Tag Archives: health care

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.

Conservatives: Who’s Your Daddy?

20 Nov

In his column this morning, David Brooks has a roundup of young conservative voices we should be listening to. He divides them into four groups: paleoconservatives, lower-middle reformists, soft libertarians, and Burkean revivalists. I want to focus on the last, for as is so often the case with Brooks, he gets it wrong—but in revealing ways.

Burkean Revivalists. This group includes young conservatives whose intellectual roots go back to the organic vision of society described best by Edmund Burke but who are still deeply enmeshed in current policy debates.

Yuval Levin, the editor of National Affairs is one of the two or three most influential young writers in politics today. He argues that we are now witnessing the fiscal crisis of the entitlement state, exemplified most of all by exploding health care costs. His magazine promotes a big agenda of institutional modernization.

It just so happens that I was reading yesterday a piece by Levin from the summer 2012 issue of The New Atlantis (h/t the kind reader who sent it to me; I can’t now find who you are) on the problem of health care and entitlement spending.

After the usual heavy breathing and hortatory throat-clearing that are characteristic of such think pieces on the right—”Our weaknesses and problems, no less than our strengths and advantages, are reflections of the society we are, and so to understand them we would do well to reflect upon the question of just what sort of society that is.”—Levin sets out the boiler-plate, one part Straussianism, two parts bullshit.

The ancients sought virtue, a life of excellence lived in and through the polis; the moderns (Machiavelli, Descartes, Bacon, Hobbes, and Locke) perpetrate “a lowering of aims.” The moderns see “the preservation and protection of life and of health as the primary functions of society.” Motivated by “safety and power,” they care nothing for the higher goods of religion or morality. Instead, they “assert for health a place at the very top of the heap of human goods.”

It’s the usual hash of modern political thought that you find in certain precincts of the Straussian right. What’s interesting about it is how Levin connects it to our health care debate and the market, and whom he draws inspiration from in doing so.

The health care challenge we face, insists Levin, is not merely the narrow economic problem of ballooning costs; that would be too pedestrian. It’s that we have so lost sight of other goods—excellence, justice, and so on—that we are willing to spend every last dime, and our children’s dimes, on staying alive, the world be damned. Because of “our disproportionate and even reckless elevation of health,” we have become the small people—our society the “vessel for self-absorption and decadence”—that we are.

That concern with self-absorption and decadence should tip us off to where we stand with Levin: not under the bright sun of the ancients or the Founders—or, pace Brooks, Edmund  Burke—but in the shadow of Nietzsche. (Setting aside the connection between Burke and Nietzsche, which I allude to in The Reactionary Mind.)

I’ve argued before that Nietzsche is the master theoretician of the modern right, but Levin makes it especially clear.

In understanding that liberal temptation, our best guide is not Descartes but Nietzsche, who described what could become of us in an age beyond responsibility, an age he believed was the inevitable destination of liberal societies. The degeneration of virtue in such societies, he argues, will atrophy our ability to plan for the future, our drive to work, and our interest in governing. In such a state, people will lack the noble aspiration to a virtuous life, setting their aims far lower, as Nietzsche writes. “One has one’s little pleasure for the day, and one’s little pleasure for the night: but one has a regard for health.”

Our regard for health, it seems, can easily coexist with a society that we would not otherwise be proud of. Unbalanced and unmoored from other goods, such regard can become a vessel for self-absorption and for decadence. It can cause us to abandon our commitment to our highest principles, and to mortgage the future to avert present pain.

What makes Levin’s invocation of Nietzsche even more fascinating is that he sees the market as the antidote to this culture of decadence. Where Nietzsche loathed the culture of the market and of capitalism, modern conservatives who walk in his path have found a way around that hostility. They see the market as the proving ground of the heroic self, as the crucible from which a being of ancient excellence and moral virtue—or, if you’re jonesing for a more modern version, a tragic chooser of incommensurable goods—can arise. In Levin’s case, the market is the instrument by which our ravenous desire for health at any cost will be forced to confront the constraints of cost, leading us to prioritize our values—and creating a space, he hopes, for other values to emerge.

It’s not at first clear why Levin thinks such other values would emerge, given that he thinks we’ve lost sight of them, but at the end of his essay he draws what seems to be an unearned distinction between the people and the government, claiming that it’s not the citizenry that’s corrupt but the state. The institutions of liberal democracy can’t make hard choices, tied as they are to the base drives of politicians. But the market can.

After all, markets don’t just make expensive goods cheaper — they are also extraordinarily effective prioritizers, allowing many individual decisions to be made close to the ground. In the case of health care, that would mean having more critical decisions about spending made by patients, by families, and by doctors, and creating a strong incentive for those decisions that have to be made by insurers to be made in ways that will be perceived as fair by their customers.

Market solutions would by no means eliminate all the grave difficulties involved in prioritizing health care. There would still be rationing, there would still be times when being out of money means you are out of options, there would still be decisions made by insurance company bureaucrats that strike patients and doctors as unjust. But there would be far fewer than under a system that assigned rationing decisions to public officials and gave patients far fewer choices and far less control.

In a properly regulated but competitive insurance market, we would have a much better chance of actually prioritizing health among the goods we value. Because while liberal political institutions are unsuited to such prioritization, we liberal citizens are often up to it. Families, which after all are not liberal institutions, can make difficult choices — balancing the needs of different generations and the importance of different needs and wants — in ways that democratic political institutions often simply cannot.

Read that last paragraph carefully: “We liberal citizens are often up to it.” Why? Because we live in “families, which after all are not liberal institutions.” It’s the family, by which Levin means the anti-liberal or illiberal or non-liberal parental authority unit, that makes the difficult choices. So we have the market as the disciplining agent working with whomever controls the finances in the family (and we all know who that is) to create the conditions for a society that cares about something more than its health.

Over the last year, I’ve been working on a project that seeks to explore the elective affinities between Nietzsche and neoliberalism, the hidden dialogue between the German criticism of decadence and the Austrian School’s celebration of capitalism. In the coming months, I hope to be publishing an article about this, but I’ve already given some hints of my views on that connection in various posts on Tumblr.

In the meantime, I urge you to take a look at Levin’s essay insofar as it gives you a good sense of the Nietzschean dimensions of contemporary conservatism, especially that “Burkean” conservatism which gets praised by the likes of David Brooks.

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