Listening to years of bickering over the ACA--and bickering is indeed the word to use here--has left me with a sense that we need to restart this 'conversation' from first principles. And after thinking about health insurance from first principles, I've come to the realization that the biggest problem with health insurance isn't whether it's controlled by the government or private insurers (although there are indeed problems associated with both of these). The biggest problem with health insurance is the very idea of health insurance itself. 'Health' and 'insurance,' as we understand them, are wholly incompatible.
Consider, for example, the bickering over the 'individual mandate' imposed by the ACA. Conservative opponents of the ACA and the mandate argue that it's immoral to force healthy, young people to buy health insurance. Supporters of the individual mandate (notably, a conservative idea) argue that it's necessary to accomplish the broader aim of the ACA: to bring down healthcare costs and keep premiums low by having a broad, 'diverse' pool of insurance customers.
At what point does someone realize that this is a completely stupid argument?
By looking at healthcare from an insurance perspective--which is to say by minute calculations of risk akin to those done by car insurers, hedge fund managers, and casino operators--it would certainly seem silly to force a healthy 25-year-old to buy health insurance. At the same time, it would certainly seem necessary to have that healthy 25-year-old as part of the client pool to contribute favorably to an insurance company's risk profile, to offset all those expensive old people who run higher risk of needing care, and needing it paid for. But this is an ass-backwards way of looking at the situation for one very simple reason: it's both socially and morally irresponsible to take risks with one's life.
To explain this further, consider that healthy 25-year-old. Most people that age don't get sick, don't require hospital care, don't require long-term care...except when some of them do. Young people can get catastrophically sick; hit by cars; break bones; overdose; get pregnant, etc. And when these things happen, as they inevitably do, however atypical they are from a risk assessment standpoint, no reasonable person in our society would say that we should deny these people care if they're not 'insured.' A physician is under ethical obligation to provide care. A hospital can't turn away a gun shot patient with no health insurance. And no one but the most extreme Randian sociopaths would argue that it should. As a society we've already made it clear, on a number of fronts, that even if our policies don't reflect our values, our values favor the preservation of human life. The left concerns itself with the risk to life born by the uninsured; the right concerns itself with the prospect of 'death panels' that decide precisely when care will no longer be administered to the dying. And the private medical sector makes these choices every day. And never without regard for doing the most we can with what we have to preserve life.
And herein lies the fundamental problem: unlike when you wreck your car without auto insurance, you can't just junk a catastrophically sick person, whether they're insured or not. Healthcare reformers have argued for ages now that because of this dynamic, we have to be mindful of the costs to government and taxpayers of 'free riders' who are without insurance but nevertheless must go to hospital to get care when they need it. The risk associated with ill health, then, is not a risk at all. It's always a guarantee of care, at least from a moral standpoint. You insure cars; you can't insure people. It's a moral impossibility.
So if we know that we'll always provide care to the 25-year-old who didn't purchase insurance, why are we treating this situation as a matter of risk management, or as a matter of insurance?
The alternative is to be honest with ourselves about our values, rather than abstracting them (and thus contorting them) by running them through competing risk analysis protocols under the guise of 'efficient' provision of 'insurance.' Access to healthcare, therefore, must be understood as a right, not a risk. In ideological terms plenty of people will lose their respective heads arguing against the idea that healthcare is a right; and yet if you ask any of these people whether they think, therefore, that someone who hadn't the foresight (or the money) to insure themselves should be left to suffer and/or die, none of them will actually say we should just let people die. That would be mortifying, indeed, sociopathic. In practical terms, therefore, we're actually fairly united in understanding access to health care as a pretty basic right. It's time we start treating it that way in policy terms.
Friday, March 28, 2014
Monday, March 24, 2014
Understanding the Politics of Normal in 3 Easy Examples
Despite all the money in politics, a skilled, educated reader is a very powerful thing. Those able to influence policy with their money spend billions of dollars putting words in front of readers, words designed to manipulate the way we think about issues. And yet skilled readers who understand rhetoric can pull apart manipulative words and images, exposing them for the propaganda that they are. One manipulative technique we should be paying more attention to is the rhetorical definition of normal.
In academia, the politics of normal is alive and well. One can take a class in '20th century American Literature,' and one can take a class in '20th century feminist American literature.' The designation 'feminist' added to the subject matter 'American literature' is doing something very important here. By modifying the baseline 'American literature,' 'feminist American literature' reads like a special subset of American literature. In fact, when we title courses this way, this is exactly what we mean. What we perhaps don't mean to do, however, is to define the normal--'American literature'--with an implicit assumption about what constitutes 'American literature' but not 'feminist American literature.' Put simply, you might expect to read authors like F. Scott Fitzgerald, Thomas Pynchon, Philip Roth, T.S. Eliot, etc. in a '20th century American literature' course; you might even expect to read female authors, like Toni Morrison or Joyce Carol Oates, in such a course. But you won't expect this course to have anything to do with 'feminist literature,' even if the American 20th century featured landmark developments in women's rights, as well as an abundance of feminist literatures. The designation of 'feminist' as a special subset of the normal '20th century American literature' makes the implicit assumption that feminist literature is not part of the 20th century American 'normal,' when in fact it very much was. This might seem like a small, even nit-picky detail; but this detail fundamentally changes the expectations we have about what constitutes 'normal' and what is an 'additional' or 'special' category in relation to normal.
A second and more overtly political example of the rhetorical definition of normalcy is the discourse of 'class warfare.' When we invoke 'class warfare' in contemporary American politics, we mean to suggest that those who are in the poorer classes of American society are agitating with jealousy and scorn to bring the rich back to earth. Thus, when a celebrity billionaire complains that he feels persecuted by those who are jealous of his wealth, the plea is to stop the 'class warfare.' The reason such a plea is so effective is that it rhetorically constructs normalcy as the rich already having justly earned their money and the poor already having failed to do so for themselves. The rhetoric of class warfare depicts a scenario in which everybody started from the same line, and those losing the race are just sore losers. If we look at it from this standpoint of normalcy, the poor complaining about what the rich have does indeed look like an act of aggression; hence, 'class warfare.' Looking at it another way, however, we might see redistributive policies that the rich lobby for and that benefit the rich as acts of 'class warfare,' too. If we rhetorically redefine the normal as a competitive market system in which those who already have an advantage work effectively to manipulate that system to solidify further advantage at the expense of the poor, this, too, looks like 'class warfare.' A tax policy that redistributes wealth from the poor to the rich--like mortgage tax deductions and the carried interest loophole--might also look like class warfare. But if you use rhetoric to set the status of 'normal' at a point in the political process AFTER which all of this kind of policy manipulation has happened, then 'class warfare' becomes the poor's aggression, rather than reaction. A similar resetting of normalcy is at work in discussions of who gets 'government welfare,' even if a vast majority of government spending is, via the tax code and via subsidies for large industries and corporations, spent on the rich, not the poor.
A third and final example of resetting the normal is to do with how we think about the 'free market' itself. The current debate over the minimum wage is good place to start with this example. Opponents of minimum wage increases--or of the minimum wage itself--argue that the 'free market' isn't setting the wage increase, therefore such an increase would be a regulatory and 'artificial' imposition on the 'free market.' By defining the 'free market' BEFORE minimum wage adjustments or IN RELATION TO workers' wages as the normal, critics of minimum wage increases can make it seem like anything above this normal is manipulation. But by defining the 'free market' this way, these people are simply aligning market manipulation policies that they like as 'free,' and policies they don't like as 'artificial' interventions into the 'free market.' Of course, the 'free market' is subject to countless manipulations, from tariffs to interest rates (and other kinds of currency manipulations) to government subsidies to governments outright banning some enterprises while awarding government business directly to others (as in New Jersey, whose government is shutting down Tesla sales operations in that state). What we know rhetorically as the 'free market' is really not free, unregulated, or unmanipulated at all. What one person sees as 'artificial' regulation and what another sees as a product of the 'free' market can change entirely depending on how we set and argue for the definitions of 'artificial' and 'free.' So again, by setting 'normal' AFTER the manipulations that give employers leverage over employee wages--which have remained stagnant for decades now, even as the US economy has continued to grow over this time--those with personal and ideological interests in keeping wages low can claim that the minimum wage increase is an 'artificial' act that violates normalcy.
As you can see, then, so much of our political discourse is very crucially affected by how and where we use rhetoric to establish normalcy standards that favor one side over another. Another way to envision how this works in everyday life would be to have a tug-o'-war match in which one side has to pull 3 feet to the other's 7, while the judges are working under the assumption that the distance is 5 to 5. Better reading and rhetorical awareness enables us to judge more accurately in an environment in which we're constantly manipulated to think that there are no ideological advantages, only 'facts.'
In academia, the politics of normal is alive and well. One can take a class in '20th century American Literature,' and one can take a class in '20th century feminist American literature.' The designation 'feminist' added to the subject matter 'American literature' is doing something very important here. By modifying the baseline 'American literature,' 'feminist American literature' reads like a special subset of American literature. In fact, when we title courses this way, this is exactly what we mean. What we perhaps don't mean to do, however, is to define the normal--'American literature'--with an implicit assumption about what constitutes 'American literature' but not 'feminist American literature.' Put simply, you might expect to read authors like F. Scott Fitzgerald, Thomas Pynchon, Philip Roth, T.S. Eliot, etc. in a '20th century American literature' course; you might even expect to read female authors, like Toni Morrison or Joyce Carol Oates, in such a course. But you won't expect this course to have anything to do with 'feminist literature,' even if the American 20th century featured landmark developments in women's rights, as well as an abundance of feminist literatures. The designation of 'feminist' as a special subset of the normal '20th century American literature' makes the implicit assumption that feminist literature is not part of the 20th century American 'normal,' when in fact it very much was. This might seem like a small, even nit-picky detail; but this detail fundamentally changes the expectations we have about what constitutes 'normal' and what is an 'additional' or 'special' category in relation to normal.
A second and more overtly political example of the rhetorical definition of normalcy is the discourse of 'class warfare.' When we invoke 'class warfare' in contemporary American politics, we mean to suggest that those who are in the poorer classes of American society are agitating with jealousy and scorn to bring the rich back to earth. Thus, when a celebrity billionaire complains that he feels persecuted by those who are jealous of his wealth, the plea is to stop the 'class warfare.' The reason such a plea is so effective is that it rhetorically constructs normalcy as the rich already having justly earned their money and the poor already having failed to do so for themselves. The rhetoric of class warfare depicts a scenario in which everybody started from the same line, and those losing the race are just sore losers. If we look at it from this standpoint of normalcy, the poor complaining about what the rich have does indeed look like an act of aggression; hence, 'class warfare.' Looking at it another way, however, we might see redistributive policies that the rich lobby for and that benefit the rich as acts of 'class warfare,' too. If we rhetorically redefine the normal as a competitive market system in which those who already have an advantage work effectively to manipulate that system to solidify further advantage at the expense of the poor, this, too, looks like 'class warfare.' A tax policy that redistributes wealth from the poor to the rich--like mortgage tax deductions and the carried interest loophole--might also look like class warfare. But if you use rhetoric to set the status of 'normal' at a point in the political process AFTER which all of this kind of policy manipulation has happened, then 'class warfare' becomes the poor's aggression, rather than reaction. A similar resetting of normalcy is at work in discussions of who gets 'government welfare,' even if a vast majority of government spending is, via the tax code and via subsidies for large industries and corporations, spent on the rich, not the poor.
A third and final example of resetting the normal is to do with how we think about the 'free market' itself. The current debate over the minimum wage is good place to start with this example. Opponents of minimum wage increases--or of the minimum wage itself--argue that the 'free market' isn't setting the wage increase, therefore such an increase would be a regulatory and 'artificial' imposition on the 'free market.' By defining the 'free market' BEFORE minimum wage adjustments or IN RELATION TO workers' wages as the normal, critics of minimum wage increases can make it seem like anything above this normal is manipulation. But by defining the 'free market' this way, these people are simply aligning market manipulation policies that they like as 'free,' and policies they don't like as 'artificial' interventions into the 'free market.' Of course, the 'free market' is subject to countless manipulations, from tariffs to interest rates (and other kinds of currency manipulations) to government subsidies to governments outright banning some enterprises while awarding government business directly to others (as in New Jersey, whose government is shutting down Tesla sales operations in that state). What we know rhetorically as the 'free market' is really not free, unregulated, or unmanipulated at all. What one person sees as 'artificial' regulation and what another sees as a product of the 'free' market can change entirely depending on how we set and argue for the definitions of 'artificial' and 'free.' So again, by setting 'normal' AFTER the manipulations that give employers leverage over employee wages--which have remained stagnant for decades now, even as the US economy has continued to grow over this time--those with personal and ideological interests in keeping wages low can claim that the minimum wage increase is an 'artificial' act that violates normalcy.
As you can see, then, so much of our political discourse is very crucially affected by how and where we use rhetoric to establish normalcy standards that favor one side over another. Another way to envision how this works in everyday life would be to have a tug-o'-war match in which one side has to pull 3 feet to the other's 7, while the judges are working under the assumption that the distance is 5 to 5. Better reading and rhetorical awareness enables us to judge more accurately in an environment in which we're constantly manipulated to think that there are no ideological advantages, only 'facts.'
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