Posts tagged Healthcare

Toward A Really Social Safety Net

These are consolidated from a pair of comments that I made in a thread back around last November on Thaddeus Russell’s Facebook wall. The thread was originally about some silly noise that comes up about once every four years, but it branched out into some interesting discussions about the left, individualist and libertarian perspectives, and so on. My interlocutor’s questions unfortunately seem to have disappeared from the thread, and I hate leaving writing locked up in a web silo, especially in the middle of a big, gradually composting discussion thread, so I’ve tried to condense it into a post here.

I’ve often been asked — by friendly-but-skeptical leftists, and even sometimes by fellow anti-capitalist anarchists — why market libertarians — who may be opposed to the government war machine, police, prisons, and all the other obviously destructive and repressive and regressive things done by the state, for fairly obvious reasons — are also so opposed to, and so hard on, social programs, like TANF, food stamps, WIC, Medicaid, Social Security, etcetera. (The question is usually posed in terms of contrasting government programs that hurt and kill people with government programs that, at least in principle, are supposed to be helping people.) And there are different ways to think about this. To a great extent, left-wing market anarchists don’t spend a lot of time focusing on social programs, and generally insist on prioritizing the core state violence and primary interventions of war, police, prisons, prohibitions, borders, and bail-outs as categorically more important than, say, opposing Medicaid or complaining about government spending on food stamps. And as a matter of strategic priorities, I agree — opposing the crowbars will always be more important to my idea of liberation than imposing the crutches. But I don’t think that means that there is nothing to say about problems that are inherent to the welfare state and government social programs, or that they ought to be considered as neutral or benign. Left-wing market anarchists have important reasons to oppose them — reasons to oppose governmental social programs, not from the economic Right, but from the radical Left.

So when I am asked, what I can say is that this doesn’t have all of the reasons, but it does have some of them:

. . . The key to an understanding of relief-giving is in the functions it serves for the larger economic and political order, for relief is a secondary and supportive institution. Historical evidence suggests that relief arrangements are initiated or expanded during the occasional outbreaks of civil disorder produced by mass unemployment, and are then abolished or contracted when political stability is restored. We shall argue that expansive relief policies are designed to mute civil disorder, and restrictive ones to reinforce work norms. In other words, relief policies are cyclical—liberal or restrictive depending on the problems of regulation in the larger society with which government must contend. Since this view clearly belies the popular supposition that government social policies, including relief policies, are becoming progressively more responsible, humane, and generous, a few words about this popular supposition and its applicability to relief are in order.

There is no gainsaying that the role of government has expanded in those domestic matters called social welfare. One has only to look at the steadily increasing expenditures by local, state, and national governments for programs in housing, health care, education, and the like. . . . But most such social welfare activity has not greatly aided the poor, precisely because the poor ordinarily have little influence on government. Indeed, social welfare programs designed for other groups frequently ride roughshod over the poor, as when New Deal agricultural subsidies resulted in the displacement of great numbers of tenant farmers and sharecroppers, or when urban renewal schemes deprived blacks of their urban neighborhoods. . . . As for relief programs themselves, the historical pattern is clearly not one of progressive liberalization; it is rather a record of periodically expanding and contracting relief rolls as the system performs its two main functions: maintaining civil order and enforcing work. . . . But much more should be understood of this mechanism than merely that it reinforces work norms. It also goes far toward defining and enforcing the terms on which different classes of people are made to do different kinds of work; relief arrangements, in other words, have a great deal to do with maintaining social and economic inequities. The indignities and cruelties of the dole are no deterrent to indolence among the rich; but for the poor person, the specter of ending up on the welfare or in the poorhouse makes any job at any wage a preferable alternative. And so the issue is not the relative merit of work itself; it is rather how some people are made to do the harshest work for the least reward.

— Francis Fox Piven & Richard A. Clower (1970)
Introduction to Regulating the Poor: The Functions of Public Welfare

The left-wing market anarchist addition to this leftist analysis is, first, to point out the extent to which the forms of structural poverty, deprivation, marginalization, concentrations of wealth and ultimately the desperation and civil unrest that social programs are designed to mute, are not simple or inevitable offshoots of market profit-taking, but rather themselves manufactured by the political entrenchment of capitalism and constantly reinforced and sustained through precisely the core state violence and primary interventions — the war, police, prisons, prohibitions, borders, bail-outs, military-industrial complex, monopolies, and other regressive and repressive functions of government — that we prioritize. (On which, see Markets Not Capitalism, etc.) And, second, to insist on the essential importance of positive grassroots, community-based alternatives rather than trying to save or liberalize institutionalized government programs.

Social programs administered by government are a weak and alienating substitute for the grassroots, working-class institutions of mutual aid, labor solidarity and fighting unions that they were largely designed to crowd out, replace, or domesticate. Grassroots social movements aimed to provide relief and person-to-person solidarity by creating alternative institutions that would be in the hands of workers themselves, so that they could better take control of the conditions of their own lives and labor. Government social programs have systematically aimed to monopolize the relief while abandoning any effort at worker control, instead transferring power into the hands of a politically appointed bureaucracy, and largely leaving working folks’ interests at the mercy of party politics. See, for examples, David Beito’s From Mutual Aid to the Welfare State and Paul Buhle’s Taking Care of Business, or, more recently, scott crow’s Black Flags and Windmills or Occupy Sandy, etc.

So (as a left-wing market anarchist) I am all for social programs and a social safety net — but I should like them to be really genuinely social, rather than governmental. So in my view, a libertarian view on markets needn’t, and shouldn’t, have anything to do with economic Rightism or corporate power; it can just as easily mean advocating militant industrial unions, strikes, sit-ins, Food Not Bombs, neighborhood mutual aid, lodge practice contracts, Panther breakfasts, women’s self-help clinics, Common Ground, Occupy Sandy, etc. as models of grassroots social change. And — holding that these are models that are preferable to the politically-controlled, professional-class-dominated and highly paternalistic bureaucracies — OSHA, TANF, WIC, EEOC, Medicare, PPACA, FEMA, etc. — that political progressives are too often inclined to treat as the non-negotiable defining commitments of the economic Left.

* * *

In the original conversation that inspired this note, a friendly-but-skeptical progressive said that she appreciated the focus on grassroots, community-based forms of mutual aid, labor solidarity, and participatory safety nets; but wanted to know whether government programs might have a role to play given that grassroots organizing is always going to demand a very high level of social participation, and sometimes people might be looking for institutions that can handle some problems without everyone in the community constantly having to be constantly involved in everything that anyone might need. It was a good question, and I definitely understand the desire to be able to take a step back in some cases. (It’s certainly something I’ve often felt, as I’m sure anyone who’s ever done a lot of participating in a community effort or an activist project eventually does feel.) But what I’d want to say is that the important thing about grassroots, non-governmental group is not so much the fact of constant participation (I sure hope I don’t have to do that!) as the constant possibility of participation. And the possibility of withdrawal is if anything just as important (so if the local Food Not Bombs or Common Ground clinic becomes completely dysfunctional you can always leave and start devoting your efforts to something else more worthwhile. But if a county social-services office becomes completely dysfunctional, they typically stay paid regardless, since you don’t have any way to redirect how your personal tax dollars are allocated. That’s controlled by a political process and a fairly elaborate set of rules for evaluating civil-service performance, which are an awful lot of degrees removed from the people most aware of and directly affected by the dysfunction.)

In any case, as far as participation goes, sometimes you want to take a step back and let others do a lot of the work, and of course that can happen. (The lodges had officers and divided up organizational work among the members, Panther breakfasts and FNBs and free clinics served a lot of people in the community, some of whom volunteered to help out, lots of whom didn’t, and lots of whom would spend some time on and some time off.) But all of this is an important difference from the politically controlled programs, where there’s no opportunity to step up and take a participatory role, even if you want to; where if they are seriously underserving or misserving or treating their clients in manipulative or exploitative ways, there isn’t any real remedy because they hold all the power in the relationship and the only voice you have in the proceedings, if any at all, are the incredibly attenuated processes of trying to vote in different political parties, etc.

I don’t know how much that answered the question, in the end; but I hope it at least points in a fruitful direction for thinking about what an answer would look like.

Also.

Universal health care does not mean government health care.

I’ve seen this note that I wrote a while back at ThinkProgress.org popping up here and there on the Internet. I’m glad that people have found it useful. Since it is currently locked up in a horrible Facebook-based dynamically transcluded comment thread thingy, I figured that I would re-copy and re-print here, so that the point, if it was worth making, can have a something of a real home on the Internet. The comment was in reply to a reply to Matt Yglesias’s reply to Roderick Long’s reply to a conversation between Wolf Blitzer and Ron Paul about healthcare policy. Roderick (rightly) thought that Paul’s answer to the questions betrayed a serious mistake about how to think about free-market healthcare. Yglesias (wrongly) thought that Roderick was encouraging libertarians to avoid the important question. A commentator called ds_at_yglesias chimed in:

If you oppose universal health care, you by definition support letting people who can’t afford health care die.

Most conservatives are socialized to not say such things in public, but of course they believe it.

—ds_at_yglesias, 15 September 2011, 7:39pm

Of course, I don’t give a tinker’s cuss about saving the reputation of political conservatives. But there’s an important conceptual issue for anti-authoritarians. So I replied (emphasis added):

Maybe so. (Certainly, there are plenty of conservatives who are all too comfortable with — or even enthusiastic about — a lot of needless suffering in the world.)

But I hope that you realize that not everyone who supports universal healthcare supports government healthcare, and not everyone who opposes government healthcare opposes universal healthcare. The one might follow from the other if the only way to get universal coverage were by means of a political guarantee of coverage. But that’s not so: there are folks who oppose government healthcare because they think corporate healthcare is awesome and they don’t mind if people die; but there are also folks who oppose government healthcare because they support non-governmental, non-corporate universal coverage through grassroots social organization and community mutual aid. (See for example http://radgeek.com/gt/2007/10/25/radical_healthcare/ or the closing sections of http://www.thefreemanonline.org/headline/health-care-debate-meaningful/.)

Of course, that leaves open the question of whether they (we — I’m one of ‘em) are right about the best means for getting universal coverage. Maybe social means are inadequate; or maybe there is some reason, which has yet to be mentioned, why governmental control is preferable, as a means for getting it, to voluntary associations for mutual aid. But whether the position is right or wrong, it’s certainly not one that can be answered simply by defining it out of existence, as you do when you pretend that the only alternatives available are (1) corporate coverage of only those who can afford it; or else (2) universal coverage by means of government mandates; as if there were no (3) universal coverage by non-governmental means.

—Charles Johnson, 16 September 2011, 10:32pm

Also.

There’s the part where you say it, and there’s the part where you take it back…

From the Wall Street Journal (16 May 2011).

Gingrich Blasts House GOP’s Medicare Plan

White House hopeful Newt Gingrich called the House Republican plan for Medicare[1] right-wing social engineering, injecting a discordant GOP voice into the party’s efforts to reshape both entitlements and the broader budget debate.

In the same interview Sunday, on NBC’s Meet the Press, Mr. Gingrich backed a requirement that all Americans buy health insurance….

— Laura Eckler, Gingrich Blasts House GOP’s Medicare Plan in the Wall Street Journal, 16 May 2011

Just a reminder: There’s No Right Way to Manage a Subsidy. And no right way to manage a captive market, either.

  1. [1] [Phasing out Medicare over the next 10 years in favor of a government subsidy for retirees to buy special government-regulated corporate health insurance plans for old people. —R.G.]

Monday Lazy Linking

Lazy Linking of the Libertarian Left

  • If you’ve decided that you’re not interested in helping limited-governmentalists make the trains run on time, one of the first replies you are always going to get from minarchists and minarcho-enablers is some snide remarks about how you must advocate doing nothing out of a prissy or sanctimonious concern for ideological purity. Of course, this reply is usually plain nonsense, since it depends on the completely unargued, and in fact easily refuted, principle that the only alternatives on the table are (1) partisan politicking in government elections, or else (2) doing nothing. Of course these are not the two options, and the only reasons that you would act as if they are is (a) if you are wearing the conceptual blinders of statist political analysis, or else (b) you don’t have a clear or concrete enough conception of what someone might put down for option (3). I tried to make my point clear about problem (a) in my follow-up post; but for a more straightforward approach to the problem, see also this great post tackling problem (b) from Francois Tremblay at Check Your Premises (2008-01-22): Eight ways you can personally help to smash the State: One of the problems with Anarchism is that, unlike other political ideologies which rely on the system, the courses of actions one can take are not obvious. People who are convinced by the arguments are discouraged by the notion that there’s nothing I can do, and new Anarchists, not seeing any way out, turn to political means as the only solution. … So what can we do to resist? Not as a movement, but personally? There are a number of things that a single individual can do that brings concrete, if small, change. Read the whole thing, and note especially numbers 5–8.

  • Thomas Knapp, a market anarchist and sometime Libertarian Party activist, who has used the freedom train metaphor often in the past (and who I quoted in Take the A-Train), has a lot of thoughtful remarks in reply to my criticism, in KN@PPSTER (2008-02-01): Train kept a-rollin’, part 1 of ???. There’s some good points here, both by way of objection and by way of agreement, which I should have linked some time ago, and which provide a lot of great discussion-fodder and deserve a reply when my brain is a bit less fried than it is right now. I’m not especially convinced by some of Knapp’s rejoinders — e.g. I think that the claim that it’s easier to get from Anarchotopia once the train has already pulled in at Minarchistan is refuted by, or at least faces an as-yet unanswered challenge from, precisely the points that I raised in my follow-up post. But while I unfry my brain enough to talk at more length, you should definitely read the whole thing.

  • Mutualists and counter-economists alike may find something of interest in Michel Bauwens’s mention of the unMoney Convergence - a conference on money, liberation and systems change, to be held in Seattle April 14–16. The convergence will discuss the emergence of alternatives to government money (community currencies, Internet currencies, open currencies, etc.); the development of open, peer-to-peer infrastructures for gifting, sharing, and exchange; and efforts to move to open money systems over the next ten years. (The convergence will no doubt include plenty of crankery and rubbish along with plenty of genuinely good discussion and perhaps even mildly thrilling developments. But that’s par for the course. Again, more stuff that I’d be interested to talk about and hash out — e.g. the tensions between genuine mutual money and community exchanges, and progressive Monopoly-money deliberately obstructing non-local use — once back in a post-brain-fried state.) Anyway, read the whole thing and follow the links.

  • Finally, for a change of speed, we have the latest Radical Healthcare Reform proposal from New York Times humor columnist Paul Krugman (2008-02-04): Clinton, Obama, Insurance, in which it is revealed that the most significant policy difference between Hillary Rodham Clinton’s scheme for massive government subsidies to third-party health insurance bureaucracies and Barack Obama’s scheme for massive government subsidies to third-party health insurance bureaucracies is that Hillary Rodham Clinton’s plan would force everybody to buy health coverage from a big corporate insurer, whether it’s in their financial best interest or not; whereas Barack Obama’s plan, although forcing everyone to subsidize other people’s use of big corporate insurers through taxes, would at least give each individual person some choice over whether or not it’s in their own best interest to buy corporate health insurance for herself. Krugman then suggests that reveals a major defect in Obama’s plan and a major virtue of Clinton’s plan. Because, apparently, the purely statistical achievement of universal coverage is an obvious good, regardless of what that coverage amounts to or what the cost of achieving it is, whereas the notion that a bug-government-mandated captive market for big, bureaucratic insurance companies might not always be the best way for each and every one of 300,000,000 very different people with very different needs to get their healthcare costs covered, is an idea that could only be advanced by the dupes or hirelings of the same insurance firms that stand to massively profit from this subsidy program (!).

    This is, apparently, what passes for Leftist economics among the professional statist-blowhard class in America. Libertarian mutualists, i.e. the genuinely Leftist alternative to the corporate liberal managerialism and progressive statism fraudulently passed off as Leftism today, know that radical healthcare reform would mean something very different — the abolition of government obstacles in healthcare and the emergence of grassroots networks and institutions for mutual aid among the working class, not a massive effort by the policy elite to universalize and ossify the existing boss-and-bureaucrat model of third-party healthcare coverage.