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Thursday, August 23, 2018

Crafting a Health Insurance Law Acceptable to Both Libertarians and Socialists


     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

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