Monday, September 10, 2007

Worthiness in Capitalism, Free Market Forces, and Government and Individual Responsibility

I began this series with a post that examined the issues about universal healthcare and worthiness, which led to a heated discussion that continues on another forum. In this blog post and my next, I will represent a debate I had with someone arguing for a “free market” approach to healthcare in which human value is measured by one’s wealth and government monies ought not to be used to ensure care for everyone.

Following I present his initial points and give my replies.

Point 1) He wrote: “Our value to our society is measured by our wage.” In other words, the value of a human being—the essential/basic/inherent worth of a person—according to the American Capitalist model, is measured by how much money one makes/has.

[My reply] Yes, this is a shameful reality of our society. The more wealth you have, the more “worthy” you are considered and the more “valuable” a person you are. That’s crap! The wealth you have, the more you can buy … PERIOD! It has nothing to do with your inherent worthiness or human value. In fact, human worthiness and value are just concepts; there are no such things. Even the concept of “deservingness” is made up.

Yes, there is such a thing as “buying power,” but the question is whether it should apply to the delivery of essential healthcare. One’s opinion on this matter, I suggest, depends on one’s wealth. People who can afford excellent insurance and cover out-of-pocket costs would say they deserve (are worthy of) better healthcare than a homeless person. That’s because our Capitalistic system promotes such an irrational belief. The reality is that they can afford better care only because that’s the way our economic system operates. But if they have a financial catastrophe, they will be reduced to the realm of the unworthy … the undeserving … and, I bet, will suddenly change their perspective on who should have access to good care.

That means everyone, no matter how much money and possessions one has, is worthy of the best possible healthcare.

Point 2) He wrote: “My friend, you have a serious psychological problem with the ordinary general sloppiness of human existence. Saint that you are, you are never going to make it tidy. People are just messy.”

[My reply] While I never claimed to be a saint, I do try to think and act wisely, although I’m not always successful. Being human, I realize that I, like everyone else, am a fallible creature with all sorts of weakness I must recognize and deal with in order to develop my potential. So, yes, humanity is “sloppy,” people tend to think irrationally and overreact emotionally, seek pleasure and escape from life’s pains/frustrations in self-destructive ways, be short-sighted, be greedy and self-centered, engage in wishful thinking, let their egos get in the way, be self-deceptive, and so on. I’ve spent the past 40 years studying human nature and almost two decades treating psychological disturbance, so I know much on the topic. Anyway, you’re right: Humanity is never going to be “tidy” (that would take mass enlightenment and major social evolution).

Point 3) He wrote that: "[I appear to condemn] the American Capitalist model as some villain passing judgment on us…It is, after all merely a modified economic extension of natural selection, a process that does a fine job improving the species.”

[My reply] Well, I’ve never said that any model can be villainous our pass judgment; only people can act in ways defined as “villainous” and pass judgment on others. But the American Capitalist model does encompass rules and processes that enable people to claim certain groups to be more worthy of good healthcare than other groups based solely on one’s material wealth. I do have a problem with that.

As far as natural selection goes, I take issue with your claim that our modified economic extension of natural selection has been improving our species. After all, our species is as messed up as ever and, with all the negatives in the world today (from global warming to religious warfare to political corruption to the concentration of wealth), we are doing a poor job in converting them to positives.

What it has help improve, however, is the quality of life for many people, which is good, even though the degree of improvement is increasingly lopsided in favor of the wealthy and against the middle class, but that’s another issue.

Point 4) He wrote: “I'm not interested in living in a mud hut so I can afford to pay my tax bill to support universal health care.”

[My reply] Neither am I. Although I don’t have the means to do the actual research and number crunching, it seems to me that reducing waste in our healthcare system by delivering high-value care consistently, by focusing on prevention and effective self-maintenance, and by minimizing unnecessary administrative overhead, as well as by reducing waste and (legal and illegal) corruption in government and reallocating our national resources, then we could pay for universal healthcare without increasing taxes.

BTW, I do think a system such as QALY should be instituted as a means of controlling costs, and that we should focus more on developing more effective and efficient ways to

He then wrote:

It appears you support a socialist economy in general, since "the American Capitalist model" also passes judgement regarding housing, education, clothing, food and drink, etc. In a Marxist "Shangrila", what motive would the species have for improving their condition. Without struggle, there is no advance. What motive for anyone to excel at anything, when the wealth they earn is confiscated "for the public good" and those without ambition, industry, or moral conscience, are considered deserving of their share.

The beauty of a free market system is that if you have no worth to society, you are immediately made aware of it by your poverty, and thereby motivated to develop some worth. I find nothing shameful about it. The poorest among us are living longer, healthier, wealthier lives than we have in any other period in human history. While there are those few that are unable, through no fault of their own, personal charity is the moral solution. The problem being the gov't has usurped this very human role with their handouts and ridiculous taxes. They have stolen our humanity, and used it to buy votes.

If we are going to use a totalitarian method, let's cap the earnings of everyone in the medical profession at about twice the median income. That would be just as fair as socializing health care (and may be one of the end results).

I applaud your altruism. I am afraid, however, that your lofty goals would require as much bureaucracy as we have now, possibly more. The only way to bring waste, inefficiency, fraud, greed etc. under control, is with free market forces. The corruption in an unconstitutional gov't is the biggest hindrance we have in reaping the rewards of a true free market. They are no more likely to surrender their power to socialism.

…I am a person of moral conscience, and have no desire to burden my countrymen with my problems.

The EARNING of wealth is the measure of our worth to society. If you have value to society, someone will pay you for it (without the gov't putting a gun to their head).

And I responded:

According to Baumal, Litan and Schramm’s new book, “Good Capitalism, Bad Capitalism,” the Capitalistic model, in general terms, is an economy in which a substantial proportion of its means of production (farms, factories, etc.) are in private hands rather than owned and operated by the govt. They argue that the best kind of Capitalism fosters “smart economic growth” through the right combination of small company entrepreneurial (technological) innovation and big- firm market capabilities, without restrictions on free trade, brings about a higher standard of living for just about everyone in that country. I’m certainly not at all opposed to this. On the other hand, there is “state-guided” Capitalism, in which government tries to guide the market by supporting particular industries it expects to be winners, and “oligarchic” Capitalism, in which most power and wealth are held by a small group of people. There are pros and cons to each form, but the first two are the best way for Capitalism to serve the greater good, and American Capitalism has that potential. But what’s needed to sustain it, they contend, is three preconditions: (1) Adequate incentives for productive entrepreneurship, (2) disincentives for unproductive entrepreneurship, and (3) continued rivalry among and innovation by large firms. All this require government regulation, but that’s not socialism.

What seems to be happening is that American Capitalism is becoming oligarchic by virtue of not having truly free democratic markets.

Although Baumal, et al. say nothing about “free markets,” Frances Moore Lappe, in her book, “Democracy’s Edge,” argues that there is no free market. She writes: “In complex societies like ours, markets that work to create wealth for all are the product of democratic governments. The market depends on truly representative government—the obvious point that is lost on those who see the market and government in eternal battle. Also …we’ve been taught that there’s only one way [or organize a market]: Make business decisions using a single criterion—maximum return to shareholders. So every decision returns wealth to people who already have it. … [No wonder] the richest 1 percent of American households now control more wealth than the bottom 95 percent combined. … We’ve been made to believe that this game of concentration…’is fundamental to the success of capitalism because it weeds out the weak and allows the fittest to survive … [but what] it really does benefit is a select few who know how to play this new game while it threatens almost everyone else.’” (pgs 63-64).

Now I don’t claim to be an economist, I don’t promote a “totalitarian method,” and I never thought of myself as a socialist; but it seems to me that our government has an important role to play if our form of capitalism is to benefit the masses …and it is failing miserably. I’d rather see a government bureaucracy assure healthcare for all, than assuring the continued concentration of wealth.

If our government begins to spend money wisely and without corruption; if it implements policies to control waste, inefficiency, fraud, greed etc.; and if people were charged for healthcare based on their ability to pay … I believe we could support universal healthcare without the tax increases you fear.

In many ways, we actually seem to be in agreement.

My problem with defining human worth in monetary terms is a philosophical/psychological issue, as well as a moral one. If poor people have no worth to society, as you say, then do they have any worth … or are they just worthless nothings who better get motivated to become worthy by making good money, or else die of untreated illness because their poverty make them undeserving of the care received by people with financial means? Lack of wealth ought not make someone undeserving of the essentials of life (food, water, shelter, education, healthcare, opportunity, etc.).

Click here for part 4 in this series.


Anonymous said...

Consider this (a variation of an argument I use a lot with people who are proponents of the "wealth trumps all" approach:

An ICU nurse may be reasonably well-paid as nurses go, but certainly they are not wealthy nor will become wealthy on their nurses' pay. Yet that ICU nurse may be called upon to save and extend the life of a very wealthy person, who is by the "wealthy" definition worth a lot more than that ICU nurse. If that wealthy and very valuable person would otherwise die without the intervention of the ICU nurse, what value does this place on the nurses' worth?

It is, of course, an idiotic comparison. Every person has an inherent worth that is not tied to wealth or poverty, and any self-respecting civilization would consider that as a sacrosanct feature of the worth of its society and render aid appropriately.

Another form of this argument: what worth do we place on the unborn child of a welfare mother? According to (presumably) capitalist pro-lifers, that worth is infinite. But then what about the second after the child pops out? Is it a child in poverty and therefore, by definition, worthless?

Brian Robinson

steve7 said...

Capitalism in conjunction with government guidance and assistance has worked for a long time. Look at the home mortgage and student loan markets. Healthcare may benefit from this type of governent support in a captialistic system. Look at and read the suggestion for a Healthcare Access Card. It will be hard to get the type of healthcare reform being pushed by unity08 without engaging the stakeholders-insurerers, doctors, hospitals, and employers. We need ideas which will move us in the right direction. Those ideas need to take into account that the stakeholders are doing well in the current system. We can't ignore that fact. Our political system is not suited to revolution so universal healthcare, which exists already for those who are covered, needs a more unique approach. The forum on is suited to generate the ideas and recognize that the political and philosophical stances need to move more to the middle. That web site has the contacts to come up with solutions that could have traction.