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Health Care and the National Will

The Curse of Privatization

by NORMAN POLLACK

“Obamacare,” the felicitous handle to disguise corporate pre-emption of the ideological-political-structural ground which deals with what should be viewed as a justifiable, humane entitlement affecting all people: health insurance as a basic, non-negotiable right integral to the constitutional foundation of the State. I capitalize “State,” not as an appeal to isms at either pole of the spectrum, but to signify “All-of-us,” the nation as its people, not as, and in contrast to the supposed legitimacy of, its ruling class. By firmly endowing health care, i.e., institutionalizing it, with privatization as the antecedent condition, we place our lives at the mercy of the centers of profit and the structure reinforcing them.

Serves us right. Capitalism, especially as it historically developed in America, in which alternatives to its puristic organization were steadily ruled out (the Lockean primacy of property as be-all and end-all of society almost by definition—all else a variety of communism), has resulted in a systemic cohesion wherein strengthening the private sector in one area, here, health care, redounds to the further benefit of property-concentration in all other sectors. Think of it. Could the single-payer system, proven quite compatible with extant capitalisms (plural, because few other capitalist nations are as rigidly organized and ideologically defended so unmercifully as ours) elsewhere, be absorbed into the American system without affecting its whole ethos and structure of power?

“Obamacare” is at one with every other recognizable facet of contemporary US policy, domestic and foreign. Capitalism as successfully consolidated in America over now going on four centuries (even the New Deal constituted a series of emergency measures for the purpose of saving capitalism, its success allowing for systemic continuities in further wealth-concentration, despite efforts to introduce a genuine and lasting public realm truly crediting welfare entitlements) makes little allowance for what appear as dysfunctional elements in the formation (successively, I fear) of a Class-State, then National-Security State, and now, closing in through massive surveillance and the disregard for civil liberties, an emerging Police State. How, therefore, expect or anticipate an authentic health-care framework, when the social order is prior-systematized to bring together in common purpose industry, finance, military, service, educational, media, indeed, every dimension of elite centralized control defining and promoting its functional operation?

A nation does not dedicate itself to global hegemony for the specific purpose of advancing the capitalist interests of its elites, and at the same time find within its governing structure the will and desire to serve its people free from ulterior profit-considerations, itself habituating them to the glories of capitalism as the only way to address their needs. In this way, the continued privatization of health care provides the means for ideological social-control, an insurance policy, so to speak, to keep the US on course in which the very concept of “public” is dishonored and humiliated. “Public” is seditious, not only because it is associated with socialist, but also, conveys respect for the people and people’s power to reorder society along lines avowing community, peace, fundamental rights—all anathema to the present-day political culture and its bipartisan consensus on intervention and war abroad, tightening limits on social change at home.

A capitalist-centric societal formation has a well-defined core, obviously, pertaining to property, yet even more basic, that which informs capitalism with its well-known traits of competitive dissociation of human beings (not simply as a means of preventing the rise of class consciousness, but the ideological formation of individualism to preclude sharing with and caring for others), the conversion of use value into pecuniary value, and good old-fashioned, obnoxious greed, selfishness, self-indulgence, in which fellow persons become objectified, from subject to object itself erasing human identity and the respect for the rights of the individual which follow. This may appear pedantic, but to know “Obamacare” and the forces and personalities producing it, start with Marx’s Economic and Philosophical Manuscripts of 1844 for understanding how the health-care system is embedded in the commodity-structure of US capitalism.

Instinctively, the Republican attack (a lucky hit, for prime facie political-sociological idiocy) on Obama’s health plan is in one respect absolutely on target: namely, health care, like civil liberties, is an excellent indicator of the democratic character of a society, especially with advances in medicine and technology in the last 150 years. When such a system reeks with duplicity, and bestows on intermediaries and the providers of services disproportionate rewards (compounded through tapping the public till) for what they render by way of the public good, we begin to recognize how important it is to see the centrality of this sector for shaping, coloring, giving tone to, the overall nature of a nation’s institutional framework and the many sectors defining its existence.

Parenthetically, for those who know or otherwise have studied Cuba, one finds the total inversion of the Republican (and here I must include a large majority of Democrats, given their cowardice in refusing to stare Obama down on single-payer, as well as their wholly uncritical acceptance of capitalism, including its perceived requirements of war, intervention, wealth-concentration, etc.) position on health care, so that instead of singling it out as dangerous because of its implied welfare dimension, Cuba, and I start here with Fidel, treats health care as the very pride and flowering of socialism, a vast potentiality for life-enhancement and the actualization of freedom which society proudly wears in its crown. Cuba, with far less resources at its disposal than America has, has made of health in all its forms (I recall the youngsters lining the walls of a mid-size clinic, in Santa Clara, waiting their turn for orthodontia), life-threatening to trivial, a true national priority, with the result that prevention, significant research into disease, medical education, all prosper, as though a tonic to, and floor underpinning, how people view one another and their society.

This is out-of-reach to America, the endeavor to transcend the commodity-structure both of social relations and, just as important, how the individual conceives himself/herself. There are several basic criteria for societal evaluation (in passing I have implied that of class relations, income distribution, the individual’s privacy and freedom from manipulation, to which one could add, among others, behavioral and cultural patterns affecting the environment and climate change, and active, constant, agitation for, discussion about, and implementation of, social justice), but I come to this newly-awakened thought: Health care, as shorthand, beyond itself, for a vital comprehensive social safety net, thrust upward as a fixed entitlement to which society must honor and respect, provides the analytical wedge determining claims of democracy and freedom. “Obamacare” hardly passes muster, nor does POTUS for disguising its evisceration at the hands of interested parties eager to preserve their own profit-edge as well as the ideological advantage of not conceding an inch to the modification of capitalism.

As for his party, the members’ essentially unified support and a largely bovine political base reflecting the same, it, too, fails to pass muster as even remotely constituting a democratic social force—only a thin line separating it from critics to the Right, who are fast dropping off the scale (dragging petrifying Democrats with them) into the ideological zone of nascent fascism. If Obama is not yet there, his wider militarization of the American political economy indicates his own willingness to be swept along, using the more vocal Republican opposition as cover for executing a decisive Rightist course without seeming to have done so. Why the masquerade? The liberal façade has got him to where he is; occupying overt right-wing ground, he would be one of many, and lack the accolades and stature conferred by race on him through a constituency long on political correctness and short on political consciousness.

Rather than declare health care a natural right as voiced in classical political-philosophical discourse, I simply call attention to its significance—in addition to being a measure of society’s general well-being—in revealing the established priorities set by its ruling groups via implementing the structure of power. When imperialism, global hegemony, surveillance, assassination and paramilitary operations geared to regime change or, on behalf of “partners,” the stabilization of despotic government, are of paramount concern, that is a tip-off that health-care propositions cannot be qualitatively different from them, i.e., favoring capitalist measures exclusively as solutions to societal problems. No surprises here, yet the idea of interrelatedness as the systemic attribute of policy-making and execution, meets with dulled eyes and ideological resistance. Health care has to be progressive, those nasty Republicans prove it so.

The militarization of capitalism drives a further nail into the coffin of a meaningful democratic structural agenda. “Obamacare” goes only so far—single payer and public option deliberately cast as subversive elements in the American cosmology, as meanwhile space is opened for widening class-differentials of wealth and power in America which, on its current trajectory, will ensure a substantial underclass that will be underserved from the standpoint of health needs—and everything else. When I say, America deserves its fate, here a health-care system riddled with privileges above, runarounds below, I recognize the harshness of the thought, but WHAT will it take to arouse people, make them into an active citizenry who will stand up for their rights, dignity, welfare? Societal breakdown, increased misery, still greater class-differentiation—possibly none of the foregoing, so long as the human being remains a commodity and is gulled by the trappings of liberalism.

My New York Times Comment on the editorial, ”What G.O.P.-Style Reform Looks Like,” Feb. 2, wherein Republicans become the scapegoat for the deficiencies of “Obamacare,” follows, same date:

If equal energy were expended on Obama’s plan, in which both the single-payer system and the public option had been eliminated, one could then see how neither the Republican proposal nor the current legislation was responsive to America’s needs–in both cases, privatization trumps effective, comprehensive health care. Both programs have more in common with each other than either has with a genuine standard of the social welfare. Obama, too, has favored the insurers, pharmaceutical industry, indeed all who profit from sickness and disease. As much as the Republican senators named, he has betrayed the American people, putting a liberal stamp on a retrograde policy to hide its structural limitations.

Public policy is a charade, in which we see the magnification of differences over less than essential elements. Not surprising, since Democrats have shown contempt for basic rights (of which health should be considered one, as in other industrial countries), given their acceptance of massive domestic surveillance and targeted assassination. Policy is a unitary phenomenon–rejection of universal health care and affirmation of intervention and a huge military budget go hand-in-hand. There is bipartisan consensus on savaging the social safety net, only the respective rhetorical justifications differ.

Norman Pollack has written on Populism.  His interests are social theory and the structural analysis of capitalism and fascism.