‘Private’ vs. ‘For-Profit’ in the Health-Care Debate

I just came across Mike Stanfill’s cartoon from last week, which captures a truth about the way the coding of the words “public” and “private” function in our debates about our laughing-stock-of-the-developed-world system of “health care.”

(You know, health care for those who can pay and aren’t sick, health care as a reason to stay in a lousy job with more unpaid overtime and less vacation than the Japanese, health care for the last ten days of your life, but not the first thirty years, etc, etc. The whole pile of crap–which appears irrational until you see how efficiently it operates in its actual purpose, which isn’t “health” but to provide second homes, compliant spouses, and boats for a bunch of jerks you were right to despise in college.)

One way the insurance parasites are beating Obama is in allowing their side to be described as the “private option.”

Part of what’s going on here is the oft-observed prejudice against the public, a phenomenon those of us in higher ed know pretty well.

But another dimension is the way that “private” remains unexamined. In higher ed, private can mean Swarthmore and Georgetown, but it can also mean DeVry.

That is–in higher education, we distinguish between public and private, but we draw a bright-line distinction between them and for-profit education.

Maybe I haven’t followed the debate closely enough, but I haven’t observed any major Democratic player trying to control the terms of the debate in a similar way–by labelling the insurers advocates of “health care for profit.”

It wouldn’t be that difficult–the other side has opened the door by describing publicly-funded health care as “socialism.” (If only!)

The Nation’s First Black CEO

There’s more to say here–part of the problem is that Obama’s been weak on health care since declaring his candidacy– though who knew he’d be worse on education? If Obama’s idea of an education secretary is Arne (“squeeze ‘em”) Duncan, who’s he going to appoint to oversee his public health care plan? Jack Welch? Leona Helmsley? Why not Dick Cheney? 

(Hey, I know you think I’m exaggerating about Obama and quality-managing higher ed back into the stone age of correspondence schools, but I’m not. Please feel free to describe to me the significant policy differences between Obama-Duncan and the pro-business “reformers” of higher education at intellectual sinkholes like the “John William Pope Center” who’ve set a couple of their cheesy PR flacks on me this year. )

A big part of the problem is that Obama’s theory of the presidency is that he’s a good manager, hired by the people to clean up Bush’s bad management and restore what he views as the better quality-management of the public sphere represented by Clinton-Gore. (Albeit with more charisma than the latter, and minus the messy personal life of the former.)

Getting back to Clinton-Gore didn’t sound like much of an ambition to me during the campaign, and it still doesn’t–and if Obama’s Wal-mart views of higher education are any measure of his idea of a public health care plan, I can understand why some people are worried.

A public option that’s run by people who want it be private and are operating under the delusion that they’re great managers–you know, like Arne Duncan, who privatized and militarized the Chicago public schools–might not be much better than the straight-up privates. 

Seriously–would you want your health care managed by this guy?

As the cases of Chuck Manning, Mark Yudof, and countless others clearly prove: there is no evidence that bureaucrats are better managers than private executives. The efficiencies of public works don’t come from superior public management, period.

Instead they come from not having to pay the bill collectors, lawyers, lobbyists, advertising agencies, PR flacks, bill-collecting programmers, executive bonuses and, above all, the shareholders.

Unless Obama gets over being a great manager in his own mind, and dumps would-be privatizers and executives-of-everything like Duncan–unless, like Ted Kennedy, like FDR, he stands up to the moment, overcomes his own failings and previously-articulated bad ideas–unless he outlines a compelling case founded on actual theory of the public good, he’ll end up as what he presently most fears: an historical curiousity, the “first Black president.”