"A heart that's full up like a landfill.
A job that slowly kills you. Bruises that won't heal. You look so
tired, unhappy. Bring down the government, they don't speak for us.
I'll take a quiet life, a handshake of carbon monoxide."
The
existential sorrow in Thom Yorke's voice has never sounded as poignant as it
does today in "No Surprises", a track of lonely capitulation on Radiohead's
monolithic OK Computer. The
song evokes images of helplessness and retreat in the face of globalization and
corporate capitalism. The accompanying music video features Yorke's head
in a bubble helmet that slowly fills up with water (1). The symbolism in
both the lyrics and the video has become increasingly relevant since the
record's release fifteen years ago.
Some call it America in
Decline and it's a theme that has been explored extensively over the recent
years, months, and weeks (2) (3) (4). The idea is obviously met with
skepticism. In order to understand it, we have to put it in perspective
and define a context. What exactly is America and what's in decline?
It remains the richest
country in the history of modern civilization. It controls the most
powerful and comparatively advanced military machine ever assembled: a likely
result of spending more than the rest of the world combined (5). The two
characteristics are intimately related.
Indeed,
the idea that the accumulation of wealth inculcates suspicion and the need to
defend it has even been discussed by 6th century philosopher Boethius in The
Consolation of Philosophy: "the
wealth which was thought to make a man independent rather puts him in need of
further protection" (6). In fact, the need for institutional protection
of private property is one of the most heavily explored topics of classical
liberalist thought and framed much of the debate during the United States'
formative period. We like to think that the nation was founded on
principles of total equality and personal liberty. But the chief concern
among the framers was how to create a system where landowners can remain
landowners without having to worry about greedy peasants.
The concept rapidly
generalizes to capital accumulation today. Wealthy and privileged members
of society want the government to perform its intended function which is to
protect their assets. What would have previously been labeled agrarian
reform is basically equivalent to progressive taxation. However, any
rational politician will cater to privileged interests especially when
legislative positions are virtually bought in the current system.
The collection of votes is now regarded as a secondary consequence of properly
financing an electoral campaign.
Social reforms that benefit the
overwhelming majority of the population--where political power is least
concentrated--are marginal issues that require populist demonstration in order
to enter the political arena. The civil rights movement, the feminist
movement, and the AIDS movement are just a few examples. That these were
issues that could not be influenced by voting highlights a particularly
sinister illusion of franchise. We vote for politicians that seem
relatable given their stance on satellite issues. Presidential candidates
will resort to tactics such as showing up on MTV discussing underwear in order
to clinch the youth culture vote. In other venues he'll discuss how to be
tougher on crime or how to withdraw from some foreign conflict in some vague
number of years.
But where's the candidate
that speaks to immediately relevant issues such as access to health care or
proper retirement benefits? The former example is pretty striking,
actually. Government sponsored medical coverage has been a prominent
domestic concern for almost 40 years (7) (8). Even a recent 2009 NY
Times/CBS News poll suggested that 72% of the population were in favor of a
government administered health insurance program that would compete with
current private plans (9).
Furthermore,
there's no longer any doubt that a public option would drastically reduce
health costs and thus relieving some of the burden on consumers. A 2003
study published in the New England Journal of Medicine concluded that health care
administration costs account for 31% of health expenditures in the U.S. which
comes out to almost $300 billion. Canada's administration costs, on the
other hand, makes up 16.7% of their total health expenditures (10). The
high costs of U.S. health administration are a direct result of having to
navigate the extreme complex channels of billing and reimbursement through
private insurers. As one would expect, the system's complexities are
tailored to minimize payouts to consumers and simultaneously maximize profits.
The U.S. has very little to
show for its insanely expensive health arrangement. Its per capita costs
are twice those of other advanced OECD nations (11). However, it ranks
pretty low in health outcomes such as infant mortality and and life expectancy
(12).
And the burden on the general
population is, indeed, quite severe. Two landmark 2009 studies by
Harvard physicians David Himmelstein and Steffie Woolhandler were able to show
that the extraordinary costs of healthcare and insurance impose crushing
financial burdens and leave many who cannot afford insurance to die. They
found that 62.1% of bankruptcies filed in the United States in 2007 had medical
causes. This value is sharply contrasted with an estimated 8% in 1981 and
46.2% in 2001. 80% of the 2007 figure had health insurance and most were
well-educated and middle-class (13). Furthermore, the researchers were
able to link the lack of health insurance to 45,000 working-age deaths per year
in the U.S. and conclude that the uninsured are 40% more likely to die than
those with private insurance (14). This figure, too, is in sharp contrast
with a 1993 estimate of 25% (15). The spectrum of health outcomes
parallels socioeconomic status as one would expect, but the worsening trends
and sheer quantity of deaths are so morally alarming that they cannot be
ignored.
The outlook is even more
depressing when we examine a recent U.S. Census Bureau report which revealed a
striking racial distribution of uninsurance. 21% of blacks and 31% of
Hispanics in the U.S. are uninsured compared to 11.7% of whites (16).
This, too, is not that surprising. The proportions are probably similar
for those who drive Range Rovers, but we have to remain cognizant of the
fundamental difference between the two commodities.
The consequences of private
administration of healthcare are fairly predictable. A corporation's
chief concern will always be self-sustenance and growth. Consumer benefit
is only a priority when it contributes to the two main goals. The touted
virtue of free market efficiency is based on the symbiotic relationship between
consumer benefit and corporate profit. Unfortunately, it's not really a
free market. The government is continually prohibited from acting as a
significant competitor even though most of the population agrees that it should
be. Because of the fundamental difference between health and Range Rovers
as commodities, consumers do not have the option of simply boycotting the
product or choosing a competitor and thereby placing downward pressure on
costs. Saying no to healthcare is simply anti-human.
Furthermore, patent-protected
pharmaceuticals will sell at premiums with markups sometimes up to a thousand
percent. It's often argued that patent protection and value markup are
required in order to fund research and development. However, we cannot
ignore the costs of advertising, marketing, lobbying, and profit margins.
The economist Dean Baker has done significant work in exposing the
inefficiencies and deceitful practices of the pharmaceutical industry that
ultimately harshen the financial burden on the general public (17). He
has argued for several years that publicly funded research for the development
and distribution of patent-free drugs would be far more advantageous than the
current system that spends an estimated $300 billion per year on prescription
drugs.
The prospects for change are
pretty bleak given the virtual disenfranchisement of the general population
which brings us back to American decline. Media-propagated illusions are
partially responsible. The current debate surrounding Obamacare is a ripe
example. Government-sponsored insurance is not even on the agenda and the
public is led to believe that the Affordable Care Act and its guaranteed coverage
is the solution we have long waited for. This illusion is based on the
false dichotomy between Democrats and Republicans. It's a bad joke,
really. Obamacare is modeled on the Massachusetts health plan the origins
of which trace back to the Heritage Foundation (18) (19). It was
implemented by then-Governor Mitt Romney. I'll spare the irony.
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
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