Last Sunday, David Brooks said in The New York Times that to solve the mess that’s called “health care” in America, Republicans believe we need to “create a genuine market with clear price signals, empowered consumers and an evolving process.” Now, fellow “Brainstorm” blogger Diane Auer Jones chimes in with “We must empower consumers to make good decisions by providing them with more information about the options they have. …”
Ah, the “empowered consumer”! — that unicorn invoked by the Republicans whenever a societal need that obviously requires some substantial government participation doesn’t jibe with their mantra that the market always knows best. Admitting no difference between “consumer” decisions involving, say, what sort of DVD player to order for the minivan and a working family trying to avert medical and financial disaster when a child falls ill, Republicans never relent in trying to protect “consumers” from dictatorial, lefty Democrats plotting to take away their consumer freedoms. And how to secure these freedoms? Why, if only they could have more information — then they’d make “good decisions,” and getting medical attention would be a cinch.
If this sounds familiar, it should. At the start of our new century, some Republicans had a notion to rescue from government dictatorship and restore to the arena of “consumer choice” a program called Social Security. Mind you, this system was itself a public solution to the enormous catastrophe wrought by the virtually unregulated laissez-faire financial market under some non-Democrat Presidents named Harding, Coolidge and Hoover. Those with morbid imaginations might want to contemplate what would have happened to a privatized Social Security (i.e., a social security made up of wonderful, freely chosen “personalized savings accounts”) and the people dependent upon it in the meltdown of 2008.
But what does an “empowered consumer” really mean? It means, in the apt words of a reader commenting on Mr. Brooks’s column, “working-class families pouring over the pages of punitive, Byzantine provisos in small type, concocted by various health-insurance companies that are one step ahead of legislation, in order to extract the highest possible premiums while paying out the lowest possible benefits in order to extract the biggest possible profits.” And health-insurance companies, the reader pointed out, don’t dispense any medical care. They merely shuffle billions and billions of dollars and take as much as they can off the top. How much? Let’s just say that Ron Williams, of Aetna, hauled in more than $23-million in salary and compensation in 2008—as well as enjoying the perks of a corporate aircraft and vehicle (Republicans think he deserved it, I’m sure; after all, it takes a brilliant mind to make that scale of profit from shuffling paper regarding people’s health) and that the health-insurance industry could afford to spend $600-million on propaganda in trying to defeat any and every health-care reform proposal the Democrats have come up with since Obama was sworn in.
All this talk of consumer “empowerment” (odd how the Right has appropriated a warm and cuddly word from such left-leaning movements as feminism and rights for gays, movements it has repeatedly, stalwartly resisted) is wearying in the extreme. It reminds me of, for instance, the hours — and I mean hours — spent on hold while waiting to speak on the telephone with an insurance company rep (rather than a robotized voice) about such a simple question as, “How do I get a new insurance card that reflects my husband is on my plan?” Consumer “empowerment”? Talk about lipstick on a pig! In an intensely complex, modern world where even college-educated, literate, and numerate people struggle daily with the consequences of deliberately arcane fine-print consumer traps embedded in the likes of credit-card agreements and cable TV contracts, it’s hard to believe that Republicans really believe any of this “consumer empowerment” smack when it comes to a social time bomb like 40-plus million de facto uninsured people in America. Can they really think that in trying to obtain health insurance, an “empowering” array of “choice” is going to make shopping for health as easy and painless as shopping for peanut butter and fabric softener? Do they ever consider that the consequences of “choosing” a bad health insurance company or plan might somehow be more disastrous than choosing bad peanut butter or bad fabric softener?
Republicans keep telling us that competition in all things is an a priori good — except, of course, when they tell us that a public option in health insurance, to compete against those of health insurance companies whose CEO’s earn millions in salaries every year, would be bad. Competition among for-profits (now there’s an understatement), Republicans tell us, will drive the quality of coverage up and premiums down. We already have that kind of competition, and when’s the last time somebody you know had the quality of their care go up or their premiums go down? I can’t remember, but then my memory is clouded by the way that competition on Wall Street led to Americans with simpler, more honest, more transparent, more straightforward ways of borrowing money.
Since the best social choice, single-payer option (Medicare becoming the health-insurance equivalent of Social Security—and Social Security doesn’t seem to have put stockbrokers out of business) was long ago taken off the table as an anathema to free enterprise (heaven help us if the hallowed “free market” should be hampered from working its miraculous economic medicine), since even a public option has been fear-mongered as socialism, the extant healt-care reform proposals have ended up an overly compromised patchwork.
But even those reforms — much, much better than nothing, especially if one dares to (gasp!) talk about the ethics (I’m so glad that Diane Auer Jones has health care for her 19-year-old son, but perhaps she needs reminding that millions don’t have coverage for their 3-year-olds) of our abysmal system — are now being peppered with Republican calls for scrapping them and starting over. 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.” Translation: Keep the bountiful profits rolling into the pockets of the private health-insurance companies. (Remember, when the health insurance companies cry poor and cite low single-digit profit margins, all they ever do — I repeat, all they ever do — is move money around, and that their profits are apparently enough that they can find six hundred mil in the PR budget to try to destroy any reform.)
Sorry, but empowered (with one of Hemingway’s “built-in bulls**t detectors) consumer that I am, I see the Republican plan as nothing but more and bigger profits for the already rich.
2 Responses to The Empowered Consumer
ledzep - March 5, 2010 at 2:57 pm
Some ok points here, mired in a lot of confusion.”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. Granted, they want to have these customers while keeping as much control over access as possible, but that doesn’t change the fact that the government is poised to guarantee them an enormous bump in number of paying customers. The central canard here is that conservatives want this to be completely market-driven, with no safety net at all. That’s a ridiculous strawman, and if you linked to any serious market-oriented discussion in your piece your readers would see that it’s ridiculous. Maybe it’s too hard to find a serious discussion of that kind? Um, no. 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.http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/As for the moral case, that’s important – lots of people can’t get the care they need, and that’s a terrible situation – but the basic conservative point is that there are also morally relevant consequences to entrenching the cost-inflating factors the current system already has in spades.Cost is not some consideration that matters only to fat-cats looking to save a little on what they pay for their employees – cost affects access. Look at social services in California – if you can’t budget for the costs of a social program, eventually the people who most rely on it will get screwed. That’s also why when you hear horrible stories about people unable to get care because of pre-existing conditions, etc., there’s often a little paragraph buried in the story about how they actually qualify for Medicaid, but no providers near them can afford to take more patients on Medicaid. (Nick Kristof had a conspicuous example of this in a column several months ago.) Cost affects access – period. And if you believe that attaching the current pay structure for health care, with all its cost-inflating tendenccies – to an insurance entitlement program will be effectively irreversible (and you’d be crazy not to believe this – entitlements are forever), then you’re going to believe that we are saying goodbye forever for any chance to make large swaths of healthcare affordable. 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? Yes, we have programs – and food stamps are at record highs right now – but they’re not universal entitlements, 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? Yes, there’s insurance involved in health care, so that complicates the discussion about pricing and competition, but again (and again and again), no serious conservative is against a means-tested catastrophic insurance entitlement. It’s a staple of every conservative proposal – there’s a government guarantee that you can get a certain level of coverage, or that you can get into a high-risk pool, or that the government pays for everything over a certain percentage of income, etc. Two final points: first, the fact that it is morally abominable that people can’t get health care because of our current system doesn’t make it impossible for reform to be worse, in the long run, than the status quo. It simply doesn’t follow. So you have to actually think about the consequences of this particular reform – not just the nice consequences, but all of them, to the best of our ability to predict them. And since we’re talking about an entitltment, the time frame is forever.Second, the typical liberal objection to the conservative case is that the conservative ideas are politically impossible, so that they’re in effect just advocacy for the status quo. But even if that’s true, the political climate is not just some law of nature – a big part of the challenge to serious conservative ideas on the matter is that liberals will just say no. And yet they never mention this – liberal opposition to conservative-type reform ideas is just naturalized. Not your most responsibly-argued piece, in other words.
rbannist - March 10, 2010 at 1:39 am
Yeow, if the thinking presented here doesn’t wreak of Ivory Tower elitism. One basic message is empowering the population at large wouldn’t be any good because the poor little people simply aren’t smart enough to be able to weigh their options in selecting a private health care plan. The little people need the mighty government to look out for them and of course the state is the paragon of virtue that will do the right thing for the people compared to the private sector where if businesses fail to deliver what they are supposed to sell would lose all their customers and no longer exist.We can continue to make whipping boys out of the current private medical insurance industry as if it is the capitalist system that is so awful. In truth, government regulation has tied the hands of health insurers, inhibited competition, and created an environment where there is virtually no consumer choice as in most states there’s one dominant player such as Carefirst/Blue Cross in Maryland and perhaps a few lesser players.Opening up the market and allowing health insurance companies to sell across state lines would be one constructive way that would create market based competition that would increase service as folks would chose the company that provides the most consistent good service and drive costs down for the same reason. Why pay company A more than company B?Since health care in most instances is provided by employers with only some co-pays being the responsibility of the individual, the population has lost all sense of what the true cost of medical service is. Perhaps it would be better if those of us who make enough income pay for some of the small ticket items up to a certain amount but then have insurance that kicks in for the more significant and costly needs.There also seems to be an underlying assumption that there’s something dirty about profitability. Companies can be profitable by either providing good service, managing costs, and running an effective company that attracts customers and profit is the earnings for a job well-done or profits result from a situation where the game is rigged from the start where such things as favorable government regulations which crush competition hence feeds the fat cats who in turn reward the politicians accordingly and the vicious circle goes on to where it gets completely out of control. Open up the market, cut down the regulations, allow the market to work openly, quality goes up, costs go down. The bad players go out of business. The government can do things like require care for pre-existing conditions or setup provisions that there is a safety net for the chronically ill and catastrophic cases. This could perhaps be like the “uninsured or underinsured” fee we pay on automobile insurance. For those who simply cannot afford health insurance, the government could provide vouchersss which allow participants to buy insurance from a list of government approved health insurance vendors. Favorable tax policies which encourage smaller businesses to provide health benefits for their employees is also worth exploring.The free-enterprise approach is to reward the agents who provide the best quality at the best price and to provide incentives that allow businesses to be profitable. There’s no getting around good health care is expensive. At some level you only get what you pay for. The challenge to health care reform is to eliminate the unneccessary factors that drive costs up without providing any reward in return. Bureaucracies are great at making profitability and cost-effective decisions impossible. Sadly, the so-called “progressive” approach is to punish initiative, impede the ability to obtain financial reward for good work, and to politicize endeavors where government regulation and interference cripples operations from efficiency and success. If the current quasi-socialist or government-managed approaches to medical service are adopted, for the slight increase in quantity of service — the overall quality of service most people enjoy are sure to decline. Compare the shipping business, how well UPS and FedEx operate compared to the postal service. Only the postal service can raise prices for providing worse service.*****One other thing that is objectionable about this column is the bogeyman approach. Surely this article is written in part in response to the blog posted earlier by Diane Auer-Jones, a very independent and undoctrinaire thinker. Using her status as support for the these of this blog is absurd. That she might have the ability to make sure her 19 year old son is insured does not translate into being insensitive to those who don’t have such options. It’s almost as if her name alone since there’s this dirty little fairly well known secret she served in two posts in the Bush administration should strike fear and loathing in the progressive’s frame of reference. What a half-hearted way to demonize a most original and challenging thinker as little more than another shill for the Republican party or perhaps the Glenn Beck or academia. This reflects a biased refusal to absorb the points she recently made in her blog on health care. Name dropping a fellow Brainstorm blogger with whom this writer disagrees or that of David Brooks, a most intellectual and highly independent conservative writer, simply do nothing to prop up run of the mill “Capitalism BAD” “Corporations EVIL” pro-nanny state thinking that those who spend some time walking on terra-firma not breathing the rarified air of the Ivory Tower know is ridiculous.