The industrialized world has started to recognize critical factors in the development and sustainment of poverty. Globally, there is a reciprocal relationship between access to healthcare and poverty, with the states providing the most access to health care having the lowest rate of poverty (Aspalter, 2008). Born of President Roosevelt’s New Deal was the introduction of unemployment insurance and pensions, an attempt at addressing widespread and crushing poverty (Aspalter, 2008). After World War II, the UK and Sweden shifted to a “universal state services” system, which initiated a national health system addressing social welfare (Aspalter, 2008, p. 781). In 1993, the Clinton administration began to address the need within the U.S. for a better health care system, but the administration’s bill, the Health Security Act, was dead by 1994. In 2010, the Obama Administration enacted the Patient Protection and Affordable Care Act, a compulsory law that provides and requires means-tested, government health subsidized insurance. The European states’ willingness to address the need for universal and long-term health care starkly contrasts the United States’ means-tested approach to social welfare.
The Patient Protection and Affordable Care Act (ACA), colloquially known as “Obamacare,” is the United States’ most recent attempt at integrating a social policy that allows for free-market capitalism and an affordable, inclusive system of health care. The scope of conflict surrounding this law is exemplified through four dominant ideological frameworks (Social liberal/democrat perspectives and Neo-liberal/conservatives), all of which address the state’s responsibility (or lack thereof) to provide social services and intervene in the market economy. These frameworks provide a unique approach to governance and social welfare and, as a result, the truth of what the bill can do for American citizens is often filtered through the biases within the mainstream media. America’s approach to health care and social welfare subsequently leaves out a large percentage of the American population most in need (Katz, 1996). With the ambiguity resulting from media coverage and a growing economic gap between the United States’ rich and poor that hadn’t been seen since the Great Depression (Sandel, 2009), how are we to accurately assess the effect of policy on Americans from all class and socioeconomic standing?
In this paper, I will briefly summarize the ACA. I will then present one side of the media bias that suggests the government should bare some responsibility in distributing, regulating, and providing social services within the context of a capitalist structure, thus demonstrating a social liberal framework. I then will present the opposing argument to the ACA, which contends that the government should bare no responsibility in distributing, regulating, and providing social services, thus demonstrating the neo-liberal and neo-conservative frameworks. Finally, I will conclude by expounding on what is missing from these perspectives by presenting an alternative solution: the single-payer system. This discussion will build on Fraser’s concept of rights and recognition, coupled with Iris Marion Young’s critique of distributive justice.
The Patient Protection and Affordable Care Act
The United Stated Department of Human and Health Services mission is to “ help provide the building blocks that Americans need to live healthy, successful lives…(and)… is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.” (USDHHS, 2013). The USDHHS is also the agency that promotes facilitation of the new marketplace used for the ACA’s government subsidized insurance, and provides a direct web link to the marketplace’s website, HealthCare.gov. The American Public Health Association (APHA) estimates that by 2022, over 30 million Americans will have become either privately or publically insured as a result of this bill. Both the USDHHS and the APHA offer bullet point versions of the bill that allow the reader a concise and condensed version of 906 PDF document, which the reader can find in it’s entirety at the Obama administration’s website for the Act. The following is my summary of both of these website’s summaries.
Individuals are now required by law to have health insurance. Those without health insurance will be subject to a tax penalty that will increase with each proceeding year. Government marketplaces will offer subsidized insurance plans to financially qualifying citizens. Coverage will be expanded and more affordable. Insurers are required to operate with more transparency, and employers are required to offer employees benefits if the company is more than fifty people. Bans have been placed on lifetime limits and coverage cannot be denied based on pre-existing conditions. Young adults can be covered under parent’s insurance plans until age 26. Finally, the Medicaid program can be expanded, based upon an individual states decision to expand participation in the program. The bill calls for a more preventative and inclusive approach to health care.
In sum, the Patient Protection and Affordable Care Act is a multigenerational, cross-class endeavor to bestow Americans that which the developed world considers inherent human rights (UDHR, 1948). As the Universal Declaration of Human Rights states in Article 25, the right to “medical care and necessary social services”(UDHR, 1948) are included in our right to well-being and health. Next, I will discuss the articles from the Huffington Post, New York Times and Forbes through the Social Liberal and Social Democrat paradigm.
“Satisfaction…Over Time:” The Social Liberal and the Social Democrat
One lens of the medias biases views the ACA from a social liberal perspective. Bergthold of the Huffington Post states, “Satisfaction with the program is likely to grow over time.” This sentiment sums up an element of Social Liberal ideology emphasizing the wellbeing of society is likely to be achieved in an evolutionary, not revolutionary, manner (Taylor, 2007). In order to correct for inequalities in the distribution of resources and opportunities, the ACA is an attempt to incrementally move to fostering a more egalitarian society still within a capitalist paradigm (Taylor, 2007).
The New York Times further exemplifies a social liberal perspective. With the headline running, “Millions of Poor Are Left Uncovered by Health Law,” authors Tavernise and Gebeloff (2013) recognize that an “insurance-based system” established within the context of a capitalist society will omit significant proportions of society (Taylor, 2007). The Social Liberal is a champion of equality (Taylor, 2007), and because Tavernise and Gebeloff mention 24 of the states that “did not expand Medicaid [as having] less generous safety nets,” they imply that the state could or should have been more “generous in the resources” they were willing to provide (Tavernise and Gebeloff, 2013).
Finally, Keng of Forbes stated that the ACA is generally a “good idea because people should be able to live without choosing between their lives and a giant medical bill” (Keng, 2013). This statement coincides with the concept of freedom as positive liberty, or having guaranteed social, political and economic rights. The ability to be “free from economic deprivation” (Taylor, 2007, p. 56), and a modicum of equality are principles dear to the Social Democrat, an ideology that aligns closely with social liberalism but stems from Marxist theory and calls for the overhaul of the capitalist system (Taylor, 2007). Both social liberal and social democrat ideologies are community based, supportive of positive liberty and wary of free-market enterprise.
Additionally, Keng’s argument touches on social justice as it concerns distribution of decision-making, a principled concept embodied by the social democrat (Young, 1990). Moving away from the distributive justice model that theorizes on distribution of material goods (Young, 1990), Keng bolsters the social democrats call to broaden the scope of distributive justice to include abstractions such as decision-making (Young, 1990). As Young sets forth, “discussion of justice in medical care,” is usually economical and thereafter, public discourse revolves around taxation (Young, 1990, p. 329). Advancing with the economic theme, the IRS will be in charge of enforcing the tax that results from noncompliance. Keng goes as far to suggest that we should provide the IRS with more funding to help enforce the ACA, an extreme stance of government involvement that aligns clearly with a social democrat paradigm (Taylor, 2007).
I now will detail the political ideological frameworks of neo-liberalist and neo-conservative viewpoints exemplified by non-profit grassroots campaign organizations, Freedom Works and the Christian Coalition.
“Obamacare Will Destroy America:” The Neo-liberalist and the Neo-Conservative
The neo-liberalist viewpoint is a champion of free-market and free trade, and a dedicated believer of the self-regulating free-market “over state intervention” (Steger and Roy, 2010, p. 20). Dean Clancy of Freedom Works offered exemplified neo-liberal political ideology when he stated alternatives to the ACA are “designed to lower health care costs by putting patients and doctors in charge of the system instead of politicians and bureaucrats”(Clancy, 2013). Based on Ricardo’s theory of “competitive advantage,” Clancy is suggesting that if the “meddling state” stays out of private industry, it will be a “win-win” for all (Steger and Roy, 2010 p. 3-5). The neo-liberal concept that government interference hinders economic relationships stems from Hayek’s view that our needs are often “subjective” and need not be “satisfied by the state” (Taylor, 2007). It speaks to directly to negative liberty, which Taylor (2007) defines as the absence of government interference. Furthermore, suggesting that costs remain low and freedom remains high as a result of free-market principles and private ownership is essentially neo-liberalist (Harvey, 2005).
Clancy’s proposal calls for a list of neo-liberal principles ranging from self-owned health policies that are not contingent on one’s employment status, which could be viewed as a form of private property rights, and increased competition for insurance companies (i.e. allowing insurance companies to compete across state lines) (Harvey, 2005). The contract fundamentally calls for the health care field to be “subjected to the discipline exerted by market forces” (Taylor, 2007, p. 80). Freedom Works’ mission is to fight for “lower taxes, less government and more freedom,” and while their enthusiasm for private ownership, free markets and free trade are readily apparent, their mission closely allies with that of the neo-liberalist.
Another public interest group that has spoken out against the ACA is the Christian Coalition (CC). In an open letter, the Christian Coalition calls for the complete decimation of the ACA due to the proclamation that the ACA will “mandate taxpayer funding of abortion…(and)…force [Americans] on government plans” (CC, 2013). Aligned with the neo-liberalist demand for the D-L-P Formula, or “deregulation, liberalization, and privatization” (Steger and Roy, 2010, p. 14), the neoconservative is willing to assert his moral and religious views into politics as well (Taylor, 2007). The assertion that the ACA will fund abortions speaks directly to morally themed right-of-life issues. Built from a 1970’s coalition between the elite and business class, the neo-conservative works for the moral majority, the reinstitution of class power and moral values (Harvey, 2005). Aligned in terms of free-market, free trade and negative liberty, the defining focus of the neo-liberal tends to be economic while the neo-conservative is inherently moral.
Broadening the Scope of the Debate–Rights, Recognition and Distribution of Justice: A Push for Single Payer
This paper discussed the relationship between poverty and access to health care, reviewed the Patient Protection and Affordable Care Act, and analyzed media biases from social liberal and democrat lenses, and neo-liberal and neo-conservative lenses. While most of the media biases focus on the government’s responsibility, or lack thereof, to provide social services, I believe it’s important to address a citizen’s rights, both as an American and a human. Young (1990) describes rights as “relationships, not things,” defined within an institutional context. It is the institutional context (e.g. America) that further defines and clarifies rules about what people can and can’t do in relation to one another (Young, 1990, p. 167).
My opinion is that, like Article 25 of the UDHR states, “Everyone has a right to a standard of living adequate for the health and well-being of himself and of his family, including…medical care and necessary social services”(UDHR, 1948). This right is based upon membership in the “human family” (UDHR, 1948). When this right is threatened by “tyranny or oppression,” the UDHR calls forth the states to protect rights “as rule of law” (UDHR, 1948). Because the federal government has given states power in deciding to expand Medicaid, those citizens who fall into the gap between Medicaid participation and government subsidized insurance will be oppressed. However, because the U.S. has yet to sign the 65 year-old UDHR, the U.S. can openly disregard its responsibility to protect the rights of all citizens. How does a country whose pledge declares “liberty and justice for all,” leave the poorest of Americans behind (Smith, 2008), failing to recognize the human rights due to each human?
Recognition, according to Fraser’s (2000) status model, is maintained through institutional processes that create patterns of cultural values, or simply, institutionalized status order. To be misrecognized is to be denied full participation in societal practices or interactions (Fraser, 2000) and to be denied citizenship is to be denied full “membership in the community”(Glenn, 2010, p. 405). Like Glenn, I believe that membership implies “rights in and reciprocal obligations toward the community” (Glenn, 2010, p. 405). However, just as Fraser asserts that recognition is a participatory practice involving an entire community who draws the “boundaries of citizenship,” I put forth that members of America are failing to recognize other members of America, citizens who are falling between the ACA’s income gap. Taking a principled position, the ACA still “inflicts a wrong on the individual”(Sandel, 2009, p. 50).
Supplementing the pledge of “justice for all” and concept of distributive of justice is Young’s (1990) definition of social justice as the “elimination of institutionalized domination and oppression” (Young, 1990, p. 157). This definition is fully encompassing and not limited to the distributive justice paradigm that focuses on distribution of “benefits and burdens” among members (Young, 1990, p. 158). Concerning both definitions, I contend that American citizens are misrecognized and thus unable to participate fully in American citizenship. Justice is had, but not by all.
The most simple and economical solution I can surmise is the single—payer system. Already implemented in America through the Medicare program, the single-payer system would expand the amount of treatment choices and save billions of dollars (Goodman and Moynihan, 2013). More importantly, it would not discriminate against already oppressed and underserved populations. The Patient Protection and Affordable Care Act is a start, but it’s not enough.
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Clancy, D. (2013, October 17). Announcing “A Health Care Contract with America”. Retrieved from http://www.freedomworks.org/blog/dean-clancy/announcing-a-health-care-contract-with-america
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Class: 500 – Intellectual and Historical Foundations of Social Work