Friday, September 16, 2011
Is the mandate really the only answer?
Offer me a choice between a corporatist or socialist government health care system and I'll gladly take the latter. Within the confines of acceptable Washington discourse, we're not debating whether the state should intervene in the health care market and whether it that will cause more harm than good, but what form that massive intervention should take; should it be marginally more beneficial to the poor or to corporations. And though far from my ideal though the current system may be, I'll take it with the few scraps we call a safety net rather than without.
The persons that line the road to my anarchist paradise aren't those living on the margins of society, after all, but the corporations largely responsible for the stagnant wages that put them there.
Unfortunately, the health care reform bill signed into law by President Obama doesn't strike me as a marginal improvement of an awful status quo, but rather a significant step toward further entrenching the corporate health care model that's created the awful situation the reform was purported to address. For that reason, I'm not buying our old friend Matt Yglesias' claim that, in order to deal with a hypothetical “30-year-old man with a decent job [who] decides to go without health insurance” and ends up falling into a coma, the only real option available to us is to mandate that he have purchased private health insurance, as required by the latest health care reform.
Yglesias arrives at this conclusion by labeling discussion of why the costs of the status quo might force a 30-year-old man with a good job to forgo any sort of health coverage side-stepping "nonsense." Indeed, Yglesias rather ludicrously dismisses the question of cost with the headline to his piece: “Should We Let People Die If Unrelated Government Policies Tend To Drive Up The Costs Of Health Care?” When you call any health care reform other than an individual mandate “unrelated,” it's no wonder the only answer you're left with is the individual mandate.
But though he's dismissive and myopic, seeking to limit the debate over health care to WhatDoWeDoAboutJoeComa?, the costs of the U.S. health care system are hugely relevant. And huge.
Pharmaceutical giants, which spend the majority of their earnings on advertisements for penis pills, not research on cures for cancer, reap monopoly profits thanks to the fact the U.S. government grants them the exclusive right, via patents, to combine chemicals in a certain way, prohibiting cheaper competition and dramatically driving up the cost of medicine not just for Americans, but for countries that sign “free trade” agreements with the U.S. mandating they respect said “intellectual property.” As economist Dean Baker notes in his new (and free) book, The End of Loser Liberalism:
“[The U.S.] will spend close to $300 billion in 2011 on prescription drugs. In the absence of government- enforced patent monopolies, the same drugs would cost around $30 billion, an amount that implies a transfer to the pharmaceutical industry of close to $270 billion a year, or about 1.8 percent of gross domestic product. ”
In other words, Americans are spending ten times as much as they need to for medicine because of government-enforced monopolies. And the same rent-seeking costs are included in the price of medical devices and other life-saving equipment, helping explain why someone would need insurance in the first place. Baker also notes that the costs of visiting a doctor are inflated, not just by licensing, but by restrictions on foreign doctors coming into the U.S. – restrictions that were sought by doctors' groups to, of course, increase the cost of visiting doctors. Medical costs are as a consequence driven up for citizens at the same time profits skyrocket for corporations, creating a situation where many people can't afford to benefit from the Greatest Health Care System in the World.
Here's Yglesias' reaction to that line of argument:
“The government has a lot of policies. Many of them are bad ones. Many of those policies increase the price of this or that. Then over and above that, situations occur that require responses. For example, an uninsured person may be struck by some terrible misfortune and require medical attention. At which point we can let him die, or we can pay for his treatment.”
The thing is, because I'm nit-picky: The original question wasn't whether we “let him die” or “pay for his treatment,” but rather who should pay for said treatment. And even accepting the premise that we can't do away with every bad, corporate profit-boosting government policy right now so let's focus on this one particular narrow question, it doesn't follow that, once we concede we should do something, “we now have a strong prima facie case for some kind of mandatory minimum level of health insurance coverage,” by which Yglesias means mandating that every American purchase private health insurance.
A national single-payer system, while not my preference, is one obvious alternative for addressing our hypothetical coma victim that, by contrast to the insurance mandate, doesn't increase the grip private insurance companies have over the U.S. health care system. Or the federal government could – get this – devolve power and allow states and local governments to experiment with different approaches to providing health care for their constituents, which would at least allow for variation, diminish the risk of corporate capture and, who knows, maybe even allow for the rise of truly consensual, community-based approaches to health care, which entrenching the corporate system via a national mandate most certainly does not.
Not only is the mandate not the best option, even within the confines of acceptable Beltway discourse, it only adds yet another coercive element to U.S. society that directly benefits private corporations, a practice I think we ought to be minimizing, not increasing. It also burdens every not-a-coma-victim with costs that may not make sense for them, or even for most people who are, again, not coma victims; in many cases, the money spent on insurance might be better spent on healthier food, education or whatever the hell a member of a free society chooses. The mandate also prevents the rise of alternatives to corporate-provided health care; under Obama's health care reform, you literally have no choice but to go the corporate health care route, further cementing the employer-coverage link – good luck quitting your dead-end job if you want to ever get a check-up again – while securing the insurance industry a legally mandated customer base.
Anyone who has dealt with a cable company knows what customer service is like when a corporation, or in this case an oligarchy, knows you have no choice. What Yglesias proposes as a life raft to our poor 30-year-old in a coma ends up looking more like an anchor to the rest of us.
Further, Yglesias' intentionally constraining argument that we ought to put aside why the health care system is the way it is and just accept the status quo with the band-aid of a mandate is similar in spirit to a lot of the arguments I remember hearing in the aftermath of 9/11. No, no, let's not consider how U.S. foreign policy creates enemies around the world by killing loads of innocent people, in turn causing blowback that kills loads more. No, let's just discuss who we kill next. This is a post-9/11 world, thank you. And since U.S. foreign policy isn't going to radically change, your comprehensive, holistic solutions to terrorism just won't do, so who do we bomb now?
Finally, I can't help but ask: whatever happened to vision? Why – and this is a rhetorical question – are liberals like Yglesias so reflexively dismissive of discussing broader, radical reforms to the system? Since when did milquetoast reformism become the rallying cry of the Left? I know many leftists still value decentralism and community-based solutions to problems such as the health care crisis -- they're key planks of the Green Party's platform -- but if you listened to the Ygelsiases and Ezra Kleins of the world, you'd think only a Tea Partier could object to a centralized solution that mandates the purchase of a private company's product.
What a world . . .