Neoliberal Interventionism: American Adventures in Healthcare

Recently, the United States government shut down for a short period of time.[1] Judging from mainstream analysis there was plenty of blame to go around, and local discourse was even more confused regarding the issues. What emerged, both leading up to the shutdown and following was a focus on the Affordable Care Act (ACA), also known as “Obamacare.” Unfortunately, the ACA was already law, and the shutdown would do nothing to affect this aside from delaying its implementation. The fact that this shutdown occurred anyway speaks to not only the political climate, and our political leaders grasp on reality, but the very system that created it. What is the issue regarding healthcare in America, and why is the more conservative (more pro-market) party opposed to a conservative authoritarian pro-market system, when a so-called left-wing party adamantly supports it?

I’ll begin my position on this by suggesting that healthcare is as close to a human need as one can get without becoming a human need; if we were to use Maslow’s hierarchy, it would exist in the realm of safety needs.[2] This being said, healthcare is a human right and part of what compromises basic human dignity. This position explains why it is that (aside from the United States) every advanced country on Earth (including Canada, China and Mexico) provides healthcare as a government service, all of which are smaller economies than the US.[3][4] This also explains why so many in the US are willing to pay so much for it. In fact, the US pays more for healthcare than (all) other countries.[5] This is also consistent with the broad and bipartisan support for increasing access.

The object of healthcare in the United States exists as a class dynamic belonging to those with the greatest market purchase ability. Many low-income persons in the United States have no healthcare, even if they are able to afford basic insurance.[6] Surely, many of us are familiar with friends and family who have been denied coverage for treatment, or medical bills. Historically speaking, prescriptions, preexisting conditions (cancer, diabetes, minor heart conditions) and women’s healthcare have not been covered, though this is something the ACA purportedly fixes by declaring this practice illegal. Unfortunately, not all of this has been addressed as of yet.[7]

In the build up to the ACA, there was a plethora of problems unearthed regarding healthcare. Many of the issues were complicated, and some were matters of opinion. What could be agreed upon as fact, however, was that there were 44 million Americans without health insurance.[8] Without exploring the reasons behind this, the lack of insurance became synonymous with lack of care—and why not, it makes sense, our politicians all have insurance and receive care. Therefore, in order to address one issue with healthcare, the ACA created a five-tiered system (catastrophic, bronze, silver, gold and platinum) of insurance to be purchased on an open market. As coverage goes up, logically the price increases, and if you are low income you may qualify for government subsidy for the insurance.[9]

Functionally, what this means, is insurance plans reinforce class status. The wealthiest will still have the best coverage, and therefore the best care. Ironically, the group that can afford the most per month in insurance payments is also the same group that could afford a higher medical care cost when the times comes for treatment. Unfortunately, still, the poorest are still underserved by this system. For example, the lowest tier plan, known as ‘catastrophic’ is available for those with very low income and does not even cover prescription drugs.[10] What good is healthcare if you are still unable to afford the copay? Without doubt, it sounds like an economically sound, but socially and ethically dissonant plan.

Bearing this in mind, I suggest that increasing healthcare (defined as improving mental and physical wellbeing of an individual) ought to be a process creating positive health; that insurance does not necessarily equal care; and that this plan does not improve wellbeing, but rather taxes low-income persons to a greater extent, in turn, reducing not only economic wellbeing, but also emotional and mental wellbeing based on the emotional relationship humans have with market economics and the overall loss of happiness within market democracies.[11][12] In conjunction with generalized reduction in happiness, for those experiencing prolonged economic hardships, this system perpetuates many of the problems associated with poverty.[13]

This brings us back to the latter half of the question initially posed in this essay: why is the more conservative (more pro-market) party opposed to a conservative authoritarian pro-market system, when a so-called left-wing party adamantly supports it? To begin with, we must acknowledge that America does not have a true left-wing party; it has two pro-market parties. Pro-market, with differing affects towards the market system: The Republicans suggest that market intervention is negative, whereas the Democrats believe in market intervention. The ACA represents a de facto intervention into the market by requiring that all people choose a plan based on their purchase ability, thus it is favored by the Democrats (the party that favors intervening in the market), and opposed by the Republicans (the party opposed to market intervention). This suggests that while both parties could agree that there is an issue with healthcare and coverage in America, there remains only two alternatives: 1) let the market sort itself out; or 2) the solution we currently have: to intervene in a market-based solution, guiding the system to a solution. In addition, the real healthcare solution that would benefit all Americans was a single payer system in which individuals received care based on need, and not ability to pay. Unfortunately, this solution could never have been an option.

Solutions are marketed to the American public as beneficial to the public, but in reality are anything but. The neoliberal stranglehold on American politics requires any solution to be a market-based solution, even (and perhaps especially) when it espouses a progressive agenda. Thus, the ACA becomes a twisted and violent solution that causes pain and poverty to grow among those in our society with the least (the have nots), and benefit the corporations and the individuals of the 1% (the haves). And here we see again the seemingly irrevocable and omnipresent narrative of this country surface in a way that negatively affects its populace.

The ACA will deliver insurance to Americans, and may address certain aspects of the healthcare system, but it will not deliver affordable healthcare, nor truly deliver care to those most in need. The solution perpetuated under neoliberalism is one that decreases overall wellness among humanity, and a new mythology of care to hide that fact.

It is my hope that the ACA is merely the start of a conversation, and America can move away from requiring insurance bought through the free market as a means to ‘care’ and towards a guarantee of care for all Americans, especially those with the greatest need. We must not become complacent with potentially small gains made by the ACA and continue to advocate for a single-payer plan, a plan that does not reinforce American class divisions.

Notes:
[1] Oleson, M. (2004), Exploring the relationship between money attitudes and Maslow’s hierarchy of needs. International Journal of Consumer Studies, 28: 83–92. doi: 10.1111/j.1470-6431.2004.00338.x

[2] The 40 Biggest Economies In The World. http://www.businessinsider.com/largest-economies-world-gdp-2013-6

[3] Weisman and Parker, “Republicans Back Down, Ending Crisis Over Shutdown and Debt Limit.” New York Times 10/16/2013.

[4] “Health Care Systems: Three International Comparisons.” http://www.stanford.edu/class/e297c/poverty_prejudice/soc_sec/health.htm

[5] “Health Costs.” http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-comp...

[6] “Achieving Better Quality of Care for Low-Income Populations: The Roles of Health Insurance and the Medical Home in Reducing Health Inequities – The Commonwealth Fund.”

[7] “Millions Previously Denied Insurance Coverage Because Of Health Problems Look To Online Marketplaces – Kaiser Health News.”

[8] “PBS- Healthcare Crisis: The Uninsured.” http://www.pbs.org/healthcarecrisis/uninsured.html

[9] How Much Will Marketplace Insurance Cost,” https://www.healthcare.gov/how-much-will-marketplace-insurance-cost/

[10] “What are the Different Types of Health Insurance,”https://www.healthcare.gov/what-are-the-different-types-of-health-insurance/

[11] Papadimitriou and Wray, The Elgar Companion to Hyman Minsky. Chapter 13 “The psychology of financial markets: Keynes, Minsky and emotional finance”.

[12] Lane, The Loss of Happiness in Market Democracies. Yale University Press (2000).

[13] Lynch, Kaplan, and Shema, “Cumulative Impact of Sustained Economic Hardship on Physical, Cognitive, Psychological, and Social Functioning.” More importantly, this correlation was one-way; economics causing decreased wellness and function, and not the other way around.