Friday, February 20, 2009

Will economic conservatives learn any lessons from this crisis?

By LindaBeth

Yesterday I wrote about Republicans' victim-blaming rhetoric in their critique of Obama's housing plan. I was not only interested in their rhetoric because of its interesting blaming structure, but also because lately I have been wondering if our current economic crisis might change the way we think about, talk about, and approach public policy regarding the unemployed and working poor. Now that many “hard-working Americans” are being laid off “through no fault of their own,” will the Right rethink their stance on social services for unemployed and working poor Americans?

I suppose this is opposed to the “normal” unemployed and working poor who are in their state entirely through fault of their own. It seems that when structural economic hardships happen en masse, it’s not “their fault”, but when structural hardships perpetually happen to a good fifth of Americans, it is their fault? Or is it when the middle and upper class find themselves un-or underemployed (and thus can’t pay their overconsumption-induced bills), someone else’s is to blame, but when high-school educated, full time workers can’t even break out of poverty, they themselves are to blame? Do not both scenarios arise from corporate greed? Is not the health insurance through employment formula a major factor in both hardship situations? Do we only have sympathy for the middle class who become poor but not for the poor who can’t make it anywhere close to middle class?

It took my own personal struggles to break me free from the American Dream brainwashing I had received from my conservative upbringing. In the spring of 2003, I found myself a new college graduate, with several years in retail management under my belt, and a partner with a Master’s Degree. We moved back to our hometown because he owned a home there with no mortgage. Because we “voluntarily” moved back to the town where he owned a home rather than stay in the college’s town with our part-time minimum wage jobs, we could not qualify for unemployment–or any social service–when 3 months later, we were still unsuccessful in finding jobs in our fields. We shifted to looking for any job, which is more difficult than you think for two fairly educated people. No factory wanted to hire someone with a Master’s Degree. In the end I realized a few things:

  1. The system is degrading. It is not very empowering to sit at DSS and beg to be approved.
  2. It is not all that easy to obtain social services. You must own so little, or at least look like you do. (46% of all poor families receive no welfare)
  3. Our society has no short-term safety net–nothing that covers you between jobs or between college and employment. Unemployment is not so easy to get.
  4. Hard work and education does not mean good employment. Life outcomes are not the direct result of one’s self-making.
I share my experience because this is what it took for me to understand that (full, or even decent) employment is not a function of personal worth or hard work and that even if our social services are organized poorly, the idea of them–their necessity and our duty as a society to provide them–is non-negotiable.

While pessimistic, I wish that this economic crisis would be the jolt that conservative America needs to rethink poverty in America, to recognize it as structural, and to stop always “blaming the victim.”

(Cross-posted to Speak Truth to Power)

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8 Comments:

  • Hi Lindabeth,

    As a conservative myself, I find your article interesting. In particular I appreciate the suggestion that the link between employment and health insurance needs to be severed.

    As suppose as a self-professed liberal you are probably in favor of a national health policy, perhaps single-payer. But single-payer health care systems, be they in Canada or England or in the US with Medicare, are very poorly rated by the patients using those systems, according to the WHO. For this reason, conservatives like me oppose single-payer health care systems.

    But the status quo is as unacceptable to us as it is to you. It is unacceptable because it leaves out too many of our sickest and most vulnerable, a point you allude to in your article.

    There is a solution though, if both sides would be somewhat less inflexible. And that solution is to study the examples of France and Germany, two countries with very high patient-satisfaction ratings. Personally I have done some research into the French system.

    The first thing to note is that France (rated #1 overall by the WHO) does not have a single- payer system, but rather a system of heavily regulated insurance companies. And rather than having policies that are meant to cover everyone for everything, the "base" policies that every person in France gets only cover essentials. Additional coverage is available in many varieties, depending on individual needs and budgets, and 85% of French people elect to buy additional coverage in the form of one of these "mutuelles."

    An additional point to consider regarding the French system is that they themselves do not consider their system to be "socialized." The patients are free to get coverage from any doctor or facility they desire. And the patients help to control costs by paying up front for services, collecting reimbursement from their insurer only after the bill has been paid. Caregivers can charge whatever they want, but patients will only be paid back a preordained sum for any service, so persons are free to pay more if they want (or buy a mutuelle) to work with a specific doctor.

    Contrast this with the US, where people with employer sponsored plans seldom know the value of their policy, or what it costs for a visit to the doctor.

    Overall, the French system meets the goal of providing for all of its' people, while not surrendering any of the autonomy that patients have in selecting when, where, and from whom to seek treatment. There is no medical board like the British NICE to upbraid doctors for failing to adhere to government endorsed best (read: cheapest) practices. There is no rationing.

    Now, how do we get there from here?

    As you might expect, my conservative leaning leads me to advocate free market reforms, including the severing of the employer tax break for providing health insurance. I also advocate allowing reimportation of drugs, to end the practice of phamaceutical companies selling vast quantities of a drug overseas for one price and then selling the same drug to individuals in the US at FDA-inflated rates. And finally, we must allow patients to buy policies from whichever state has the best policy for them. Want a policy that covers you for physical therapy, or alcoholism treatments? No problem, just buy a policy from Massachusetts. Want a barebones policy that covers you for catastrophe and nothing more? Try Idaho.

    But the biggest reform I would advocate is this two part solution: we must have guaranteed issue, so insurers cannot cherry-pick (as they do now) and we must have a cap in rates, so that the sick are not priced out of coverage entirely.

    In practice this will result in higher rates for the healthy than would exist in an unregulated free market. But it will also result in lower rates for the sick, allowing more to afford coverage.

    And as for the poor, we can simply provide direct subsidies to allow them to buy a policy.

    In sum we would be able to use the free market to help control costs by pricing out some of the silly mandates that exist in some states. And involving consumers in the purchasing of policies and in pricing out treatments would help control costs as well.

    And at the same time we would provide a means for the sick and the poor to buy policies at reasonable rates (subsidized by the healthy).

    And we could do all of this without rationing care, or imposing mandates on unwilling consumers.

    Sorry to have prattled on so long on your blog. If you want, you can return the favor in kind on mine:

    http://mrrightwing.blogtownhall.com/

    By Anonymous Anonymous, at 6:45 PM  

  • People always complain about their health care. The only exception is cadillac health care where the providers spend money on making the patients feel coddled instead of spending it on maximizing the quality and efficiency of the health care. And then, the patients complain about the cost.

    The problem as I see it is we already have de facto government-funded emergency care for destitute people. That's the most expensive national care there is, especially for destitute people, who are disproportunately susceptible to preventable illnesses. Almost any health care worker who has been on the job more than ten years has personally seen a variation of Hillary Clinton's story about the kid with the tooth abcess who consumed a hundred grand in emergency care and died anyway from an infection that should have been treated early for a hundred bucks but wasn't because the mom couldn't afford it. This totally changes the question should we have universal health care. If we're gonna say no and mean it, that means the emergency rooms have to turn away those who don't demonstrate the ability and willingness to pay for their services. Otherwise we're pretending to say no but really saying yes and that's too expensive to sustain.

    You know what else we need to face up to? The whole idea of punishing criminals by confinement was a mistake from the very beginning. One of the worst things about it is its unpredictability. If you know someone once served six months you have no idea whether it was a productive time-out or a soul-crippling experience. I don't pretend to know the answer to what to do with very bad criminals but I'm quite sure prison isn't it. Suppose your son faced a choice of twenty-five years in a bad prison or amputation of a hand. Which would you choose for him?

    By Anonymous Anonymous, at 5:43 AM  

  • Whether an individual is in economic distress through willful negligence or inescapable misfortune, it is not the moral responsibility of others to assist against their will, through government programs. We have an inherent right to choose whether or not to help others and have no obligation to help persons we've never met.

    It's impractical - it spreads the misery, slowing economic growth - and immoral, since it is coerced charity.

    The solution is freedom for all Americans. History shows that actually does work and it's the only moral solution.

    By Blogger Jeffrey Perren, at 9:43 AM  

  • you'd think those on the left would suspend their arrogance and give pause, as the country and the world comment loudly via the declining stock market. but no, like the bush administration on the war, no amount of evidence/input will deter the left from their goal. as we get poorer via the markets, they'll tax us more to cover their runaway spending on health care and everything else under the sun. you ignore reality, at my peril. i will not soon forget it.

    By Anonymous Anonymous, at 10:22 AM  

  • I found Mr Right(wing)'s comments an interesting read. As for the blogger's article- It never ceases to amaze me that liberal mind thought says "Its so bad. Where is the Govt?" Of course she justs thinks that money grows on trees and its just something that should be done.
    I don't mind doing things for the poor provided it actually helps the poor. But for example if you look at Headstart as a program, it is a failure. No positive results comparing headstart students and non-head start students by the time they both reach the 6th grade. But I would bet $5,it would be a "sin" to her to even question its "Worth". Its the "good intentions" that drive these liberal nuts not the actual results.
    If we survive this current dance with "liberal thought" we as a nation will be lucky. But I fear there are too many in the nation that want to "drink the water" and not "carry the water". Well time for this working ant to get back to work so the shiftless grasshoppers can commend themselves with all their bankrupt social programs deliver with "good intentions".

    By Anonymous Anonymous, at 11:22 AM  

  • mrright(wing)-

    A very thoughtful comment indeed. A few comments myself:

    I do not necessarily personally advocate one solution to health care over another. But I do advocate a system that covers everyone (at least basic health services) through the progressive tax structure. I believe health is a human right, and that (from an individual standpoint) we are all invested in each other.

    I lived in Canada for several years and I myself as well as everyone I knew personally was quite happy with the Canadian system. (Maybe Michael can speak to this more.) I do appreciate you after saying that Canada's and England's systems don't interest you that you look beyond to other models. One thing that frustrates me about conservative arguments is that often they end with saying either of those 2 systems are unacceptable, therefore the idea of health care for all won't work, which seems so goofy to me. If we are all this "greatest country in the world" business, couldn't we improve on other countries' models and make one that could work well here? One other point is that Canada's system and England's system are VERY different, and more often than got get conflated in the media by legislators who don't much know or care to distinguish. Canada's system is not socialized either--I had my choice of doctors, for example. Socialized/nationalized systems are ones where the the state actually owns the services. That is the case in England, but not in Canada.

    On a related point (but not directed at you), we need to provide a more accurate definition of the word "socialized" and stop using it as a political red herring.

    Re: your marketplace solution, how do you ensure that policies are "affordable"? Who determines what is affordable? Who will count as a "family" for the expected means-testing that will ensue? These are some of the questions that plague our system even right now.

    I have a broader question for those opposed to "pushing" choices on people, as you indicate in your comment about pushing mandates on unwilling customers. Americans (not necessarily you, I'm back to the general now) seem to have a selective understanding about the way our society works. We already have socialized/nationalized programs in place. It's true. Firefighters, police force, primary education, for starters. All government employees, all provide services funded by the taxpayers, to everyone regardless of their ability to pay. (The VA? Now that's socialism as well.) Why are these services socialized in our fine, free market? Because they are services we believe serve the greater good of society, that we have a duty to provide safety and a basic education to everyone. You may disagree with me, but I believe health care falls in this realm. And I think that some level of care (what level can be debated) needs to be guaranteed to all. And making a plan nationalized doesn't have to mean you give up doctor choice and all the other scary things that often are mentioned. It means that as a society, we have a commitment to the safety, education, and health of all our citizens.

    At the very least we need to get away from inflammatory language, throwing around words like "socialism", conflating different types of national health policy, and assuming that the only options out there are the only ones that can be done.

    One of the defining moments in the 2008 campaign was in the debate, when McCain and Obama were asked if health care was a right or a privilege; Obama answered the former, McCain the latter. That, in my opinion, is the flaw in the conservative approach to health care.

    By Blogger lindabeth, at 1:03 PM  

  • Mike--

    t never ceases to amaze me that liberal mind thought says "Its so bad. Where is the Govt?" Of course she justs thinks that money grows on trees and its just something that should be done.

    I have no idea what you mean here, or how this statement applies to what I wrote. Could you be more clear?

    I don't mind doing things for the poor provided it actually helps the poor.

    I agree too. I do not support programs that do not work, either.


    I am not a liberal. I am a progressive. And an academic social and political critic at that. So I have no investment in anyone's pet programs if they do not work and I push no one's agenda. I do not think the ideological political argument is over whether or not certain social programs work, it's over whether or not we should have them at all.

    Conservatives are so quick to say "welfare doesn't work, therefore welfare is bad". That's not the correct equation. The correct one is "our welfare system isn't working, therefore we should work to fine one that will."

    Thus my statement,

    even if our social services are organized poorly, the idea of them–their necessity and our duty as a society to provide them–is non-negotiable.

    Please do not project criticism of liberal politicians' policy aims onto my thoughtful analysis. I am not a liberal politician.

    By Blogger lindabeth, at 1:11 PM  

  • "structural hardships happen to a good fifth of the American people".... oh please!
    Stop it with the Bolshevik nonsense, will you? Socialism and the welfare state haven't worked anywhere on earth. Why is it you liberals think you are so brilliant as to have the RIGHT way to do socialism?

    I suggest that you google Dinesh D'Souza at the Oregon State University Socratic Club and watch his short five minutes with Michael Shermer. It's about a sandwich and a wagon. It puts your liberal nonsense right where it belongs - in the garbage heap.

    By Anonymous Anonymous, at 5:29 PM  

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