Why the free market can’t cure health care

September 3, 2009

We need a guaranteed right to health care--and while we're at it, the right to nutritious food and to have a decent place to sleep at night.

THAT THE free market is the surest guarantor of life, liberty and the pursuit of happiness is an article of faith among today's assault-rifle-toting, town-hall-disrupting brownshirts--and, to be sure, among their allies in America's corporate boardrooms.

Unfortunately, it is also an article of faith among the leading lights of the "party of the people"--the Democrats.

The right can howl all they want that Obama is a socialist. In truth, he is supporting a health care plan that will be a huge bonanza for private insurance companies. First, we are all about to be mandated to purchase their product. And second, the government is going to subsidize that purchase for unknown numbers of people. Can you say "ka-ching"?

Meanwhile, the "public option" (itself a far cry from socialized medicine) is fading fast. "Choice and competition" are Obama's new buzzwords for health care reform. That's politician-speak for free-market magic.

And just when you thought it couldn't get worse, along comes John Mackey, the CEO of Whole Foods, with a Wall Street Journal op-ed article in which he argued that Americans should not think of health care as a "right":

Many promoters of health-care reform believe that people have an intrinsic ethical right to health care--to equal access to doctors, medicines and hospitals. While all of us empathize with those who are sick, how can we say that all people have more of an intrinsic right to health care than they have to food or shelter?

Health care is a service that we all need, but just like food and shelter, it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America.

If there's any idea worth rethinking these days, it's the idea that our needs are best met through "voluntary and mutually beneficial market exchanges."

That we rely on such exchanges to organize the delivery of health care means that the organizers--private health insurance companies--have an incentive not to provide treatment. Health care, as mediated by the free market, is anything but "mutually beneficial." No wonder that here, in the richest country in world history, our free-market health care system ranks 37th among all nations. In a moment of blunt honesty, Obama called this system "perverse."

Why the free market can't cure health care

MACKEY IS correct that we don't have a right to food or to shelter, either. But shouldn't we? It occurs to me that these markets are equally perverse.

It is precisely the fact that food is a commodity, not a right, which explains why so many people around the world are starving.

According to a 2007 study, 37 million people in the U.S. live in "food insecure" households. "Food insecure" is really just a euphemism for "hungry." The United Nations estimates that there are 854 million people worldwide who are undernourished.

That's right--nearly a billion people don't have the money to participate in enough "mutually beneficial market exchanges" to get the food they need to survive.

And here's the kicker--there's plenty of food. Increases in the rate of food production continue to outstrip population growth.

But don't hold your breath waiting for Whole Foods to do anything about hunger--giving away food would cause their prices to drop. Yes, the free market contains a built-in disincentive to feeding the hungry. Now that's perverse.

You'd have to be a pretty cold-hearted SOB--or perhaps a CEO who's gotten rich by selling overpriced food--to argue that the free market is the best way to feed people. But we're not done with Mackey yet, for he has gone out of his way to remind us that we also don't have a right to shelter.

For the 3.5 million people estimated to experience homelessness each year in America, the housing market is altogether out of reach. And now, thanks to the bursting of the sub-prime mortgage bubble, home foreclosures rose 81 percent from 2007 to 2008, for a total of about 5.6 million foreclosures filed in those two years alone.

And we mustn't forget to thank free market "magic" for the millions of jobs lost as the dominoes keep falling through our economy.

Surely, when it comes to jobs, we are dealing with perhaps the most perverse market of all. Put aside, for the moment, the disturbing possibility that there are actually more slaves today than at any point in human history. I'm talking about the buying and selling of labor power on the "free" market.

Think of your latest job-hunting experience--your gut tells you there's something unholy about the process. Marx revealed the reason behind your nausea in his description of the position of the modern employee--the contradiction of "freedom" for the worker under capitalism:

Free laborers, in the double sense that neither they themselves form part and parcel of the means of production, as in the case of slaves, bondsmen, etc., nor do the means of production belong to them, as in the case of peasant-proprietors; they are, therefore, free from, unencumbered by, any means of production of their own.

In other words, having no means to produce a living on our own, we are both free to choose any employer we wish--and "free" to starve if we find none.

Which brings us back to John Mackey's argument, and to what, in my mind is the real heart of the health care debate: what will be the future of the "exchanges" on the most important market of all--the job market. Will we, the wage workers, confront our potential employers in the marketplace as people armed with a whole array of rights, or as desperate, indentured servants?

I'm reminded of the scene from Michael Moore's film Sicko, where he sat down with a small group of Americans living in France. One of them, an African American woman, commented that in America people are afraid of the government, and that in France, the government is afraid of the people.

Could there be a connection between free health care, free college education and the higher level of protests, strikes and demonstrations in France?

Perhaps if you don't start out in life tens of thousands of dollars in debt, and if you don't live in perpetual fear of getting sick, you might be a little more "uppity" at work? Perhaps you might have the nerve to speak up, to protest, even to strike against your employer, if you know that your basic needs will be taken care of?

Could it be that Mackey doesn't want you to have a "right" to food, shelter, or to health care because such rights would embolden his employees in their struggle to unionize Whole Foods?

BACK IN October 2008, candidate Barack Obama was asked point-blank by Tom Brokaw whether health care should be considered a privilege, a right, or a responsibility. Obama didn't blink:

Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills--for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition, and they don't have to pay her treatment--there's something fundamentally wrong about that.

Yes, there is something fundamentally wrong about that, and yes, health care should be a right. But you can bet your bottom dollar that "choice and competition" are not going to get us there.

We need a universal, single-payer system to guarantee an "intrinsic ethical" right to health care. And while we're at it, we should have the right to nutritious food and the right to have a decent place to sleep at night.

We can't wait for our employers--or the mainstream political parties they sponsor--to give us those rights. They must be wrested from the government by a movement of working people motivated by their own independent interests and liberated from the shackles of free-market ideology.

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