The problem of unnecessary humans

This article originally appeared in Dissident Voice on 8/6/2012.

Dealing with superfluous populations has been a vexation shared by all industrial capitalist societies for generations.  In other words, the problem for modern rulers and leaders is what to do with societal segments that contribute little to wealth creation by production or consumption.  Columbia Professor Emeritus of Sociology Herbert Gans referred to the modern U.S. constituents of these segments as “surplus workers” that eventually become superfluous via indefinite unemployment (1).  The “surplus pool” increases in size with the failure by job creators to do what they claim to do.  The concept, however, generalizes to any society or state in which the exploitation of land and/or resources is being obstructed by the presence of unnecessary humans.

Throughout history, ruling classes employed a variety of strategies to shrink the surplus pool.  In 1788 the British Empire began exporting some of its surplus to Australia in order to establish a new penal colony.  The endeavor was delayed by the presence of the indigenous society that needed to be dealt with: one surplus displacing another.  Similarly, they and other European empires exported feudal leftovers to the Americas and subsequently established colonies after exterminating the native civilizations we learn about in elementary school.

Other alleviating mechanisms include war enlistment, extreme poverty resulting in death, or illness resulting in death.  All three effectively reduce the burden of superfluous populations.  Moral traits and altruistic inclinations, however, get in the way sometimes and history does reveal welfare implementations for the indigent, orphaned, and widowed that were often inspired by Abrahamic doctrines.

Enlightenment-era renegotiations of the social contract and the upsurge of global wealth during the rise of industrial capitalism gradually reinforced the notions of not only expecting but demanding the fulfillment of welfare commitments by state governments particularly in Europe.  The United States, however, was never as anchored to social obligations as mainland Europe given its comparatively blank sociopolitical history.  This contributed to the country’s delayed abolishment of slavery and recognition of worker organization.

The chattel-based planter economy of the early Union along with concurrent industrialization in its northern territories created difficult conditions for poor white farmers.  To avoid drowning in economic hardship, the only option was to take part in the drive toward western expansion that was eventually encapsulated in the philosophy of Manifest Destiny.  In order for the blossoming nation to move forward with continental ownership, the truly unnecessary Native Americans had to undergo displacement or simple erasure.

20^th century dynamics labor-capital dynamics limited the ways in which the United States could deal with its superfluous elements.  The Great Depression highlighted the inability to exterminate, export, resettle, or enslave the unemployed.  It was during subsequent administrations over several decades that the formalized welfare provisions were enacted which are readily recalled as the New Deal, Social Security, Aid to Families with Dependent Children, Medicare, and Medicaid.  And of course, consecutive military engagements were able to partially absorb displacement shocks.

These welfare distributions became increasingly important as neoliberalism and financial enterprises began to dominate U.S. policy beginning with the collapse of the Bretton-Woods system in 1973 which allowed multinational corporations to benefit from an unprecedented degree of capital mobility (2).  Naturally, domestic labor being restricted by land boundaries and sociocultural beacons was thus unable to sync with overseas investment by U.S. firms.  This ultimately contributed to increasing unemployment, downward pressure on wages, poverty, and further dependence on welfare programs.  Indeed, Nobel laureate and economist at Columbia University Joseph Stiglitz warned that unaddressed inequality in America, already the worst among industrialized societies, is fostering a resemblance to two-tiered societies of the Third World (3).

Peter Edelman at Georgetown University Law Center has revealed a great deal about current poverty in the U.S. (4) (5).  His research demonstrated that as of 2010, 103 million Americans had incomes below twice the poverty line i.e. below $36,000 per year for a family of three.  20 million Americans live in deep poverty which includes incomes below half the poverty line i.e. below $9000 per year for a family of three.  These are people that depend on healthcare assistance such as Medicaid, nutritional assistance like food stamps, and tax credits.  Research done by the Heritage Foundation estimated that federal welfare spending approached $700 billion in 2010 alone (6).

The growing surplus pool has been a constant irritation to policymakers and business planners seeking to tap into the welfare cashflow.  The vast portion of that money that is not filtered through private institutions (e.g. public funded private health coverage) is largely wasted on unnecessary humans.  The most prominent effort to correct this blunder is the endeavor to privatize Social Security which happens to be a quite functional, efficient, and well-funded system as Nobel laureate Stiglitz confirmed (7).  However, the current implementation sustains beneficiaries without generating very much profit.  Allowing them to simply pass would free up potential sources of capital.  Another possibility would be for them to take out loans which perhaps can be repaid by their children.

These latter two options, however, would be difficult to implement given their friction with values of sympathy and compassion that reside in the ethos of the general public.  That is to say, the moral foundation that sustains welfare spending the U.S. threatens the viability of such measures.  In the face of this type of opposition, legislators and executives have resorted to the employment of subversive rhetoric appealing to irrational elements of the human psyche in order to justify institutional oppression of superfluous segments.  This includes the exploitation of latent nativism, racism, jingoist nationalism, and religious adherence to the obscure and, in fact, unknowable motives of the “founding fathers.”

The clearest example is undoubtedly the United States penchant for incarceration that disproportionately targets racial minorities as Michelle Alexander’s recent book The New Jim Crow explains in great detail (8) (9).  The War on Drugs that was escalated by President Nixon in the 1970s was continued by Presidents Reagan and Clinton with some pretty ugly consequences.  The strategy was to impose over-the-top punishments for minor drug offenses overwhelmingly committed by the poor while at the same time demonizing blacks as welfare queens and gangsters.  The effect is the underhanded shift of superfluous elements into prison camps where they can perform something comparable to slave labor and simultaneously evade poverty statistics (10).  And of course, for efficiency purposes, a portion of the public spending on incarceration is handed to correctional corporations that profit from America’s toughness on crime (11).

The state-initiated demonization of population segments not in accord with neoliberal reforms is not unique to the United States.  The Indian government has repeatedly labeled a vast sector of its own population as terrorists in order to justify the use of paramilitary forces to destroy associated rural societies that obstruct economic initiatives.  The reactionary group, known as the Maoists, has employed violent tactics in an effort to oppose the corporate and government infiltration of the farmers’ lands (12).  For these people, there is no New World or Manifest Destiny to absorb them.  The only options aside from succumbing to state violence are to pick up and move into urban slums to find work or to simply commit suicide.  Incidentally, the latter option has become a full-blown crisis with a quarter-million farmer suicides since 1995 (13).

However, overt violence like that in India would be intolerable in the United States.  Still, there are other tactics aside from incarceration that severely undermine surplus citizens struggling to keep up with the new global economy.  Take, for example, the Affordable Care Act which is President Obama’s flagship legislation.  Its purpose is to deal with the current healthcare crisis that has left over 50 million without health insurance: 17% of the population.  Furthermore, recent estimates link 26,000+ deaths of working-age adults annually to lack of medical insurance (14).  To be honest, Obamacare is quite far from solving the actual problem and in my opinion is, in fact, a step in the wrong direction.  The fact remains, however, that it would expand the insurance umbrella over millions previously uninsured.  Though that insurance may still bankrupt them, it would at least allow them to see a doctor when they’re sick.

The opposition to the health reform has been expectedly silly.  Conservatives claim that it’s too expensive a burden for a debt-ridden economy.  The latest CBO projections, however, show that Obamacare is likely to reduce the federal deficit by $109 billion over ten years: a modest amount, but a reduction nonetheless (15).  Falseness makes a weak argument, so Governor Rick Perry of Texas resorted to evangelical constitutionalism when declaring combat on the new law recently by rejecting federal funding to expand Medicaid.  He patriotically refused to “socialize” medicine in the great state of Texas out of respect for the kind of freedom envisioned by the Founding Fathers (16).  Unfortunately, Texas happens to be the state with the most egregious coverage gap in the country: 25% uninsured while home to some of nation’s best hospitals.  Governor Perry’s refusal to address the problem reflects outright contempt for his state’s unnecessary humans.

So at this juncture we ought to ask ourselves, how far has civilization come in the treatment of underclass constituents?  Governor Perry is a small example, but his outlook readily generalizes.  He can’t exterminate or export them, but ignoring them seems to work.  Though the implications for democracy are frightening, sometimes it’s difficult not to laugh at the irony present in religious devotion to founding principles.  To be sure, the poor and/or unemployed are, in a commercial sense, valueless.  They effect no labor and they can’t afford to buy any products.  The only thing that makes these people necessary is their capacity to cast votes, but only in a functioning democracy.  Do we have one?  If we could deposit our superfluous population in prison, in war, or underground, would we have one then?

Notes.

1)      http://www.nytimes.com/2011/11/25/opinion/the-age-of-the-superfluous-worker.html

2)      http://www.attacmallorca.es/web/uploads/Kotz1.pdf

3)      http://finance.yahoo.com/blogs/daily-ticker/american-dream-myth-joseph-stiglitz-price-inequality-124338674.html

4)      http://www.democracynow.org/2012/5/23/so_rich_so_poor_peter_edelman

5)      http://www.huffingtonpost.com/peter-edelman/america-has-class-problem_b_1676928.html

6)      http://www.forbes.com/sites/peterferrara/2011/04/22/americas-ever-expanding-welfare-empire/

7)      http://www.thedailyshow.com/watch/wed-july-25-2012/exclusive—joseph-stiglitz-extended-interview-pt–1

8)      http://www.slate.com/articles/news_and_politics/jurisprudence/2010/10/toxic_persons.html

9)      http://www.globalresearch.ca/index.php?context=va&aid=25376

10)   http://www.nytimes.com/2012/03/07/books/michelle-alexanders-new-jim-crow-raises-drug-law-debates.html?pagewanted=all

11)   http://thinkprogress.org/justice/2011/09/26/328486/us-private-prison-population-lobbying/?mobile=nc

12)   http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/8355156.stm

13)   http://www.thehindu.com/opinion/columns/sainath/article3595351.ece

14)   http://www.reuters.com/article/2012/06/20/us-usa-healthcare-deaths-idUSBRE85J15720120620

15)   http://www.cbsnews.com/8301-503544_162-57479021-503544/cbo-health-care-repeal-would-cost-$109-billion/

16)   http://www.huffingtonpost.com/2012/07/09/rick-perry-obamacare_n_1658934.html

The real joke: oppression through marginalization

This article originally appeared in CounterPunch on 5/4/2012.

It’s not easy to get the President of the United States to provide meaningful answers to questions regarding issues of serious concern to the population.  During a Q&A session with Obama put together by YouTube in January, a woman pressed him about her husband’s extended unemployment to which he responded: “send me your husband’s resume” (1) (2).  Dodging questions is pretty standard especially when the truth is not going to make you very popular.  The jobs issue is central to Obama’s presidency so it’s likely that he could have provided a meaningful albeit depressing answer.  Unfortunately, the show has to go on and it did so by ignoring the most popular questions which—remarkably enough—did not have to do with his wedding anniversary or the midnight snacking habits that were discussed, but rather with the War on Drugs (3) (4).

Given his role as the President, one would hope that his public appearances and remarks would serve useful purposes such as providing substantive and honest information regarding policy positions and government activity.  His responses during the YouTube Q&A were not totally egregious, but the superficial behavior at these Correspondents’ Dinners is just depressing.  Performing skits and telling jokes was the top priority last year while Operation Neptune Spear was being carried out.  Again, the show had to go on.  The subjects tackled during this year’s Dinner included eating dogs, Young Jeezy, and casual homophobia.  The funniest bit, however, was the greasy comment on what he declared to be a great American tradition: “a free press that isn’t afraid to ask questions, to examine and to criticize” (5).

Whether or not those questions get answered, the free press he was referring to is far from traditional.  For one thing the spectrum of representative interest is sharply polarized.  For example, there are blogs and there are media conglomerates much like there are local coffee shops and there are Starbuckses.  Even though both provide similar commodities, the two sides operate in different ways because they exist for different reasons.  So even though neither ThinkProgress nor The Wall Street Journal is under any coercion, the latter is still owned by the multibillion dollar News Corporation which exists to make profits for investors.   This has two major implications for an outlet like WSJ.  Firstly, as a corporate subordinate, its terminal function is to contribute to wealth consolidation.  It may not accomplish this explicitly (e.g. “playing politics”), but it would not have been absorbed if it did not contribute to Rupert Murdoch’s bottom line (6).  Secondly, its massive financial backing inexorably enables it be ultra-prominent and consequently ultra-powerful.  Its elite status will obviously influence its content by filtering out writers with non- or anti-elite sentiments.  These principles generalize to other dominant media such as The New York Times and The Washington Post.

So just whose views are the big three free press outlets representing?   An April report published by FAIR looked into which perspectives were being represented on their op-ed pages during September and October 2011 when the Occupy movement was in full swing: the movement which is now recognized to have dramatically shifted political discourse in the U.S. as recent articles in the Post and in Rolling Stone make clear (7) (8).  The report revealed that elites from academia, think tanks, big business, and government institutions made up 84%, 84%, and 73% of the guest column bylines in the Times, the Journal, and the Post respectively.  Those proportions aren’t surprising because they’re pretty much taken for granted: you wouldn’t expect anyone else’s opinion to be important enough to be featured.  The study also found that op-ed writers were overwhelmingly white males: 80-90%.  Furthermore, the Occupy movement was barely discussed in the opinion pages of all three papers.  Again, given the structure of American society, it’s not that surprising.  However, the connection you’re not supposed to make is the obvious one that contradicts principles of a “free press” (9).

To make this connection, we can start by acknowledging some major domestic concerns which, unsurprisingly, include job creation, Social Security, education, and Medicare (10).  The problem is that elites from academia, think tanks, big business, and government are the least burdened by these concerns.  The fact remains that there are people that depend on Social Security for survival (11).

Another hot issue involves reproductive rights and the War on Women (12).  Male op-ed writers comprised 80%, 84%, and 87% of the NYT, the Post, and the Journal respectively.  When the topics include obstetrical sonograms, contraception, abortion, and equal pay/benefits for women, the integrity of the discussion is going to suffer when male perspectives dominate.

The same logic applies to race issues.  Latinos make up 16% of the U.S. population, but their voice was confined to less than half a percent of the op-ed bylines which might not bode well for discussions on immigrant rights or border control.  Blacks were under-represented too which has frightening implications.  Michelle Alexander’s newly popular book The New Jim Crow discusses the scandalous incarceration rate in the United States (highest in the world) that disproportionately targets the black population and supplements a growing “undercaste” (14).  She traces it back to the Nixon and Reagan administrations’ schemes to exploit white working class racism and fear to gain political power.  It’s a national horror that just so happens to not really involve white elites from academia, business, think tanks, and government or their friends or their families.

The race issue is particularly egregious.  Blacks are incarcerated at a rate that is comparatively appalling and often for petty drug crimes such as marijuana possession.  In prison, they’re basically free (slave) labor.  When they get out they are disenfranchised, barred from juries, and struggle to find employment and therefore healthcare.  The fiscal consequences of the War on Drugs or the ethics of incarceration versus treatment are topics that are usually discussed in the papers (15) (16).  Lucid commentary on the grave human damage does come out, but infrequently (17) which is remarkable because the issue is so deeply offensive to principles of compassion and liberty that it ought to be making headlines.

Incidentally the major assertions made by Michelle Alexander in The New Jim Crow are not groundbreaking or radical.  The trajectory of the War on Drugs and its disproportionate affect on the black population had already been figured out by the mid-90s but mainstream discourse was just not ready for that kind of information (18) (19).  Alexander’s study, which is deeply researched and excellently delivered, just came out at the right time.  (Actually it took two years for it to get popular).  This reveals a great deal about the nature of our press.

Well if the press’ function is to inform the public mind so as to facilitate democratic participation and influence political discourse, what can we expect to hear from elected and appointed officials?  Gil Kerlikowske, the Director of the Office of National Drug Control Policy gave a talk a few days ago on drug policy reform at the Center for American Progress (20).  I work in the same building and I happened to walk by him on the way in: I wouldn’t have known about it otherwise.  Even with prodding by the Center’s president Neera Tanden to address incarceration, Kerlikowske managed to avoid talking about drug war casualties by focusing strictly on drug abuse treatment.  In this capacity, he labeled the Affordable Care Act “revolutionary” for its requiring insurers to treat drug addiction like any other disease.  There was barely any mention of the incarceration disaster and absolutely no mention of the effects on the black population.

His lauding of the AFA, however, is interesting.  Obama’s health plan and his drug control strategy are similar in their ostensibly liberal motivations.  Furthermore, these superficialities are reinforced by the White House and the press.  Obamacare expands coverage which helps the poor and sick so therefore it must be populist, liberal, and benign and so on (21) (22).  Similarly, the drug control strategy will treat addiction and help ex-convicts find housing and not relapse so therefore it’s humane and progressive (23).

Unfortunately, the sinister and anemic properties of either are rarely addressed.  Obamacare’s expanded coverage is a blessing to the very entities that are responsible for the health crisis: it funnels billions to private insurers and pharmaceutical companies (24).  Similarly, targeting addiction is not an answer to the incarceration problem nor does it confront the damage to black communities (25).

But for the White House to highlight the hidden problems would irritate investors that influence campaigns through lobbying.  Private correction corporations such as CCA and GEO profit off of taxpayer funded incarceration.  Studies have shown private prison population grew in the last decade as their lobbying dollars increased (26).  A Boston Phoenix article reads: “Despite clear racial, economic, and cultural disparities, cries from constituents fell on deaf ears while law-enforcement lobbyists successfully cajoled and frightened congressional leaders” (27).  Operating through outfits like ALEC, they push for legislation that harshen sentencing for crimes (28).

Health insurance and pharmaceutical companies similarly influence the Affordable Care Act and thus the rhetoric available to Obama.  (29) (30).

Given that vast sectors of the American population hang in the balance in all of these issues, you might assume that the “great American free press” that isn’t afraid to question or criticize would actually ask questions or speak critically in regards to these discrepancies.  But the lives and careers of politicians, business executives, and elite journalists are so intertwined and symbiotic that the public has to be marginalized.  The reason is simple, their interests are opposed.  Furthermore, the public mind is clouded by superficial dichotomies such as Democrats vs. Republicans, pro-life vs. pro-choice, drug treatment vs. overpolicing, etc.  For an elite journalist, these topics are perfectly valid on intellectual and professional levels.  For a politician, they serve invaluable rhetorical purposes.  Forgotten, suppressed, and marginalized, however, are the issues pertinent to the millions that personally have to worry about food, rent, healthcare, education, transportation, debt, and retirement.  That’s the real skit.  That’s the funniest joke.

(1)    http://www.youtube.com/watch?v=eeTj5qMGTAI

(2)    http://www.washingtonpost.com/blogs/44/post/obama-offers-to-find-woman-a-job-during-google-chat/2012/01/31/gIQAckhbeQ_blog.html

(3)    http://www.huffingtonpost.com/2012/01/30/obamas-pot-question-will-_n_1242008.html

(4)    http://www.theatlantic.com/politics/archive/2012/01/retired-lapd-brass-challenges-obama-on-drug-policy/252187/

(5)    http://www.youtube.com/watch?v=GfG8Btb0l3g

(6)    http://www.guardian.co.uk/media/2009/dec/14/rupert-murdoch-wall-street-journal

(7)    http://www.washingtonpost.com/blogs/ezra-klein/post/occupy-the-regulatory-system/2012/04/27/gIQAjo21lT_blog.html

(8)    http://www.rollingstone.com/politics/news/ready-for-the-fight-rolling-stone-interview-with-barack-obama-20120425

(9)    http://www.fair.org/index.php?page=4513

(10)http://www.people-press.org/2012/01/23/public-priorities-deficit-rising-terrorism-slipping/

(11)http://www.cbpp.org/cms/index.cfm?fa=view&id=3260

(12)http://www.salon.com/2012/04/30/war_on_women_isnt_over/singleton/

(13)http://www.washingtonpost.com/blogs/blogpost/post/trayvon-martin-death-has-echoes/2012/04/02/gIQAVievqS_blog.html

(14)http://www.huffingtonpost.com/michelle-alexander/the-new-jim-crow_b_454469.html

(15)http://online.wsj.com/article/SB10001424052702303425504577353754196169014.html

(16)http://online.wsj.com/article/SB10001424052702303592404577364313277369518.html

(17)http://www.nytimes.com/roomfordebate/2012/03/12/young-black-and-male-in-america/spend-money-on-schools-instead-of-the-war-on-drugs

(18)http://www.commondreams.org/views/041200-104.htm

(19)http://www.mendeley.com/research/race-criminalization-black-americans-punishment-industry/

(20)http://www.americanprogress.org/events/2012/05/drugs.html

(21)http://www.thenation.com/article/167256/how-affordable-care-act-saves-lives

(22) http://www.whitehouse.gov/blog/2012/03/21/affordable-care-act-saving-lives

(23)http://www.huffingtonpost.com/r-gil-kerlikowske/white-house-drug-policy_b_1432966.html

(24)http://pnhp.org/news/2010/march/pro-single-payer-doctors-health-bill-leaves-23-million-uninsured

(25)http://www.nytimes.com/2012/04/10/nyregion/reducing-crime-squandering-good-will.html

(26)http://thinkprogress.org/justice/2011/09/26/328486/us-private-prison-population-lobbying/

(27)http://thephoenix.com/Boston/News/73092-Freedom-watch-Jailhouse-bloc/?page=3#TOPCONTENT

(28)http://diversityinc.com/investigative-series/who-profits-from-the-prison-boom/

(29)http://floridaindependent.com/10163/how-the-american-legislative-exchange-council-turned-health-care-repeal-into-a-national-wave

(30)http://thinkprogress.org/economy/2009/12/05/72376/bcbs-alec-health/

Healthcare considerations of the American decline

This article originally appeared in CounterPunch on 4/17/2012.

“A heart that’s full up like a landfill.  A job that slowly kills you.  Bruises that won’t heal.  You look so tired, unhappy.  Bring down the government, they don’t speak for us.  I’ll take a quiet life, a handshake of carbon monoxide.”

The existential sorrow in Thom Yorke’s voice has never sounded as poignant as it does today in “No Surprises”, a track of lonely capitulation on Radiohead’s monolithic OK Computer.  The song evokes images of helplessness and retreat in the face of globalization and corporate capitalism.  The accompanying music video features Yorke’s head in a bubble helmet that slowly fills up with water (1).  The symbolism in both the lyrics and the video has become increasingly relevant since the record’s release fifteen years ago.

Some call it America in Decline and it’s a theme that has been explored extensively over the recent years, months, and weeks (2) (3) (4).  The idea is obviously met with skepticism.  In order to understand it, we have to put it in perspective and define a context.  What exactly is America and what’s in decline?

It remains the richest country in the history of modern civilization.  It controls the most powerful and comparatively advanced military machine ever assembled: a likely result of spending more than the rest of the world combined (5).  The two characteristics are intimately related.

Indeed, the idea that the accumulation of wealth inculcates suspicion and the need to defend it has even been discussed by 6^th century philosopher Boethius in The Consolation of Philosophy: “the wealth which was thought to make a man independent rather puts him in need of further protection” (6).  In fact, the need for institutional protection of private property is one of the most heavily explored topics of classical liberalist thought and framed much of the debate during the United States’ formative period.  We like to think that the nation was founded on principles of total equality and personal liberty.  But the chief concern among the framers was how to create a system where landowners can remain landowners without having to worry about greedy peasants.

The concept rapidly generalizes to capital accumulation today.  Wealthy and privileged members of society want the government to perform its intended function which is to protect their assets.  What would have previously been labeled agrarian reform is basically equivalent to progressive taxation.  However, any rational politician will cater to privileged interests especially when legislative positions are virtually bought in the current system.   The collection of votes is now regarding as a secondary consequence of properly financing an electoral campaign.

Social reforms that benefit the overwhelming majority of the population—where political power is least concentrated—are marginal issues that require populist demonstration in order to enter the political arena.  The civil rights movement, the feminist movement, and the AIDS movement are just a few examples.  That these were issues that could not be influenced by voting highlights a particularly sinister illusion of franchise.  We vote for politicians that seem relatable given their stance on satellite issues.  Presidential candidates will resort to tactics such as showing up on MTV discussing underwear in order to the exploit youth culture.  In other venues he’ll discuss how to be tougher on crime or how to withdraw from some foreign conflict in some vague number of years.

But where’s the candidate that speaks to immediately relevant issues such as access to health care or proper retirement benefits?  The former example is pretty striking, actually.  Government sponsored medical coverage has been a prominent domestic concern for almost 40 years (7) (8).  Even a recent 2009 NY Times/CBS News poll suggested that 72% of the population were in favor of a government administered health insurance program that would compete with current private plans (9).

Furthermore, there’s no longer any doubt that a public option would drastically reduce health costs and thus relieving some of the burden on consumers.  A 2003 study published in the New England Journal of Medicine concluded that health care administration costs account for 31% of health expenditures in the U.S. which comes out to almost $300 billion.  Canada’s administration costs, on the other hand, makes up 16.7% of their total health expenditures (10).  The high costs of U.S. health administration are a direct result of having to navigate the extreme complex channels of billing and reimbursement through private insurers.  As one would expect, the system’s complexities are tailored to minimize payouts to consumers and simultaneously maximize profits.

The U.S. has very little to show for its insanely expensive health arrangement.  Its per capita costs are twice those of other advanced OECD nations (11).  However, it ranks pretty low in health outcomes such as infant mortality and and life expectancy (12).

And the burden on the general population is, indeed, quite severe.   Two landmark 2009 studies by Harvard physicians David Himmelstein and Steffie Woolhandler were able to show that the extraordinary costs of healthcare and insurance impose crushing financial burdens and leave many who cannot afford insurance to die.  They found that 62.1% of bankruptcies filed in the United States in 2007 had medical causes.  This value is sharply contrasted with an estimated 8% in 1981 and 46.2% in 2001.  80% of the 2007 figure had health insurance and most were well-educated and middle-class (13).  Furthermore, the researchers were able to link the lack of health insurance to 45,000 working-age deaths per year in the U.S. and conclude that the uninsured are 40% more likely to die than those with private insurance (14).  This figure, too, is in sharp contrast with a 1993 estimate of 25% (15).  The spectrum of health outcomes parallels socioeconomic status as one would expect, but the worsening trends and sheer quantity of deaths are so morally alarming that they cannot be ignored.

The outlook is even more depressing when we examine a recent U.S. Census Bureau report which revealed a striking racial distribution of uninsurance.  21% of blacks and 31% of Hispanics in the U.S. are uninsured compared to 11.7% of whites (16).  This, too, is not that surprising.  The proportions are probably similar for those who drive Range Rovers, but we have to remain cognizant of the fundamental difference between the two commodities.

The consequences of private administration of healthcare are fairly predictable.  A corporation’s chief concern will always be self-sustenance and growth.  Consumer benefit is only a priority when it contributes to the two main goals.  The touted virtue of free market efficiency is based on the symbiotic relationship between consumer benefit and corporate profit.  Unfortunately, it’s not really a free market.  The government is continually prohibited from acting as a significant competitor even though most of the population agrees that it should be.  Because of the fundamental difference between health and Range Rovers as commodities, consumers do not have the option of simply boycotting the product or choosing a competitor and thereby placing downward pressure on costs.  Saying no to healthcare is simply anti-human.

Furthermore, patent-protected pharmaceuticals will sell at premiums with markups sometimes up to a thousand percent.  It’s often argued that patent protection and value markup are required in order to fund research and development.  However, we cannot ignore the costs of advertising, marketing, lobbying, and profit margins.   The economist Dean Baker has done significant work in exposing the inefficiencies and deceitful practices of the pharmaceutical industry that ultimately harshen the financial burden on the general public (17).  He has argued for several years that publicly funded research for the development and distribution of patent-free drugs would be far more advantageous than the current system that spends an estimated $300 billion per year on prescription drugs.

The prospects for change are pretty bleak given the virtual disenfranchisement of the general population which brings us back to American decline.  Media-propagated illusions are partially responsible.  The current debate surrounding Obamacare is a ripe example.  Government-sponsored insurance is not even on the agenda and the public is led to believe that the Affordable Care Act and its guaranteed coverage is the solution we have long waited for.  This illusion is based on the false dichotomy between Democrats and Republicans.  It’s a bad joke, really.  Obamacare is modeled on the Massachusetts health plan the origins of which trace back to the Heritage Foundation (18) (19).  It was implemented by then-Governor Mitt Romney.  I’ll spare the irony.

The bottom line is that the individual mandate would require everyone to buy in to private insurance risk pools to decrease medical premiums.  It will funnel hundreds of billions of dollars to private insurers and Big Pharma and further inflate their political clout.  Even if it passes, an estimated 23 million of the current 50 million Americans will remain uninsured (20).  Alternatives such as a single-payer system or at least a public option are completely missing from the debate even though majority of the population is in favor of them.  Of course, with these alternatives, private insurance companies would stand to lose.  Corporate executives would lose money and perhaps workers would be laid off, but that overall human suffering would be less is an obvious conclusion of alternatives that are marginalized by the media and our politicians.

Thus, the current trend can be visualized as a hollowing out of the American identity.  The military and financial prowess of the United States makes it an undeniable juggernaut in the global theater, but it has very little advantage for most of the population.  Unemployment and healthcare are the two most pressing concerns for most Americans, but there’s very little that can be done via the electoral system due to its deeply financial nature.  Those that do climb the socioeconomic ladder are driven into virtual fiefdom via debt burdens that are owed in part to the absurd costs of tuition for higher education (21).  Crushing debt burdens discourage social activism and inculcate profit-seeking values.  Those that cannot afford to climb the ladder or choose not to will have to confront the depressing avenues of uninsurance and poverty which only exacerbates the vicious cycle of decline.

1)      http://www.youtube.com/watch?v=u5CVsCnxyXg&ob=av3e

2)      http://www.hoover.org/publications/defining-ideas/article/82581

3)      http://www.truthdig.com/report/item/american_decline_debated_contested_obvious_20120410/

4)      http://www.tomdispatch.com/archive/175502/

5)      http://armscontrolcenter.org/policy/securityspending/articles/fy09_dod_request_global/

6)      http://www.gutenberg.org/files/14328/14328-h/14328-h.htm

7)      http://www.kff.org/healthreform/upload/7871.pdf

8)      http://www.fair.org/index.php?page=3633

9)      http://www.nytimes.com/2009/06/21/health/policy/21poll.html

10)   http://www.pnhp.org/publications/nejmadmin.pdf

11)   http://www.commonwealthfund.org/Publications/Issue-Briefs/2011/Jul/US-Health-System-in-Perspective.aspx

12)   http://www.nejm.org/doi/full/10.1056/NEJMp0910064

13)   http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf

14)   http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2008.157685

15)   http://www.ncbi.nlm.nih.gov/pubmed/8336376

16)   http://aspe.hhs.gov/health/reports/2011/CPSHealthIns2011/ib.shtml

17)   http://www.guardian.co.uk/commentisfree/cifamerica/2011/may/31/healthcare-pharmaceuticals-industry

18)   http://www.heritage.org/research/reports/2006/04/the-significance-of-massachusetts-health-reform

19)   http://www.heritage.org/research/reports/2006/07/the-massachusetts-health-plan-lessons-for-the-states

20)   http://pnhp.org/news/2010/march/pro-single-payer-doctors-health-bill-leaves-23-million-uninsured

21)   http://www.usnews.com/education/blogs/student-loan-ranger/2011/09/28/college-tuition-growth-rate-is-biggest-bubble-of-them-all

Affordable care act: an allegorical perspective

This article originally appeared in Common Dreams on 3/29/2012.

Let’s imagine ourselves as belonging to a remote valley population that survives on water supplied by groundwater reserves.  As a society we have collectively decided to send the best and brightest to use their ingenuity to find the reserves and dig efficient wells that can sustain the population.  They consider it a proud public service.  As a result of population growth and technological advancement, more wells are dug farther and farther from the valley.  The society subsequently grants a charter to a group of businessmen to incorporate and manufacture electric cars to transport people to and from the wells.  Again, this is considered to be for the good of the population: people need access to water.  These businessmen are allowed to behave according to classical market principles whereby profits incentivize efficiency.  Higher efficiency means better access water which is essential for survival.

As time passes, the population continues to grow and technology continues to advance.  It becomes increasingly clear that the most efficient way to facilitate water access to the population is to a construct a high speed train that the entire population can use.  Since it’s a train, it would eliminate the need for each person to purchase an electric car.  When you need water, all you would need to do is hop on the Aquatrak.  People would rather concern themselves with creative endeavors and personal relationships than how they’re going to afford an electric car.  Water is essential to human life, so implementing the Aquatrak is pretty obvious, right?

Wrong, because we forgot about the owners of Megawatt Motors.  We let them incorporate and accumulate profit which became an addiction.  They became wealthy enough to bribe our leaders and chief decision-makers.  They couldn’t let Aquatrak develop or they would lose all their business.  It doesn’t matter if all of their employees stand to benefit greatly from the better access to water.  The profit distribution at the top would inexorably decline.

Eventually people get unruly and uncooperative as their collective sympathy kicks in upon witnessing the poor go without electric cars and the thirsty go without water.  To check the unrest, Megawatt Motors allows for the construction of Aquatrak.  They refuse to fund it, but they demand that only the poor and the old can use it.  This, too, starts to unsettle the savage population so they stipulate that you can get on the train if you’re about to die from thirst, but those wonderful people we sent to dig the wells are going to have to pay for it which makes them jaded and cynical.  Everyone else needs to buy a car if they want water.

Some discover that you don’t need to buy a car.  If they really need water, they figure they’ll just walk the distance to the closest groundwater well.  If, along the way, they realize that they were too brash and can’t make it the whole way, they have three options: 1) die 2) rent a car or 3) board the emergency train.  Each option is a problem.  Our society doesn’t like dying which leaves the latter two.  Option 2 is bad because Megawatt Motors needs to cover its costs.  So when less people buy their cars, they increase the unit price which is only rational.  Increasing the unit price is bad for everyone else because they have no choice but to pay the extra cost: they need the car because they need water.  Option 3 is bad because, again, those bright groundwater seekers have to pay for it.  But they’re jaded and cynical now so they bill at a higher rate for their labor.

So now both electric cars AND water are ridiculously expensive which burdens the society.  The motor of public unrest begins to turn again.  People are angry that access to water has become so expensive.  It did not used to be this expensive.  They can no longer focus on their passions because they are always worried about water.  Disdain forms between those who can afford electric cars and those who cannot afford electric cars.  The entire population becomes bitter and suspicious.  They don’t understand why they are paying for an Aquatrak that they’re not allowed to use.  They become angry at those using the Aquatrak.  Blinded by consumerism, xenophobia, and nationalism, they cannot understand what is happening.

Megawatt Motors eventually sees a grand opportunity.  They see this opportunity because they are clever which they have to be in order to feed their addiction.  They allow a single idea to penetrate the hazy confusion and reveal its head above the cloud.  Society begins to entertain the idea of forcing its constituents to buy electric cars.  It seems like a great idea because the cost of water and water labor will decrease.  It appears to be an answer to the big problem, a solution in the midst of turbulence.

If everyone buys an electric car, everyone gets water and both become cheaper.   To many, it’s a no-brainer.  But the rest can’t let go of their suspicion and bitterness.  They detest the idea of being forced to buy an electric car. They feel that it is unfair, oppressive, and hostile to their liberty.  Megawatt Motors waits silently as the two sides argue bitterly against each other.  The legal obligation to purchase an electric car would be great for business and profits would soar.  That’s why they let the idea grow, develop, and reach public consciousness.

In the chaos, the general population forgets about the power of Aquatrak, the simplest solution of all.  One train versus an electric car for each person.  The train is NOT fueled by the addiction to profit, but rather by the need for water.  Everyone is allowed on the train, so no one is suspicious of each other.  Everyone takes the train, so our innocent water collectors can go back to digging new wells instead of running tabs.  Collective sympathy is restored.  We remember that water isn’t a commodity, but an element of societal survival.

Aquatrak represents a single-payer universal healthcare system that cuts out the insurance middlemen represented by Megawatt Motors.  During Tuesday’s Supreme Court session, attorney Paul Clement argued with Justice Kagan about the difference between electric cars and health insurance as market entities: “My unwillingness to buy an electric car is forcing up the price of an electric car…If only more people demanded an electric car, there would be economies of scale, and the price would go down” (1).  Clement argued that that sort of inaction does not indicate active engagement in commerce and likewise with failure to buy health insurance.  Kagan disagreed with the analogy and argued that healthcare is by nature different in that even if you do not buy health insurance, you are still entitled to healthcare.  It would be like refusing to buy an electric car, but reaping the benefits of automated travel.

This forced intimacy between two “markets” is the absurdity that we all overlook.  to buy or not to buy health insurance is NOT the question.  It doesn’t have to be.  Congress does not have to impose commerce.  Article 1, Section 8 of the Constitution: The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States.  There’s no reason to force the people to do business with Megawatt Motors when Aquatrak can be financed via taxes.

These Supreme Court proceedings cloud the importance of health not as a commodity but as elemental to human civilization.  Every human depends on it and, as such, it unites us in solidarity.  We care about each other’s access to it.  How can we stay silent as Americans when we’re the only modern industrialized nation where loss of employment means loss of health, loss of life?  Why is corporate profit so intimately connected with popular sustenance?   If healthcare distribution by wealth weren’t so viscerally immoral, why did we find it necessary to forbid emergency rooms to turn people away?  Is that really the limit to our moral imagination?

We can’t see the 47 million uninsured, but we know they are there.  How is this okay?  Mandated coverage under Obamacare will not come near closing that deficit, but we’ve allowed the debate to be framed in such a way that there is no other option.  Not only does it not go far enough, it’s going in the wrong direction.  Channeling billions right back to private MCOs and pharmaceutical giants is not a band-aid on a papercut.  It’s cauterizing a stab wound to the neck.  It might stop the bleeding, but it will become infected.

(1)    http://www.supremecourt.gov/oral_arguments/argument_transcripts/11-398-Tuesday.pdf