Sunday, July 16, 2017

Nevada's Dean Heller, Healthcare, and Liberalism

Nevada Senator Dean Heller spoke a real truth when asked about his party’s assault on Americans’ healthcare earlier this year: “This bill would mean a loss of coverage for millions of Americans, and many Nevadans. I’m telling you right now, I cannot support a piece of legislation that takes insurance away from tens of millions of Americans, and hundreds of thousands of Nevadans.”  Now, it seems, the Republican senator is having second thoughts, and is considering toeing his party’s line in support of a measure that would have devastating consequences for Nevadans and Americans.
Republicans’ efforts are driven by economic fundamentalism (a fundamentalism which yields substantial gains to their wealthy backers and the class represented by Donald Trump and his cabinet of one percent-ers), and hatred for President Obama’s healthcare reforms which, though tentative, inadequate, and piecemeal, represented a real effort to improve the lives of Americans.
In attacking the principles underpinning healthcare reform, and pushing back at efforts to create more universal access to healthcare (each version of their ‘reform’ pushes huge numbers of Americans out of the system), Republicans are setting out their stall--dishonestly--as good liberals, concerned about the fate of individuals in the face of overweening state power.  If the state makes decisions about healthcare, who knows what grisly fate awaits individual men, women, and families?
Several things go unsaid here.  Firstly, in the absence of state intervention, individuals still have precious little control over their fortunes in a vast healthcare market, where most of the power resides with the insurance and healthcare industries, who have made stupendous donations to Republicans and sceptical Democrats over the years.  In a state of hundreds of millions, any given individual will always have limited control over the vast structure of healthcare, and therefore over their immediate experience of the same.  They must choose between which set of interests they believe can best structure the terms on which this service is delivered and this right is realized: massive industries, the primary concern of which is profit, which often means marginalizing “customers” who for one reason or another do not look profitable to them; or the public sector, which however damaged has as its primary charge looking after the general public interest.
Finally, the status of Republicans as liberals needs reevaluating.  Here I mean liberal in the earlier sense of the word, a sense which persists virtually everywhere in the world outside of the U.S., where the term can mean anything ranging from Communist to neoliberal.  Liberalism is a set of ideas which suggests there is a relationship between freedom in markets and freedom in society.  On the one hand, its proponents possess an almost evangelical faith in the work of “free” markets to set people free and yield good outcomes (“good outcomes for whom?”).  On the other, they defends the civil and political rights--equality before the law, the right to vote--of individuals.  
People have long, and rightly, been sceptical of the narrative about the virtues of the free market.  Free from what, and for whom?  Without the state intervening, markets, and the power that goes along with them are most frequently captured by and made to serve the ends of those who already possess great wealth.  A laissez-faire attitude toward political economy, in which the state refrains from trying to intervene in people’s lives, means that middle and working class people instead have their lives structured by the interests and wealth and bottom lines of those who are wealthy.
The absence of the state does not mean the absence of power and “meddling.  It just means that power is exercised by people with no mandate, no need to be transparent, no obligation to serve the public interest, and no legitimacy. It means economic and therefore political power being exercised for private rather than public interest.
This then is the liberal pose adopted by the modern day Republican Party.  I say pose because in their turn to neo-liberalism they have dropped one of the distinguishing features of liberalism: a belief in individual political and civil rights.  Today’s Republican Party seeks to enshrine the rights of corporations at the direct expense of the rights of citizens.  They seek to use redistricting, ID laws, and a host of other measures to disenfranchise significant numbers of Americans directly, while limiting the power of others by limiting our ability to use democratic mechanisms to hold large agglomerations of corporate economic and political power to account.
This explains the Republican approach to healthcare, which cuts away at public components of the system like Medicare while liberating the private healthcare industry from the responsibilities imposed upon it by American citizens through their voting and advocacy.  The “savings” in their plan are disproportionately passed on to the wealthy, and businesses are absolved of their social obligations to employees, while Americans with pre-existing conditions, the elderly, women, and new families find support for their needs weakened.
This also explains their mockery of those of us who suggest that access to healthcare should be a right.  They celebrate the freedom of individuals to make decisions for themselves, and embrace what they see as the justice of crippling burdens on those who make “bad decisions,” ignoring how centuries of inequality in terms of race, class, and gender mean that what they portray as “personal” failings are failings of a larger set of structures.  They ignore the relationship between their beloved Declaration of Independence’s “right to life” and the work that healthcare does in literally keeping people alive.
One alternative to the existing messy, expensive, and profoundly unequal healthcare system in the U.S. (it’s really absurd to call it a system) is some version of universal healthcare, which comes in different forms.  In some cases, it is an actual healthcare system run by the state.  In others it consists of payments or subsidies from the state to a heavily and rigorously regulated private healthcare industry.  In every case, citizens pay their taxes and receive virtually all of their healthcare without additional charge.  While some of these systems in Europe, Australasia, Canada, and Asia have been weakened over time, they have a number of benefits.
Firstly, the access they provide is universal in a way that does not exist in the U.S.  Secondly, they are cheaper, because in either case there are strong regulations imposed on the healthcare industry or sector.  Thirdly, they are predictable, because citizens know that having paid their taxes, they do not need to fear life-altering medical bills in their moment of need.  Fourthly, for the same reason, they are fairer.  And finally, they tend to be connected to a larger, robust welfare state which attempts to ensure greater degrees of stability, safety, prosperity, and equality in society, and which can do so with greater ease because of their universal character and their interconnected character.
Liberals--Republicans in the U.S. who claim to stand for both free markets and free people--claim that these kinds of healthcare systems would crush the souls of Americans, and turn them into Soviet-style automatons, incapable of living meaningful lives, held under the government’s authoritarian boot, and powerless to change their politics.
But here’s a thought to put the minds of supposedly moderate Republicans like Nevada’s Dean Heller at ease.  The welfare systems in Europe--take those in Britain and Scandinavia, for example--were built largely by social democratic parties.  But the idea at their core is a very liberal one, and therefore one with which Republican citizens and politicians alike should feel comfortable.  Even many of the individuals behind the construction of welfare states were liberals, individuals who were sceptical of the evangelical claims of their party’s dogma in the face of evidence from daily life.
Much of European social democracy was a fundamentally liberal project, with the ambitious and emancipatory goal of creating individuals who could lead meaningful, unconstrained lives.  But it departed from the premise that this required life organized around the public interest, having recognized that unconstrained “freedom” of markets often worked counter to the welfare of the middle and working classes that constituted overwhelming majorities of citizens.  
In order for people to live these unconstrained lives, social democrats believed they should be liberated from the fear, uncertainty, instability, and powerlessness imposed upon them by the fantasy of a free market which worked best for the wealthy.  Their logic was that while paying slightly higher taxes into a regulated healthcare or education sector might represent some form of constraint, it paled compared to the straitjackets imposed upon people by having their life chances, their health, and their day-to-day lives governed by massive businesses and industries.
The fact that few if any parties even on the right in places where they exist openly challenge the existence of these social democratic welfare states and their logic, suggests that citizens are happy with this compromise.  Many people view “freedom” in a very different way from Americans, and look at our healthcare system and the burdens--economic and psychological--that it imposes on people as fundamentally restrictive and harmful.  The same is true of a range of features of welfare states.
The Republican healthcare bills in the House and the Senate have threatened to roll back the inadequate and clunky reforms of the Obama administration, and increase the fear, uncertainty, instability, and powerlessness that Americans outside of the top few percent experience as they seek to care for themselves and their families. Dean Heller and his colleagues should reject the Senate bill and get to work on serious healthcare reform.
Good, sensible, and social democratic reform to America’s healthcare system could yield benefits that would satisfy both those on the left and those on the right.  A universal system of healthcare would simultaneously remove the corrosive influence of private interest, and free businesses from the obligation to flounder in search of insurance for their employees in a lopsided market.  It would require greater contributions in terms of taxation from the wealthy, but would also liberate individuals from the uncertainty about the costs of meeting illnesses and misfortunes which have consistently dogged and inhibited the ingenuity, life trajectories, and aspirations of generations of our citizens.