There is a segment of the population that is just not going to listen when it comes to making changes in the nation’s healthcare system.
I’m talking about a vocal minority that has ruled out any involvement of the government — that views government as a foreign, antagonistic force. There may be some truth to it in practice these days, but not because government is inherently bad. The problem in the United States is that the corporate order has taken it over and the citizenry has lost the ability to set priorities and influence its actions.
That is the issue with health care. Our corporate-run, profit-driven system has nothing to do with health or care. It is about money. Insurance companies make money by collecting premiums and then refusing care. It is a simple equation.
The results, of course, are poor health and high costs.
The only way to fix this is to change the incentive structure, to reward doctors and patients for enhancing and improving health — and that means taking profit out of the system, expanding and spreading the risk pool and essentially declaring health care a human right independent of the ability of anyone’s ability to pay.
That means not just government involvement through subsidies and regulation, but replacing private insurance with a single insurer, basically expanding Medicare to cover all Americans.
Critics are going to say that Medicare has proven a failure. The critics are wrong on this count. True, Medicare is struggling with high costs that are creating a deficit in its accounts, but that has more to do with the skyrocketing cost of care throughout the system and the changes made to Medicare to privatize portions of it over the last two decades than it does with any intrinsic flaw in the program.
Seniors universally like the program, according to survey after survey; more importantly, if you compare the health of those between the ages of 55 and 60 (non-Medicare) to those between 65 and 70 (Medicare), you find that the older folks are healthier even though they are older. The reason is that they have guaranteed access to care.
The same issues come up when comparing the U.S. with other systems, comparisons that show us paying more per capita than anyone else (by quite a bit), paying more for big-ticket items and drugs, but also ranking near the bottom on most measures of health (infant mortality, life expectency, etc.).
And yet, the debate too often is tied to anecdotal criticisms of the British and Canadian systems, stories that often are true but in no way are representative of the efficiency or effectiveness of socialized (British) or single-payer (Canadian) medical care.
What is so troubling about this — and not just when dealing with the healthcare issue — is that we have allowed our discussions of government to be distorted to such a degree so that we fail to understand how government actually functions, what its role is and why we need it as a bulwark against corporate power.
It is corporate power, after all, that is the evil here, and not government as a theoretical entity. Government is not separate from the people; it is the people, working collectively to bolster their power, to provide us with defense at home and abroad, to ensure the public welfare, to protect us from the rapaciousness of big business and massive concentrations of power.
Noam Chomsky once said that government was the only entity he knew of that could level the playing field for citizens in their dealings with the corporate world. He defined himself as an anarchist and intensely suspicious of concentrated power. But he also wanted to make it clear that power concentrated in the hands of a profit-driven corporate order was far more of a threat to individual liberty and well-being than the growth of a regulatory state.
I’m an old-time anarchist from way back. I don’t think the federal government is a legitimate institution. I think it ought to be dismantled, in principle; just as I don’t think there ought to be cages — I don’t think people ought to live in cages. On the other hand, if I’m in a cage and there’s a saber tooth tiger outside, I’d be happy to keep the bars of the cage in place — even though I think the cage is illegitimate. I think that image is not inappropriate. There are plenty of good arguments, in my opinion, against centralized government authority. On the other hand, there’s a much worse danger right outside. The centralized government authority is at least to some extent under popular influence, and in principle at least under popular control. The unaccountable private power outside is under no public control. What they call minimizing the state — transferring the decision making to unaccountable private interests — is not helpful to human beings or to democracy or, for that matter, to the markets. In this time when we are told there is “a triumph of the market,” the markets are threatened themselves, aren’t they? What’s developing is a kind of corporate mercantilism with huge centralized, more or less command economies, integrated with one another, closely tied to state power — relying very heavily on state power, in fact — and enforcing social policies and a conception of social and political order that happen to be highly beneficial to the interests of the top sectors of the population, the richest sectors.
That was in 1997. His critique, however, remains valid. Government, as the collective will and embodiment of the people, has a responsibility to defend those things that are or should be human rights: free speech and expression, privacy and personal safety and the right to feel secure in our homes, obviously, but also freedom from want and hunger, access to medical and preventitive care, a clean environment, etc.
A system that views economic efficiency as the highest of goals, that is willing to consign millions to a metaphorical poorhouse as it gobbles up more land, taints more water, enslaves and kills more and more people and generally equates power with money is not just absurd but deadly, both physically and spiritually.
Our only hope is to push back, to protest, to demand a restructuring of society that respects and protects the individual, protects our autonomy and engages our spirit. We must become rebels, as Chris Hedges pointed out this week, men and women who “refuse to be either a victim or an executioner” and “have the moral capacity to say no, to refuse to cooperate.”
The capacity to exercise moral autonomy, the capacity to refuse to cooperate, offers us the only route left to personal freedom and a life with meaning. Rebellion is its own justification. Those of us who come out of the religious left have no quarrel with Camus. Camus is right about the absurdity of existence, right about finding worth in the act of rebellion rather than some bizarre dream of an afterlife or Sunday School fantasy that God rewards the just and the good. “Oh my soul,” the ancient Greek poet Pindar wrote, “do not aspire to immortal life, but exhaust the limits of the possible.” We differ with Camus only in that we have faith that rebellion is not ultimately meaningless. Rebellion allows us to be free and independent human beings, but rebellion also chips away, however imperceptibly, at the edifice of the oppressor and sustains the dim flames of hope and love. And in moments of profound human despair these flames are never insignificant. They keep alive the capacity to be human. We must become, as Camus said, so absolutely free that “existence is an act of rebellion.” Those who do not rebel in our age of totalitarian capitalism and who convince themselves that there is no alternative to collaboration are complicit in their own enslavement. They commit spiritual and moral suicide.
And they may just take the rest of society down with them.
Hank Kalet 