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Central, these days, to the discussion on health care reform, is what George Lakoff refers to as the neoliberal position of thought. . Neither purely progressive nor purely conservative, this mode of thought shares progressive values and the ethics of care, insisting on maximizing health care coverage, and at the same time accepts a conservative version of market principles that guarantees profits to insurance companies.  An inherent tension between the two goals, the government to provide real quality health care and the profit-maximizing insurance marketplace, is thus created.

Of the Democratic presidential candidates, most favor the neoliberal position on health care reform. They believe that the market can be efficient and serve moral ends. They believe that markets can be effectively regulated to serve human interests and so, argue for technocratic changes to existing markets as a means to achieve progressive ends. They are unfazed by health care solutions that involve profit-maximizing private insurance companies.  They think they are on the move.  Republicans snidely refer to this jumble as “socialized medicine”.  But then, you know the republicans, anything, no matter how screwy, to get the fear factor in play.

The fly in the ointment is that profit-maximizing private insurance companies need to make  – profits!  Once upon a time, back in the day, it was all-good.  Profit maximizing insurance companies insured, for the most part, houses and lives.  Since not too many house burned down or blew away, they could take your premium dollars, invest them and maybe even turn a total profit on your account.  Same for life insurance because most of that insurance is term and is set to expire before you do.  Sweet!  But health insurance is another story.  Yuuk!  Everybody gets sick and weak and older.  Lots of benefits to be paid!  No profit in that!  And then they figured it out.  By excluding the tired, poor and sick and by denying claims to those who had purchased coverage, they could make a profit.  Health insurance became an industry that made money by not delivering the services it was paid to deliver. Yes!  And nothing is going to change no matter how much technocracy is employed.  Profit-maximizing industries are not going to stop doing what they do.  And with health care projected to become a 4 trillion dollar industry by 2012, wild horse won’t drag them away from that feeding frenzy. 
  So, good luck, Hillary, John and Barak in trying to regulate this baby into something that “serves moral ends”.

Lakoff cautions against the dangerous trap of “Surrender in Advance” thinking and states:

Those who pragmatically focus on appeasing what they assume will be unavoidable political opposition to their proposals also run the risk of moral surrender.  For instance, assuming strong, possibly insurmountable conservative resistance to government based health care solutions, they will embrace profit maximizing private insurance solutions because they believe that 1) political opposition can be muted and 2) the “free” market, properly regulated, can serve moral purposes. Proponents of these neoliberal solutions often overlook the fact that the very source of the health care crisis is the structure of the insurance: the less care they authorize, the more profit they make, and profits come first and are maximized.

Lakoff argues that the sanctioning of technocratic solutions for health care causes a failure of articulation of more progressive values.  Those values, health care for all, empathy and responsibility, protection and empowerment, go unstated. We are inundated with market management mechanisms that are next to impossible figure out.  We are so overwhelmed by complicated program principles that we are not even able to combat the Republican Propaganda Machine as it drearily drones out its mantra of “socialized medicine”.  Americans hear only the conservative moral view, and consequently, move toward that viewpoint. I am thinking of Pogo right now.

My dictum, in thinking of health care reform, is “all of the people, all of the time”.  A simple standard of measurement can be: “Does this improve the health care security of all of our fellow citizens in concrete ways?”  Progressive values for health care reform must be kept in the forefront of discussion to avoid being lost in the murky depths of technocratic improvisation.  I haven’t been hearing much of the progressive platform lately.  What I am hearing is that Americans will be able  (or compelled) to purchase “coverage”  (which means insurance) to the extent of their ability to pay, or perhaps they might be able to lobby (beg) for a subsidy or something (following extensive means testing of course), as represented in the ongoing saga of the SCHIP, but that they will have a choice over public or private insurance mechanisms.  Whatever the case, they will have some “coverage” depending upon their ability to pay. It seems that the more things change, the more they stay the same.  Hillary, John, Barak, are you listening?