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.


Arvilla said...

"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."

But haven't you heard? Obama is pragmatic! How on earth "pragmatism" got to be more admirable than having actual values is beyond belief for me.

t said...

Yeah, man! Obama is just being 'realistic' and grasping the truth, articulated by the majority party Democrats, that more progressive reforms are 'not politically feasible'...

Wait, how is it that the Democrats (the party in power) can claim that they are restricted in what they can do by what's 'politically feasible' when THEY ARE THE ONES WHO DETERMINE WHAT IS FEASIBLE? This line is even worse when it comes from the Kent Conrads and the Max Baucuses... as thought THEY weren't the ones constricting what possibilities are up for grabs in the health care debate?!