Obromneycare
The Supreme Court has reached a decision. Obromneycare + individual mandate have emerged from their rather cushy gauntlet intact. How? The penalty for the uninsured has been classified as a tax. (See Correntewire for an excellent summary of Roberts’ legal gymnastics). Discussion of Obromneycare’s constitutionality or lack thereof has been covered quite well elsewhere, so I’m going to do something else. First, a brief summary of my own experience with the individual mandate in Massachusetts, where we’ve been living with the Romneycare to which Obama has attached his “Ob”:
For a while, I was covered by a subsidized plan because neither of my jobs offered insurance and my annual income was just under the cutoff point (300% of the federal poverty level). Then I finished graduate school and moved to full time at one job, gaining insurance through my employer. The tanking economy took a toll on that employer, which led to a reduction in my hours – which caused me to lose full time status – which allowed human resources to decree that I was no longer entitled to full time benefits – which meant my insurance was no more. Luckily, I was able to keep three of my original five days a week at that job, and still had weekends at my other job, giving me a patchwork full time schedule, but no benefits. I couldn’t go back on the subsidized plan, because my income was now too high. At the same time, the cheapest available private plan that satisfied Romneycare’s holy writ cost more than double what I’d paid for the subsidized plan, and nearly double what I’d paid through my employer. Obviously, I couldn’t afford it, and even if I could, I’d never have been able to pay the outrageous deductible if I had needed any care. I then found that the penalty (properly called a penalty and not a tax here in Massachusetts) was lower than the cost of the cheapest plan and thanked the stormin’ mormon that I would be allowed to not buy a terrible, useless and expensive product, but could simply pay an arbitrary fine for the privilege of living with no health insurance. Thanks, Mitt! When tax time rolled around, I dutifully filled out my state return, waiting anxiously to see the outcome of the still relatively new healthcare schedule that would determine the extent of my fine. I was surprised. A handy chart through which I was obliged to search until I found the entry under my zip code informed me of what the state deemed an affordable payment for health insurance for my income group in my area. The schedule I was filling out then spilled the beans: because the cost of the cheapest available plan exceeded the state’s notion of an affordable payment in my zip code at my income, I was off the hook. No penalty. Of course, I was still without insurance.
What lessons can we extract from my experience? First of all, Romneycare, touted as “universal” by both Romney (that is, past-Romney. Present-Romney has sworn to slay the beast he now retroactively did not spawn.) and current Massachusetts governor Deval Patrick is anything but. Large groups of people throughout the state are deemed unable to afford the most affordable plans produced by the vaunted private sector, but are not sufficiently impoverished to warrant the attention of the state. My situation is not unusual. Depending on the overtime, I’m quite firmly in the 32-35k range, and the mixing and matching of part time positions is not at all strange in this era of underemployment. It’s worth pointing out that Commonwealth Care, the group of subsidized plans here in Massachusetts, is available to a larger income group than Medicaid will be nationally under the ACA, meaning that even more people nationally than in Massachusetts will slip through the middle and be uninsured despite the new law. In short, there’s nothing ‘universal’ about any of this. There’s really no need to discuss the difference between care and insurance, as anyone interested in this issue is already aware of the health insurance industry’s apparent business model (“Find a way not to pay”). The horrific deductibles many of the Romneycare spawned plans feature make the plans themselves so insubstantial, they serve no recognizable purpose other than fulfilling the minimum requirements necessary to avoid the penalty. When I had to look into these “plans” a few years back, I found that some of them didn’t even offer prescription drug coverage, though it looks like that, at least, has been (partially) corrected. If you’d like to see for yourself, just head over to the MA HealthConnector and shop around. Have fun. In effect, what the Massachusetts reform has accomplished is to establish a requirement that enables health insurance providers to sell bad products to a captive market. At the same time, it allows those (like me) with whom private business would rather not deal to go without. Private insurers therefore have free reign to sell barely there insurance to whatever groups of consumers they feel comfortable selling to, and leave the rest of us out to dry.
By creating a captive market, the ACA (like Romneycare) will basically carve out a fiefdom for the health insurance industry. Purchasing terrible coverage under threat of a penalty (or tax) with no coverage amounts to nothing more than a legal obligation to fork cash over to an unaccountable private entity. It’s downright feudal. Which brings us to…
Dead Peasants
While working on my master’s degree in a field in which I would later fail to find work, I developed an interest in agrarian history, which led me to the work of historian Thomas Bisson. One of Bisson’s lesser known works is a book called Tormented Voices: Power, Crisis and Humanity in Rural Catalonia, 1140-1200. The book was inspired by and largely based on research from a collection of peasant complaints regarding uncustomary abuse, violence and seizure of property and possessions. Bisson frames the complaints within a narrative of the attempted expansion of seigniorial authority by local lords. Within many of the complaints themselves, one can see the origins of some modern practices, including what has been called “Dead peasant insurance,” a practice in which a company will take out an insurance policy on the life of an employee. Bisson makes several references to a woman named Ermessen who complained that she and her husband were forced to pay their lord 5 sous because their son had died. This has nothing to do with health insurance (it’s really more about life insurance), but it does get at the diseased frame of mind we’re dealing with. “Dead Pesants” is also a great title. Bisson’s lords and knights set about trying to impose new fees, fines, dues, etc. on their peasants and used violence and systematic humiliation to force compliance. The peasants complained to the Count of Barcelona (and later, the King of Aragon) hoping something might be done about their local lords. Eventually, the King did take action, though this action occurred in the context of an ongoing struggle between royal and local authority, so how much weight the peasant’s complaints had is uncertain. In any case, there is a clear parallel between the neo-feudal concept of dead peasant insurance and the neo-feudal health insurance dues now owed to the likes of Lord Aetna and the Holy Order of the Blue Cross & Shield. Unlike in 12th century Catalonia, however, the current seigniorial overreach of the health insurance industry is not being done behind the back of a royal authority that might one day oppose it. It is instead the result of collusion with that authority. The ACA represents official sanction for the private management (and profit) of (and from) a properly public function. It is legitimized neo-feudal rentier capitalism.
The Limits of Liberal Imagination
The ACA represents the present limits of both liberal political will and imagination. I suspect that conceptual constipation and lack of historical memory play a role in this quagmire. Why else would the allegedly liberal wing of the democratic capitalist enterprise, the would be heirs of 1789 or at least 1776, have no better ideas than pressing for dues and rents from debt incumbent serfs, the way their old foe the feudal nobility did? The situation would be hilariously bizarre, if it weren’t so transparent and sad.
Delusional hysteria isn’t the exclusive property of the parties Republican and Tea. There’s just as much making the rounds amongst the Dems. If those shaking from terror and screaming “Socialism!” in the ACA’s general direction are deluded and dead wrong (and they are), then those cheering about how it’s a step toward single payer are just as ridiculous. By funneling cash into the pockets of insurance providers while simultaneously making them an integral part of a formally legislated healthcare plan, Obama & friends have created a barrier to single payer. Should we ever have such a plan here in the US, it will need to be forced on a more, not less powerful insurance lobby. It will exist despite, not because of, the ACA. That polls have consistently shown that a majority of Americans favor single payer really makes one wonder why the liberal imagination doesn’t seem to encompass this popular idea. I once thought this could be explained via the usual logic regarding lobbyists and corporate money, but it’s more than that. It’s a failure of imagination. The ACA is the ultimate expression of a world view incapable of looking for solutions beyond the boundaries of the neoliberal consensus. One might even argue that the individual mandate itself is an admission that American capitalism as it now exists has failed. Private insurers have failed to achieve universal insurance in the “free” market. The solution? Don’t rethink markets – use the state to force people into them! This represents an intellectual as well as a material failure, in that the initial, material failure (the existence of the uninsured, insured people denied claims) is compounded by a failure of imagination (“Private insurance didn’t work. Try it again harder.”). The ACA and in particular the individual mandate are at their core the self-cannibalization of American liberal capitalism. The capitalist component is forced to eat a bit of liberty to sustain itself. We’ve already seen this in other more obvious areas, such as the NDAA, the crackdown against the Occupy Movement, etc. It is more and more apparent that liberals, shackled as they are to neoliberalism, will not be able to save liberty from capitalism. Only the real left can do that.
