22 October 2007

Listen to Lakoff

George Lakoff has written a topnotch explanation of how conservatives, progressives, and neoliberals view the healthcare debate.

Lakoff posits that conservatives see the market as the definition of morality: it forces people to take individual responsibility, it punishes those who do not, and it rewards those who do. Healthcare is no different than a plasma TV: if you've been good and worked hard, you get one (or you get healthcare); and if you've not been good and worked hard enough you don't. End of story.

Progressives, on the other hand, see morality in terms of empathy and taking responsibility for ourselves and others.

Neoliberals see morality in those empathetic terms as well, but also see the market as a potential tool for morality — that is, it can be reformed and constrained to be an agent for good.

Lakoff argues that's not the case with health insurance, since the very structure of the market rewards companies that decline to give care.
The basic fact is this: the sicker you are, the more you cost and the less the company makes by covering you. This is the opposite of the way markets normally work; namely, the more product a company delivers, the greater its profits. But in the health care industry, it is the opposite: the less care an insurance company authorizes, the greater the profit. As long as insurance companies are responsible for authorizing health care, this will be true.
Lakoff ends by arguing that the neoliberal compromise here won't work. By going along with the idea that the perverse health insurance market can work, we've conceded that the market is moral — which in this case it certainly isn't.
The best way to proceed is to keep what we care the most about at the center of the discussion of health care security. What we care the most about is the actual health and well-being of flesh-and-blood people. Keeping this care in our hearts does not mean that temporary compromises will not be necessary. It means only that we don't begin with compromise....

System tinkering — eliminating pre-existing condition exclusions, adding mandatory coverage for this or that ailment, subsidizing (substandard) health care for the poor — will make a difference for many, but not for all. It will leave many more people with the kind of dissatisfaction that those with present health insurance have rightly been complaining about. Tinkering like that is more concerned with saving a system that has already failed than it is with the health of a society, indeed, with saving lives.

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