Thursday, October 1, 2009

The bizarre meaning of "choice" in American political rhetoric

Americans love the idea of choice.  It seems to embody the freedom that we value.  We elect, or choose our presidents, and when we go to the store we see the variety of toothpaste or dish detergents as a emblematic of our deeper political freedoms.  Politicians discovered this long ago, and it is hard to find a domestic issue that some do not attempt to frame in terms of choice on once side and government dictates, or lack of choice, on the other.  Often as not those who succeed in framing a political position in terms of choice wins the day, especially when that position fits well with the right-wing agenda.  But even when the left has successfully focused on choice, it has been relatively successful.  Had it not been, the abortion debate unending as it may be would long ago have been won by anti-abortion activists because so many people, including this reader can't get away from the awkwardness of what abortion means, the ending of a life.

Why the right is more successful in shaping debates in terms where they are the supporters of choice is something of a mystery, though I think one reason is that with the exception of the abortion debate, politicians on the left seem not to think of it as theirs, while the right treats it as their birthright  In so doing they have allowed, if not implicitly abetted a narrow consumerist understanding of choice that seems to focus more on enabling corporations than to enable Americans as individuals to make choices as they see fit.  This is perhaps best exemplified by the way cable companies have succeeded in winning approval for a most limited system of cable options, in which the vast majority of Americans end up paying for with a multitude of cable channels they rarely watch just so they can have access to the handful they do.   But it is in the healthcare debate that the concern about choice is talked about has its deepest and most perverse affects.

. During the campaign for health care reform in the 1990s the battle cry among opponents was the need to be able to choose one's physician, and on that point they have won for the most part, except for those of us who cannot necessarily access the doctor we would like because of our health insurance plan.  Yet, if being able to choose one's physician makes sense, and fits in well with the American understanding of freedom to choose.  After all we all want to have a doctor we feel is competent and seems to understand us and is preferably reasonably easy to access, and when we need a specialist that we can if needs be in the hands of the best qualified to deal with our problems.  Yet, as the healthcare debate has unfolded this year, we have not heard much about choosing our doctors, the issue of choice has been focused on the choice of health insurance provider, and whether the planned reforms will somehow curtail the existing choice, or leave the existing choice limited to private health insurers, which according to reform advocates will prevent the real reform by keeping the huge bureaucracies that determine eligibility intact.

There are a number of problems with this.  First, legitimate as anger at health insurers is, they are hardly the only ones at fault for our current mess. Indeed for a very different perspective from the one that has been at the center of the mainstream media narrative, I heartily urge people to listen to the two "This American Life" programs about America's healthcare system, sector is, especially chapter 3 of the second, where healthcare economist Uwe Reinhardt makes the case that the crux of our current crisis is the weakness of insurance company's vis-a-vis hospitals, not insurance company's near monopoly hold in many markets. Beyond the hospitals, the doctors, pharmaceutical companies, and even us and our demand for top care whenever and however much it costs. But at the heart of all this is fact that health care simply does not fit the normal assumptions of a economics, and focusing on choice, beyond the personal decisions we make to see a doctor we trust when we need to, will not solve the problem. 

Unfortunately, the last thirty years have made it very difficult to talk about that, thanks to the Milton Friedman and triumph of the Chicago school because they got licking inflation right and because the choice they proclaimed the solution seemed diametrically opposed to the failure of communism.   The notion that markets do not solve everything is so far out of the mainstream for most people, who are not already far to the left. Meanwhile, under the spell of Friedman's mentor F. A. Hayek the right has become so allergic to the notion that state involvement even when the importance of markets is a mantra that they are unable to process the contrary to Hayek's predictions the Western European social welfare state has not descended into Communism, and has remained thriving innovative economies.

1 comment:

Sarah said...

In class, you responded with something very similar to this when I said something about feminism being about choices. This did help me re-frame my view of thinking, and I decided feminism should ultimately be about rights, which includes the right to make certain choices.