Face The Nation

The failure of the American Health Care Act provides an insight that might be useful in combating neoliberalism. Paul Ryan centered his defense of ACHA around the notion of individual freedom. But there is a better view of freedom that the Democrats could offer: freedom from fear.

Ryan explained his view of freedom, the neoliberal view that freedom exists only in monetary transactions, in an appearance on Face The Nation March 12, 2017:

DICKERSON: How many people are going to lose coverage under this new —

RYAN: I can’t answer that question. It’s up to people. Here — here’s the premise of your question. Are you going to stop mandating people buy health insurance? People are going to do what they want to do with their lives because we believe in individual freedom in this country. So the question is, are we providing a system where people have access to health insurance if they choose to do so. …

The most important talking point in this whole interview is freedom; Here’s another example:

…[W}e’re not going to make an American do what they don’t want to do. You get it if you want it. That’s freedom.

What if you want it but do not have the money to get it? You are free not to get it. One of the problems with the ACA is that even with subsidies, people can’t afford a decent policy. A lot of people have a policy that doesn’t cover them sufficiently to prevent bankruptcy, or they have a policy but can’t afford to use it because of high deductibles and co-pays.

Ryan’s solution was to get rid of the Essential Health Benefits mandated by the ACA. These set the minimum coverage for any policy offered on the exchange. They include lab tests, drugs, maternity care, treatment for substance abuse and mental illness, and others. If insurance companies can issue policies that don’t cover these mandated benefits, they can offer cheaper policies. That doesn’t help anyone. It increases the number of people with policies that don’t cover treatment they suddenly need, and raises prices for others to buy fuller coverage.

Ryan and the Republicans think we only care about a few bucks we don’t have to pay an insurance company. They only value the freedom to buy and sell in unrestrained markets, as if anyone actually wanted to spend any part of their precious lives studying insurance contracts.

So there we have Ryan’s definition of freedom. You have the freedom to give money to an insurance company to buy any policy you can afford, and you can shop around for a policy that may or may not provide the coverage you eventually need, or you can take the risk of bankruptcy or denial of health care.

That’s a peculiar kind of freedom.

The Democrats have the possibility of offering a different kind of freedom: the freedom from fear that you and your family and your friends and neighbors and fellow citizens won’t be able to get health care when they need it. This kind of Freedom is the foundation of Franklin Roosevelt’s Second Bill of Rights, so it’s well within the historic tradition of the Democrats, at least before their neoliberal turn. The outpouring of public hostility to the ACHA proves that this definition of freedom is much more popular than Ryan’s.

Another way to phrase this idea is that what people want is the freedoom to pursue their own projects, projects that they choose for themselves and that give them a sense of satisfaction. John Maynard Keynes thought that as the age of work came to an end, people would pursue artistic, intellectual and cultural pursuits. Maybe. Maybe it’s going fishing, learning how to weld, or following the Cubs. For maximum freedom, there are areas where people would rather have the government protect them from the “market”, rather than wasting time coping with yet another market, or living in fear of the consequences of not handling the market. I think his is an idea with a lot of general appeal.

If we raise taxes fairly, or reorder our budget priorities favoring defense contractors, we can all get good health care at a price we can all pay. That’s the kind of freedom I want: freedom from fear and freedom from the endless consumerism we have to endure because of the other version of freedom. Not to mention freedom from profit-maximizing insurance companies.

25 replies
  1. bloopie2 says:

    FYI, clicking the title of the front-page blurb takes me to the Face The Nation page, not to your article.  Clicking “Read More” gets me there.  Good article, thanks.  We need to be reminded of how words can be used against us.

      • earlofhuntingdon says:

        Yep.  Bad link remains.

        One work around is to click on the previous article and use the button on the left to move to the more recent article.

  2. B says:

    Is it freedom when you force me to buy something? Just so you can pay for those who choose to spend their money unwisely? (I have found the the “Poor” always have money for booze and smokes and lots of things like fashion and the latest phones and such) …


    If you want free health care for everyone (I don’t, ’cause I think it will end up, like all socialist things, mediocre or worse for everyone) then I’ll trade that for the “entitlements” that you socialists also give to the “Poor” No more free whit and then you can more than afford the health care.


    • Artemesia says:

      I can only assume you have no actual experience of a decent healthcare system.  I spent several days in a French hospital this last fall while they operated on my badly broken elbow and wired it together.  The cost of ER, 4 days in the hospital, several sets of X-rays, anesthesia, Surgery etc was $4000; if I were French of course, it would have been ‘free’ as part of my single payer plan.  I paid $350 for several sessions of PT in Paris once the cast was off; my co-pay for PT for this elbow in the US was higher than the individual sessions in Paris.  My visit with an orthopedic surgeon in Paris (injury was in southern France) cost 80 Euro; that is about 20% of the cost of my follow up visit to a similarly qualified orthopedic surgeon in Chicago.  One reason European health care offers more for less is that the COST of health care is lower as well as everyone being covered.

      I have a Canadian friend who had a premature baby with a heart problem; she said ‘I was so grateful not to be in the US; here all I had to worry about was my baby, not about losing my house and being in debt for the rest of my life.’  Her son got the treatment he needs and is fine now.   Most people driven into bankruptcy by medical care in the US have insurance and it still doesn’t cover the costs of a serious illness or injury.  The reason is that we make bloated profits for pharma, medical providers and insurance companies the most important thing, rather than care for people.  With the money we now spend on health care for some of our people in a system that even with insurance impoverishes people who are covered, we could have the best health care system in the world.  I’d be pretty happy with what Germany or France have — they do it differently but they both do it well.

    • Ron B says:

      To say that health care

      will end up, like all socialist things, mediocre or worse for everyone

      is certainly a lie. Most countries that provide their citizens with health care have better outcomes than we do with our expensive, so-called free-market version. Providing payment for the care through government bureaucracy versus corporate bureaucracy doesn’t change who provides the care. It’ll be the same care but paid for more efficiently.

      The claim

      (I have found the the “Poor” always have money for booze and smokes and lots of things like fashion and the latest phones and such)

      is another lie but even more hateful and bigoted. The insinuation is that all poor people waste their money. No doubt some do, but the percentage is probably small. However, it seems the poor will be criticized for owning cars, phones, nice clothes and anything else they need to find and keep a job.

      Also, if you live mostly without opportunity in a world of abundance, what is wrong with occasional recreation? A movie, a beer, a cigarette, a cup of tea or coffee, a candy bar, a piece of pie or frosted cake?

      Limo owners won’t suffer materially because of it. They will only need to cope with the psychological pain of having to witness the undeserving being less than totally miserable. The socialized health care system might even pay for visits to a psychiatrist who can assure them their feelings are normal and right.

    • John Casper says:



      What we’ve got is socialism for the elites.

      From the Comptroller of the Currency:
       “The notional amount of derivative contracts held by insured U.S. commercial banks and savings associations in the first quarter increased by $12.0 trillion (6.6 percent) to $192.9 trillion from the previous quarter (see table 10).” 
      For perspective, annual U.S. GDP—Gross Domestic Product—is around $18 trillion. 

      “Congressional appropriations to the Pentagon from 2001-2016 have totaled more than $8.5 trillion.” 

      Social Security’s Trust fund is around $2.3 trillion. 


      Why wasn’t this free insurance on derivatives “pay-as-you-go?”

      Why isn’t private insurance complaining that government spending is “crowding” them “out” of the market?

    • John Casper says:


      Why do you spend on booze and smokes?

      Before the bubonic plague hit, your ilk complained about being forced to pay for sewers. Are you still opposed to that “entitlement?”

      Aren’t the meat and dairy oligopolies taking away your freedom by feeding antibiotics to livestock, thus reducing their effectiveness in humans?

      “The Overuse of Antibiotics in Food Animals Threatens Public Health”


      Did Eisenhower take away your freedom when he constructed the interstate highways?

    • greengiant says:

      Arch Libertarian would say that government mandated monopolies and government controlled price fixing are the root cause of US medical debacle.   “Corporate” controlled hegemony of Executive, congress, and state governments drive exponentially increasing Medical share of gross domestic product,  not to mention work force.   No change in outcomes,  just more profit and more money wasted for the sake of absolute control.   Want to die at home?  No can do,  we will call adult protective services.  You could not pay your health and care costs but state Medicaid paid for them,  fine, if Pennsylvania we will arbitrarily bill one of your children.    So bad that to get media time you don’t go and talk about prosecuting under current laws,  you rag about ACA to fit into the media agenda.   We get the truth out of Putin’s RT before we get it from US media.

      At first I thought deep state, or any number of governments or NGOs set up the Russians.   Trump has been mixed up with the Russian mafia since the 80s.  The volume and vehemence of the deniers and trollers have been factors in changing my mind.   I think the clinton foundation server hack and then later the Podesta phish had greater affect on the election.   I think if Clinton had deep sixed the foundation or divorced Bill she would be president.  Her habit of spinning the polls to show momentum fooled at least me to think she was just going to win.  Very hard for me to believe that the election interference had a larger goal than just stirring the pot.

    • bmaz says:

      Yes, how dare society try to get YOU to do your part to better society and help your common man.

  3. earlofhuntingdon says:

    Ryan seems to be adopting the Wal-Mart mantra: “lower” prices and freedom to choose.  The low prices are false.  They are heavily subsidized by a plethora of tax breaks, public assistance for their low income employees, a direct govt subsidy for corporate profits, and unenforced labor laws.  They are subsidized by Wal-Mart’s monopoly power, which allows them to drive their competitors out of business and their suppliers into submission and profits too low to stay in business without using predatory practices on their own employees.

    The freedom to choose is false.  It is freedom to buy only what Wal-Mart sells, generally high profit, low quality goods made in the ends of the earth by destitute labor and sold by employees who are poorly treated and underpaid.  That’s where those low prices come from.

    Ryan’s health care “choices” are similarly false.  He assumes the government cannot negotiate for drug prices.  He assumes government cannot regulate the predatory excesses of health insurers, health care providers, and drugs companies.  To do so would be to interfere with the perfect, perfectly working and omniscient market.  He assumes people choose to forego rent, food and education in order to buy inadequate access to health care.  People choose to go without because as perfect economic actors operating in a perfect market, they are making a rational choice.

    Mr. Ryan’s assumptions are false.  He needn’t believe them, he just needs to legislate as if he did.  It works for his corporate sponsors but not for the people of America.

  4. earlofhuntingdon says:

    Neoliberals sling the “socialism” word around like beer at a frat party. In their view, it hits everything, clings to everything, makes it all stink. Their version is common, garden variety propaganda directed at any idea, any group conduct that is not “sufficiently predatory” and profitable for a very few.

    It’s hard to believe anyone in the GOP has the faintest notion of what socialism is or how it works. In fact, it’s all around us, every family practices it, and for good reason. The Goopers are among its most fastidious practitioners, making their propaganda another example of their constant projection.

    Whereas non-establishment Democrats might aim their collective action toward the betterment of large groups, Goopers aim it toward helping the few. Howard Zinn marvelously skewered the haves, who believe in socialism when it comes to Ivy League admissions and secret society memberships, helping each other into the Union Club or the Country Club, sharing interlocking board memberships and anti-labor consultants. They despise it when others use collective action, when one working woman helps another, when voters enable their government to combat anti-labor and anti-monopoly practices, when community members work together for better schools and safer foods, water and working conditions. That’s bad socialism, not the good socialism practiced in the Back Bay and on the Upper East Side.

    It’s good socialism when companies bind together in the US Chamber of Commerce, share information, and spend millions influencing government to increase their bottom line. It’s bad socialism when communities insist on practical affordable access to health care (health insurance is only a method to get it).

    The French, Germans and Dutch have among the world’s best and most affordable health care. Health insurers are intermediaries, working to a high-efficiency, low-risk, low-profit cost-plus model. Health care is a common good that lifts everyone, not an opportunity for rent extraction. That’s the American way.

  5. jonf says:

    There is an interesting opinion piece in the NY Times by Alan Johnson that talks a bit about Hayek, Friedman and neoliberalism. (march 28) :
    “Why Brexit Is Best for Britain: The Left-Wing Case”

    • earlofhuntingdon says:

      The Lexit criticisms are correct.  But brexit is a vastly expensive, wasteful, resource and time consuming approach to fixing them.  The NYT’s opinion piece also misses that the EU neoliberals have national counterparts.  Chief among them has been Britain’s Tory Party, now leading the charge to leave the European frying pan so that they can enjoy the British fire.

      • Jonf says:

        Yes, wasteful but at some point the serfs gave given up on how much this costs the elite.  England is able to exit. Greece is trapped, however,  and must endure.

  6. PeasantParty says:

    Well, I certainly have the freedom to call this mess what it is.  It is Insurance Company care.  It has nothing at all to do with health, or medical need.  I do agree with your post.  I wish we the people could base all the things they do in DC on the Constitution and call them out on it issue by issue.  Freedom should give us that opportunity.  Are you Free?

  7. lefty665 says:

    Ryan’s vision of freedom has a lot in common with Kristofferson’s “Freedom’s just another word for nothin’ left to lose. Nothin’ ain’t worth nothin’ but it’s free”.


  8. SHW says:

    A failure of liberals for decades is the assumption of shared goals across the aisle, or put another way, the stultifying incredulity that an elected person in power does not give a sh*t about other people or the planet. Some legislators never did and still don’t give a sh*t. Paul Ryan does not care about single mothers, people of color, or anyone else who tends to be poor. How much louder does he have to scream it before we stop the apologist wonkifying of him and label him correctly as a feudal lord?  Trump is chaos but Ryan is a predictable conservative, an aristocrat posing as a man of the people. Worse, Ryan wants us beholden to him for every staple of life we take for granted: health care, food, shelter. We are Ryan’s peasants in his worldview,–either we work for him or we are disposable.

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