Tagged: Healthcare

Barbara Ehrenreich on Our Obsession with Aging

Earlier this week on WNYC’s newish program, Midday on WNYC, Barbara Ehrenreich spoke with guest host Kai Wright about her new book Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer. (Buy through this link and I’ll get a commission, or get it from her website.)

There were a lot of great insights into this interview, especially her critiques of medical testing, wellness, fitness, and mindfulness that mirrored a lot of Michel Foucault’s work, particularly that which deals with surveillance, discipline and what he calls “discourse,” knowledge that is produced by a power structure. Here are a few takeaways from the interview:

  • Ehrenreich characterizes the escalation of medical testing to surveillance over the body, bringing to mind Foucault’s critical history of the panopticon as a technology of surveillance.
  • Ehrenreich describes the dedication to fitness as a kind of control one exercises (ha!) over the body. In an age when people feel powerless over various social and economic conditions, exercise acts as a mechanism to maintain a sense of power.
  • Ehrenreich argues that the contemporary obsession with wellness can function in two ways, largely dependent on economic class.
    1. For the working class, it acts as a form of Taylorist surveillance for the employer to manage the employee’s health. This is done in the name of reducing health insurance payouts but in effect trains the employee to shape his or her behavior.
    2. For the upper class, wellness is a form of conspicuous consumption, where rich people can show off their commitment to fitness through expensive workout regiments and pricey foods and nutritional practices. While Ehrenreich illustrates this trend with a wellness coach who advocates eating pearls to combat aging. I immediately thought of the boutique gyms that pepper affluent cities and communities that were the subject of a recent Washington Post article. The article describes a diversity problem—a disproportionate number of young, rich, and white people in an otherwise demographically diverse cities—at expensive, boutique gyms. However, I think that the diversity problem is largely due to the uneven distribution of wealth, especially among younger people who have ascended economically since the Great Recession of the last decade. Hence, these gyms function as a token of affluence and commitment to health.
  • Ehrenreich also critiques the recent surge of mindfulness as Silicon Valley’s solution to the problem they created with digital devices and their distracting platforms. What began as a spiritual ritual practiced by Buddhists has been emptied of any religious properties and reduced to an app on a smartphone or Apple Watch.

I do quibble with one of her suggestions: to Google your health questions and add a few keywords such as “controversy” or “evidence based.” I think one of the reasons that so many people have become followers and practitioners of junk science is because of this very practice. On the Internet, good information and quack-pot theories are almost indistinguishable, especially to many who lack the training or experience in doing research.

Overall, however, I do appreciate her larger message that I would paraphrase as this: life is too short to worry about death.

Trumpcare Collapsed Because Republicans Cannot Govern

As you may have heard, Trumpcare—the efforts to repeal and replace the Affordable Care Act—appears to be dead. Jonathan Chait attributes the reason to the Republican party and conservatism as a movement because it is incapable of governing and meeting basic public needs. As he writes:

The collapse of the Republican plan to repeal and replace Obamacare is an especially vivid demonstration of the broader problem. The cohesion Republicans possessed in opposition disintegrated once they had power, because their ideology left them unable to pass legislation that was not cruel, horrific, and repugnant to their own constituents.

Frankly, I couldn’t agree more. Back in May, I wrote that the Republican Party is incapable of governing because their ideology is incompatible with government playing any role in most aspects of public life. In other words, they can’t govern because they basically want to abolish government. However, the reality is that government intervention is necessary when the market fails to provide necessary services. For most of the twentieth century, the government has generally balanced private industry and public intervention on the grounds of the “public good,” using a formula that looks something like this:

  1. Allow the market to operate freely and provide whatever it is we need.
  2. Identify areas where market failures do not provide for the public good.
  3. Devote government resources to provide those necessary services.

We’ve done this with labor protections, the environment, civil rights, education, and, in expensive localities, with rent control. But we haven’t done this with healthcare, and that’s why we’re in this mess.

Market-based healthcare is a failure because healthcare providers charge as much as they want and because patients have no idea or control over what those costs are. Insurance providers and government health plans can only negotiate with the providers in an opaque system that keeps costs high for everyone. This is even more true for those who aren’t covered by a group insurance plan, such as those provided by an employer, or by a government health program, such as Medicaid or Medicare.

What is necessary to truly reform healthcare is universal regulation over rates for health services. The free market has failed to control costs, and that’s the real reason why health insurance premiums are higher every year. There’s nothing to control those underlying costs. The Republican Party line—that “Obamacare is a failure”—is true because it didn’t address the cost of health services: it only made it so that health insurance cover more people that couldn’t afford it before, including the poor and patients with preexisting conditions. The Affordable Care Act can’t keep premiums low because it is an attempt to reform from the supply side. Its aim is to give health insurance companies more customers so they could spread healthcare costs over a bigger pool of patients. But what we truly need is a demand-side reform. Regulate the health services markets, standardize the rates, freeze their costs, and reward providers who implement efficiency measures to provide better health services at a lower price. In essence, this is what single-payer healthcare does, but this is not the only possible solution.

Government reform of the health services market would do what we need most in the US healthcare system: cover everyone and keep health insurance premiums down. But doing this requires Congressional leaders to put on their big-kid pants and to actually govern, and we see what happens when we let try to do that.

Dismantling Government is Hard When You Have to Govern

In the aftermath of 11/8/16, there have been a lot of uncertainties about the direction of our country, but last month at the CPAC conference, senior advisor to the president Steve Bannon very clearly outlined the game-plan for the Trump administration. All of the goals seemed terrifying to anyone with a sense of history because it threatened to undo nearly 100 years of economic and social progress. But one goal stood out: the dismantling of the administrative state.1

Since the inauguration in January, we’ve seen Trump and his administration use executive authority to tear down parts of the government, piece by piece, and to pave the way for an autocratic, neoliberal state that would have made even Ronald Reagan nervous. One of the first steps to undo the administrative state was to repeal the Affordable Care Act. To do this, Trump needed the help of his party, but as has been clear for a generation now, the Republican Party is incapable of governing.

Economist and former secretary of labor Robert Reich notes as much in a piece, “No, Paul Ryan, Your Healthcare Defeat Wasn’t Because of ‘Growing Pains,'” published yesterday. He writes about the Republican Party…

Their real problem isn’t the “growing pains” of being out of power. In reality, the Republicans who are now control the House – as well as the Senate – don’t like government. They’re temperamentally and ideologically oriented to opposing it, not leading it.

Repealing Obamacare wasn’t the problem. The Republicans had all the pieces necessary to do it: they had a majority in the House and a Senate process in place to pass it. They had a president ready to rubber-stamp whatever bill he received.

The political reality, however, required them to craft a replacement plan, and the party of “nay” couldn’t do it. They couldn’t figure out how to actually make a better plan and sell it to members of their own party, much less the American people.

Aside from trying to repeal Obamacare, the Republicans spent the entire Obama presidency fighting him on two very public fronts: raising the debt ceiling and passing a Federal budget. Those battles culminated in a downgrade of the US government’s credit rating in 2011 and in the government shutdown in 2013. Both are coming up on the Congressional agenda in the coming months, and both will require making an actual plan. Unless the Congressional leadership reaches out to Democrats to counteract the persistent “nay” votes, expect more of what we saw during the Obama presidency. Congress will kick the can down the road and will pass more continuing resolutions to keep the government from shutting down.

This however doesn’t mean that the Republicans can’t succeed in tearing down the government. Dismantling the administrative state won’t always require replacement legislation to do so. There’s plenty of opportunities for Republicans to do lots of, what Robert Reich calls, “irrevocably awful” things between now and when we get to vote for a competent government in 2018.

  1. Bannon actually said “deconstruction of the administrative state,” but he meant “dismantling.” Deconstruction means to take something apart to analyze it, not to destroy it. ↩