Healthcare Debates: The Cost of Neoliberalism

A new today poll from USA Today shows the potential perils in one of the underlying tenets of neoliberalism (http://www.usatoday.com/news/washington/2009-08-10-healthcarepoll_N.htm). The idea is that acting in our own self-interest leads to the best outcome for all. This has always been a fallacy outside purely economic terms (and sometimes within in), but healthcare brings the problem into focus in a way that few other issues do. Healthcare has social costs and benefits that transcend the individual. This is particularly true given the incredible power that healthcare providers hold – essentially the power to directly or indirectly affect the quality of your life; and more seriously it’s length. Making decisions primarily based on one’s own interests, undermine the ability to address the two biggest problems today – costs and the uninsured. In the long run, the uninsured cost all of society, but neoliberal ideology, and American society in general, have a hard time looking to the long run. And the only way to control costs is to act collectively -- as shown most clearly by the fact that the power to control costs come predominantly from the number insured within a particular group.

As debates continue and fear becomes a key factor, it appears the aging population of the U.S. is predominantly making decisions based on their own interests – in the poll as the sample participants get older, they are more interested in controlling costs than dealing with the uninsured. Among 18-29 year olds, we do see more worried about the uninsured than cost containment. But every other group believes controlling costs is more important (with the percentage increasing as the cohorts age). There is also a race dynamic here, as 75% of Blacks and 66% of Latino/as believe we should expand coverage to the uninsured. Left out of so many of these discussions are the people who can’t vote – the millions of children who do not have access to basic healthcare that could very well affect them the rest of their lives. And the group most opposed to healthcare reform are the elderly.

Healthcare and education are really public goods, with huge externalities that the market is often unable to capture. These externalities are both positive and negative. A healthy society has lower medical costs and thus a workforce that can increase productivity and reduce shared social costs. A well-educated public provides more high skill workers and a more vibrant democracy that can challenge its problems through informed, diversified participation in the public sphere. Without effective healthcare and educational systems a country can easily fall into debt and long-term decline. This is also the case with the environment, with the middle class and rich the only one’s generally able to make ecologically responsible decisions. It is also the case with the corporate world, where more and more make decisions that benefit themselves but hurt others – not because they are “bad apples” but because we have set up a system where profit maximization trumps social responsibility and the common good. The U.S. is currently on a path where the privatization of public goods could send us into a hinterland from which we will not recover. Can we convince people to think beyond their self-interest, recognizing that in the end it is in their self-interest to think collectively about key public goods?