Note:
The full title of this article is
“Crafting a Health Insurance Law
Acceptable to Libertarians and Socialists,
and Reducing Health
Insurance Rates Through Voluntary Cooperatives and Syndicalism,
by Expanding Choice and Competition, While Cutting Taxes, Subsidies, and
Barriers”.
Earlier
this month, 22nd District
Michigan State House of Representatives candidate Matt Kuehnel
received the nomination of the Socialist Party of Michigan. This is a
phenomenal feat, especially considering that he has already received
the nomination of the Libertarian
Party of
Michigan.
Dual
nominee Kuehnel, an HVAC service technician and carpenter residing in
Warren, is a member of the Libertarian Socialist Caucus (L.S.C.) of
the Libertarian Party (L.P.). That caucus, one of at least 40 in the
party, was originally named the Black Flag Caucus, when it founded on
August 25th,
2017, by Mike Shipley of Arizona.
For
the past 90 or 100 years, and especially between approximately 1980
and 2006, the split between American right-libertarians and the more
left-leaning anarchism and radicalism of Europe has been noticeable.
Many people, Libertarians and socialists included, have their doubts
as to whether and how an alliance between the two groups could work.
That's because each group has its own reasons for suspecting the
other of being predisposed to authoritarianism.
On
the matter of legislative policy concerning health insurance, most
libertarians are adverse to any calls for “universal health care”
or “Medicare for All”. Of course, “universal health care”
does not necessarily always mean “Medicare for All”, so we
should at least acknowledge that “universal health care” does
sound appealing, even if we might not agree about which specific
policies it would involve.
That
considered, it's entirely true that the vast majority of people want
health care, and also want health insurance to help them pay for it.
If libertarians want a voluntary society, then shouldn't they
logically approve of people voluntarily pooling their purchasing
power together into cooperatives? Moreover, following that line of
logic, shouldn't those cooperatives be free to cooperate with each
other, in order to maximally benefit from the reduced cost effect
of their economy of scale?
What
I am advocating is essentially “group insurance pooling” on
steroids. Senator Rand Paul of Kentucky promoted group insurance
pooling in 2017, as part of his four-point health insurance reform
plan. While his plan focuses on allowing people to join into
voluntary cooperatives on the basis of common profession, I would
like to see that idea extended so as to include any voluntary
association.
The
practice of urging cooperation between cooperatives on a voluntary
basis may be referred to as either cooperative federalism, or
syndicalism. When done entirely on a stateless, voluntary,
horizontal, autonomous basis, this cooperation among cooperatives is
called anarcho-syndicalism; whereas, when done as a matter of public
policy, it is state syndicalism or national
syndicalism. Groups of cooperatives are referred to as secondary
cooperatives, cooperative unions, syndicates, and cooperative
wholesale societies.
Both
Kuehnel and the current Libertarian Socialist Caucus platform accept
Medicare for All as one of several “pragmatic” reforms to
consider. The Platform of the Libertarian Socialist Caucus of the
Libertarian Party was adopted on March 21st, 2018. Section
1.2 of the L.S.C. platform, on “Incremental Reform”, reads thus:
“We
advocate the abolition of harmful laws, regulation, agencies, and
positions wherever possible. However, we do recognize electoral
politics as a valid form of tactical harm reduction, provided that
incremental policy reforms do not further cement the oppressive power
of the state. Such incremental policy reforms may include Universal
Basic Income, some version of “Medicare for All”, a Land Value
Tax, and others. These are not libertarian solutions but socialist
ones, which are arguably preferable to the current […]
non-libertarian, capitalist model. The caucus does not endorse these
policies as libertarian solutions, but will not explicitly exclude
individuals supporting such policies from the caucus.”
While
right-libertarians such as at-large Libertarian National Committee
representative Joshua Smith may argue that they pursue the goal of
uniting all “small-L libertarians”, the so-called “Bottom
Unity” which the L.S.C. is pursuing, accomplishes just that. But by
any reasoning or measure, it does that much better than an alliance
solely between free-marketeers and libertarian-conservatives, which
the “libertarian Southern Strategy” paleolibertarians and the
so-called Fusionists are proposing.
What
we are discussing is whether the Libertarian Party should be about
that (that is, right-unity), or whether it should be about Bottom
Unity. While right-unity focuses on preserving capitalism more or
less at any cost, whether it attempts to operate with or without
the state helping it, Bottom Unity opposes authoritarianism and
absolutism and totalitarianism of all varieties, regardless of which
economic system it enacts, or whose class interests it serves.
Kuehnel's
candidacy, and the Libertarian Socialist Caucus's advocacy and
outreach efforts, are certainly pragmatic, as is their stance on
being open to Medicare for All without wholeheartedly endorsing it.
In my opinion, the Libertarian Party needs more of this: suggestion of possible, voluntary solutions - and many of them - to prove to voters that we're full of ideas, but also that we don't want to impose any of those solutions on people (at least not before they can be convinced that a measure is in their best interest).
The
Libertarian-Progressive Alliance, which South Carolina Senator
Lindsay Graham once called an “unholy alliance”, consisted of the
likes of Ron Paul, Ralph Nader, Dennis Kucinich, Mike Gravel, Bernie
Sanders. Towards the end of the second Bush administration, these
politicians banded together in opposition to illegal wars,
irresponsible budgeting, unsound monetary policy, usurious banking
practices, and continuing the failed war on drugs, among other
issues.
Although
Nader, Kucinich, and Gravel became much less involved in politics in
the several years following the 2008 election, the legacy of the
alliance continued on in the halls of Congress with Ron Paul and
Bernie Sanders, as well as Cynthia McKinney of Georgia. Another
figure who was around at that time was Chuck Baldwin, the
Constitution Party's 2008 nominee for president.
The
spirit of the alliance carried on with the 2012 and 2016 debates
which the Free and Equal Coalition held, inviting third-party
candidates for president. In 2012, Free and Equal founder Christina
Tobin co-moderated the debate with Larry King, and participants
included Libertarian nominee Gary Johnson and Green nominee Jill
Stein, as well as Constitution Party nominee Virgil Goode, and
Justice Party nominee Rocky Anderson. In 2016, Tobin moderated along
with actor-turned-activist Ed Asner, and Johnson and Stein, again
nominated by their parties, declined to participate, resulting in a
debate between Gloria LaRiva of the Party for Socialism and
Liberation (P.S.L.), Constitution Party nominee Darrell Castle, and
independent Rocky de la Fuente.
I
hope that the first anniversary of the Libertarian Socialist Caucus
of the Libertarian Party – roughly coinciding with the announcement
of the L.S.C. endorsing or aligning with seven additional
candidates nationwide, as well as Matt Kuehnel's dual nomination
and first television appearance (on RT's “Watching the Hawks”)
will hopefully prove to be a key event in the history of the revival
of the Libertarian-Progressive Alliance.
I
also hope to see even more candidates reach out to multiple parties –
Green, Constitution, Justice, P.S.L., etc. - in order to
become dual or even multiple nominees. While living in Portland in
2014, I noticed that a Libertarian in a local race had only one
challenger, a candidate who was endorsed by both the local Democratic
and Republican parties. I thought, “If they can do it, why can't
we?”. Unfortunately, it is illegal for petitioners to collect
ballot access signatures for multiple candidates nominated by
separate parties.
But
on the other hand, there is no reason why multiple parties cannot
work together when their cooperation is legal (like when
they're cooperating in non-political respects, such as through
speech, advocacy, and activism), and when multiple parties are not
competing for votes in the same races and districts. Practically, it
would work like this: if you're a Green, and there's no Green running
in one of the races you can vote in, then if a Libertarian or a
Socialist (etc.) is running, then feel free to vote for
any one of them that you like.
Each
of those parties agreeing to vote for each other wherever competition
isn't occurring, and also agreeing to pursue societal change outside
of politics (in addition to their political advocacy), can help
to build and revive the Libertarian-Progressive Alliance and promote
Bottom Unity. Not only that; they will also, very likely, inspire
many anarchists and politically disinterested and disaffected people
to vote against authoritarianism, and thus help spread awareness of
the Alliance of the Libertarian Left and the ideas of synthesis
anarchism and “Anarchy Without Adjectives”.
Additionally,
I believe that these efforts will help lead the Libertarian Party
(along with its platform) to the logical conclusion of libertarianism
and a voluntary society; that in a stateless society, people may
choose to live however they please; including as a member of any
voluntary association, cooperative, or intentional community, as long
as it doesn't conscript people into joining it and into paying and/or
working for their services.
Ideally,
these organizations would not be affiliated with any legal monopoly
on violence (i.e., a state), and they would be free to
cooperate with each other, or else refrain from associating with each
other if they do not choose to cooperate.
And
that brings me back to legislative policy on health insurance.
Although
Medicare for All is far from my first choice in regards to national
policy on health insurance, I cannot say that I don't see the point
which the L.S.C. and Kuehnel are making.
After
all, pooling everyone together would maximize the effects of
the power to leverage prices down, thus reducing the costs of
bargaining and the price of the policy. Moreover, there's no
reason why Medicare for All, nor even a purchase mandate, would
conflict with the idea that if public services serve the common good,
then they must serve everybody. Given that some high-income people
are being put on Medicaid while others who need it get kicked off or
struggle to get insured at all - and given that the insurance that
citizens buy should be good enough for our politicians as well – Medicare for All certainly looks like it could be pitched as a
practical, pragmatic solution.
I
would hope that if such a measure were implemented, it would only be
temporarily, and I would hope that it would be done in a manner which
balances both the needs of voluntary participation and the interest
of the states to self-direct on health policy to the extent to which
they have negotiated with the national government that they retain
such authority.
As
someone who wants free, open, and fair markets, one issue that I have
with calls for “universal health care” is that the response to
that is usually to implement a single-payer system. In a single-payer
system, the government would be the sole entity allowed to purchase
health insurance (which it would do on behalf of all citizens). We
might describe this state of affairs as giving the government a
“monopoly on purchasing”, but the proper term is monopsony.
While
a “monopoly” describes a situation in which a single firm sells
some good or service, a “monopsony” describes a situation in
which a single firm buys, purchases, or pays for a
good or service. Therefore, the single-payer system which “Medicare
for All” would create, would be a “monopoly” on the purchase of
health insurance.
It
sounds good, because it includes everyone, pools purchasing power,
and potentially even abolishes for-profit health insurance. However,
no individual person, nor entrepreneurial nor cooperative firm, nor
voluntary association, nor “lower-level” state or local
government, would then be free to purchase health insurance; only the
federal, national, or central government would. Such a measure might
violate antitrust and anti-monopoly laws, and if it doesn't, then
maybe it should.
Additionally,
such a measure might only be possible through requiring all citizens
to purchase health insurance, which would almost certainly lead to
higher costs. This, for the simple reason that if you can force
someone to buy something, then you can charge them whatever you
please. That goes even if they're “forced to choose” from among a
small set of insurers, because it's illegal not to buy from one
of them, so collusion becomes
likely. Additionally, subsidies for insurers render the health
insurance market rigged and unfree, even if those subsidies are
intended to lower policy rates.
I
do not buy into what I consider the false dichotomy between “free
markets” vs. “free
stuff”. I believe that there is a way to achieve “free
markets” (free competition and free cooperation) and low-cost
health insurance at the same time. And that is to legalize untaxed
not-for-profit insurance, and to allow cooperatives leverage their
purchasing power against the selling power of large companies, so
that costs can decrease. If similar measures are done in industries aside from health insurance, the likely result would be increased cooperative ownership of property, but without abolishing markets (or, at least, not before most of us are ready).
I
also believe that private health insurance might even continue to
exist; and maybe even without hindering the freedom of individuals,
cooperatives, charities, and public options to exist and compete as
well. I believe that the key is to tax the profits of any subsidized
insurers and medical technology sellers, but to tax solely the
unimproved land value of non-subsidized
insurers.
While
I do not believe that Senator Rand Paul is perfect or always right,
he is a doctor and he does understand a few things about health care
and insurance. Paul believes that it's possible to make health
insurance available for $1 per day. He supports refundable tax
credits, expanded access to health savings accounts, and keeping
people with pre-existing conditions on Obamacare subsidies
temporarily for 18 months.
Senator
Paul has even admitted that capitalist health care is flawed, saying
“the reason capitalism doesn't work in health care is the consumer
is disconnected from the market”. explained that this means
capitalism hinders the ability of consumers
to demand low prices. I even heard a rumor that Paul's home state of
Kentucky has established a $26 monthly price floor on health
insurance policies. If such a statute truly exists, then it should be
repealed, or else efforts to legalize low-cost health insurance in
that state are almost certainly futile without significant reform
elsewhere in the law.
One
of the most important points in Paul's four-point health insurance
reform plan is to allow “group insurance pooling”, and the
creation of what he terms “buying pools”. That is, he wants to
legalize the purchasing of health insurance by cooperatives,
organized on the basis of a common profession. Potentially, such
cooperatives could be organized on any other basis
aside from profession as well, but I believe that the idea which
should drive Paul's idea forward is the practicality of insuring
people based on mutual safety and health risks to which they are
predisposed to being exposed (depending on their profession,
membership in any type of club, school attendance, etc.).
Through
uniting large numbers of people, voluntary cooperatives can leverage
their purchasing power against the selling power of large insurance
sellers, in the same way that pooling people together in a “public
option” can. The only difference is that a voluntary cooperative
plan would do that voluntarily. Given these facts, it would be difficult to argue that an implementation of "Medicare for All" could prove to be the most economically efficient solution to the problem of high health insurance costs (that is, as long as it includes significant deference to separation of powers, decentralization, and individual rights).
Through sufficient consumer
information and voter education, I believe that it would be possible
to convince at least 60% of the American population, if not
significantly more, that universal pooling would be financially
advantageous for all insurance customers. But I also doubt
that most of those people would object if the cooperatives plan were
implemented on a voluntary and local basis rather than a mandatory
and centralized basis.
There
are several health care and insurance proposals which I believe would
do wonders to both alleviate poverty and restore individual choice to
the health insurance system. Among them: 1) offering incentives for
providers of health care who operate on charity bases; 2) eliminating
barriers to untaxed non-profit and low-cost health insurance; 3)
eliminating barriers to untaxed non-employer-provided health
insurance policies; and 4) eliminating unnecessary sales taxes on
medical devices, as well as eliminating import fees on foreign
medicine. These proposals, along with the “state lines plan” -
which Trump praised in the debates, but failed to adequately explain
- would do wonders to achieve a free interstate market in health
insurance. I hope that it will be one which is open to participation
by private, public, cooperative, non-profit, and individual actors
alike.
Despite
the many flaws of Trump, Rand Paul, and Ted Cruz, I believe that they
are more or less correct in their agreement that the solution to
health insurance will involve “getting rid of the lines around the
states”. The “state lines plan” will help establish an
interstate market for health insurance, enticing companies to expand
their geographic market reaches outside the boundaries of the states
in which they are headquartered, and allowing companies to compete to
provide better and cheaper policies. Once competition is introduced,
fewer places will be stuck having to “choose” from among only one
insurance company, which due to its monopoly can charge whatever it
wants. If done right, the “state lines plan” will result in more
choices and lower prices.
What
the plan specifically involves is convincing certain states to
legalize
health insurance policies issued from other states, as long as those
policies satisfy the laws of the state in question. This probably
sounds familiar. Although Obamacare's authors and architects stated
that the A.C.A.
would accomplish exactly that, they unfortunately lost sight of that
original goal very early on (because they decided that a monolithic
federal law was the only way to ensure the uniformity of insurance
policies).
Unfortunately
for our representatives in Congress, the “state lines plan” is
not
something that cannot be done by the federal government (at least not
constitutionally). Only five states currently allow their citizens to
purchase plans from out-of-state, so the most that a person holding a
federal office can to is to urge governors and legislatures of the
other 45 states to support the “state lines plan”, by enacting
statutes legalizing purchase of out-of-state policies which comply
with state health insurance laws.
Senator
Ted Cruz notes that another way to help this “interstate health
insurance market” plan along, is to eliminate the federal tax
credit for employer provided health insurance. That tax credit makes
it comparatively more expensive for an employed person to find and
afford insurance when he changes jobs or moves to a new state. If you
think about it, it's almost as if the employer tax credit serves as a
financial incentive to fire people before they get coverage through
their employer, or to reduce their hours to part-time, such that
they're no longer required to insure those employees. Amending
H.I.P.A.A., so as to eliminate that federal employer tax credit, will
remove the disincentive for employees to purchase any policy other
than one which follows them from job to job and from state to state.
My hope is that someday such a policy will be legal and offered by a
non-state actor.
Three
things that I feel are making medicine and medical technology more
expensive than they should be, are: 1) taxes on the sale of, and
profits from, medical devices; 2) non-tariff importation barriers on
foreign medicines that are perfectly legal in (and approved by) other
developed countries, and 3) unnecessarily long duration of patents on
pharmaceuticals and medical devices, which hinder the ability of
technology to adapt quickly. I hope that Libertarians begin to see intellectual property protections as not just contracts but laws; enforced by the state, the Patent Office funded through coercive extortion from the taxpayers' earned income from productivity.
I praise Senator Sanders and Senator
Paul for their opposition to importation barriers which affect health products. Senator
Paul, for example, supported a law that would legalize the
importation of foreign medications, as long as they come from
industrialized developed countries that have approved those
medications, and 90 days have passed since approval. Senator Cory
Booker notably opposed a similar measure regarding importations of
cheap drugs from Canada, on the grounds that he felt that the bill in
question did not do enough to establish sufficient consumer
protections.
I
believe that these three measures will cause the price of health
goods to plummet, leading to improved affordability for the most
vulnerable people in our society. So will eliminating subsidies for
Big Pharma, the employer tax credit, and the individual purchase
mandate. But in the spirit of promoting free trade among nations, we must also achieve free trade among states in regards to health insurance policies. That is why I believe it will also help reduce rates to establish an interstate health insurance market; through the “state lines plan”.
Allowing medical technological innovation and competitive pricing to run
their courses will help the cheapening process along, without either diminishing quality, revoking the rewards of "innovation" prematurely, or hindering people's freedoms to find and produce alternatives which adopt those "innovative" scientific developments (which are not inventions, but merely applications of known scientific laws, which are nobody's property).
In
the best-case scenario, and if all taken together, these measures could potentially cause health
goods to become so cheap that the entire
health insurance industry becomes obsolete, not just the for-profit
model.
If it doesn't, then perhaps a “radical” solution might
involve encouraging provider networks to ask doctors and nurses if
they would like to formally, and
voluntarily, agree to
be held liable to the part of the Hippocratic Oath which requires
them to treat people regardless of their ability to pay. This could
be accomplished through signing a contract which obligates the
network to penalize or dismiss them for refusing to treat those who
are incapable of paying, and it could be enforced by a non-state-affiliated dispute resolution organization just as easily as it could be enforced by the state.
Contrary
to what “market fundamentalists” on the right will tell you, free
markets
are supposed
to
give us “free stuff”. Some libertarians love to say
“T.A.N.S.T.A.A.F.L.” (“There
Ain't No Such Thing as a Free Lunch”), which is basically code for
“there's no such thing as a free anything”.
However, it doesn't make sense as a motto of a group that is
supposed to be telling us how
great freedom is; that
it can and does exist, that we're born free, that nature is free, and
that markets should be free. Yet not a peep about freedom is coming
from these people anymore, because they're worried it means stealing
in order to get free stuff. But government subsidization isn't the
only way to make things inexpensive; as a matter of fact, sometimes
subsidization only protects
the producer from having to rely on improving productivity in order
to acquire wealth, instead of getting by on taxpayer money that was
arguably extorted (at least from a libertarian perspective).
Achieving
“universal coverage” or “free health care” doesn't
necessarily have to mean stealing from people, nor taxing people
more, nor even taxing the rich more (although certainly we should be
taxing those who take advantage of the public to make money, whether
they're rich or not). Achieving lower-cost health insurance and care
through free-market measures should involve: 1) advocating for free
markets, free competition, and free cooperation to provide lower
costs and lower prices; 2) establishing open markets, free trade, and
free interstate commerce, with free movement of goods (in this case,
of health insurance policies, medicine, and medical technology); and
3) simpler taxation, and letting taxpayers keep more of their own
money.
When
discussing health insurance, keep in mind that it's impossible to
insure against something that has already happened; because sick
people don't need health insurance, they need health care.
Getting bogged down discussing health insurance legislation can do a
lot to distract us from talking about how much of our suffering could
be relieved by some of the amazing technological and scientific
breakthroughs that are happening right now in medicine,
pharmaceuticals, and medical devices. These include surgery performed
with robotic assistance, adult stem cell treatment, gene therapy and
telomere therapy, and 3-D printed organs.
It
is regrettable that, considering all of these advances, many people
still call for the legalization of euthanasia (“the right to die”).
Nevertheless, I and the L.S.C. support voluntary euthanasia. But we
also support the “right to try” unapproved medications which
might save lives, even if their potential hazardous effects are yet
unknown. But on the other hand, reducing the costs of bargaining for
lower health insurance rates, and eliminating unnecessary taxes on
health providers, might just help make health care and insurance so
cheap, that the development and dispersal of medical technology
accelerate to the point where more terminally ill people demand
access to experimental medications and devices than the number of
terminally ill people demanding doctor-assisted suicide.
Maybe then, we can relieve the paradoxical burden of having to work while injured in order to stay healthy, and we can direct our attention at taking care of ourselves - and towards living longer, healthier, better lives - instead of being focused on competing against our friends and family for the means of survival, in (what is supposed to be) a voluntary and civilized society.
Something else that will help us focus on avoiding and preventing unnecessary stresses on our bodies, is to promote the mass production, and mass ownership, of robotic assistants in the home and workplace, specialized for the task of assisting in the movement of heavy objects. Additionally, it will help to promote their affordability and availability. Additionally, to promote the affordability and availability of 3-D printers; whether it be for use in home manufacturing, or C.A.D. (computer-aided drafting) and C.N.C. (Computer Numerical Control) router cutting and related fields, or medicine, etc.
Finally, another thing that will help us avoid getting sick in the first place, is to get poisons out of the consumer products we buy, and toxins out of the air we breathe and the food we eat. But as libertarians, we should not jump to bans are the way to solve the problem of hazardous materials near us and inside of us. Voluntary and legitimate methods should remain available, and be considered; including lawsuits (with increased responsibility for corporate board members), or voluntary recalls of unsafe and unhealthful products.
If right-libertarians claim to support the free market, yet they believe that we should protect the freedom to charge exorbitant rates on insuring the health of the poor, then maybe they can be convinced that it's in the interest of people's freedom to charge exorbitant rates to insure firms that produce and sell dangerous products (and then get the government to pass taxes and subsidies to effectively order us to buy those products and work for those companies).
Written
on July 4th, 20th, 26th, and 27th,
and August 1st through 4th, and 6th,
2018
Edited
and Expanded on August 23rd, 2018
Originally
Published on August 23rd,
2018