The Disempowered Consumer

After arriving home from school last night, I read a long reader response to my post on why the idea of “consumer empowerment” (now used by everyone in the health-care debate) is wrongheaded. Commentator ledzep, arguing against my unapologetic liberal leanings on the issue of health care, concluded by saying it was not my “most responsibly argued piece” — as if, like a teenager arriving home a little drunk, I needed chastising. Here’s my response:

ledzep (quoting LF): “Translation: Keep the bountiful profits rolling into the pockets of the private health-insurance companies.” And how does the individual mandate do anything different from this? Even more, in fact – the profits will increase. Do you think the insurance companies are afraid of being given a captive market? The government is going to force young, healthy people into buying insurance – the insurance executives are high-fiving themselves in their offices… the government is poised to guarantee them an enormous bump in number of paying customers.

Note that ledzep conveniently ignores my conclusion, where I wrote, “It’s an iteration of the Right’s old strategy for ‘starving the beast’ — underfunding government programs and then pointing to their underperformance as evidence of the inevitable failure of government programs) — that might be called ‘hamstring the beast.’” Which is to say — horrors — socialist single-payer is never on the table, and — horrors — socialist public option is beaten off of it, so what you’re left with is a “reformed” system of private health insurance. Then the Right says to moderate Lefties, “You wouldn’t want to deliver even more customers to the likes of Aetna, would you? So let’s start over.” What ledzep means is, “Let’s pretend to start over while, in reality, you reformers just give up.” It’s a nice trick. I guess it needs spelling out that the idea is that price regulation with even the littlest bit of teeth will prevent mandated coverage contributing to the gouging. As for the government-guaranteed bump in customers for the health-insurance industry: Well, duh, of course, if you’re going to get those 40-plus million people covered, and you’re not going to permit a public option, the health-insurance companies are going to get more customers. A bitter pill to swallow, but a better pill than no pill at all.

And yes, a good insurance plan must force young, healthy people to buy insurance. When a 22-year old breaks a leg while jogging, or has an attack of appendicitis, or comes down with swine flu, tell me what a good society (which is the real underlying debate here) should do. “So sorry that in your lack of wisdom you failed to buy insurance. Now go die.” Keep in mind that many libertarian sorts, believing the government had no right to “tell them what to do,” rebelled at laws requiring using seat belts in cars. Yet though the law constricts individual freedom, the law is just if considered in light of the good of the whole. Among other things, it’s valuable in a utilitarian sense. It protects those of us who choose to use seat belts from bearing the serious consequences of letting others “freely choose” to not use them. 

ledzep: The central canard here is that conservatives want this to be completely market-driven, with no safety net at all.

Here’s the proper metaphor: A man (the 40-plus million de facto uninsured Americans) has to jump from a tall building (his uninsured status) in order to escape a fire (death, debility or financial ruination); conservatives, who aren’t totally heartless, want the man to have a safety net — a hula hoop with some cheesecloth duct-taped to it. Anything more substantial amounts to “socialism.”

ledzep: You could take a look at David Goldhill’s piece in The Atlantic, which is only one of the most talked-about pieces of journalism to come out on the subject in the past year.

I looked. The Goldhill article in The Atlantic has lots of problems — which may be why ledzep attaches only the neutral adjective “talked about” to it instead of something more praiseworthy. Note in particular that Goldhill admits that his proposal is complicated and would take years and years to implement. And that’s before Congress has a go at it.

For an argument deeply opposed to Goldhill’s, read what Wendell Potter, the ex-Cigna executive who spent 20 years on the inside of the health insurance industry (easily giving him as much credibility as Goldhill) has to say. Regarding the most recent dramatic rise in health-care insurance rates for individuals and small businesses, Potter says: “Well, these [insurance] companies are for-profit companies, and they think first and foremost about their shareholders. That’s the first stakeholder that they consider. And they know that they have to meet those expectations or their stock prices will suffer.” Potter supports the current health-care bill, warts and all. But I suppose ledzep thinks Potter would change his mind if only he’d listen to the same fatherly advice about “responsibly argued” opinions on health care he offered me.

ledzep: As for the belief in the magical informed consumer, has it ever occurred to you that although everybody certainly has as much of a right to sustenance as to decent health care, we don’t need a system like the proposed health insurance entitlement to ensure that everybody in America can eat? … and the cost of food for everyone is held down, in large part, by just those market tendencies that you so ridicule in the health care context. … Why is the moral status of health care somehow different from that of food?

Let me get this straight: Since we have no government program that makes sure that nobody starves to death, it follows (logically? pragmatically? ethically?) that we should have no government program to make sure that everybody has health insurance. And, I suppose, since we have no government program that makes sure everybody has health insurance, it follows that we should have no government program that requires students stay in school until they are 16. And so on.

Contrary to what ledzep says, the cost of food for everyone is not held down largely by “those market tendencies you so ridicule in the health context.” The cost of food is held down largely by the government through the enormous subsidies given to giant agribusiness corporations, who bear somewhat the same relationship to actual farmers as health insurers do to doctors. Differences between health care and food? Let’s see. Hungry and with no money, you cadge a meal from a friend. Broken arm and no money, you ask a friend — say, an insurance company executive — to set it for you.

ledzep: A a big part of the challenge to serious conservative ideas on the matter is that liberals will just say no.

To make the sentence above jibe with current reality, switch the words “conservative[s]” with “liberal” and remove the word “will.”