From the Comments: Health Care Reform, Anarchist Public Policy

Anonymous commented:

"You have some truly great suggestions here. I really enjoyed this. However, the one thing that gave me prickles was the idea of "regulating" toxic chemicals. I agree there should be no toxic chemicals in our environment, but how does one "regulate" this from an anarchist standpoint? "Regulation", unless voluntary, is a governmental function. The State regulates. And the big boys usually find a way to co-opt that process. In fact, it has historically been big business who funded and fueled the "progressive party" regulation movement. One possible direction might be to research and then remove laws which protect companies producing toxic chemicals from liability. Liability suits could then make it more costly for companies to produce, and if an anti-toxicity collective participated in such a suit, they could utilize the damages in part to pay for a big media campaign to educate people about the effects of toxicity. From there, a consumer boycott could be another voluntary, non-State technique to "regulate" these chemicals."

I guess I should preface my reply by stating that I am profoundly toxified and reactive to chemicals. It's something that has affected every aspect of my life and has brought me an indescribable amount of pain. So when I talk about regulating toxins, I speak from a very emotional place. I don't want this shit to happen to anyone else.

I understand your reluctance to regulate things, the government hardly has a good track record on this subject. But chemicals are so ubiquitous and easy to hide, as Lou showed in a recent post. I'm not sure that liability suits and consumer boycotts are sufficient. It's just such a huge and deeply ingrained problem -- I don't see anything other than the force of law changing it quickly enough to prevent another generation of children from being turned into chemistry labs.

Another way of saying this is that corporations are so powerful these days that I can't see individuals being effective enough to contain their abuses. If corporate personhood were ended and 150 years of regulations protecting them from liability were rolled back, then I would agree with you -- individuals should be able to manage their own regulations. But the playing field is not level and I don't see it being leveled anytime soon, short of a complete collapse.

Because of this, as a matter of public policy I have no problem with the government declaring that certain substances are simply too toxic to be allowed on the market -- and that their use is an assault upon the community.

As an anarchist, I believe that all power centers are to be distrusted and made less powerful. But as a practical matter, that's not the world we live in. So as an anarchist, I believe that the second best thing to do is to use one power center (the government) to limit the abuses of another power center (toxic corporations). This is no more contradictory, in my mind, than using a diesel truck to haul building supplies to build a passive solar home in the woods. I believe in using the tools available to us in order to promote a more sane and sustainable world.

I also wanted to add that I really like this idea:

"Liability suits could then make it more costly for companies to produce, and if an anti-toxicity collective participated in such a suit, they could utilize the damages in part to pay for a big media campaign to educate people about the effects of toxicity."

I appreciate the discussion, thank you.

Health Care Reform: Anarchist Public Policy

From part 2:

"Promoting optimal human health means eating nutrient dense foods, living in a nontoxic environment, being physically and emotionally engaged in the world, and using medicine as a tool to determine what specific elements a patient is lacking (such as a magnesium deficiency, or spending 8 hours a day in a sick building). Taking pills created from petrochemicals, cutting invasively inside the body, and dosing the body with radiation would be a last resort once it was clear the body wasn't capable of healing itself."

I would argue that this is the starting point for human-centered health care. This would vary by region, vary by spiritual path, and vary based on a person's individual biochemistry. Some people thrive on a raw foods diet; others need cooked nutrient dense foods to thrive. This variability is entirely natural, and a human-centered health care system would recognize this.

Once in a while on this blog I dip my toe into what an anarchist public policy might look like. I recognize the difficulty and arrogance of this ... I see it more as playing around with ideas, not as some magisterial pronouncement of How Things Should Be :) Nor do I consider these ideas to be 'canon' with anarchist theory. So please consider this post in that light.

My starting assumption is that destroying 1/8 of the US economy and starting over from scratch isn't in the cards -- but I'm also assuming that systemic change through shifting of priorities would be possible.

With the caveats out of the way, I would consider these changes to be positive and in comportment with basic anarchist beliefs:

* Highly regulate all chemicals used in buildings, food, and industry.

The Obama adminstration has taken baby steps in this direction, but it is simply unconscionable that our lives are filled with toxicity:

“About 40 percent of (human) deaths worldwide are caused by water, air and soil pollution.” Source

10 year old girls should not be drinking BGH enhanced cow milk out of plastic bottles, nor should they be ovulating. Male sperm counts should not be 50% lower than a century ago. Plastic nanoparticles should not be more common than algae in the oceans. Mercury should not be in our lakes. Rivers should not be oily to the touch, nor should they catch on fire. 90% of our topsoil should not be in the rivers and oceans. Food should not be grown from oil. Uranium should not be allowed anywhere on the surface of the Earth.

This is evil.

If we don't change these practices, then our species deserves to be replaced by cockroaches.

* End the oligopoly on accreditation, and allow for alternate ways to demonstrate medical competence. Recognize that a decade of schooling and training in Western medicine isn't the best way to treat every single health problem.

* Allow patients to choose their own doctors and treatment methods, with significantly less interference from regulators or insurance actuaries.

I recognize the harm that could come from this -- it would need to be done very carefully. However, many beneficial treatment methods are also prevented from helping patients. It is far, far more common for the media to report scare stories than they are to report doctors being shut down for employing non-FDA approved methods that have clearly demonstrated an ability to help certain patients. As an anarchist who considers authority to be suspect, I trust in the power of individuals to determine their own path to optimal human health. The critical part is that people need to be able to seek out these alternate treatment paths while they're healthy and able to make informed decisions; it is difficult to make a good decision while you're sick and in pain.

* Significantly reduce the power of corporations, and put an end to for-profit medicine.

Yes, for-profit medicine can create wonderful things like pacemakers and prescription drugs. They might even be better at this than a nonprofit would be (although this point could be argued).

But the opportunity cost is significant. For-profit corporations promote drugs at the expense of vitamins, 'miracle foods' instead of solid nutrition, and are now beginning to patent the very basis of life itself.

* Stop subsidizing large insurance companies and hospitals, shift the money into community-based health care.

Any form of health care involves trade-offs, or (at worst) rationing. These decisions are better made at the local level. Local community organizations should be funded and empowered to decide their own (nondiscriminatory) priorities, and to promote the health of their community in a manner best adapted to their local health needs.

* Aggressively promote community-based agriculture, breaking up large corporate-owned farms and training a generation of unemployed young adults how to raise their own organic food and bring it to market.

* Significantly reduce highway subsidies, shifting funding into bike paths and electric rail. Encourage walkable, livable communities.

* Aggressively promote less toxic, renewable energy development. Significantly reduce the use of polluting fossil fuels.

* Aggressively promote less toxic, highly energy efficient home-building and remodeling.

These are the sorts of policy changes that would promote human health, and reduce the toxic burden we place upon our environment (which eventually comes back to affect human health).

It's important for people to be healthy ... but in the end, humans will only be as healthy as the environment we live in. If we don't address the larger issue of environmental health, then every effort at promoting human health will eventually hit a brick wall.

Corporate Personhood

Corporate Personhood was created on a shaky legal foundation, but it's likely to get worse as the US Supreme Court looks at the issue. They're likely to grant corporations even more free speech rights, further unfettering their ability to influence public policy.

Stephen Colbert tackled this subject in recent shows, I have to say I do not recall the concept of corporate personhood being questioned in the media in ... well, forever.

But even more surprisingly, Justice Sotomayor recently stated that:

"... the majority might have it all wrong -- and that instead the court should reconsider the 19th century rulings that first afforded corporations the same rights flesh-and-blood people have.

Judges "created corporations as persons, gave birth to corporations as persons," she said. "There could be an argument made that that was the court's error to start with...[imbuing] a creature of state law with human characteristics."

If there was a unified anarchist political party, I'd have to guess that ending corporate personhood would be at the top of the party platform.

A Followup to Post on Anarchism

Maxcactus asked, "Is the size or power more concerning? It seems that to accomplish something big like an electric grid, or the internet it would take a big structure of people and resources. I would imagine that an anarchist would prefer the smallest organization necessary for the task."

Programs or institutions that are big, powerful and long-lasting tend to be problematic. It's possible to design a program so that one or more of these characteristics is limited.

For example, a way to limit power is by making an institution directly accountable to the public. The police would be less powerful if they were assigned to a neighborhood, and had to face the voters there every year.

A way to limit the power of a utility company would be by encouraging local power production and distribution.

Limiting the power of corporations could be accomplished by limiting their lifespan to 30 years. They could be big and powerful, but not immortal. (This isn't such a radical idea; this is the way corporations used to work).

I guess what I'm getting at is that anarchism doesn't mean "no government" as a tautology, I believe that as a political philosophy it can make a contribution to public policy discussions.

Anarchism

I used to be a liberal. I believed that society was perfectible, that the problem with the US government was that it spent too much money on guns and not enough on butter.

My political views have changed quite a bit since then, and have become much more anarchistic. This term tends to throw people off, however. They tend to think this means either "bring it all down, man!!!" or equate it with some form of libertarianism.

So, here's my stab at defining these political viewpoints.

Liberal

I define a liberal as someone who believes that, given enough resources and attention, most problems can be made better ... primarily through new or improved programs created by governments or nonprofits.

I'll repeat a Daniel Quinn quote used in a previous posting, I think it helps to make this point:

“Programs make it possible to look busy and purposeful while failing. If programs actually did the things people expect them to do, then human society would be heaven: our governments would work, our schools would work, our law enforcement would work, our penal systems would work, and so on. When programs fail (as they inevitably do), this is blamed on things like poor design, lack of funds and staff, bad management, and inadequate training. When programs fail, look for them to be replaced by new ones with improved design, increased funding and staff, superior management, and better training. When these new programs fail (as they invariably do), this is blamed on poor design, lack of funds and staff, bad management, and inadequate training.
This is why we spend more and more on our failures every year. Most people accept this willingly enough, because they know they’re getting more every year: bigger budgets, more laws, more police, more prisons — more of everything that didn’t work last year or the year before that or the year before that.” (Quinn. Beyond Civilization.)

Liberalism is an ideology that makes sense if you believe that bureaucracy is capable of deep and lasting reform.

Anarchist

Anarchism is an ideology that has very little traction in academia, particularly in political science. It is dismissed as the unenlightened stepchild of communism or socialism, or as an impractical utopian ideal.

I would argue, however, that anarchism has its roots in traditional methods of human social organization. It is a political viewpoint that respects natural law (defined here as the way the natural world organizes and sustains itself), time-tested methods of human social organization, and looks with skepticism on young upstart ideologies which are intent on transforming the world for the short-term benefit of human bureaucracies and economies.

That being said ... anarchism is difficult to define because it is not a very uniform ideology. In the context of modern society, however, most anarchists believe that increasing the scope and scale of human bureaucracies misses something essential about human society and natural law. At some point, these programs can become iatrogenic and do more harm than good.

The typical life cycle of a program or bureaucracy is as follows:

1. A problem is identified (for example: preventative health care in retirement homes), a small and limited program is created to solve it, and this program seems to work well. The net benefit is large.

2. The program is expanded. (After all, it worked so well in the small-scale or pilot program!)

3. Procedures which worked well in a small program are found to be flawed in a larger program. Loopholes are found, the program is abused by some people. The program is found to be lacking formal criteria to evaluate who it helps and the manner of help offered to them. To remedy this, case workers are given strict criteria on how to manage the needs of their clients. A bureaucracy is created to manage these new rules and mandates.

4. The program's managers and employees get used to their jobs, they like having a steady paycheck. There may be a few doubts ("We could help people so much more effectively in the old days, before we had all these managers and rules"), but most members of the program believe they are doing good by helping people. The program becomes an established part of the bureaucracy.

5. A new manager comes in, she intends to work there for 2 years ... then move up the ladder. In order to maintain this 2-year promotion cycle, she needs to pad her resume with a new initiative or program. She finds willing ears in the nursing staff when she talks about the need to expand the current program to reach more people -- rural retirement homes are being underserved. This means more jobs for nurses, perhaps even overtime.

6. Wouldn't you know it? Once the program is expanded, the nurses identify several other unmet needs in the rural retirement home population. The program expands to cover nutrition and psychological counseling.

7. The government has a budget crisis. 10% of the case workers are laid off, and one more middle manager is added to manage their caseloads (to maximize efficiency). The elderly population the program is serving is given less individual attention.

8. This same process, steps 5-8, occur half a dozen more times.

9. What was once a small, adaptive program that offered individual attention to retired people has now become a large, complex bureaucracy that does an awful lot of paper shuffling. The program absolutely improves the lives of some people. However, it also tends to push prescription medication (the costs are covered by a Federal program) and reinforces the idea that retired people are simply clients to be served.

10. The program has come to help people, yes, but it has also come to replace human social institutions which used to serve in its place ... such as families taking in their grandmothers and great uncles, where they are kept active by the bustle of life taking place around them.

Bureaucracies require complex rules and procedures to manage these programs, and the end result is that we become reliant on these technologies (see Marshall McLuhan) which causes our own internal aptitudes to atrophy.

An anarchist does not necessarily argue that this sort of a program is wrong, or bad on the face of it. An anarchist questions whether the establishment of another layer of complex bureaucracy is really the best way to help older people be more healthy and happy.

An anarchist is not opposed to programs and bureaucracy as a tautology, but as a practical matter believes that their scope should always be limited ... and that these programs should work with, rather than against, the natural processes that are already in place. Anarchists would never tolerate a bureaucracy that displaces older people from their communities, places them into holding rooms (called retirement communities by people with no sense of irony), then introduces new programs to help these older people cope with their disconnection from anything of consequence in the outside world.

An anarchist is much less hesitant to end a program or hobble a bureaucracy if they believe that it is causing harm. The reason is not that they hate government, but because they do not believe that these complex social institutions are capable of deep and lasting change. For example -- the aforementioned a retirement home is highly unlikely to transform into a thriving center of the community, a place that young and old alike come to in order to form connections with other human beings. The retirement home is far more likely to institute a 'community outreach program', make a lot of noise about it for 6 months, then quietly drop the program in 12-18 months.

In the case of the fictional program described above, an anarchist response might be to simply end the program and seed the money out directly into the community (let the locals figure out the best way to help retired people). Other anarchists might simply want to end the program and allow the natural societal processes the program replaced to re-emerge. Still another response might be to fire 75% of the managers, shred 90% of the program's governing rules, and let the case workers use their own discretion to a much larger extent than they've been allowed to. Another anarchist solution might be to fire *all* of the managers, put the retired people themselves in charge, and allow them to define what sorts of things the case workers should actually be doing to improve their lives.

Libertarian

While there is some overlap between anarchism and libertarianism, there are also significant differences on their views on property, power and human nature.

Libertarians want government to get out of the way so that individuals can do whatever they want. They don't seem concerned with what individuals will do with this power, just so long as the government isn't involved.

Anarchists want all private and public sources of authority to get out of the way whenever they infringe unduly on natural social or environmental processes. They are deeply concerned with the concentration and application of power, and seek to limit its scope whenever it is practical.