Friday, February 5, 2010

This isn't reform, either

Recently, Rep. Paul Ryan, a Republican, offered up a plan to "reform" Social Security and Medicare with what amounts to privatization and a massive reduction in benefits. While the shadow budget doesn't have a snowball's chance of seeing the light of day just yet, it does give us an idea of the mindset of Ryan and his allies (including those who wish to be coy). Medicare enrollees after 2021 would be given vouchers for private health insurance. This bit is a mild criticism, but worth noting:
OMB Director Peter Orszag last week said the Ryan budget provides a "contrast" to the White House plan and criticized the Social Security and Medicare elements.

"[I]ndividuals are on their own in the health care market. And the voucher does not keep pace with health care costs over time," Orszag said of the Medicare portion of the plan.
My concerns are many. One that I find quite salient is to ask a question about how sustainable the "privatize or perish" model really is. Think for a moment about our current economic straits. We've hardly seen anything on the level of, say, a massive collapse on the scale of that of the former Soviet Union, but we got an opportunity to stare into the abyss. And in doing so, I was reminded of a part of a talk Dmitry Orlov gave a few years ago:

Slide [16] The Soviet government threw resources at immunization programs, infectious disease control, and basic care. It directly operated a system of state-owned clinics, hospitals, and sanatoriums. People with fatal ailments or chronic conditions often had reason to complain, and had to pay for private care – if they had the money.

In the United States, medicine is for profit. People seems to think nothing of this fact. There are really very few fields of endeavor to which Americans would deny the profit motive. The problem is, once the economy is removed, so is the profit, along with the services it once helped to motivate.
So,  what happens when the empire collapses for real (I realize that's not a politically correct question to ask)? With so much of the infrastructure - including health care delivery - privatized, what happens when the profits are no longer there to be had? My guess is that the services, which are becoming increasingly inaccessible to those of us with modest means as it is, simply go bye-bye. In the case of health care, you're looking at a future in which what counts for "medicine" is little more than folk remedies. At that point you play the cards you're dealt, but the thing is that the cards in question needn't have been in the deck in the first place. If one reads Orlov, the picture he paints of Russia post-collapse is hardly pretty - in fact the situation was downright awful during the Yeltsin era (IMF-imposed "shock therapy" made matters far worse). Thing is that there was still something of an infrastructure in place that could survive the crash, putting the Russians in better shape than we would be under similar circumstances. If I were in a position of influence and in a reform-minded mood, I'd be seriously proposing among other things, putting in place a health care infrastructure that focused on basic care and prevention, and that largely ditched the primarily for-profit model that is currently inflicted on us. In general, if we want something that might still resemble something passing for civilization post-crash, our best hope will come from ditching neoliberal (or what a number of economists call neoclassical) orthodoxy asap. Regrettably, I see very few signs that those with actual influence in DC actually get it.

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