone to buy the for-profit health insurance industry's product? I agree with Ezra Klein that we shouldn't shed a tear, because this anti-mandate ruling could even turn out to be a blessing for those who actually believe in real health care reform:
If Republicans succeed in taking [the individual mandate] off the table, they may sign the death warrant for private insurers in America: Eventually, rising cost pressures will force more aggressive reforms than even Obama has proposed, and if conservative judges have made the private market unfixable by removing the most effective way to deal with adverse selection problems, the only alternative will be the very constitutional, but decidedly non-conservative, single-payer path.I'm tempted to say that conditions with or without the mandate will, in the long run, create pressures for more aggressive reforms. But the point is well-taken, the removal of the mandate erodes even the dubious idea that somehow the market could be made to provide "universal coverage".
This may be a setback for Obama, but it is not a setback for progressives who believe in real health care reform.
Sunday, November 7, 2010
(More of) Obama's Legislative Accomplishments
Here. Some context here is helpful. Obama used to tell progressives that he believed in single payer, a position which he subsequently would come to reject. Having rejected the idea of single payer, Obama started off the Democrat primaries in the run-up to the 2008 election with the most conservative health care proposal in the field.
His proposal, essentially a watered-down version of Romney-Care from Massachusetts, has a history that is worth noting. The idea of an individual mandate to purchase private or public insurance emerged in the early 1970s from Richard Nixon as a response to Ted Kennedy's push for single-payer. The idea of a "health care marketplace" was hatched by the right-wing American Enterprise Institute as a response to Clinton's (already weak-sauce) proposal for health care reform. The idea of using a public plan (itself modeled on private plans) to pick up the slack left over after the for-profit plans have cherry-picked all of the least costly individuals to insure, was first put into action by Republican governor Mitt Romney in Massachusetts. So there you have it- basic components components of Obama's proposal emerged from the likes of Richard Nixon, AEI, and Mitt Romney. Progressive indeed.
Now, this is just a brief history of the ideas included in candidate Obama's proposal. The actual bill itself is actually a great deal less ambitious than the Republican-drafted proposal described above. Obama gave up on the public option when it became clear that industry "stakeholders" weren't having any of it (that's funny... I don't remember voting in elections in 2008 determining who the industry "stakeholders" with veto-power over legislation would be, do you?). Moreover, the Democrat's point-person for drafting the bill, Max Baucus, received the most contributions from the health insurance industry of any congressperson in 2008 (don't forget that the industry has something like 5 lobbyists for each member of Congress). All told, the industry spent millions trying to exact concessions from the Democrats, and so far it has proven to be money well-spent.
At every single stop along the way, Obama and the Democrats have compromised and given concessions to the powerful for-profit insurance industry. The priorities of Obama and the Democrats are on display here for all to see.
And, as if all of this wasn't frustrating enough, now it turns out that the Federal Government isn't even interested in enforcing the already tepid bill it passed, as the SW.org article above makes clear.
But just hold on one second- it actually gets worse. Obama and the Democrats signaled even before the Midterms that they are interested in making punishing cuts to Social Security and Medicare. It seems now, in the wake of the Midterms, that the Democrats are going to be even more aggressive in pushing through austerity measures. That means, in short, forcing the majority of the population to pay for the mess caused by reckless financiers and bankers who got bailed out by the Bush and Obama administration. Again, the priorities of the Democrats are on display for all to see. They sold us out to protect the assets of the rich and powerful. This has become something of a guiding theme since the Democrats took back Congress in 2006.
The task of progressives is not to apologize for this kind of right-wing treachery, but to fight it. Voting for the Democrats has little to do with democracy. This is what democracy looks like.
Monday, October 18, 2010
More on Obama's Legislative (Non) Accomplishments
Check this out. As Henwood points out, the already tepid public option was more or less taken off the table because the "stakeholders" (i.e. the for-profit insurance industry, hospital industry, etc.) were virulently opposed to it.
So when you hear liberal apologists for Obama asking that you forget recent events and join in endorsing empty propaganda about how successful Obama's presidency has been for progressives, recall who was calling the shots when health "reform" was being decided. Recall that nothing substantial changed at all, and that the "weak sauce" Public Option was proscribed because Obama cares more about placating powerful capitalists than about the well-being of the American people. And we should be clear not to place all of the blame on him as a person, of course: the entire Washington political system, and especially the Democratic Party, represent Wall Street, not the majority.
Monday, October 11, 2010
Saturday, August 7, 2010
Tuesday, June 8, 2010
Doug Henwood on Obama
The following is from his excellent letter to the editor in the Financial Times:
Financial Times – April 16, 2010
Republicans are in the White House
From Mr Doug Henwood.
Sir, Clive Crook’s call (April 12) for a revival of an old-style GOP opposition is a little strange, since Barack Obama himself is a liberal Republican. Or maybe not so liberal a Republican.
Consider the healthcare bill. The individual mandate has its origins in the Nixon administration’s response to Teddy Kennedy’s single-payer bill in the early 1970s. The insurance marketplace has its roots in the American Enterprise Institute’s response to Bill Clinton’s healthcare scheme. Speaking of Mr Clinton, wasn’t it he who said “we’re all Eisenhower Republicans here”? And he wasn’t too happy about it.
The not-so-liberal Republican part is most visible in education policy. President Obama has continued George W. Bush’s “No child left behind” emphasis on testing and charter schools, and has even taken up attacking teachers’ unions.
Arne Duncan, his education secretary, has declared in terms indistinguishable from Milton Friedman’s that Hurricane Katrina was the best thing that ever happened to the New Orleans school system because it furthered that quasi-privatisation agenda.
Who needs “moderate” Republicans in opposition when they’re already in power?
Doug Henwood,
Left Business Observer,
Brooklyn, NY, US
Sunday, April 11, 2010
Bernard Williams on the Idea of Equality
I recently read Bernard Williams's classic essay "The Idea of Equality" and thought I would share what I took away from it.
In my view, the clear upshot of the essay is that most of the usual objections to equality rely upon misconceptions about what equality requires. It seems to me that there are two objections in particular that the essay shows to be unfounded. The first holds that the idea of equality is absurd (since "people are not, in fact, equal"), the second that equality is trivial (because "the mere fact that we're all human doesn't entail any political vision whatever").
The familiar right-wing mantra about equality is that "it's just a fact that people are different in their abilities, so egalitarian politics is fundamentally misconceived." In other words: "people aren't created equal... they have different amounts of talent and ability, and political claims to equality simply ignore this fact". This is more of a card-trick than an argument.
It's an open question what exactly the fact of human differences in talent actually means. I would say that the range of different abilities between us are rather small in proportion to what we share in common. But even the standard deviation is quite large, you cannot unproblematically move from observing certain inequalities (be they social or "natural") to the claim that these inequalities should be the justification for social/political hierarchies. That's a bait and switch.
A statement to the effect that people are not equal in abilities, say, does not entail that people should not be morally or politically equal. By moral or political equality, I mean the kind of equality wherein all people, insofar as they are people, are owed equal consideration or are owed equal standing (or an equal voice) in matters of politics, law, and so on. If you disagree, then you should have no problem saying that people who are extraordinarily good at tennis, say, should have more votes than others who aren't so talented. It's not even clear that such a claim would make sense. Quite obviously, one kind of inequality simply doesn't follow from the other.
So, when egalitarians claim that all people are equal, they are not saying that all people are "equal in their skill, intelligence, strength or virtue". Instead, as Williams makes clear, the egalitarian claim is that all people are equal insofar as they are all people: "it is their common humanity that constitutes their equality".
Now this might strike you as trivially true. But I am with Williams in thinking that this claim still has unrealized critical potential.
For example, when Williams wrote this article (in the late 50s/early 60s) it was quite obviously not a trivial political claim (and, I would add, it is still non-trivial). As he himself points out, the deep-seated racial injustice of Jim Crow in the US was basically premised on the idea that black people were not people in the full sense. This is why the slogan "I am a man" had such critical bite and emancipatory power.
And this is only one example. History (as well as the present global order) is littered with hierarchical social formations in which political arrangements systematically neglected this obvious common humanity between people by treating some as though they didn't possess certain human capacities (e.g. the ability to speak a language, use tools, live in societies, feel pain and affection, the capacity for creativity, virtue and so on) that we all obviously possess.
And we should understand the arguments against common humanity for what they are: irrational rationalizations or ad hoc apologetics for political domination. That is, they aren't well-thought-through moral or political theories: they are merely window-dressing for domination and hierarchy. Thus, in the face of such views, it is surely not trivial to reassert the "apparent platitude that all people are, in fact, human".
But if we all share a common humanity, what would it mean to respect someone as a common human being? What political content does this claim have?
Let's consider first what it wouldn't mean. To respect (or relate to) someone merely as an occupant of a certain given social role, status or title would not yet be to respect them as a person. This technical or professional attitude or way of seeing others is deeply flawed and limiting: whereas this attitude regards others solely in terms of titles of this kind, a "human approach would regard others as persons who happen to have a certain title (among others), willingly, unwillingly, through lack of alternatives, with pride, etc." Respecting people as fellow human beings would not be to regard them "merely under professional, social or technical titles, but with consideration of their own views and purposes". In other words, the human approach "enjoins us not to let our fundamental attitudes toward others be dictated by the criteria of technical success or social position, and not to take them at the value carried by these titles and the structures in which these titles place them".
Now you might be tempted to read this suggestion to take a more "human approach" as implying that we should try to see other people and the roles they occupy from the "others' point of view", i.e. in light of their "own views and purposes". But this line of reasoning is fraught with difficulty. As Williams points out:"there are forms of exploiting men [sic] or degrading them which would be thought to be excluded by these notions, but which cannot be excluded merely by considering how the exploited or degraded men [sic] see the situation. For it is precisely a mark of extreme exploitation or degradation that those who suffer it do not see themselves differently from the ways that they are seen by the exploiters... they may in some cases acquiesce passively in the role for which they have been cast".
This is consonant with Malcolm X's powerful challenge to black people in the early 1960s: "who taught you to hate yourself?". The idea was that black people had, over time, come to internalize white supremacist norms in such a way that they needed to be cognitively liberated from an entire way of seeing the world that tended to justify (rather than resist) the white power structure. The same could be said about the way that women may internalize or are socialized into accept certain oppressive social roles that serve to maintain their continued oppression. In both cases, it is a condition of emancipation that the oppressed throw off the conceptual framework they've inherited from oppressive social conditions.
Williams argues here that "we evidently need something more than the precept that one should restrict and try to understand another man's [sic] consciousness of his [sic] own activities; it is also that one may not suppress or destroy that consciousness".
All of us, all human beings, are potentially conscious of how social structure influences our ideas about our role in society. But not everyone, as a matter of fact, is actually conscious in this way (this is why "consciousness raising" is an intelligible political activity). As Williams points out:"it is precisely one element in the notion of exploitation that such consciousness can be decreased by social action and the environment; we may add that it can similarly be increased... all human beings are capable of reflectively standing back from the roles and positions in which they are cast; and this reflective consciousness may be enhanced or diminished by their social condition".
One way that hierarchical political arrangements are maintained is by the idea of necessity: "the oppressed are made to believe that it is somehow foreordained or inevitable that there should be these orders; and this idea of necessity must be eventually undermined by the growth of people's reflective consciousness about their role, still more when it is combined with the thought that what they and the others have always thought about their roles in the system was the product of the social system itself".
From here Williams goes on to discuss what this understanding of equality would be mean if applied to basic social and economic institutions. Here again, Williams helpfully demolishes some conceptual confusions that often allow the Right to strawperson arguments for increased social/economic equality.
First, Williams starts off with a distinction between (1) inequality of need, and (2) inequality of merit, and thus: (1') goods demanded by need and (2') goods that can be earned by merit. Goods of the second sort typically have a competitive aspect lacking in the case of the first sort of goods that correspond to needs.
The example of (1) that Williams examines is the case of need for medical treatment. Williams holds that the structure of social institutions involved in delivering health care should be organized in such a way as to fulfill this basic function: the only proper ground of distribution of medical care is ill health, which is to say need.
Yet in many societies (e.g. the US, in spite of recent "reform") the possession of sufficient amounts of money becomes a necessary condition of actually receiving treatment. Williams argues that this is irrational. The good in question, medical care, is not like a trophy or a medal for winning a competition. It is indexed to human needs, and it does not make any sense whatsoever to ration medical care according to competitive ideas such as "merit" or "financial achievement" that are alleged to attach to the wealthy (side note: I register my skepticism that the wealthy and powerful are wealthy and powerful merely because of "merit").
Why is it irrational to structure health care institutions in this way? Because, Williams argues, this way of structuring health care (according to "merit") is not appropriate to the sort of thing health care is. We don't think of health care as a luxury, or privilege, or trophy-like achievement. That's simply not the sort of thing it is. If you want to understand the sort of good that medical care is, if you want to understand its proper function, you wouldn't think of it in the same way that we think of goods such as winning the Pulitzer Prize, for example. Medical care simply isn't the same sort of thing as a trophy or medal. Medical treatment attaches to human need, not to merit or competitive norms that we attach to, say, a bicycle race. The upshot is that we should organize health care institutions according to rational principles, viz. according to principles appropriate to the kind of good that medical care is.
The operative idea here is that there are different kinds of goods, and they should be distributed with these differences in mind. Conceptual clarity here helps to demolish the dismissive (and rather obtuse) attitude towards equality harbored by those on the Right. There are at least three kinds of goods relevant to our discussion here:
Importantly, the aim of these distinctions is to demolish the following Right wing "argument":The Left argues that everyone should have medical care and education, but that's like saying everyone should be allowed to win the Nobel Prize. It's just a fact that there are going to be winners and losers, and therefore we shouldn't try to secure, for example, health care for all.
It should be clear now why this "argument" is invalid: it conflates different kinds of goods and suggests (falsely) that medical treatment is the a similar good to winning a gold medal in the Olympics. There is no tension in thinking that, on the one hand, gold medals should be awarded on the basis of athletic achievement in a competition, and on the other that access to medical care should be distributed merely according to need. They are vastly different kinds of goods. And to think that they're the same is either to do something disingenuous and sneaky, or it's to be wildly mistaken about the sorts of things that gold medals and medical treatment are.
We need to distribute and value goods according to the sorts of good that they are. We should not assume that the exchange-value logic of capitalists markets is the only kind of value there is. Often this form of evaluation is totally inappropriate to many things we value (e.g. friendship, love, and so forth).
This mistake is submitted to severe scrutiny in Elizabeth Anderson's excellent Value in Ethics and Economics (Harvard: 1993). Her argument is that we value different things in different ways, according to the features of the thing in question. It would thus be a serious mistake to assume, as economists often do, that we value all things in precisely the same way (i.e. as satisfying mathematically equivalent "consumer preferences").
Thus Anderson attacks this way of thinking (common on the Right) that assumes that value is univocal and may be commonly measured by cash value. Different goods, Anderson argues, "differ in kind and quality: they differ not only in how much we should value them, but in how we should value them". Anderson thus concludes that everything shouldn't be put up for sale: universal commodification is irrational.
Consider the following example. Treating something like a commodity means asserting that its value can be expressed in a price. But this evaluative attitude is not appropriate to everything: we don't think its appropriate to put human beings up for sale because this fails to properly value them. Assigning exchange-values to human beings misunderstands what human beings are. Assigning a price to human life doesn't merely undervalue human beings: it misvalues them.
There are numerous other examples. Education, we tend to think, is a "primary social good" of the Rawlsian sort if there ever was one: education is something that every person wants, whatever else it is that they may want. And if that's true of the sort of thing it is, then it would be absurd to think that education should be commodified and subject to market forces. This would be misunderstand the kind of thing education is: education is not like an iphone or a luxury item. Assigning a market price to education and rationing it according to ability to pay is to misvalue education. Education is not a commodity, and thinking of it in these terms is to systematically distort its significance.
Wednesday, March 31, 2010
When Wall Street loves reform
Read SW editorial on the health bill here. Here's an excerpt:
Indeed, for many people who are sick and tired of conservatives getting their way, the bill's passage signaled a potential shift in the political winds in Washington. So after months when it appeared that the right was making a big comeback, the health care reform could translate into a growing confidence that working people can make real progress today after all.
The question is, how are such gains to be made? If matters are left to the Democrats, we'll see a repeat of the health care reform debacle, in which widespread demand for fundamental change is diverted into weak legislation that leaves powerful economic interests unchallenged.
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.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.
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.
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.
Monday, March 22, 2010
Krugman's Prescient 2006 Words
(via New York Review of Books)
A mere shift of power from Republicans to Democrats would not, in itself, be enough to give us sensible health care reform. While Democrats would have written a less perverse drug bill, it's not clear that they are ready to embrace a single-payer system. Even liberal economists and scholars at progressive think tanks tend to shy away from proposing a straightforward system of national health insurance. Instead, they propose fairly complex compromise plans. Typically, such plans try to achieve universal coverage by requiring everyone to buy health insurance, the way everyone is forced to buy car insurance, and deal with those who can't afford to purchase insurance through a system of subsidies. Proponents of such plans make a few arguments for their superiority to a single-payer system, mainly the (dubious) claim that single-payer would reduce medical innovation. But the main reason for not proposing single-payer is political fear: reformers believe that private insurers are too powerful to cut out of the loop, and that a single-payer plan would be too easily demonized by business and political propagandists as "big government."
These are the same political calculations that led Bill Clinton to reject a single-payer system in 1993, even though his advisers believed that a single-payer system would be the least expensive way to provide universal coverage. Instead, he proposed a complex plan designed to preserve a role for private health insurers. But the plan backfired. The insurers opposed it anyway, most famously with their "Harry and Louise" ads. And the plan's complexity left the public baffled.
We believe that the compromise plans being proposed by the cautious reformers would run into the same political problems, and that it would be politically smarter as well as economically superior to go for broke: to propose a straightforward single-payer system, and try to sell voters on the huge advantages such a system would bring. But this would mean taking on the drug and insurance companies rather than trying to co-opt them, and even progressive policy wonks, let alone Democratic politicians, still seem too timid to do that.
Compare this with his claim yesterday that the bill in congress represents a "triumph for the American soul".
Healthcare "reform" passes: Roundup
It has passed. Well, something has passed, at least. It isn't single-payer, it doesn't even contain a public option, and it doesn't even pretend to insure everyone. Here's a look at today's opining (sans the expected Republican hysterics which will only get your blood boiling):
Timothy Noah at Slate gets hopeful about the future of healthcare, based on the student loan reforms in the bill, which cut out private banking middlemen.
Jon Walker at FDL details the six greatest flaws of the bill.
Jos at feministing breaks down the good (more people will have insurance) and the bad (anti-woman, anti-immigrant).
Ezra Klein is doing some hard work over at his WaPo blog, trying to explain the ins and outs of the bill and when they go into effect. Particularly interesting is his effort to put the size of what is being called the biggest social policy bill ever into some real perspective.
Dana Goldstein at The Daily Beast on what a betrayal Obama's last-minute executive order is for reproductive rights.
HuffPo lays out ten immediate benefits you might get from the bill.
And Dr. Margaret Flowers at Monthly Review calls this "a step backwards"
And former Bush speechwriter David Frum says healthcare reform will be Republicans' Waterloo, lamenting:
No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?
Thursday, February 25, 2010
Bullshit on stilts
said Senator Max Baucus, Democrat of Montana. “I just believe in the disinfectant of the sunshine. The more we have got questions on both sides, gradually the American people are going to see more and more and more that we really do need health care reform.”Complete robotic balderdash. I could be a Democratic Senator, it's easy. Just keep repeating nonsense like this over and over: "both sides" "American people" "bipartisanship" "moderation", "good ideas" blah blah blah. And for that matter, I could get a job as a political analyst with the New York Times without changing my tune. Take a listen:
"Mr. Obama will face adversaries who are well prepared to joust with him on the finer points of health policy before a large audience that will be judging both sides and looking for signs of bipartisanship."Let's see what we have here. The NY Times is telling everyone that they're looking "for signs of bipartisanship". Are they? Do we have any basis whatever for this claim? If that's true, then why did so many people vote for Democrats in 2008 if they were first and foremost concerned about this nebulous idea of "reaching across the aisle"? If we don't have any determinate idea about what should be done and which party should do it, why do we even have elections?
[..]
"One way Mr. Obama could throw Republicans off stride would be to make a bold opening offer to embrace one of their health care priorities, like limiting medical malpractice lawsuits — an idea one Democrat close to the White House said had been under consideration."
What else is the NY Times pontificating about? Well, they've got a brilliant strategy that would enable Obama to "throw the Republicans off stride". Evidently what he should do is start off the negotiation by offering to embrace "tort reform". What a brilliant idea, indeed, one that has worked wonders for Obama throughout his presidency so far. In effect the advice is to focus on "bipartisanship" in itself, rather than the ostensible goal of whatever policy is in question.
Why doesn't he just ask the Republicans nicely and then claim that they're "mean" if they say no?
Suppose you're buying a car. In a capitalist society, buyers and sellers are pitted against one another in an agnostic relationship in which their interests fundamentally diverge. Buyers want to purchase low and sellers want to sell high.
Now, you don't walk up to the salesperson and begin by offering them some piece of "what they want" and expect them to then to reciprocate. Market transactions are not reciprocal (and this, in my view, is a knock against the market itself). What the salesperson will do in this case is simply continue their strategy of trying to get the highest price they can. That is their goal, not trying to arrive at some compromise because that has some intrinsic worth.
If you start off with a tepid demand, the effect of more compromise is an even more watered-down and tepid demand.
Health care isn't a "debate", it isn't a "compromise" and it isn't a "conversation". It is a power struggle. Whatever ends up in the final bill will be the result of the relative balance of power (broadly construed). And we forget this at our own peril.
The ideological fantasies pedalled by the NY Times under the guise of "analysis" obscures the basic facts about how politics functions in a society like ours. The Republicans (even less than the Democrats) don't care about health care reform: their goal is to derail it and forestall and serious change. Does anyone really doubt that this is true?
The Democrats realize something has to change, but their goal is to "change" it in such a way that nothing important really changes. This is, admittedly, less obvious to many people, but no less true. Of course, is the paper of record actually stuck to gathering the appropriate facts and scrutinizing the statements of politicians.... perhaps it would be more obvious than it is at present.
Friday, February 19, 2010
Distortions in the health care "debate"
In the past, I've written on this blog about the discourse of "soaring prices" in the health care debate. These ideas about "soaring prices" are again circulating in the discourse as people in California are hit hard by steep increase in premiums.
Absurdly, Paul Krugman (who certainly knows better) claims that "we need comprehensive, guaranteed coverage — which is exactly what Democrats are trying to accomplish". Of course he's right that we need comprehensive reforms and universal, guaranteed coverage. But even the left-liberal reader of Krugman's own columns should be well aware that this is not what is on offer in the Democrat bill in Congress.
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.
The crucial question here (which is frozen out of the discussion altogether) is whether we should accept as legitimate the entire idea that health care is a mere commodity, and that health and well-being is merely a consumer preference. To drive the point home: why should we think that the best way of organizing health care institutions is along the axes of consumption, markets, and capitalist enterprises at all? Is a "preference" for health really analogous to a "preference" for Gucci?
My view is that the above ways of organizing health care institutions is ludicrous. This way of configuring the health care system is only attractive from the narrow perspective of investors and stakeholders in the (extremely lucrative) for-profit firms that dominate the "industry".
Think about it this way. With the exception of the top 1% of earners, nobody in the contemporary United States can afford to pay out of pocket for all of their medical needs. Even the very-well off (those making, say, $350,000/yr) would quickly find themselves bankrupt if they had to pay entirely out of pocket for cancer treatment.
Thus, for the vast majority of people (99% of us) insurance of some kind is required in a society such as ours. All of the talk of "just you and your doctor" is pure fantasy. Some kind of collective financing (i.e. insurance) for health care is unavoidable for everyone except for the super-rich. And we should not forget that insurance, by its very nature, is necessarily collective. Risks, costs, and so on are always weighed and calculated in large, collective contexts. Every premium, co-pay, deductible and so on is indexed to a host of collective considerations that the insurance company has.
So given that insurance is a necessity in a capitalist society such as ours, the question then becomes: what kind of insurance do we (as a society) want?
The obvious answer is that we (i.e. everyone) would want the most extensive, efficient, stable and guaranteed access to health care that is possible.
Now, nobody claims that institutions of this kind are "free", so a question then arises about how to best collect the necessary funds from a highly unequal society to pay for it. The answer to this question is simple: people should be required to pay according to their means. We should not ask people making $20,000/yr to pay the same flat rate as those earning $220,000/yr. That would not make any sense.
The simplest, least bureaucratic way of collecting these funds is by simply increasing the marginal tax rate. Notice that this would mean no more premiums, no more deductibles, no more copays. As long as you'd paid your taxes for the year, you would therefore have already paid every single health bill as well.
Notice also that simply increasing marginal taxation as a way of collecting funds means that we wouldn't need any new health insurance paperwork. We could just use existing paperwork. That is to say, this would entirely eliminate all of the atrocious wasteful bureaucracy associated with filing claims and determining patient eligibility. Under the current for-profit insurance regime, most doctors, for example, have to pay full-time staff whose only job is to sort through the labyrinth of different complicated forms associated with thousands of different insurance plans. Our current system is a bureaucratic nightmare whose fragmented, tangled mess of plans, policies, deductibles and copays are a constant source of frustration. This need not be so.
Notice also that this needless bureaucracy and billing is a waste of social resources: we should be spending that money on covering more people, building more hospitals, and training more doctors and nurses. We should not waste important dollars of our insurance payments on needless bureaucracy, advertising and silver lining for investors.
What we need is one large institution, one set of forms, and one huge collective pool of people in order to streamline paperwork and spread risk as widely across the population as possible. Everybody in, nobody out.
But the way current institutions are organized, all of the criteria above are subordinated to the demands of profit maximization. For instance, the person in need of medical attention is simply not recognized as a person in need at all: they are a merely unit of production from whom profits may or may not be effectively extracted. They are numbers on a screen. This is the reality of health care organizations whose operating principles are indexed to profits rather than to human needs.
Wednesday, December 16, 2009
Sanders Ammendment being debated now!
(via HC-NOW!):
Bernie Sanders has introduced an amendment extending Medicare to all americans. Watch it being debated in the Senate on CSPAN right now!
Friday, October 30, 2009
Excellent Paul Krugman article on Health Care
It's an oldie but a goodie. Read it here.
Here's a basic statement of one fundamental irrationality in our private health insurance system:
Can you see how these deep-seated structural problems with private insurance will be solved either by the current 'reform' bill, or by a 'public option'? Neither can I.[T]he only way modern medical care can be made available to anyone other than the very rich is through health insurance. Yet it's very difficult for the private sector to provide such insurance, because health insurance suffers from a particularly acute case of a well-known economic problem known as adverse selection. Here's how it works: imagine an insurer who offered policies to anyone, with the annual premium set to cover the average person's health care expenses, plus the administrative costs of running the insurance company. Who would sign up? The answer, unfortunately, is that the insurer's customers wouldn't be a representative sample of the population. Healthy people, with little reason to expect high medical bills, would probably shun policies priced to reflect the average person's health costs. On the other hand, unhealthy people would find the policies very attractive.
You can see where this is going. The insurance company would quickly find that because its clientele was tilted toward those with high medical costs, its actual costs per customer were much higher than those of the average member of the population. So it would have to raise premiums to cover those higher costs. However, this would disproportionately drive off its healthier customers, leaving it with an even less healthy customer base, requiring a further rise in premiums, and so on.
Insurance companies deal with these problems, to some extent, by carefully screening applicants to identify those with a high risk of needing expensive treatment, and either rejecting such applicants or charging them higher premiums. But such screening is itself expensive. Furthermore, it tends to screen out exactly those who most need insurance.
The often-repeated mantra on the "center left" that we need to sit down, crunch numbers, and try anything and everything that might "work" is disingenuous. All of this faux-pragmatist garbage from Obama is not only false, but patronizing. We don't need to sit around and listen to 'all the best ideas' and continue to be 'open minded'. We need to realize that the 'conversation' going on right now isn't a discussion among fair-minded participants all aiming at getting things right; the 'conversation' is merely a proxy for a political struggle between divergent interests (e.g. maintaining the economic power of some vs. realizing universalizable interests like securing universal coverage).
The "pragmatic" truth here is that it is obvious what a rational, just, efficient health care system would look like. Despite the complications introduced into the discussion by Obama and co., this is not a complicated issue whatsoever. The only complicated question here should be how to most effectively fight against powerful industry interests and free-market fundamentalism.
Here's a simple question that we are publicly barred from asking: what purpose should our health care institutions serve? In other words, what should be the raison d'etre of insurance as an institution?
Answer: to provide the best quality health care to the greatest number of people for the lowest cost.
This seems painfully obvious. But think about what this 'purpose' is not: ensuring that doctors and hospitals earn maximally high amounts of money, ensuring that the interests of health industry investors are put above all else, etc.
The first principle of insurance is that the larger the pool of people inside, the lower the risk for all. A trivial feature of market exchanges is that when you buy in larger quantities, you get lower prices because you have more bargaining power as a consumer. Whole-sale is cheaper than retail.
The obvious next step would be to conclude that a rational and efficient health insurance scheme would include everyone (to minimize risk) and would use its massive purchasing power to get better deals with health providers. In other words, the obvious conclusion is that single-payer is the most rational and efficient means of attaining the ends identified above as the purpose of health insurance (to cover the most people for the lowest cost). The fact that single-payer would completely eliminate the absurd bureaucratic waste (from screening, advertising, unnecessary forms, overhead, etc.) required by having tons of different private insurers is only icing on the cake.
Here's another question: what is the purpose or raison d'etre of the massively fragmented web of private insurance companies that constitute a large bulk of our system?
Answer: they exist to make profit for those who own them, full stop.
The incentives driving the organizational structure and actions of these institutions are reducible to a drive to make money. Everything else is instrumental in realizing that obvious goal. What benefits the system may yield for some are merely incidental.
Why then is anyone surprised that our health system does such a terrible job? It isn't even designed to do what any reasonable person agrees is the raison d'etre of health insurance. But what it is designed to do, it does quite well.
Getting upset that our health insurance system is 'flawed' is like getting angry at pencil sharpener for not being a toaster.
Our system is irrational, inefficient, unnecessarily labyrinthine, and unjust. A 'reform' effort that countenances any of these profound problems is anything but. As Krugman put it in 2006:
So what will really happen to American health care? Many people in this field believe that in the end America will end up with national health insurance, and perhaps with a lot of direct government provision of health care, simply because nothing else works. But things may have to get much worse before reality can break through the combination of powerful interest groups and free-market ideology.
