w/ Ammon Hennacy, Dorothy Day, John Dear, Kathy Kelly, Tom Cornell, Daniel Berrigan, Phillip Berrigan, etc etc etc.
A couple of months ago, I was sitting in a webinar about coding for outpatient medical and nursing procedures billed to Medicare. As I was led through the maze of arcane formulas and requirements, I got to thinking about how much Medicare has inflated the costs of health care. Here I was, being paid $40 an hour, as were seven or eight of my nurse colleagues, to listen to consultants (who were surely getting paid way more than I), quote from other consultants (more $$$) about how to fill out papers to maximize the amount of reimbursement the hospital I work for can receive from Medicare. And this is all because the people who work for Medicare ($$$) issue coding guidelines that are vague and open to interpretation, so that bills are constantly bounced back to providers for more processing ($$$) to justify or explain the charges so they can be re-billed. What a ridiculously expensive and inefficient process.
But this experience served to demonstrate to me once again that though there are clearly problems in the way American health care is consumed, provided, and paid for, advocates of increased government involvement are taking the wrong approach. The state is already a key player in regulating and financing the system and has only served to exacerbate the few problems which it did not create or facilitate in the first place.
The feds and lower levels of government license providers, thus granting monopoly status to doctors, nurse, therapists, and so on. They control the number of training programs by picking and choosing which ones can receive government-provided scholarships and grants. They legislate or otherwise dictate which drugs can be used, and by whom, by allowing or prohibiting the sale and use of specific drugs and granting health professional the exclusive right to write prescriptions for most medicines. These controls by the state are the basic reason why the pool of providers is small, and, as in any other oligopoly situation, the product is expensive and often of lesser quality than one would hope.
In addition to this infrastructure of control, the government exerts its influence on the health care system in many other, and equally destructive, ways, but perhaps the primary mechanism through which the feds influence, and damage, the provision of medical services in the united states, is Medicare.
Medicare was created as part of the social security system to provide health insurance for old people. It has never worked well and gets worse and worse with time. It is riddled with restrictive rules that often make it hard for old people to get adequate primary care. This leads to people getting treatment later in the course of an illness, which results in more hardship to the patient, more likelihood of a bad outcome, and more expensive treatment than would otherwise have been needed.
The reason that primary care is becoming less available for Medicare patients is that Medicare reimbursement is inadequate to cover the costs of providing this care. When providers agree to accept Medicare, they are prohibited from billing for or accepting payment for covered services other than that provided by the government, and thus have no way of making caring for Medicare patients affordable. So, as reimbursement to providers lags further and further behind costs, fewer and fewer doctors or other practitioners will agree to take on new Medicare patients. It is a money-losing proposition and leads those who do care for Medicare patient to charge their other patients more than they otherwise would in order to make ends meet, increasing the costs to insurers and those they insure. Not only are non-Medicare patients subsidizing Medicare recipients with the taxes they are forced to pay, but they are also subsidizing them with their steadily rising insurance premiums.
Then, when those who have been unable to get primary care get ill, they show up in hospital emergency rooms, where costs are significantly higher than those in a doctor’s office. And, being older, these people tend to have multiple health problems, and commonly end up being hospitalized, again, a more expensive setting in which to receive treatment. Besides being costly, treatment in a hospital exposes patients, especially old ones, to additional health risks. Medicare breeds expensive, inefficient health care, while masquerading as the guardian of old peoples’ health.
The Pharmacy Benefit
The more the politicians try to manipulate and improve Medicare, the worse they make it. Under the guise of providing beneficiaries with less expensive access to prescription medicines, the new Medicare Part D serves only to confuse those it allegedly helps and aggrandize the companies who provide pharmacy services. It provides partial payment for prescriptions up to a total of $2400 worth of drugs per year, then provides no coverage for additional prescriptions up to $3850 in a year (the so-called donut hole), and then starts paying again, covering most of any costs above $3850 annually.
This is progress? Recipients are required to choose between a large number of pharmacy service providers, who offer different formularies and have different charges for medications. They are allowed to choose only from among these government-authorized companies and cannot shop where they like. Additionally this program provides inadequate coverage for many poor old people and results in people not taking their medications, or taking partial, and inadequate, doses of them. Basically, Part D takes taxpayers’ stolen money, redistributes it among various favored pharmacies, and leaves many ill old people inadequately treated. But this is not so different from how Medicare has operated all along.
The JCAHO Scam
As noted above, besides providing lousy care for old people, Medicare also drives up the costs of care for everyone else. In addition to soaking insured patients to subsidize the primary care of those on Medicare, it has created a system of oversight of hospitals that is riddled with corruption and very expensive, but which does little to improve care.
Medicare authorizes the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) to “certify” that hospitals and other providers of health services are eligible to receive reimbursement from Medicare. Since upwards of 40% of a typical hospital’s revenue comes from Medicare and Medicaid (another government health insurance plan), both of which require JCAHO certification, virtually all large hospitals in the country participate in this scheme. Purportedly, JCAHO monitors hospitals for the quality and safety of patient care, but many of its rules are arbitrary and have nothing to do with either. When they inspect a hospital they spend some time checking to see if processes are in place to minimize harm to patients and maximize safe and effective care, but they also spend a significant amount of time and effort on nonsense such as checking that employees can parrot the hospital’s mission statement, seeing that nothing is stored under sinks, and making sure that patient food and staff food is kept in separate refrigerators (I kid you not). In addition they survey records with a fine tooth comb, searching for variations from their prescribed requirements for documentation, many of which, like much of the rest of JCAHO’s standards, have nothing to do with taking care of people, but instead cause staff to spend lots of time “charting to standard” rather than actually caring for sick people.
This whole certification charade wastes more than time, however. Like the coding system I discussed earlier, JCAHO inspections create jobs for many parasites. First are the JCAHO staff, including the inspectors, who add nothing to the care of patients, but all draw salaries for their trouble. Then there are the consultants hired by the hospitals to interpret the ever-changing JCAHO rules and help them create an idyllic, but phony, picture of how the hospital operates for the benefit of the inspectors. Then there is the money wasted on procedures and charting mandated by JCAHO but having nothing to do with curing or caring for ill people. And, not unlike the federal government and the industries it regulates and/or funds, people switch back and forth between jobs at JCAHO, the hospitals, and the consultancies, creating fertile ground for corruption. The whole structure is a scam designed to maintain bureaucratic control of health care provision and transfer wealth into the pockets of insiders under the guise of assuring and improving health care.
Health Care Reform
Given how badly the government manages the parts of the health care system it already controls, it surprises me to hear critics of the often sorry state of American health care advocate further political intervention as the way to reform the system. One hears stories about how wonderful medical care is in Canada or the united kingdom, and some form of universal “single-payer” (read state-run) health care is supported by many politicians, businesspeople, and even unions. It makes sense for politicians to support such proposals, since it would increase their power, and businesses like it since they could save money by no longer having to subsidize insurance for employees.
Unions and other working people, however, would do well to be careful what they ask for. Besides exacerbating such problems as mismanagement of resources and bureaucratic corruption, a medical system more completely controlled by the state will allow consumers much less latitude in managing their own use of providers, medications, and institutions.
Most working Americans have employer-subsidized private health plans, and a frequent complaint I hear from my co-workers in my role as a union activist is that they don’t have enough choice in what providers they can see, what hospitals they can utilize, and what drugs they can purchase on their insurance plans. They don’t seem to realize that they will have even fewer choices if the United States goes the route of Canada or Britain. These countries have much tighter rules than those of American private insurance plans, and appeals are at least as difficult. In addition, waiting periods for procedures easily available to the insured in the US are months and years long in countries with single-payer or nationalized health care. Is this what these folks really want?
Making Matters Worse
The American health care system as it currently exists is largely a creature of government. The problems with access and expense that those advocating reform show such concern about are directly related to rules and regulations forced on providers and customers by the state as it strives to control people’s lives and put our money into the pockets of favored clients, like the bureaucrats and drug company executives and stockholders. Americans will face a rude awakening if they believe that expanding the role of the state in supervising and funding health care will do anything but increase costs, graft, the lengths of the lines people already wait in when seeking care, and the number of hoops they have to jump through to get procedures and medicines they want.
Economics: A Means or an End for Anarchists?
All anarchists seek a world free of government and every other coercive institution. This is what makes them libertarians. But this is often the only thing on which they can agree among themselves.
Different anarchists have all sorts of priorities and visions for the future society. Their ideas about what goals are most important to achieve in an anarchist world influence their thoughts about how economic exchanges, decision-making, and social relations would take place in a libertarian setting. For instance, many anarchists seem to consider economic equality as their primary aim, and a libertarian social order organized on some sort of collective or communal basis as the way to achieve it. They seek anarchy because they believe it is the best method of attaining economic parity.
Individualists, on the other hand, believe that individual freedom of action, as long as it does not impinge on the equal freedom of others, is the most important goal of anarchists. According to this view, libertarian economic and social interactions should serve to promote and protect the autonomy of the participants. And individualists believe that an anarchist society based on private property, free exchange, and use and occupancy land tenure would be best suited to this purpose.
Private Property and Capitalism
Anarchist individualists advocate private ownership (or in the case of land, tenure) of property and free exchange of goods and services both now and in any future anarchist society. We believe that individuals should retain the full value of whatever they produce and should be free to occupy and use only that land which they can put to use without employing the labor of others. Of course, being anarchists, we also maintain that individuals would be free to pool their labor, property, and/or land in order to increase their economic efficiency, better provide for others in need, or simply enjoy the company of their fellows. But these would still be voluntary, private arrangements, wherein the individuals concerned would share the products of their labor and contribute to the joint project as long as they see fit, while retaining their freedom to leave the enterprise if and when they so desire.
Although individualists envision a society based on private property, we oppose the economic relationships of capitalism, whose supporters misuse words like private enterprise and free markets to justify a system of monopoly ownership in land and the means of production which allows some to skim off part or even most of the wealth produced by the labor of others. Such a system exists only because it is protected by the armed power of government, which secures title to unjustly acquired and held land, monopolizes the supply of credit and money, and criminalizes attempts by workers to take full ownership of the means of production they use to create wealth. This state intervention in economic transactions makes it impossible for most workers to become truly independent of the predation of capitalists, banks, and landlords. Individualists argue that without the state to enforce the rules of the capitalist economy, workers would not allow themselves to be exploited by these thieves and capitalism would not be able to exist.
Inequality in an Individualist Society
One of the criticisms of individualist economic proposals raised by other anarchists is that a system based on private ownership would result in some level of difference among people in regard to the quality or quantity of possessions they have. In a society where people are able to realize the full value of their labor, one who works harder or better than another will possess or have the ability to acquire more things than someone who works less or is less skilled at a particular occupation. But economic inequality would not have the same significance in a non-capitalist anarchist society that it does in today’s societies.
The differences in wealth that arise in an individualist community would likely be relatively small. Without the ability to profit from the labor of others, generate interest from providing credit, or extort rent from letting out land or property, individuals would not be capable of generating the huge quantities of assets that people can in a capitalist system. Furthermore, the anarchist with more things does not have them at the expense of another, since they are the result of the owner’s own effort. If someone with less wealth wishes to have more, they can work more, harder, or better. There is no injustice in one person working 12 hours a day and six days a week in order to buy a boat, while another chooses to work three eight hour days a week and is content with a less extravagant lifestyle. If one can generate income only by hard work, there is an upper limit to the number and kind of things one can buy and own.
More important, though, than the actual amount of economic inequality between individuals is whether the person who has more wealth thereby acquires more power or advantage over others. In a statist world, one can buy political favors with one’s money and influence government action affecting oneself and others. This would not be an option in an anarchist society since there would be no government or other political structure through which individuals or groups could coerce others and use their greater wealth to further aggrandize themselves through political means, as happens in a society of rulers and subjects.
But even if money could not buy power in a libertarian community, some might object to a private property system and its inevitable inequality on another basis. They may believe that economic differences are necessarily unjust, or that people unable to work much or at all because of physical limitations would be unable to obtain the resources to make a life for themselves. Individualists would argue that economic inequality of some sort is inevitable in any truly free society. People have varied needs, wants, and mental and physical abilities and are therefore unequal in many ways. Some produce more, some produce less, and there is no injustice in the fact that this would result in different amounts of wealth. A society or community that prohibited those who so desired from retaining the full value of what they produce in order to create an artificial economic leveling would infringe on the freedom of individuals and thus violate a basic anarchist principle. As for those who produce little or nothing because of some disability, there are other means of providing for the less fortunate than communal economic arrangements. There is a long tradition of groups of individuals taking care of sick, injured, and otherwise incapacitated people through voluntary organizations from friendly societies to cooperatives of various sorts to trade unions. People who value private property are no less benevolent than those who favor free collectives, and would figure out any number of ways to care for those in need of assistance from others.
Inequality in the Commune and Collective
While individualists concede that there would be some economic inequality in the society they promote, their critics among other anarchists often presume that the kind of societies they envision would be completely egalitarian and free of inequity. But, although the collectives proposed by anarchist syndicalists, communist anarchists, and libertarian socialists might well be free of economic differences, this would likely take place only at the expense of the liberty of some of the members of such communities, creating an inequality in individual freedom.
It is unlikely that people in any future world would all be of one mind about everything, any more than they are today. Some will wish to live and work alone, interacting with others only when necessary. Others will wish to work in groups and share everything. And others, perhaps most, will prefer one of these models to another at different times and for different purposes, or even some combination of the two. And any anarchist society worthy of the name must allow for this.
As noted above, individualists believe that pooling of resources, land, or anything else by autonomous individuals can be fully compatible with individual freedom. Unfortunately, however, there are some anarchists who advocate the outright abolition of private property, not allowing any opportunity for those who prefer a different economic arrangement. If such an economic model was imposed on the world, those who wished to live otherwise would not have the freedom to do so. Allowing people no alternative to joining the local commune or syndicate would simply replace the tyranny of state capitalism with the oppression of an involuntary “community.” There would consequently be an inequality between the society, or more likely, the committee or other “delegates” who presume to represent it, and the individual. The group will make decisions and the dissenting individual must comply. Thus, in many a collective or commune no one will be poorer than another, but some will certainly be less free.
This is not to imply that all communist or collectivist anarchists believe in imposing their economic views on those who view the world differently. Many who advocate some form of communal society are as committed to personal liberty as are private property advocates. But there is a tendency on the part of many anarchists to present a “one size fits everyone” economic model for the future, not realizing the possible implications of such an all-encompassing ideal.
For Economic and Social Freedom
Individualists see the economic system they propose as simply the means to an end. And that end is a free society of free individuals. We believe that only free economic exchange, based on private property, can produce and protect every individual’s autonomy, their freedom to live as they see fit, which we believe is the essential goal of the anarchist project. Moreover, while such an arrangement would encourage and reward individual initiative, more collectively-oriented people would be free to construct whatever group enterprises they wish by coming together and sharing production, consumption, or both.
People in a society based on individual ownership of property and tenure of land would be able to choose whatever economic or social system best suits their interests, personal relationships, geographic location, and temperaments, without sacrificing the option of changing their minds and making other arrangements whenever they decide to do so. While some amount of economic inequality would be unavoidable in such a world, schemes which seek to bring about absolute parity in wealth and possessions would simply produce another kind of inequality, where individual wants and desires would be subservient to those of the group, and limits would be placed on the freedom of those who wish to live their lives in their own way. Such social inequality between and among individuals and groups and the limits on liberty which it would produce are precisely what individualists, and, one would hope, all other genuine anarchists, seek to eliminate from the world.
So you want me to tell you what Anarchism is, do you? I can do no less than make the attempt, and in my own simple way try to make you understand at least that it is not what the uninformed and the capitalistic newspapers, liars, fools and villains generally say it is.
In the first place, let me urge upon all who desire to learn the truth about Anarchism not to go to its enemies for information, but to talk with Anarchists and read anarchistic literature. And it is not always safe to take what one, two or even a dozen persons may say about it, either, though they call themselves Anarchists. Take what a goodly number of them say and then cancel those statements in which they are not in accord. What remains in all probability is true. For example, what is Christianity? Ask a dozen or more people and it is likely their answers will not agree in every particular. They may, however, agree upon some fundamental propositions. This more likely to be the correct position of Christianity than the statements made by any one of them. This process of cancellation is the best way of finding out what any philosophy is. This I have done in determining what Anarchism is, and it is a fair presumption that I have arrived tolerably near the truth.
Anarchism, in the language of Benjamin R. Tucker, may be described as the doctrine that “all the affairs of men should be managed by individuals or voluntary associations, and that the state should be abolished.”
The state is “the embodiment of the principle of invasion in an individual, or a band of individuals, assuming to act as representatives or masters of the entire people within a given area.”
Government is “the subjection of the noninvasive individual to an external will.”
Now, keep these definitions in mind, and don’t use the word “state” or “government” or “Anarchy” in any other sense than that in which the Anarchist himself uses it. Mr. Tucker’s definitions are generally accepted by Anarchists everywhere.
The state, according to Herbert Spencer and others, originated in war, aggressive war, violence, and has always been maintained by violence. The function of the state has always been to govern–to make the non-ruling classes do what the ruling classes want done. The state is the king in a monarchy, the king and parliament in a limited monarchy, elected representatives in such a republic as exists in the United States, and the majority of the voters in a democracy as in Switzerland. History shows that the masses are always improved in mental, moral, and material conditions as the powers of the state over the individuals are reduced. As man becomes more enlightened regarding his interests, individual and collective, he insists that forcible authority over him and his conduct shall be abolished. He points to the fact that the church has improved in its material affairs, to say nothing of the spiritual, since the individual is not compelled to support it and accept its doctrines or be declared a heretic and burned at the stake or otherwise maltreated; to the fact that people are better dressed since the state has annulled the laws regulating dress; to the fact that people are happier married since each person can choose his own mate; to the fact that people are better in every way since the laws were abolished regulating the individual’s hair-cut, his traveling, his trade, the number of window panes in his house, chewing tobacco or kissing on Sundays, and so on without number. In Russia and some other countries even now you would not be allowed to go into the country or come out of it without legal permission, to print or read books or papers except those permitted by law, to keep anyone in your house over night without notifying the police, and in a thousand ways the individual is hampered in his movements. Even in the freest countries the individual is robbed by the tax-collector, is beaten by the police, is fined and jailed by courts–is browbeated by the authority in many ways when his conduct is not aggressive or in violation of equal freedom.
It is a mistake often made, even by some Anarchists, to say that Anarchism aims to establish absolute freedom. Anarchism is a practical philosophy, and is not striving to do the impossible. What Anarchism aims to do, however, is to make equal freedom applicable to every human creature. The majority under this rule has no more rights than the minority, the millions no greater rights than one. It assumes that every human being should have equal rights to all the products of nature without money and without price; that what one produces would belong to himself, and that not individual or collection of persons, be they outlaw or state, should take any portion of it without his knowledge or consent; that every person should be allowed to exchange his own products wherever he wills; that he should be allowed to co-operate with his fellows if he chooses, or to compete against them in whatever field he elects; that no restrictions whatsoever should be put upon him in what he prints or reads or drinks or eats or does, so long as he does not invade the equal rights of his fellows.
It is often remarked that Anarchism is an impractical theory imported into the United States by a lot of ignorant foreigners. Of course, those who make this statement are as much mistaken as though they made it while conscious of its falsity. The doctrine of personal freedom is an American doctrine, in so far as the attempt to put it into practice is concerned, as Paine, Franklin, Jefferson and others understood it quite well. Even the Puritans had a faint idea of it, as they came here to exercise the right of private judgement in religious matters. The right to exercise private judgement in religion is Anarchy in religion. The first to formulate the doctrine of individual sovereignty was a blue-bellied Yankee, as Josiah Warren was a descendant of the Revolutionary General Warren. We have Anarchy in trade between the states in this country, as free trade is simply commercial Anarchy.
No one who commits crime can be an Anarchist, because crime is the doing of injury to another by aggression–the opposite of Anarchism.
No one can kill another, except in self-defense, and be an Anarchist, because that would be invading another’s equal right to live–the antithesis of Anarchism.
Hence assassins and criminals generally are called Anarchists only by the ignorant and malicious.
You can’t be an Anarchist and do the things which Anarchism condemns.
Anarchism would make occupancy and use the sole title to land, thereby abolishing rent for land.
It would guarantee to each individual or association the right to issue money as a medium of exchange, thereby abolishing interest on money in so far as co-operation and competition can do it.
It denies the justice of patent and copyrights, and would abolish monopoly by abolishing patent rights.
It denies the right of any body of people to tax the individual for anything he does not want, but that taxation should be voluntary, such as is now done by churches, trade unions, insurance societies and all other voluntary associations.
It believes that freedom in every walk of life is the greatest possible means of elevating the human race to happier conditions.
It is said that Anarchism is not socialism. This is a mistake. Anarchism is voluntary Socialism. There are two kinds of Socialism, archistic and anarchistic, authoritarian and libertarian, state and free. Indeed, every proposition for social betterment is either to increase or decrease the powers of external wills and forces over the individual. As they increase they are archistic; as they decrease they are anarchistic.
Anarchy is a synonym for liberty, freedom, independence, free play, self-government, non-interference, mind your own business and let your neighbor’s alone, laissez faire, ungoverned, autonomy, and so on.
Now that I am done, I find that you have been given only a faint outline of what Anarchism is and is not. Those who desire to pursue the subject further will find food for intellectual adults in Tucker’s Instead of a Book; Proudhon’s What is Property? and Economical Contradictions; Tandy’s Voluntary Socialism; Mackay’s The Anarchists; Auberon Herbert’s Free Life; The Demonstrator; Lucifer, and a lot of other books, papers and pamphlets which may be had by addressing Henry Bool, Ithaca, NY, E.C. Walker, 244 West 143rd Street, NYC, “Liberty,” Box 1312, New York, or “Mother Earth,” P.O. Box 217, Madison Square Station, New York city.