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 So I ask you: if you really care about genuine health care reform, what do we stand to lose if ObamaCare is repealed?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?
Showing posts with label single-payer. Show all posts
Showing posts with label single-payer. Show all posts
Thursday, January 6, 2011
What would we lose?
Tuesday, December 14, 2010
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 11, 2010
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, 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.
Wednesday, August 19, 2009
Raymond Geuss on the discourse of "soaring prices"
Much of the terrain of recent health care 'debates' has been fought over how to hold down 'soaring' or 'excessive' costs. As this helpful interactive history of health reform makes clear, this is not new. Today the issue is again framed as one of 'excessive' costs. Yet in any reasonably comprehensive discussion of health care reform talk of costs should be marginal, at best.
What about, for instance, the justifiability of subjecting access to health care to market forces at all? What about the status of access to health care: is it a 'human right', as a matter of social justice should everyone have access to basic medical care? Should the institutions responsible for financing people's access to health care be run by profiteers who ration care according to the dictates of profit-maximizing calculations? Should access to health care be thought of in the same way that we think of any other commodity? All of these crucial questions are totally lost in the fray of the technocratic quibbling over 'soaring costs'. As Geuss presciently explained in his most recent book published last December:
"Diverting attention from the way in which certain beliefs, desires, attitudes, or values are the result of particular power relations, can be a sophisticated way of contributing to the maintenance of an ideology, and one that will be relatively immune to the normal forms of empirical refutation. If I claim (falsely) that all human societies, or all human societies at a certain level of economic development, have a 'free market' in health services, that is a claim that can be demonstrated to be false. On the other hand, if I focus your attention in a very intense way on the various different tariffs and pricing schema that doctors or hospitals or drug companies impose for their products and services, and if I become morally outraged by "excessive" costs some drug companies charge, discussing at great length the relative rates of profit in different sectors of the economy, and pressing the moral claims of patients, it is not at all obvious that anything I say may be straightforwardly "false"; after all, who knows what "excessive" means? However, by proceeding in just this way I might well focus your attention on narrow issues of "just" pricing, turning it away from more pressing issues about the acceptance in some societies of the very existence of a "free market" for drugs and medical services. One can even argue that the more outraged I become about the excessive price the more I obscure the underlying issue.... relatively marginal issues come to be presented as though they were central and essential."- From his Philosophy and Real Politics (Princeton UP, 2009).As Geuss makes clear, the more intensely we are encouraged to focus in on issues of pricing, the more the underlying issues are obscured. The debates over HMO's in the late 60s and early 70s were fought over issues of 'soaring prices', which makes painfully clear how easily the uproar over 'unjust pricing' can be appropriated by the Right. Its not a far reach from the language of 'soaring costs' to move quickly into a fiscally austere, cost-cutting and belt-tightening orientation toward social spending as such. We have already seen some of this right-wing appropriation latent in complaints about 'greedy doctors', which as a friend pointed out to me recently, threatens to become the new 'welfare queen'.
This is not to say that thinking of large, aggregate social costs is not important when devising how the reform of health insurance institutions must proceed. But talking about large, macro issues is a qualitatively different activity from the depoliticized rabble rousing about costs lighting up the 24-hour cable news circuit. The quibbling about costs to individuals says nothing of how much of GDP is spent on health care, how much tax revenue is available to be spent on health care and how best to collect it, how much per capita is spent at present compared to other rich capitalist nations, how much private health insurers set aside for their own enrichment, for advertising, for needless bureaucracy and overhead.
To passively adopt the language of costs is already to accept an entirely unjust set of institutional arrangements. It is to accept the idea that access to health care is a commodity floating amidst a fray of market forces.
Friday, August 7, 2009
GritTV: Rep. Weiner puts Single Payer on the Table
I'm not sure I understand the logic of getting a vote on Single-Payer. I think I'm sympathetic to the argument that Single-Payer should be part of the discussion to give the Left leverage over the conversation, in effect, pushing the entire debate to the Left. But what will an up or down vote do? I'm not sure I see the point. I suppose any publicity is better than none, and perhaps forcing a discussion by any means necessary is what's going here, but I'm not clear if this is the motivation or not.
I must say, as disgusted as I was with the modesty of Obama's plan and the way in which Single-Payer was locked out of forums purporting to 'put all options on the table', I am ready to start struggling just to get Obama's plan passed. Faced with the prospect of yet another right-wing foot-dragging assault on reform, I think I am ready to table medicare-for-all demands for the moment and start struggling against these kooks who watch Glen Beck or whatever. Perhaps the best way to participate is to air the medicare-for-all argument in order to balance out the complete morons who are whining about 'stalinism', etc.
Thoughts?
Tuesday, June 30, 2009
SW.org Editorial on Health Care
Read the rest here."WARNING: THE federal government is poised to commit robbery. And the poor, defenseless victim is...the health insurance industry.
Say what?
That's what top executives of the health care industry and the politicians who represent them want you to believe about the Obama administration's health care reform proposal--because the White House is promoting (with a lot of qualifications) the so-called "public option": a government-run program that the uninsured could choose in order to get coverage.
"We don't believe that it is possible to create a government plan that could operate on a level playing field," moaned Karen Ignagni, president of the insurance industry's lobbying group, and Scott Serota, president of the Blue Cross and Blue Shield Association, in a letter to senators. "Regardless of how it is initially structured, a government plan would use its built-in advantages to take over the health insurance market."
Thursday, June 25, 2009
Eliminate private-insurance profits
From a letter to the Editor in the NYTimes today:
"To the Editor:
Re: .Democrats Study New Ideas to Cut Health Plan Cost. (front page, June 19): Congress appears poised to adopt a health care compromise that leaves most Americans worse off than they are. Both parties have apparently bought the convenient new mantra that everyone is .overtreated. and that the way to reduce medical costs is to make everyone buy .coverage,. pay doctors less and give everyone less actual care.
The real way to save money . eliminating or at least restricting the profits of the insurance companies . is never seriously considered.
The original objective of assuring universal access to affordable comprehensive health care seems dead on arrival. The question is reduced to how the private insurance companies will be paid for policies employers or individuals will have to buy . coverage that will look good on paper but cost too much in deductibles and co-payments for many people to use. Is this the .reform. we were promised in return for electing President Obama and a Democratic Congress?
Judy Olinick
Middlebury, Vt., June 19, 2009"
That seems to sum it up rather well.
Monday, June 22, 2009
Max Baucus recieved most $$ from health insurance lobby of any member of Congress
(Via Democracy Now):
"Montana Senator Max Baucus, the chair of the Senate Finance Committee, is the Senate’s point man on healthcare reform. A new article in the Montana Standard finds that Senator Baucus has received more campaign money from health and insurance industry interests than any other member of Congress."
Watch more here.
Hmmmm. Whoever argued that public-financing of elections is a necessary precursor to having single-payer in this country was probably correct.
But seriously... why isn't this grounds for discrediting him and removing him from his post as chairman? If this isn't a conflict of interest, what is?
Wednesday, June 17, 2009
"Gummint-run health care is a disaster"
As if these sorts of folks needed any help looking ridiculous, try substituting "Fire Department" in for "Health Care" every time you see/hear some blathering screed against "universal health care". The result is that what they say should even make them look ridiculous by their own lights.
For instance: "If the government runs the [Fire Department], I hope you're prepared to see massive administrative bloat, huge bureaucracies, and ungodly amounts of paperwork. Moreover, all of the loafers and invalids will be capitalizing on the hard work of others. We can't just give away [Fire Protection Services] to everyone! Just ask yourself this, do you want BUREAUCRATS [putting out fires] or do you want a free-enterprise system?"
If this argument is correct, why not launch a huge campaign to privatize Fire Departments in order to have a free-market Fire Protection system? Why not introduce a system where individuals purchase their own fire-protection policy on a market where policies are sold by various for-profit companies? If your house catches on fire and you happen not to have the proper insurance policy against fires, well, too fucking bad. Burn baby burn. Sounds great, right?
(for even more absurd consequences of this argument, try and imagine a fully privatized police force, or better yet, a fully private market-based set of military institutions, who only protect those who have the money to purchase an 'anti-coercion insurance policy' on a market...)
These people's (those who huff and puff about 'socialized medicine') obsession with 'bureaucrats' is incredible. Don't they realize that (1) bureaucracies are an intractable feature of complex contemporary capitalists societies, which obviously includes institutions run by capitalists (tell me CIGNA isn't a huge bureaucracy!) and (2) there are already massive amounts of 'bureaucrats', or desk-top murderers if you like, who decide whether or not you get the care you need? They work for the current private, for-profit insurers and their positions would no longer exist under a single-payer system (i.e. you nix advertising and marketing, 'patient eligibility' claims officers, debt. collection agents, etc.). What's worse, these capitalist-driven bureaucrats ration the public's access to health care, only their metric for rationing isn't whether we can grant access to the largest possible number of people, but rather how best the company can maximize profits for its ownership.
Geez, can't these people be bothered to read some Weber? 'Bureaucrats' of some sort or other are involved in just about every major social institution that people rely upon on a daily basis, most of which are all private, for-profit enterprises.
Saturday, June 13, 2009
Hoover-Obama
Another short excerpt from the Kevin Baker piece in Harper's:
"Speeches almost as powerful have followed, always linking these ideasYeah, check older posts on this blog about Obama, unions and EFCA. He said to sold-out crowds that he would "stand up and fight for EFCA, rather than just waiting for it to arrive at his desk". This shouldn't really be surprising. But its still disappointing to think about how many people in the union movement mobilized to help get Obama elected, just to seem him prove what they should have realized would happen all along: He'd do what Democrats do best, and bow to Capital when push comes to shove.
together. But, like Hoover, Obama has been unable to make his actions
live up to his words. Health care is being gummed to death on Capitol
Hill. Obama has done nothing to pass “card check” provisions that
would facilitate union organization and quietly announced that he
would not seek stronger labor and environmental protections in
NAFTA. He has capitulated on cap-and-trade in the budget outline and
never even bothered to push for an actual carbon tax. Only minuscule
portions of the stimulus bill or his budget proposals were dedicated to
mass transit, and his indifference to the issue—what must be a major
component of any serious effort to go green—was reflected in his ap-
pointment of a mediocre Republican time-server, Ray LaHood, as his
transportation secretary.
Still worse is Obama’s decision to leave the reordering of the financial
world solely to Larry Summers and Timothy Geithner, both of whom
played such a major role in deregulating Wall Street and bringing on the
disaster in the fi rst place. It’s as if, after winning election in 1932, FDR had
brought Andrew Mellon back to the Treasury. Just as Herbert Hoover
could not, in the end, break away from the best economic advice of the
1920s, Barack Obama is sticking with the “key men” of the 1990s."
Telling us what's off the table
From Kevin Baker's generally excellent "Barack Hoover Obama" in the most recent Harper's:
"When it came to the opposition, Franklin Roosevelt reaped the creative support of any number of progressive Republicans throughout his twelve years in offi ce, ranging from New York Mayor Fiorello La Guardia to Nebraska Senator George Norris to key cabinet members such as Henry A. Wallace, Harold Ickes, Henry Stimson, and Frank Knox. Obama, by contrast, has had to contend with a knee-jerk rejectionist Republican Party. More frustrating has been the torpor among Obama’s fellow Democrats. One might have assumed that the adrenaline rush of regaining power after decades of conservative hegemony, not to mention relief at surviving the depredations of the Bush years, or losing the vestigial tail of the white Southern branch of the party, would have liberated congressional Democrats to loose a burst of pent-up, imaginative liberal initiatives.
Instead, we have seen a parade of aged satraps from vast, windy places stepping forward to tell us what is off the table. Every week, there is another Max Baucus of Montana, another Kent Conrad of North Dakota, another Ben Nelson of Nebraska, huffing and puffing and harrumphing that we had better forget about single-payer health care, a carbon tax, nationalizing the banks, funding for mass transit, closing tax loopholes for the rich. These are men with tiny constituencies who sat for decades in the Senate without doing or saying anything of note, who acquiesced shamelessly to the worst abuses of the Bush Administration and who come forward now to chide the president for not concentrating enough on reducing the budget defi cit, or for “trying to do too much,” as if he were as old and as indolent as they are."
Yeah, and who the fuck is Max Baucus anyway?
Thursday, June 11, 2009
Private interests masquerading as universal interests
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?
Thursday, May 28, 2009
Fire engines and emergency rooms
If your house is on fire in the United States, firefighters come to put it out and save your life.
You don't receive any bills. You don't have to purchase a monthly fire protection service whose prices fluctuate according to market conditions and the demands of profitability.
You just get the service you need, when you need it. No red tape. No fees. No needless bureaucracy. Things are simple.
That's what happens if your house is on fire. But if you have a medical emergency, its a completely different story.
This is how things might go assuming you are not one of the 50 million Americans who has no health insurance at all. Imagine you break your arm and go to the emergency room. You get the immediate care you need and get released the next day. On your way out, you stop by a department of the hospital where you're to pay and fill out the appropriate insurance information (in the U.K., for example, such departments do not exist).
That wasn't so bad, right? I mean, even though you may be paying costly premiums, deductibles and co-pays, at least you're covered, right?
Until 5 months later you get a call from the hospital (or a debt collection agency paid by the hospital) demanding that you pay for your visit. You owe some ridiculous sum of money, they claim. Say, $10,000. "But I'm insured" you say to yourself. You check into things and find out that your insurance company doesn't want to cover the treatment because it was 'experimental' or because it derived from a 'pre-existing condition'. So they claim that they aren't going to pay. You press them, and they claim that they aren't going to budge.
Somehow, things get straightened out and it appears that the insurance company is going to pay for some of it. Whew. Glad that's over.
Until a year later you get a bill from the hospital demanding some smaller sum of cash that you still 'owe' them. It turns out, that the insurance company has refused to pay for 2 bandaids and a cotton swab totalling $100. The hospital, it seems, didn't send the bill in the correct format in the correct time window to the insurance company, so the insurnace company said they refuse to pay it. Since the insurance company is a huge, powerful, and attorney-fortified institution, the hospital has decided to pass the buck along to you. If the big insurance giant wont pay or will force a trial in order to cough up the cash for your bandaids, the hospital figures they might as well harass you to pay it. After all, you're not very scary and you aren't so likely to have a team of corporate atorneys at your disposal to dispatch such requests.
So the hopsital takes this outstanding balance that they're owed and sells it to a debt-collection shark. They sell it to the shark for 75% of what its 'worth', so the hospital recoups some of the cash they're owed and is absolved of having to deal with getting the money. So now you get calls from some shark demanding that you pay for the cotton swabs that your insurance company has refused to pay.
You complain to your insurance company that they should just pay this thing, but they don't listen. After persistent calling, faxing, letter-mailing, and emailing, they explain to you that they aren't paying because of 'company policy'. The company policy, after all, was drawn up in the interests of making the company maximally profitable. If you were to aggregate the amount of 'small sums' of this nature that they refuse to pay in a single year alone, it adds up to a decent chunk of money. This is how capitalist entreprises function: the bottom line is that they try to minimize costs and maximize returns.
Meanwhile you've got some jerk-off claiming that you haven't paid for cotton swabs used at a visit to the doctor that occured 3 years ago at a time when you were fully covered by what most people would consider "really good health coverage".
Invovled in this tragic comedy, are: two different health care providers (the hopsital and the contractors) who each have their own bone to pick with you, a massive insurance institution that is not 'on your side' but rather on the side of the investors who own the company, and a handful of seperate institutions that make their money by collecting debts and harassing people. If things get really bad, you can also throw your attorney and any other legal counsels fighting against you in a legal battle that might subsequently ensue, not to mention the court system, judges, etc.
Now in the United Kingdom health care works like fire departments work here.
When you get sick, you go to a hospital. You get the care you need. You leave feeling better. 3 years later you do not receive 5 different bills from 6 different bureaucracies. In fact, you never receive any goddamn bills. As a citizen and a taxpayer of the United Kingdom, you've already paid your dues. And what's more, whatever dues you did pay were proportional to how much money you made: the amount you pay for your health care isn't a 'one size fits all affair', but takes into account your ability to pay. It doesn't much matter whether you have a job when you go to the hospital, whether you're old and frequently ill, whether you are poor. You can come and get the health care you need all the same.
The United States Congress has been holding 'health care forums' recently in which they are claiming to be putting 'all options on the table' in considering ways to reform the unbelievably moronic health insurance system that the US currently has. But nothing remotely approximating the example above is being mentioned, let alone seriously considered.
The problem, after all, isn't that we have twelve different bloated bureacracies doing sixteen different tasks that have nothing to do with insuring people, but rather firguring out how not to insure the people that already paid for their insurance. The problem isn't that our system is inefficient and has too many different institutions doing the same thing poorly. The problem isnt that profiteers are in firm control of all the relevant institutions and run them according to the criteria of "let's make me as rich as possible". The problem isn't that these assholes made billions in profits last year while millions more Americans lost their insurnace coverage.
The problem, says Obama et. al, is just that 'health care costs are too high'. Right.
Thursday, April 2, 2009
Obama at the G20: The "human dimensions" of the crisis
Watch this starting at 1:28.
Speaking alongside British PM Gordon Brown, Obama spoke of the urgency of the global financial crisis and the urgency to act quickly, resolutely, and globally... so he gave examples about how the 'human cost' of the depression is taking tolls on people's jobs, their businesses, people are losing their homes, their... uh... health care... well, in "the United States people are losing their healthcare" says Obama in an awkward moment.
Shame. Speaking to Germans, French and British leaders... Obama stands up and talks about the "human cost" in those countries (as well as the US) and almost said their problems had to do with people losing their health care in a time of financial crisis, when in fact all of the citizens of those countries are unconditionally guaranteed public health insurance and access to care. Whoops.
The US marketized-system of health insurance is a laughing-stock (and one, we should add, that Obama and his cartel of economic advisers appear unwilling to let go of).
Monday, March 30, 2009
Bernie Sanders introduces Single Payer senate bill
via Healthcare-Now!: Read it here.
Of course, its Bernie Sanders, and its unlikely that much will come of it. Still... it can't hurt to have a single-payer bill on the table in some sense. If nothing else it's a rallying-point.
Monday, March 16, 2009
Not invited to Obama's healthcare summit
"As Obama's White House health care summit approached on March 5, advocates of a so-called "single-payer" system--under which the government would cover everyone, eliminating the role of private insurers--were stunned to learn they weren't invited. It was an insult to organizations that have been warning for years about the health care crisis-in-the-making and putting forward the single-payer alterative--Physicians for a National Health Program (PNHP), the California Nurses Association (CNA) and Healthcare-NOW!
Rep. John Conyers, the sponsor of a bill, known by its official designation HR 676, that would establish single-payer, personally asked Obama for an invitation when the two met at a Congressional Black Caucus meeting. The answer was no.
[...]
At the summit, Obama stated: "In this effort, every voice must be heard. Every idea must be considered. Every option must be on the table. There will be no sacred cows in this discussion."
Apparently Healthcare-NOW! has organized protests outside the meetings of the summit. Watch video here.
Subscribe to:
Posts (Atom)
