The Tea Party Republicans announced they would use the budget deadline to stand their ground against the Affordable Care Act (ObamaCare). They also made it clear that their complaint about the size of the national budget follows from their finding that the American government is involved in all kinds of Un-American activities. Using filibusters and control over the House, they shut down the federal government. In response, the Democrats say they won’t blink. The two parties play a game of chicken.
A fed up public shake their heads and wonder why the politicians don’t do their jobs and nothing gets done. But what are politicians doing when they get things done in health care? The Tea Party is called ideological extremist, but what’s different about their stance towards health care? Maybe they give an extreme answer to a cruel question that the political elite take for granted.
Health as a commodity
The Tea Party Republicans hone in on the mandatory nature of ObamaCare. The draw a red line at American citizens being forced to buy something. The funny thing is that the reason people have to be forced to buy health insurance is because the health reform insists on maintaining the private insurance system. Nobody would be forced to buy insurance if there was a single payer plan or if it came out of general taxation. But the Republicans as well as the Democrats oppose any kind of socialized health care. That’s ruled out from the beginning; its never been seriously considered in America.
That’s a nice contradiction: health care is not a normal commodity, but is forced to act like one. Health care is different from all other commodities because it’s the prerequisite for everything else: there can’t be economic activity or any society at all if there are epidemics or mass illnesses. Some modicum of health is necessary. That’s why governments don’t leave public health up to the market: because the market doesn’t keep the public healthy. There’s simply no way this social necessity can be provided on the basis of prices, profits, and individuals shopping for it.
And yet that’s how health care is made available: as a commodity; that is, as something you have to pay for. But unlike other commodities where a level of quality is offered for every income level, you can’t shop for cheaper brands if a treatment is too expensive or go without it if you can’t afford it. Health care doesn’t work that way. There is no cheap heart surgery or AIDS cocktail for poor people. There is the emergency room, but the previous Congress has decided – like everywhere else in the mature capitalist world – that this type of irregular access is inadequate, comes too late, is too expensive, and the expenses can’t be controlled.
In short: when health fully takes the form of a commodity, too many people don’t buy it – because they can’t. They are just too poor. A normal hospital visit goes for around $10,000. The insurance plans offered to private individuals are way beyond the budget of all kinds of people. There are both too many who are uninsured and health care costs are too high.
The government stake in “health”
These are the reasons that all modern developed states get involved in the provision of health services in the middle of their flourishing market economies. The state has an interest in maintaining a certain level of public health. It should be pointed out that this is different than true health in the sense of a population that is well-nourished, rested, at full capacity, free of pain. It means that the population is adequately healthy for the purposes that the state intends for them – as workers, soldiers, taxpayers, citizens. So what counts as adequate is continually under review. Is hip replacement really necessary? How much vision does a person need? Is fixing teeth necessary or should they just be removed? And so on.
The principle of socialized health care is that some aspects are removed from the criterion of profitability. How far this is carried out varies in different countries at different times. The National Health Service in Britain, for example, makes doctors and nurses state employees while medical devices and equipment are profit-making businesses. The state’s interest in a functional people is just one side of its intervention in health care. The other side is that the state wants health care to be a profitable industry. Of course, these two interests are antagonistic. That’s why health programs in all capitalist nations are constantly being reformed and debated and socialized health programs are being unravelled everywhere. Every government is dissatisfied with the level of health care that it gets and the amount of money that it costs. They all try to alleviate their budgets and install profitable business sectors to the extent this is compatible with the politically-aimed at health of its citizens.
In America, which is the dead last developed country to officially establish universal health care, the new health law tries to make every part of the system profitable – for doctors, hospitals, insurers, pharmaceutical companies, medical equipment manufacturers, etc. That’s why ObamaCare is 10,000 pages of regulations and this Rube Goldberg contraption had a chance of passing. Everyone is supposed to make money on it and everyone has to participate. This should solve the state’s problem with out-of-control health care costs. It aims not at the health problems of the people, but the drain on the budget that their poor health represents for the national budget.
Capitalist government for capitalist needs
What Obama has done by creating a national health law is no different than what any presidents does, including Republicans. No President just accepts the verdict of the market and let’s a national asset go bust. Even Bush Jr. saw a necessity to expand drug coverage for retired people. It is political practical sense that maintaining a functional population requires state intervention. In America, social measures are always struggled over because the necessity is questioned. If social measures are adopted at all, they are seen as provisional, unfortunate necessities rather than basic reasons of state. This is different from Europe where the maintenance of the working class is regarded as one of the state’s foundations. In America, every compensatory activity performed by the state has a suspicious character. Even the bailout of the financial industry, which couldn’t be more of a service to capitalism, was questioned: isn’t there some other way? Can’t the bankers take care of this themselves?
The measure of the Tea Party’s radicalism is that they refuse to recognize any state interest in maintaining its people. The Tea Party, in other words, is a radical version of the original idea of liberal government that underlies all American politics: government should be as cheap as possible, run like a business, protect person and property and then get out of the way. Only what the market considers worthwhile is worthwhile. Every service that doesn’t find a market proves that there’s no need for it. If a person can’t make a living, then that’s their private problem. The Tea Party are radical idealists of free competition – unfazed by its results and conditions, objecting only to its costs.
Why does the Tea Party hate Obama?
In practice, Obama’s “change” in the health care system is not so momentous. So why is he accused of betraying America’s political culture? In theory, it is an acknowledgement that America’s private economy can’t provide for itself. In the US, ordinary state measures are dealt with as systemic questions: is this still capitalism or is it socialism? In Europe, these are debated as pros and cons of the means; nobody asks: does the violate our way of life? America treats the necessities of any capitalist nation as doubts about whether America’s principles are still in place or about to be abolished. This is expressed in the sentiment: government is too big; this is inefficient and, above all, harmful to the moral condition of the people. The more government, the more money is taken away from those who earn it and know how to use it best. This is upheld as the basic equation of America’s success: the wealth of the rich is identical to the well-being of nation. The Tea Party sees this under fire.
Of course, American presidents tried for decades to pass health care reform. But as long as no majority could be reached in Congress, the nation just considered those people who had no access to be not so important to society. But as the number of people who have no coverage, even those with jobs, grew dramatically, an entire sector of the population that is supposed to count as middle class no longer can afford a basic element of the standard of living. Even those with insurance have health care that looks like that of the poor, i.e.: very little. So it is no longer just the margins of the society, but a growing number of economically active citizens whose health needs aren’t being met by private enterprise. The leaders of the nation have now acknowledged this is not just the problem of the poor, but a national problem.
This official admission is what drives the Tea Party ballistic. Its a blow to America’s self-conception. It says this country is not as rich as it thinks it is. For decades, America’s success as the undisputed leader of world capitalism supported the principle that America didn’t need as much government as the lower-tier powers in Europe. It could leave health care to the private sector; this was proof of its economic invincibility. That’s why the health care debate raises such fundamental questions: is this still a free country? Who are we as a nation if our basic values no longer hold? State-run health programs might be ok for Europe, but not the US. The Republicans see “American exceptionalism” as the source of its success. Acknowledging that the US has to adopt measures that are normal to other countries is a concession of decline. By acting like just another country, it is giving up its God-given destiny.
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Any government in a capitalist society questions how far its political means take it beyond the protection of person and property by means of law. It wants the private economy to subsidize the state, not the other way around. The mainstream ideology in this society is that the economy has defects, but politics is there to act as a corrective. What seems so crazy about the Tea Party is that they reject this role of politics in making up for the market. They don’t regard the lack of access to necessary commodities as a defect; they just say: everyone must compete for their livelihood and if they aren’t successful, that’s there problem. They don’t recognize a national interest in health care because nothing needs to be corrected. They refuse to recognize that capitalism fails to reproduce what it needs to exist.
However, it speaks volumes about the nature of this economy – which all parties are so keen on – that state involvement is even necessary: crucial aspects of existence can’t be left up to it. Capitalism is supposed to be so great, but something as crucial as health can’t be left up to it. Anybody who thinks it’s a good thing that ObamaCare puts America back in the mainstream of modern nations is just ignoring what it’s actually there for: to serve an economy that doesn’t fit with the most basic needs of life. Making the abundant achievements of modern medicine and quality care available for all is simply out of the question – on that, Obama and Boehner see eye to eye.
Geoffrey McDonald edits Ruthless Criticism.