Category: free-market ideology

Healthcare and Markets – why don’t they work together?

A consistent chattering point in American discussions of healthcare is the claim that if we can only bring transparency and competition to healthcare we will drive prices down and bring sanity to healthcare. The rest of the world knows that this is not the answer but we seem to remain in the thrall of universal free-market thinking.

To answer this question lets start with an example of a market that works reasonably well and which we all know very well. In our little patch here in Hudson we have four supermarkets within about a six mile radius servicing roughly 20 thousand people. I can choose to shop at Price Chopper, ShopRight, Hannafords, or Walmart. There are also farmer’s markets and roadside stands. I have lots of suppliers to choose from. Generally I shop at two places, but I certainly stop at all of them with some frequency. When I step inside I regularly pick up the green and red peppers, the onions, and other vegetables that I like to chop up for my cooking. Now, I do not hold a degree from CIA (Culinary Institute of America) so I am not exactly expert, but I generally can identify a fresh vegetable when I see one. Unlike some Presidents I do know how much things generally cost and there are price points for green peppers, for example, that reduce how many I pick up from three or four to one or none.

So,  a functioning market has a number of suppliers (sellers) and lots of buyers. The product for sale is understood by the buyers and they can examine it for quality readily. Prices move up and down in reaction to supply and demand. Market capitalism in action.

Health is not a green pepper

Health is complex and above all it is about life and death of the buyer, me and you. It is inherently emotional. Generally, people will do whatever is necessary to avoid pain and discomfort. This is not a choice between green and yellow peppers. Further, diagnosis and treatment options require many years of advanced education and training to understand. It is simply not true, and never will be true, that people without this training can make well informed decisions about which treatment path to take. Then, unlike our supermarket example, here in Hudson there is one supplier of health services, Columbia Memorial Health, the local hospital. To choose a different supplier I can drive an hour north to Albany or 45 minutes south to Rhinebeck. Even in Boston where I lived for many years, the choices were broader but then I was faced with the fact that the appearance of choice confronted me with my lack of expertise to make a well informed optimal decision. Health is not green peppers. Doctors and hospitals are not grocery stores. I did not graduate from Harvard Medical School.

Fee for services not for health – perverse incentives in action

In reality our market based healthcare system operates just as one would expect given the imbalance of expertise and relative small number of suppliers.  The suppliers have enormous power and they are taking advantage of the buyers, us. They set the prices as they wish. Through historical accident we have added a mixture of government and private insurance that obscures what is going on. Worse, this market is not selling health at all. In a self-enriching cycle, the doctors and hospitals are incentivized to use as many tests, procedures, and prescriptions as possible. They are paid for these; not for health. This is the pay for service model.

Every other developed country in the world understands all of this very well and has for decades. Each country has evolved systems to establish a national or regional budget per capita for health. This is done in negotiations between the government, other stakeholders, and the medical providers. The providers are expected to deliver health. Markets and profits enter, if at all, only peripherally. It is up to them to determine how many tests, procedures and drugs to prescribe. They can decide that preventive medicine is more effective than costly technology intensive treatment. They  optimize the mix.

The proof is in the pudding

Here are a set of facts that speak loudly to both the cost and poor quality of the American healthcare system. The US spends $9,800 per capita on healthcare. Our developed country cohort spends approximately one half of that (excepting Switzerland the outlier at approximately 70% of our spending). These countries all achieve a life expectancy between 81 and 83 years while the US is at 79 years. This numerically small gap in fact represents a very significant gap in performance. According to the most recent CIA World Factbook: “The US ranks 56th in infant mortality out of 225 countries; 48th in maternal mortality out of 184; and 42nd in life expectancy at birth out of 224.“ These facts should outrage all Americans.

Click for large size.

Trickle-Down Returns to Enrich the Rich

As the rest of us are recovering from the outrageous Senate healthcare bill released this week, Trump and the Republican Party are having closed door meetings to shape their “reforms” to the Federal tax system. Get ready for a resurgence of rhetoric about how enriching the rich will generate a surge in economic activity that will raise all boats. There will be lots of talk about “pro-growth tax reforms”. This is the return of 1980s trickle-down economics. The basic notion is that if you put more money in the pockets of the rich and corporations they will invest in creating new businesses and jobs. Thus the money trickles down to the bottom. Trump and his Republican Party allies have already claimed that this will increase the growth rate of the economy from its recent typical of 1.5% to 2% annual growth to over 3%. The difference of this one percent has enormous implications. At 2% growth the economy doubles in 36 years. At 3% growth it doubles in only 24 years.1

Trickle-Down – The Reality 

BUT, no economist, banker, or corporate chieftain not on the payroll of Trump and the Republicans believes this will happen. Leaving aside all sorts of analysis about demographics (aging population), technology, and global competition, history and current events provides a fairly comprehensive rebuke to these trickle down cover stories for the Republican give backs to the rich and corporations. Trickle-down economics was invented in the early 1980’s to explain the wisdom of Ronald Reagan’s tax “reforms”. Much space was taken up with displays of Prof. Arthur Laffer’s demand curves that were passed off as proof from the academy that enriching the rich and corporations would unleash a new wave of economic activity. Nothing like that happened in the 1980s. Nothing like that happened in the first decade of this century after Bush II’s big tax cuts.2 And most recently in Kansas, the Republican dominated State legislature had to override the governor’s veto of tax increases after a 5 year experiment there with trickle-down drove the state nearly to bankruptcy.3

Nevertheless, get ready for another round of bull shit Republican propaganda about “pro-growth tax policies”, unleashing the over-regulated, over-taxed job creators, and a great surge in economic growth. The forces of free-market capitalism just need to be freed from the shackles of government. You will here all of this and more. The media will continue to do its job of repeating all of this. You need to be clear that the vicious Republican Party is at work for their masters among the rich and corporations. There job is making sure that the 40 year stagnation in incomes for the 80% will not change course and the flood of wealth will continue to those at the top. 

 

  1. This is the rule of thumb exercise. To calculate how many years a given percent of growth or interest will take to double the initial amount you divide 72 by the growth rate – e.g. 72/2=36. []
  2. See “Trump’s Big Tax Cut Is Unadulterated Trickle-Down Fundamentalism” by Justin Miller 4/25/2017 at The American Prospect []
  3. Read “Epic fail of Kansas’ tax-cut plan offers a lesson for us all” by Eric Zorn in the Chicago Tribune 6/20/2017 []

The Environment, Trump, Koch Brothers & Big Money

Trump’s recent announcement that he is leaving the Paris Climate Accord and his ongoing gutting of the Environmental Protection Agency should come as no surprise given his billionaire class Cabinet and advisers.  Now it is clear that the Koch brothers have been at work. They are notorious for their Libertarianism, election buying and ownership of huge coal mining corporations. 

Today (6/5/2017) on the New Yorker magazine website Jane Mayer wrote in her article, “IN THE WITHDRAWAL FROM THE PARIS CLIMATE AGREEMENT, THE KOCH BROTHERS’ CAMPAIGN BECOMES OVERT” of the now publicly visible campaign by the Koch brothers and many others to make their decade’s long campaign to deny climate change bear new fruit in public policy. More evidence that the plutocrats are now so secure in their control over our politics and the government that they can come out of the shadows and rule directly through Trump.

BTW – Jane Mayer spent 5 years investigating big money and particularly the Koch brothers. The resulting book almost reads like a cloak and dagger mystery excepting for the very real people and money at play: DARK MONEY: The Hidden History of the Billionaires Behind the Rise of the Radical Right by Jane Mayer (Doubleday NY 2016) – reviewed in the NYTimes 1/19/2016 by Alan Ehrenhalt.

Neoliberalism Revisited

A return to a topic first posted 2/10/2017.

Neoliberalism – a term that needs never to be used

February 10, 2017

Dollars and Sense has been around since the 1970s. Always a source of well researched critiques of capitalism. I recently, after a more than 30 year hiatus, re-upped a subscription.

Dear Dollars & Sense,

Your new issue showed up the other day with the word “neoliberalism” in bold type on the cover. The continuing use of this term is not helpful. When I first saw this word a few years ago I wondered how the word “liberal” and “neoliberal” are connected? Then, I remembered the little I can recall about 19th century European political philosophy. Oh, its that liberalism that is new!

Really, outside of academic circles no one knows what this word means. Most in my circle find it off-putting, obscure and boring.

Free Market Religion

I prefer to refer to this ideology as “free market religion”. “Free market” is a widely used term as in “free market capitalism”. And “religion” gets across the fact that this is a counter-factual pile of BS.

If you don’t like my term, come up with something better. Please stop using “neoliberalism”.

A Reply from D&S

2/22/2017 – Chris Sturr commented on New Issue!.

in response to Mark Orton:

……

Mark, this is something that we struggle with, but we have over the years decided that it is more important to call our current economic system by the name that left economists have tended to use. You’re right that its origins are academic, but other mainstream publications have been using it more and more (for example, The Guardian, Salon, Jacobin, and (as far back as 1990) The American Prospect.

Dollars & Sense authors have been using (and carefully defining) the term “neoliberalism” for years now (most recently in David Kotz’s two-part piece on the crisis of neoliberalism (here, but for years before that). We do try to explain the term whenever we use it.

Sasha Breger Bush’s cover story makes a careful argument that Trump’s economic policies do not signal an end to the free-market, anti-government policies of the neoliberal era, but do signal the end to its globalist orientation. She’s proposing that if he gets his way we will be entering a different economic regime, and she gives it the name “national neoliberalism.” It’s a bold and thought-provoking analysis and we wanted to use her new term on the cover. We recognize that downsides, but we think our readers are familiar enough with the term and those who aren’t will read on to see what it means.

You suggest calling neoliberalism “free-market religion” (which reminds me of Bill Black’s term “theoclassical economics”–see for example here). I think that works when “neoliberalism” refers to free-market ideology. But “neoliberalism” also refers to an economic system that results after years of policy justified by free-market ideology. You’re right that the ideology is BS, and the economic set-up that results from years of “free-market” ideology is not really characterized by “free-markets” (as Breger Bush show’s, it’s just as much about corporate capture of government to promote ruling-class interests at the expense of everyone else). But the system itself is not BS and it deserves a non-pejorative name. The name that left economists have come up for it is “neoliberalism.”

Anyhow, you are surely right that it is offputting to some people, and that’s why we’ve struggled with whether to use the term. But we think the value of getting people familiar with the name of the economic system we’ve been living under outweighs the downsides of using the term. Your comment is a reminder that we need to do better about explaining what we (and left economists) mean by the term.

A Further Thought

This is of course an interesting addition to my knowledge of the thinking at D&S about the language they employ. But, even this discussion further supports my conviction that we need to develop a more robust accessible language to use in public discourse about one of the most important issues of our time. I am quite certain that the readership of D&S is not confused or put off by the term “neoliberalism”.

The audience of my concern is the average American who has been subjected to a sustained campaign of free-market thinking from the Republicans, most Democrats, the mass media, corporations, the academy…..not to mention Wall St. for the past 40 years. If we want to offer an alternative analysis we need direct language that does not refer to thinking and issues from 150 years ago that invites immediate suspicions that those speaking are academics and intellectuals who by definition are not connected to the day-to-day realities of American life.

Naive Talk about Healthcare from Adam Davidson in the New Yorker

Adam Davidson

Adam Davidson writing today in The New Yorker offered us “A BIPARTISAN WAY TO IMPROVE MEDICAL CARE – A straightforward change would save money and improve health. So why isn’t Congress talking about it?” This is an astonishingly naive misleading bit of chatter about healthcare.

The Global Context of the US Healthcare Debate

The solution to our healthcare fiasco is first to recognize its true nature and then to face down those who are consuming a fifth of our economic output while producing profoundly bad results. We need to take a much broader view in order to see that, compared to the rest of the developed countries, a) our current healthcare results are abysmal and b) our current healthcare costs are obscene.

Regulations vs Protections – more than just words

In a recent stream of comments about a post in GossipsOfRivertown, “More about Dumped Cement” Virginia Martin wrote to me: 

Mark Orton said “This is why we have government regulations.” Linguist George Lakoff would say the term “regulations” is ill-considered. He’d say they’re protections. This is why we have government protections.

I thanked Virginia for pointing this out and promised to try out “protections” in place of “regulations”. The word “regulation” has been used as an epithet and rhetorical sledge hammer by Republicans and the centrist Bill Clinton Democrats as part of a general campaign to discredit anything that the government might do. This is part of the decades long political strategy of the rich and corporations to puff up the delights of “free markets”.1 One might wonder what word we might use in place of “de-regulation” ? De-protect? Un-protect? Deregulation is so often projected as inherently a positive action yet that is hardly so. There is a parallel with the current efforts by the Republicans to “reform” health care laws.

The story of government regulation is complicated by the way in which the rich and corporations have come to dominate the writing of regulations.

  1. Here we are avoiding another word, “neoliberal” that most academics and political wonks use to describe the ideology of Thatcher, Reagan, and Clinton. The first time I came across this word I was totally confused. Liberal meant Roosevelt, unions, public education, etc. Then I realized that “liberal” in “neoliberal” referred to the use of that term as applied to 19th century liberals like Locke, Mill, Bentham and so on. Small government, maximum individual freedom thinkers. []

Dumping Concrete: a law of capitalism In action – a local example

Thanks to GossipsOfRivertown for the image.

The May 3rd post “Unbelievable” on our favorite local blog GossipsOfRivertown.blogspot.com caught our attention. This F.H.Stickles concrete truck dumping waste concrete next to a stream running into the Hudson River is a local demonstration of one of the central laws of capitalism.

For more pictures of this incident go here.

Every company seeks to get someone else to pay for as many of its costs of doing business as possible. The laws of capitalism require this. If all of Stickles’ competitors are similarly avoiding the costs of disposing of their waste concrete they must do likewise. Otherwise their cost of doing business would be higher. In the short term their profits will be lower. In the longer term they will be forced out of business because they will have to charge higher prices. This is so regardless of the moral values or sense of community of the owners of F.H.Stickles. This how capitalism works.

Building the New American Economy – Not

The title of this short book, only 130 pages, Building the New American Economy: smart, fair, & sustainable by Jeffrey D. Sachs with a foreword by Bernie Sanders (Columbia University Press, 2017) is unfortunately misleading. There is much here about the new economy. The misleading part is that there is very little about its construction, the building of the new economy.

Sachs covers many important issues in a thorough, efficient fashion. If you need a primer or a tune up about the economy this is a good place to start. These include: investment in our society, infrastructure, Federal budget, income inequality, healthcare, energy, military and the empire (not his phrase), and innovation. If you have been reading my postings over the last 5 or so years much of this will seem a bit deja vu.

BEHEMOTH (BEI XI MO SHOU) at TSL Hudson

This 2015 movie by Chinese director Liang Zhao is filled with great cinematography and sounds. It trades back and forth between scenes of enormous horizon gulping coal mines, under ground mines, iron making, and ends with scenes of a ghost city filled with enormous apartment blocks in a newly developed but vacant city West of Beijing. But, the most arresting part of the movie is its focus on the workers, men and women, in this relentlessly grim, polluted environment. The only narration is text read over scenes with a nude figure huddled on the ground in front of this devastation. It alludes to Dante’s Inferno.

Behemoth is a refresher course on why capitalism, whether in its American or Chinese variant, needs government regulation, strong regulation to prevent this egregious exploitation of the earth and mankind. Of course this presumes the government is in the hands of the people and nota tool of the rich and corporations. Therein lies the crisis.

The movie runs at TSL over this weekend and the two following. Here is TSL’s calendar.

Also playing at TSL is I Am Not Your Negro, the wonderful, challenging movie about James Baldwin.