Recently Ezra Klein pointed out (“What liberals get wrong about single payer,” Washington Post, January 13) that single-payer healthcare wouldn’t solve the problem of America having the most expensive healthcare system in the world. American health insurance premiums aren’t so high because of the overhead cost or profit of insurance companies, but because of the price of service delivery itself. The private insurance industry is an uncompetitive cartel, to be sure. But next to the almost 300% price markup on an MRI in the U.S. compared to France, or the 2000% markup on a drug under patent, the cost of insurance is almost nothing.
In response, Professor Uwe Reinhardt of Princeton added that a single-payer system wouldn’t work in the U.S. because it would be controlled by the corrupt culture of the service deliverers (“Is the U.S. too corrupt for single-payer healthcare?” Washington Post, January 16). “Medicare is a large insurance company whose board of directors (Ways and Means and Senate Finance) accept payments from vendors to the company. In the private market, that would get you into trouble.” Basically, the prices Medicare-for-all paid for healthcare services would be set by the healthcare providers and reflect their institutionalized monopoly culture.
All too often, when well-meaning people say a particular need should be a “basic human right,” what that means is that the average person gets that need for “free” — but they get it as defined by the authoritarian institutions and professional priesthoods that deliver that service. The nationalization and public financing serve mainly to lock in that institutional culture permanently, and make it difficult at best for the individual to escape that institutional model of service whether they actually want it or not.
A common theme in the work of Ivan Illich was the provision of services in all aspects of life by bureaucratic, hierarchical institutions with high overhead business models and the delivery of actual services by authoritarian professional priesthoods.
“Many students … intuitively know what the schools do for them. They school them to confuse process and substance …. [T]he more treatment there is, the better are the results …. The student is thereby ‘schooled’ to confuse teaching with learning, grade advancement with education, a diploma with competence, and fluency with the ability to say something new …. Health, learning, dignity, independence, and creative endeavor are defined as little more than the performance of the institutions which claim to serve these ends, and their improvement is made to depend on allocating more resources to the management of hospitals, schools, and other agencies in question.”
If you want an illustration of the total gestalt of the kinds of services delivered by such institutions, with their mission statements, Weberian work rules and accounting systems which define the consumption of resources as “value,” just compare the proprietary, institutionally designed “office productivity software” the IT department makes you use at work with platforms and utilities like Open Office that people willingly choose for themselves at home.
I once saw an activist critic of agribusiness on C-SPAN describing the process by which the USDA created the “Food Pyramid”; it was basically negotiated by a committee made up of representatives of Big Cereal Grains, Big Meat, Big Dairy, ad nauseam.
We have “free” education through grade 12 as a basic human right in the U.S. And what is it? A system set up for processing, grading and sorting human raw material into an input for corporate HR departments. The first statewide public school systems were set up in New England because mill owners needed hands who’d been taught to be punctual, line up on command, eat and pee at the sound of a bell, and cheerfully obey instructions from an authority figure behind a desk. As a majority of people moved into white collar jobs, this basic function persisted — with the additional task of schooling students to prioritize tasks set for them by an authority figure over their own self-directed interests, and to regard as a trivial “hobby” anything not assigned by a boss.
The proper solution to the crisis resulting from enormously expensive healthcare is not to leave the expensive business model in place and then finance it with tax money, but to cause its price to implode to affordable levels by removing all the state-enforced monopolies and institutional frameworks that make it so expensive. Imagine a society where one of Pfizer’s $10 pills cost fifty cents, an MRI was $250, outpatient treatments and tests were covered by $70/month dues at a cooperative clinic, and catastrophic insurance was $50/month. That’s what we’d have if corporate-state collusion and monopoly were replaced by competitive markets and horizontal cooperation.
Before you make something “free,” think long and hard; you may also be making it compulsory.
Citations to this article:
- Kevin Carson, When Basic Services are Guaranteed as a “Right”, Before It’s News, 01/30/14
"The proper solution to the crisis resulting from enormously expensive healthcare is not to leave the expensive business model in place and then finance it with tax money, but to cause its price to implode to affordable levels by removing all the state-enforced monopolies and institutional frameworks that make it so expensive." In the mean time, learn to accept the existing system as a manifestation of Zeus's will. Moreover, in the pursuit of ideological purity, eschew less comprehensive efforts aimed at the amelioration of the U.S. "health" care system such as a downwards redistribution of income. Better to teach your loved ones to suffer preventative pain and death in the privacy of their own homes, assuming they can afford private shelter, and if they can't, they have no one to blame but themselves and poor planning.
And we would have safer and more economical "alternative" treatments competing head to head with drugs, surgery, and high tech.
"The private insurance industry is an uncompetitive cartel, to be sure. But next to the almost 300% price markup on an MRI in the U.S. compared to France, or the 2000% markup on a drug under patent, the cost of insurance is almost nothing."
It's also important to note that the primary reason that all these basic services cost so much is because hospitals and service providers game the private insurance market by asking the insurance companies/Medicare for reimbursements that are much larger than they actually expect to receive, on the off chance that the specific insurance company's preset set rates are high.
Not really. The inflated cost of real medicine is one of the major reasons people turn to snake oil "alternatives." The alt-med industry is actually just another pathology of the system.
Problem with that is? I mean for anyone who doesn't believe we need regulatory agencies making decisions for us, those who do believe we do have forfeited their right to an opinion(they don't believe that people can make their own decisions after all). Doctors have too much privilege anyways, they have long passed the point they should be trusted; the pharmaceutical industry, especially the psychiatric wing, almost qualifies as being an eldritch abomination at this point rather than something that should be given scientific respect. Until massive reform from the very base occurs, why in the fuck should officially approved drugs be considered any more trustworthy than Unkel Spikeys Datura and snake pil extract? Sure, some of it works(good luck proving that in a way that doesn't rely on basically trusting corruption though-again, the pharm industry has made a mockery of the process of science and peer review) but so do some herbs and diet changes.
This is what it ultimately means to live in a governed society; nothing can be trusted at all, and no one can be trusted at all. So fuck you and your implication we need to be saved from our own decisions because insofar as that what you advocate you are literally everything wrong with the world. As it is, everything is a lie until it either proves itself by pure reason or I see actual evidence under circumstances that prohibit fraud, and everyone is a liar who might be advocating something because they were bought off and it suits the purposes of those in power for them to advocate whatever they're advocating. That is the world that greets us the very instant something is "regulated", or even the very instant anyone accepts that as a good idea. It's not a world worth living in except for the hope of something better, and every day makes that hope seem less likely. I'd give my life right now if it would help, but it won't… and I am not yet at the point where I'm willing to throw it away. Give it time I guess, some days the only reason I don't hang myself is because I believe that's what they want.
Kevin, as much as most of us love you for your brilliant theoretical work in most areas, you lose us social anarchists on "user fees" for anything that ought to be a public service.
I can't for the life of me understand why you think that free implies compulsory. We could easily have healthcare, education, and other vital services organised in a decentralised, cooperative, and confederative manner without the top-down bureaucratic structure and compulsory nature ones gets with social democratic proposals.
It doesn't matter how cheap you might make it – and I even doubt it would be as cheap as you claim – some things of vital necessity for human well-being and development simply should not have a price tag attached to them. To give them one implies an "I don't give a crap" ethos towards the concept of solidarity; which I'd like to believe is something that unites communitarian and individualist anarchists alike.
Imagine, if you will, a natural disaster occurring and a bunch of people getting trapped with little oxygen under a collapsed building. Someone up on the surface offers to use their personal drill-vehicle (just go with it) to transport them all out, saving their lives. However, they say they will only do so if each one of the people trapped gives them $10.
They might easily be able to do so, but most people other than a few sociopaths would regard charging people at all for something life-saving (that can be easily provided for free) is a pretty shitty and indecent thing to do.
"Someone up on the surface offers to use their personal drill-vehicle (just go with it)"
Well, no, I won't "just go with it." Did that personal drill-vehicle magically appear out of thin air, or did someone have to, you know, PAY THE COSTS involved in making it?
When someone says "X should be free," what they're actually saying is "someone, anyone but ME, should pay the costs of X."
No, it's saying that there are better ways to meet those costs other than charging individuals from their personal income.
For example, of the total net social product in an anarchist confederation, simply put aside a certain percentage to be invested in networks of cooperatively-organised public service providers.
And given that so much what is unfree today is only so because of artificial scarcity created by intellectual property and a maldistribution of the means of production, I think you seriously need to readjust your perspective on what costs really exist and which ones are illusory and manufactured.