Contrary to outraged cries from Republicans that it’s some sort of radical departure from our “free enterprise” system, Obamacare is in fact a direct continuation of the bipartisan neoliberal consensus of the past thirty years. The guiding principle of this consensus is the use of state power to protect corporate profits — which consist mostly of rents on artificial scarcity — from the radical deflationary effects of technologies of abundance. In the spirit of the original American state capitalist, Alexander Hamilton, this consensus seeks to maintain the value of the enormous concentrations of land and capital owned by the rentier classes, and guarantee the returns on them.
The Digital Millennium Copyright Act and subsequent draconian digital copyright legislation sought to guarantee the artificial scarcity rents of the proprietary content industries in the face of technologolies of abundance like file-sharing. Both the Paulsen and Geithner versions of TARP use taxpayer money to prop up bubble-inflated real estate prices. And now we have Obamacare, which operates on essentially the same premises as Bush’s Medicare Part D:
* It leaves in place all the state-enforced artificial scarcities, artificial property rights, entry barriers and cartels that act as sources of rent and fuel bloated industry profits;
* These state-granted monopolies as a given, it requires individuals to purchase these products at the monopoly price;
* It uses taxpayer money to fund the purchase of corporate healthcare at the state-enforced monopoly price for those who cannot afford it; and
* It specifically forswears, as part of a political deal, the use of the federal government’s bargaining power as a purchaser to negotiate lower drug prices.
It’s probably not a coincidence that, upon news that the Supreme Court had held up the individual mandate, health insurance companies’ stock immediately began to rise.
A free market healthcare reform, in contrast, would do just the opposite. It would eliminate all these monopolies and artificial scarcities enforced by the state, and allow market competition to drive healthcare prices down to the actual cost of provision. It would include:
* The elimination or radical scaling back of drug patents, resulting in up to a 95% reduction in drug prices;
* The elimination or radical scaling back of patents on medical equipment, opening the market to cheaper, open-source modular hardware designed for compatibility and ease of repair;
* The elimination or radical scaling back of medical licensing — in particular, the power of licensing boards to limit the number of competing practitioners, and the requirement of full medical or dental school licensing to perform procedures for which clinical practitioners are fully competent;
* The resulting reductions in overhead and capital outlay might make it feasible for community nonprofits currently in financial difficulty to reorganize as multi-stakeholder cooperatives, rather than sell out to national hospital chains — like the Bill Frist-Rick Scott Crime Family and its sister chains headquartered in Nashville — that would hollow them out and understaff them.
So our choice is not one between a healthcare system administered by the state, and one administered by Columbia HCA, Pfizer and Kaiser Permanente. Those are really just two sides of the same coin, with ordinary people locked into dependence on unaccountable state and corporate bureaucracies that keep healthcare artificially scarce. Obamacare is actually a corporate welfare program for the big healthcare corporations. The real choice is between the corporate-state healthcare system of Clinton, Bush, Obama and Romney, and a genuine free market healthcare system controlled by us.
Kevin Carson is a senior fellow of the Center for a Stateless Society (c4ss.org) and holds the Center’s Karl Hess Chair in Social Theory. He is a mutualist and individualist anarchist whose written work includes Studies in Mutualist Political Economy, Organization Theory: A Libertarian Perspective, and The Homebrew Industrial Revolution: A Low-Overhead Manifesto, all of which are freely available online. Carson has also written for such print publications as The Freeman: Ideas on Liberty and a variety of internet-based journals and blogs, includingJust Things, The Art of the Possible, the P2P Foundation, and his own Mutualist Blog.