Socialism: Converting Hysterical Misery into Ordinary Unhappiness for a Hundred Years

10 Dec

In yesterday’s New York Times, Robert Pear reports on a little known fact about Obamacare: the insurance packages available on the federal exchange have very high deductibles. Enticed by the low premiums, people find out that they’re screwed on the deductibles, and the co-pays, the out-of-network charges, and all the different words and ways the insurance companies have come up with to hide the fact that you’re paying through the nose.

For policies offered in the federal exchange, as in many states, the annual deductible often tops $5,000 for an individual and $10,000 for a couple.

Insurers devised the new policies on the assumption that consumers would pick a plan based mainly on price, as reflected in the premium. But insurance plans with lower premiums generally have higher deductibles.

In El Paso, Tex., for example, for a husband and wife both age 35, one of the cheapest plans on the federal exchange, offered by Blue Cross and Blue Shield, has a premium less than $300 a month, but the annual deductible is more than $12,000. For a 45-year-old couple seeking insurance on the federal exchange in Saginaw, Mich., a policy with a premium of $515 a month has a deductible of $10,000.

In Santa Cruz, Calif., where the exchange is run by the state, Robert Aaron, a self-employed 56-year-old engineer, said he was looking for a low-cost plan. The best one he could find had a premium of $488 a month. But the annual deductible was $5,000, and that, he said, “sounds really high.”

By contrast, according to the Kaiser Family Foundation, the average deductible in employer-sponsored health plans is $1,135.

It’s true that if you’re a family of three, making up to $48,825 (or, if you’re an individual, making up to $28,725), you’ll be eligible for the subsidies. Those can be quite substantive at the lower ends of the income ladder. But as you start nearing those upper limits (which really aren’t that high; below the median family income, in fact), the subsidies start dwindling. Leaving individuals and families with quite a bill, as even this post, which is generally bullish on Obamacare, acknowledges.

Aside from the numbers, what I’m always struck by in these discussions is just how complicated Obamacare is. Even if we accept all the premises of its defenders, the number of steps, details, caveats, and qualifications that are required to defend it, is in itself a massive political problem. As we’re now seeing.

More important than the politics, that byzantine complexity is a symptom of what the ordinary citizen has to confront when she tries to get health insurance for herself or her family. As anyone who has even good insurance knows, navigating that world of numbers and forms and phone calls can be a daunting proposition. It requires inordinate time, doggedness, savvy, intelligence, and manipulative charm (lest you find yourself on the wrong end of a disgruntled telephone operator). Obamacare fits right in with that world and multiplies it.

I’m not interested in arguing here over what was possible with health care reform and what wasn’t; we’ve had that debate a thousand times. But I thought it might be useful to re-up part of this post I did, when I first started blogging, on how much time and energy our capitalist world requires us to waste, and what a left approach to the economy might have to say about all that. It is this world of everyday experience—what it’s like to try and get basic goods for yourself and/or your family—that I wish the left (both liberals and leftists) was more in touch with.

The post is in keeping with an idea I’ve had about socialism and the welfare state for several years now. Cribbing from Freud, and drawing from my own anti-utopian utopianism, I think the point of socialism is to convert hysterical misery into ordinary unhappiness. God, that would be so great.

• • • • • •

There is a deeper, more substantive, case to be made for a left approach to the economy. In the neoliberal utopia, all of us are forced to spend an inordinate amount of time keeping track of each and every facet of our economic lives. That, in fact, is the openly declared goal: once we are made more cognizant of our money, where it comes from and where it goes, neoliberals believe we’ll be more responsible in spending and investing it. Of course, rich people have accountants, lawyers, personal assistants, and others to do this for them, so the argument doesn’t apply to them, but that’s another story for another day.

The dream is that we’d all have our gazillion individual accounts—one for retirement, one for sickness, one for unemployment, one for the kids, and so on, each connected to our employment, so that we understand that everything good in life depends upon our boss (and not the government)—and every day we’d check in to see how they’re doing, what needs attending to, what can be better invested elsewhere. It’s as if, in the neoliberal dream, we’re all retirees in Boca, with nothing better to do than to check in with our broker, except of course that we’re not. Indeed, if Republicans (and some Democrats) had their way, we’d never retire at all.

In real (or at least our preferred) life, we do have other, better things to do. We have books to read, children to raise, friends to meet, loved ones to care for, amusements to enjoy, drinks to drink, walks to take, webs to surf, couches to lie on, games to play, movies to see, protests to make, movements to build, marches to march, and more. Most days, we don’t have time to do any of that. We’re working way too many hours for too little pay, and in the remaining few hours (minutes) we have, after the kids are asleep, the dishes are washed, and the laundry is done, we have to haggle with insurance companies about doctor’s bills, deal with school officials needing forms signed, and more.

What’s so astounding about Romney’s proposal—and the neoliberal worldview more generally—is that it would just add to this immense, and incredibly shitty, hassle of everyday life. One more account to keep track of, one more bell to answer. Why would anyone want to live like that? I sure as hell don’t know, but I think that’s the goal of the neoliberals: not just so that we’re more responsible with our money, but also so that we’re more consumed by it: so that we don’t have time for anything else. Especially anything, like politics, that would upset the social order as it is.

…We saw a version of it during the debate on Obama’s healthcare plan. I distinctly remember, though now I can’t find it, one of those healthcare whiz kids—maybe it was Ezra Klein—tittering on about the nifty economics and cool visuals of Obama’s plan: how you could go to the web, check out the exchange, compare this little interstice of one plan with that little interstice of another, and how great it all was because it was just so fucking complicated.

I thought to myself: you’re either very young or an academic. And since I’m an academic, and could only experience vertigo upon looking at all those blasted graphs and charts, I decided whoever it was, was very young. Only someone in their 20s—whipsmart enough to master an inordinately complicated law without having to make real use of it—could look up at that Everest of words and numbers and say: Yes! There’s freedom!

That’s what the neoliberal view reduces us to: men and women so confronted by the hassle of everyday life that we’re either forced to master it, like the wunderkinder of the blogosphere, or become its slaves. We’re either athletes of the market or the support staff who tend to the race.

That’s not what the left wants. We want to give people the chance to do something else with their lives, something besides merely tending to it, without having to take a 30-year detour on Wall Street to get there. The way to do that is not to immerse people even more in the ways and means of the market, but to give them time and space to get out of it. That’s what a good welfare state, real social democracy, does: rather than being consumed by life, it allows you to make your life. Freely. One less bell to answer, not one more.

44 Responses to “Socialism: Converting Hysterical Misery into Ordinary Unhappiness for a Hundred Years”

  1. gigiistheone December 10, 2013 at 10:16 am #

    Touche, Corey! Once again, you are spot on!

  2. tom December 10, 2013 at 10:50 am #

    One minor fact correction, the subsidies go up to 400% of FPL, you gave the income cutoffs for 250%, the income levels at which the subsidies go away are 78120 and 45960. And yes, people just over the subsidy cutoff get hosed, if you want to make 9.5% of income the maximum percent you can pay in premium, you should link the subsidy cutoff to that rather than to x% of FPL.

    (Gratuitous ‘single payer would be better but ACA is still better than 50 million uninsured’ comment deleted)

    • Corey Robin December 10, 2013 at 11:09 am #

      The 400% of the FPL subsidies you’re referring to are for premiums only, not for deductibles and other out-of-pocket expenses.The Times article is talking about deductibles and out-of-pocket expenses. Again, just confirming my point re how complicated this all is.

  3. William Neil December 10, 2013 at 10:50 am #

    just a head’s up that I am unable to leave a comment on your site today because Internet Explorer stops working.  Don’t know what is going on… bill neil

    ________________________________

  4. aletheia33 December 10, 2013 at 11:20 am #

    if you read naked capitalism you would not have to wait for the times to figure this out. NC has been covering this well ahead of the rollout with lots of detail on the ripoff that is obamacare. just a heads up

  5. William Neil December 10, 2013 at 11:44 am #

    Corey: Let’s try this method, because I still can’t reply at your site, but saw you posted my troubles. I’ve gone this far at Maryland’s healthcare website: It was easy to explore two “bronze” plans, supposedly the ones with the lowest costing monthly premiums, before one gets to the subsidies.  The Kaiser Bronze plan has a deductible of $4500 and caps out of pocket expenses at $6350; United Health’s “All Saver” Bronze has a $5500 deductible and also caps total out of pocket expenses at $6350.  I’ll be just barely too high or at the borders of qualifying income for potential federal subsidies – I did read the same NY Times article but haven’t yet spent the time to see what these subsidies might amount too, both for monthly premiums and for help with deductibles – and I was unaware of potential help with deductibles.  But your comments are very close to my sentiments, what a process, even at sites that work.  I haven’t yet made the decision to invest the time to go into the silver plans and to the further layers required to submit income and calculate the subsidies, if I will qualify for any.  The high co-pays and deductibles are a real deterrent – as is the possibility that it all falls apart politically in Washington - or gets postponed.    For the 28 million Americans earning $9.89 per hour or less, many of whom this program is designed to cover, what we are realizing is that our low minimum wage and incomes interact decisively, and negatively, with the whole idea of the program.  Those high deductibles will push millions into “credit card” coverage, and that’s already fraught territory for tens of millions, subsidies or not.  I’m 63 and have no doctor, no health care coverage. I stood in the late summer Washington, DC heat in the home stretch for this bill, demonstrating as one of the last hold-outs for “the public option,” and we heard that the President’s limo skirted around our gathering.  I have commented privately, but now I’ll make it public: I wonder what Theodore Lowi would have to say about this bill, this process, the ultimate nightmare culmination of what he warned about in his classic 1968 work, “The End of Liberalism.”  He’s 82, and I couldn’t locate any of his comments past 2009.  If I take the process further, I’ll try to post back to this, or perhaps you’ll be commenting further; ah, my life as a consumer, a humble shopper in the great markets of neoliberalism.  Should we hope for a new, grand “app,” to make this easier?  It’s not far away, just around the corner of our free market “Utopia.” Bill Neil

    ________________________________

  6. Yastreblyansky December 10, 2013 at 12:24 pm #

    Please note for what it’s worth: In the Silver plans, often only marginally more expensive than the Bronzes, the deductible only applies to inpatient hospitalization, outpatient procedures, and non-generic drugs; you get office visits, lab work, and urgent or emergency care for fixed copays, and of course the preventive/wellness care is free. Also somebody like Bill Neil can dump a little money in a retirement amount and impoverish himself only slightly into very significant subsidies. That trick is of course exactly the kind of spending all your free time monitoring your accounts shit that you’re talking about (I am so grateful my crappy salary is accompanied by a pretty good insurance plan and I don’t have to think about it), and none of this invalidates the important points you’re making, but it does mean that life for the Obamacare victim doesn’t have to be quite as bad as the Times article makes it seem.

  7. Gerry Staack December 10, 2013 at 1:14 pm #

    The shitty deal is that conservatives screwed Americans out of “Single Payer” and now complain about the result.

    • robert lowrey December 12, 2013 at 12:52 pm #

      Bingo! How come no one else has mentioned this? This has become the Neo-con’s modus operandi to such an extent, it’s simply become invisible.

  8. cbbede December 10, 2013 at 3:27 pm #

    I long assumed that health insurance, years before ACA, was a conspiracy to prevent old folks from succumbing to dementias of various sorts by keeping their minds engaged in the minutiae of forms, deductions, co-pays, etc. The way the ACA turned out with all the compromises was to extend dementia prevention to the uninsured. But we’ll die from earlier heart attacks brought on by frustration and anger. If you ‘re lucky enough, Medicare and a F plan supplemental are about as hassle-free as you can get.

  9. Michael December 10, 2013 at 3:32 pm #

    The short answer is single payer.

    _____

  10. Stephen Zielinski December 10, 2013 at 6:44 pm #

    Reblogged this on All Tied Up and Nowhere to Go and commented:
    Corey Robin nails it in his depiction of the effects produced by neoliberal regimes like Obamacare.

  11. The Raven December 10, 2013 at 9:50 pm #

    The plans do is provide plan pricing on physician visits and prescription drugs, as well as some no-charge preventative services. Those aren’t small things. I don’t think, though, that the modest price breaks the exchange plans do provide are going to keep people from feeling shafted. The “Gold” plans are what we used to call good basic employer-provided insurance. But the exchange plans are still going to put a lot of people out of pocket. For many young, low-income people and older people making a little more than 4xFPL, they’re likely to hurt a lot. A lot of the people in the exchange plans will be self-employed, and the plans will be covering their workplace injuries. This might be positive, or negative—we’ll have to wait and see.

    What this is going to do to public attitudes and finances, in the deepest depression of two generations, I cannot imagine. Really, I don’t understand why the Republicans are fighting the ACA so hard—all they have to do is let it be implemented, and then blame the Democrats for its problems.

  12. Bob December 10, 2013 at 11:56 pm #

    Well written. Totally agree. Sadly, most of the social democrats aren’t social democrats anymore.

    • Mara December 12, 2013 at 12:34 pm #

      This is true of formally soc dem politicians, and the politicos and policy-makers behind them, the top tiers of whom are all processed through neoclassical economics and its legal counterpart.

      If you were interested, though, to see what (soc dem remnant) bureaucracy that doesn’t exist to discipline working class people with neoliberal busy-ness looks like, you still can–and I think it *should* be done, for the record. Arrange to go watch and interview bureaucrats in Sweden. It’s a whole ‘nother world up there.

  13. Systemic Disorder December 11, 2013 at 1:08 pm #

    In the U.S., health care is designed to produce profits for corporations, not provide health care. In writing about this last year, I did some calculations and found that U.S. spending on health care was $1.15 trillion per year more than the average of Canada, Britain, France and Germany for the years 2001 to 2010. That is a whole lot of money shoveled into the pockets of pharmaceutical, medical-device and insurance companies.

    A single-payer system is the only way out of this. Obama’s health care plan was fatally flawed from the start because it was designed to maintain corporate dominance of health care. The “individual mandate” is crucial here, because it forces more people into the arms of insurance companies, who of course profit from high deductibles and other measures to avoid paying out.

  14. Donna Gratehouse (@DonnaDiva) December 11, 2013 at 5:14 pm #

    Here’s young Ezra seemingly mystified as to how this wondrously complex health care plan has had problems in the execution. He thinks the answer is to fire someone, anyone. http://www.bloomberg.com/news/2013-12-11/obama-needs-to-fire-some-people.html

  15. nickbradley December 11, 2013 at 5:50 pm #

    excellent article – I saw it over on Jacobin first.

    One quibble; you left off part of the NYT passge:

    “Deductibles for many plans in the insurance exchanges are pretty high,” said Stan Dorn, a health policy expert at the Urban Institute. “These plans are more generous than what’s prevalent in the current individual insurance market, but significantly less generous than most employer-sponsored insurance.”

    you see, we improved the system. from Horrible to just plain Awful. but, still improvement

  16. Paul Handover December 12, 2013 at 10:05 am #

    Fabulous essay that I found courtesy of Naked Capitalism and going to reblog on Learning from Dogs.

  17. RanDomino December 12, 2013 at 4:02 pm #

    Thank you for making this point. I’ve used this same argument in the past against anti-State capitalism (“anarcho-capitalists” although I refuse to use that term). In short, how does it improve anything to take the most frustrating, dehumanizing, and dysfunctional aspects of the current system and make them universal?

  18. Harold December 12, 2013 at 6:32 pm #

    This is excellent coverage of a disgusting situation. As propagandistic as it was, I cried with the 9/11 veteran in Michael Moore’s Sicko when she found she could get her inhalers in Cuba at an absurd fraction of the cost in the US.

    I have long held the notion that the “healthcare” systems in this country are broken, and as dangerous as it may seem, have decided that I would rather live a shorter life than subject myself to the indignity of bankrupting myself to live longer. It already galls me to go to the doctor(s, due to the HMO hodowns) for “simple” checkups.

  19. William Neil December 17, 2013 at 4:55 pm #

    Tuesday, December 17, 2013, six days before the deadline for signing up:

    Well Corey, I promised I would get back to you and your readers after I had plunged in further at Maryland’s “Healthcare Connection” website and determined my status and to choose a plan, if any.  The Maryland site seems to have fewer of the talked about national problems, although I did have some trouble logging in.   I have moderate computer skills, not intimated easily. 

    The first task is determining, in my mind, whether I would qualify for any subsidies, either on the monthly premium payments or the co-payment/deductibles  before full coverage kicks in.  The answer was no, even though I consider myself working poor in a notoriously expensive DC metro area county, Montgomery County, where it is said one needs at least $34,000 per year to pay your bills.  I’m very close to that figure, and finish most months with under $100 to spare. 

    So what did I find after I learned that I would not be eligible for any subsidies?  The system produced about thirty possible plans to choose from, from Bronze (lowest monthly premiums but highest co-pays/deductibles);  the lowest premium I found was $315 per month with a 6000 deductible, a Bronzer to Gold and Platinum, way, way out of reach…

    When the Bronze choices dropped the deductibles to a more reachable level for those like me without savings or excess income to meet it, say, to 3500, the premium jumped to 395 per month.

    The Silver Plans with deductibles 2000-2500 range saw monthly premiums go up to the 495-500 range.

    Gold Plans with low deductibles of 1000 jumped to 562 per month.  Platinum plans had premiums in the 700 plus price range, all the way up to 951, the highest one I saw listed.

    Conclusion:  Even in a state with a moderate to progressive reputation, and an all-in-all  workable website (some friends were having more trouble than me, so I don’t want to get carried away) the whole Obama direction seems to have underestimated the financial situation of many of the working poor and what they could afford.  That’s what I sensed was happening, and going back to the Margaret Flowers (MD) Dean Baker debate from a few months ago, at the RealNews network, that’s what Dr. Flowers also thought was going to happen.   Total time invested: about 4-5 hours.  And my data stored for “safe keeping,” I hope.  In the back and forth about confirming my identity, they even listed my make and model car, info which they must have gleaned from the MD Dept of MVs.

    ________________________________

    • Yastreblyansky (@Yastreblyansky) December 17, 2013 at 5:47 pm #

      Yes. Even worse than the high deductibles, which I thought were going to be illegal, is the use of that single national poverty rate, as if being poor in Silver Spring could have the same dollar figure attached to it as being poor in some West Virginia hollow. Why do they do that?

      • William Neil December 17, 2013 at 6:07 pm #

        Yes, that’s right Yas; I live in the smallest sq. ft. rental house you can find in Rockville, just north of Silver Spring, a 1952 Levittown starter home, one story, never been expanded. And the double cruelty of the financial crisis was, after the stock market/pension losses, the 10 million national foreclosures done or in the pipeline have had the effect of driving up rents! They’ve gone up 200-300 in my area but I have been spared by a decent LL.

        Housing, rents, health care, the state of the minimum wage, they are wrapped together for the working poor (and on up into the middle class) and to put so much faith in tinkering with just one, and not the others, it is becoming increasingly plain to see, won’t work.

  20. MALLIKARJUNA SHARMA December 19, 2013 at 12:41 pm #

    US Govt should provide free medical aid to all its citizens and legal residents. Perhaps that per year would not cost it more than a fraction of the heavy military expenditure they are incurring in all the unjust wars the world over.

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