Why would anyone do that?

The answer is that very bad things do sometimes happen, and it can be, and usually is, reasonable to protect oneself from their financial consequences should they occur.   If the way to do that is to make a bet with an insurance company that you are not only likely to lose but lucky when you do, then so be it.

Consider fire insurance.  Whoever buys it is likely to come out with a net loss.  But homeowners who want to hedge against the very dire prospect of winning the bet because their houses burn down will nevertheless be eager to take that bet on.

It is relevant too that most homeowners hold mortgages, and that mortgage holders insist that mortgagees buy insurance.  Therefore even risk-prone homeowners who might be tempted to do the rational thing by staying out of the market will buy the insurance nevertheless – because they have no choice.

Then the risk pool will be enlarged to include almost every homeowner, and premiums will become cheaper accordingly.  It is a virtuous spiral.

Health insurance is more complicated because buyers are not just insuring against catastrophic contingencies and because while very few people own houses that burn down, almost everyone is likely at some point, usually at many times during their lives, to make use of health care providers.

Moreover, the cost of health care is basically arbitrary and therefore more malleable than the cost of the building materials and labor necessary for rebuilding houses.

Ironically, one of the factors affecting health care costs – usually driving it up – is insurance itself.  Providers will charge what the market will bear, and a market in which insurance picks up the bill will usually bear quite a lot.

The fact that providers must deal with insurance companies drives up costs too.  It creates administrative work that is time consuming and costly and that adds nothing to the provision of health care itself.

A way to make these consequences less onerous would be for the government to negotiate costs with providers.  Large firms do this all the time.  But the big insurance companies, the for profit health care providers, Big Pharma, and other assorted profiteers make sure that the government does not.

Thanks to their machinations, Congress won’t even let Medicare negotiate prices with drug companies.  With its enormous bargaining power, it could get prices lowered considerably; this is what the governments of other countries do.  But not our government.  The result is that Americans pay more than people elsewhere  for pharmaceuticals, and indeed for almost everything else having to do with health and health care.

One would think that the free marketeers would object.  However, few of them do.  Their faith in markets may be sincere but, for most of them, capitalists’ interests come first.

Therefore, if health care is to become more affordable for some or all people, the risk pool has to be enlarged; there are no other strings to pull.

However expanding the risk pool will not affect the cost of health care itself; at most, it will affect the cost of health care insurance.

Obamacare is therefore not really about health care reform; it is about health insurance reform.  As such, it has decent provisions.  Among other things, it puts a break on the insurance industry’s penchant for selling junk insurance and it makes it illegal for insurers not to sell insurance to people with “pre-existing conditions.”

But will it really lower insurance costs?  The answer is yes, if enough healthy people come into the system.  That is hardly a sure thing, though — even with the subsidies Obamacare offers to lower income people and the fines it levies on those who don’t sign on.

The reason, again, is that, like all insurance, health insurance is a bad bet and, for people who are short on cash and savings, as many young and healthy people are, buying it will often seem like  — and be – an extravagance.

The program will therefore work only if its designers get the carrots and sticks right.

Bipartisan support for free market theology doesn’t help.  It encourages skepticism, if not outright hostility, towards the visible hand of the state; and idolatrous worship of the more debilitating invisible hand of the market.

Nevertheless, Obamacare can probably be made to do what Obama et. al. intend.  It won’t be easy, though; and without competent administrators, it won’t be possible at all.

It would be better, of course, had Obama not jettisoned the so-called public option.   No doubt, it would have come with meager provisions, compared to private insurance plans, because a truly attractive rival would sweep all private options away

Since he and the people around him are eager to keep the money flowing into the plutocrats’ pockets, Obama would never allow that.

Even so, a public option would have some effect in holding down the prices insurance companies charge.  Better yet, its very existence would challenge their stranglehold over the entire health care system.

But thanks to the machinations of the Commander-in-Chief and his trusty aide-de-camp, Rahm Emanuel, we will never know.  Chicago’s loss is the country’s gain, but Hizzoner Emanuel’s legacy lives on.

* * *

If there were anything like a “free” market in health insurance, premiums would be tailored to the circumstances of individual buyers.

This would make health insurance unaffordable to those who need it most, while those who are unlikely to need it would still have to be properly incentivized.  In these circumstances, were health insurance sold at all, it would only be to a small niche market.

This is why health insurance companies have never been permitted to make discriminations based on a host of factors that are actuarily relevant.  In this respect, the Affordable Care Act builds on past practices.

In doing so, it further distances the kind of health insurance market it envisions from the free market theologian’s ideal.  It could hardly be otherwise: markets and health care make for an uncomfortable fit.

Even so, it should be possible to jigger things around well enough to make the system work.  In principle, all that is required is the right mix of subsidies (carrots) and fines (sticks).

Maybe the Affordable Care Act already has those in place.  Maybe the people who designed the program are more competent than the ones who rolled it out.  Time will tell.

If Obamacare succeeds in getting more people insured than now are, it will be a good thing – maybe even good enough to outweigh the ways it further entrenches the power of private insurance companies, Big Pharma and various other health care profiteers.  Time will tell on that as well.

And since there is nothing better in the offing – not with Clinton-Obama Democrats and whacked out Republican-Tea Partiers calling the shots – it is better that the system works than that it does not.

If problems of the kind presaged by the program’s rollout persist, it is doubtful that, in the short run, anything good will come of it.  If Obamacare fails now, it will almost certainly not boost the prospects for wiser alternatives; it will only prolong the status quo.

The irony is that there plainly are wiser alternatives.  The whole world knows what they are.  Before his ambitions got the better of him, even Obama knew.  Maybe in his more lucid or less corrupted moments, he still does.

But, on his orders and with the full cooperation of “moderate” Democrats like Max Baucus, Chairman of the Senate Finance Committee in 2009, single payer or Medicare for all programs were off the table from the beginning.

From even before Day One, it was clear that health care would not become a right; it would remain a commodity that individuals or their insurance companies buy.

Criminal defendants have a right to an attorney; and, as everyone who watches television knows, if they cannot afford one, the state will provide one for them.

It is far from a perfect system; well off defendants with private lawyers usually get better legal representation than defendants who rely on the state.  But there is a floor, and the presumption is that even minimal legal representation is good enough for the right to be more than a sham.

The state provides legal assistance because potential defendants cannot be expected to buy legal insurance — not even if anyone would, or could, sell it to them.  If there is to be a right to an attorney in criminal cases, state provision is the only way.

With health care there are other ways.  Highly regulated, heavily subsidized insurance markets comprised of not-for-profit firms might even be among them.  But any resemblance between that kind of arrangement and Obamacare is strictly coincidental.

Obamacare is not about implementing a universal right to health care.  To its credit, it does aim to insure more people than would be insured in its absence.   It does so, however, with at least as much regard for the interests that feed off accidents, diseases, and chronic ill health as for those who suffer on these accounts.

Is enriching those “stakeholders” its main point?  Or, as Obama apologists insist, was Obamacare fashioned that way in order to buy off the opposition?  The answer is: probably, a little of both.

However that may be, because it is profiteer-friendly by design, Obamacare will not, and cannot, finally put the provision of health care in the United States on as humane and rational a course as it is everywhere else.

And it will do nothing to counter the rise of health care costs.  This is why, in the long run, even if everything goes as well as it can, it may not even lower the cost of health insurance.

It could turn out, in other words, that the Affordable Care Act will ultimately make nothing more affordable.   Whatever his intent, Obama’s use of that word may someday be seen as a cruel joke.

*                                  *

By the early sixteenth century, the idea associated with the Greco-Roman astronomer Ptolemy, according to which the earth is the center of the universe around which the sun and planets revolve, was threatened by an accumulation of discordant evidence.

However Church authorities, their theologians in hand, were eager to retain the idea because it helped sustain Biblical notions; and scientists were loyal to the “paradigm” they knew.  There was therefore massive resistance to changing the prevailing picture of the universe and of the earth’s place within it.

Accordingly, sixteenth and seventeenth century scientists ingeniously revised the Ptolemaic theory – adding on complications, epicycles, with a view to maintaining the doctrine of a stationary earth.

The Polish astronomer Nicolaus Copernicus (1473- 1543) advanced a different idea – that the sun, not the earth, remains stationary.  His view, properly elaborated, accommodated the available evidence with extraordinary elegance and simplicity.

Nevertheless, the “Copernican Revolution” took decades to triumph completely.  When it finally did, it transformed the science of the early modern era.

Even to the extent that these rival paradigms accounted for the same observations and made the same predictions, the Ptolemaic position was a dead-end; the Copernican alternative opened up new vistas.

Everywhere but in the United States, the theory and practice of health care provision underwent a Copernican Revolution in the last century.  The capitalist market paradigm, according to which health care is a commodity, gave way to the idea that health care is a right that governments have an obligation to provide.

Obamacare is a last gasp of the old regime.  Like the Ptolemaic theory, it can probably be made to work for a while longer – provided, of course, that Obama’s functionaries, like rear-guard sixteenth century astronomers, are up to the task.

In view of their incompetence so far, this may not be the case.  We will know before long.

In any event, we can take consolation from the fact that better positions usually do ultimately triumph; that Copernicus’ understanding, not Ptolemy’s, prevailed.

Only in America is the idea that health care is a universal right still considered a radical position.  Elsewhere, it is no longer even associated with the left.  It is just simple common sense.  That is how the Copernican view came to be regarded too – eventually.

Back in 2009, when Obama had political capital to spare, perhaps he could have gotten us there; but, for that, he would have had to be the man many then thought he was.

Instead, he didn’t even try — probably because he is as wedded to the status quo as any other mainstream Democratic or Republican politician.  He squandered a rare historical opportunity.

Still, just as Ptolemaic epicycles are better than sheer ignorance, Obamacare, competently administered, would be better than the status quo.

But the time is past due for a paradigm shift, a Copernican Revolution in health care provision, here in this last bastion of the old regime.

Until this happens, Americans will continue to pay more for less, and many will still be shut out of the system altogether.  Costs too will rise, siphoning off resources that could be put to more constructive uses.

If all goes well, Obamacare will serve as a temporary palliative.  What we need is a cure.

There is one at hand, of course, but we can’t get from here to there without upsetting the plutocrats who hold official Washington in thrall.  Count on Obama to fight against that every inch of the way.

In the final analysis, this is what is wrong with Obamacare.  Like the President himself, it is on their side; not ours.

ANDREW LEVINE is a Senior Scholar at the Institute for Policy Studies, the author most recently of THE AMERICAN IDEOLOGY (Routledge) and POLITICAL KEY WORDS (Blackwell) as well as of many other books and articles in political philosophy. His most recent book is In Bad Faith: What’s Wrong With the Opium of the People. He was a Professor (philosophy) at the University of Wisconsin-Madison and a Research Professor (philosophy) at the University of Maryland-College Park.  He is a contributor to Hopeless: Barack Obama and the Politics of Illusion (AK Press).

“Ambling Toward Oblivion,” graphite, cheap ass ballpoint pen, india ink and watercolor on paper, 18×24. Drawing by Kim Nicolini.

In case you couldn’t tell, this is a drawing I did of Russell Brand. I decided to draw him as part of my Headlines series which I am currently working on.  I seriously didn’t know a damn thing about Brand until he was brought under my radar because of his essay in the October 24 Issue of The New Statesman in which Brand – pop star Katy Perry’s ex-husband, comedian, and “notorious womanizer” – talks about ineffective government,  the silencing and apathy of the disenfranchised, and the need for revolt.

What interested me more than the Brand essay itself was the backlash that Brand and people on the Left who support his political stance received from elite Academic Leftists and insulated politically correct Secular Leftists. In my opinion, Brand stirring the pot of class, activism and political agitation is even more important than the closed circles of self-congratulatory Leftists who purport to be champions of the under and working classes while they have never gotten their hands dirty and refuse to see how class affects real people – not just people who are represented as ideas in books or vehicles for propaganda.

When I announced that I was going to draw Russell Brand, my fifteen year old daughter exclaimed with undisguised disgust: “Why would you draw Russell Brand? He’s horrible!” When I asked her why he was horrible, my daughter said that Brand exploited Katy Perry by posting photos of her on Twitter without her permission. In other words, my high school age kid knew a lot more about Brand than I did, but I quickly did my research. I read his article in the New Statesman, watched his movie Get Me To The Greek, and read his book My Booky Wook: A Memoir of Sex, Drugs, and Stand-Up to get a sense of who this guy is that is getting so much attention. My first assessment is that he is a guy who came from the trenches and fought his way out with his humor and energy. He snubs his nose at the politically correct elite, and in his essay in the New Statesman he provides a voice that people (especially young people) will listen to. No, he’s not going to start a revolution, but he has stirred the pot, and motion is better than stagnancy.

Russell Brand and those who have “taken his side” have gotten a lot of shit. Brand has especially been reamed for taking the stance of the revolutionary while he is living high on the hog in his celebrity and riches. However, it must be noted that Brand himself outwardly critiques his position and asks “Who am I to talk?” Well, he is able to talk for a couple of reasons: 1) as a pop culture icon, his voice will be heard by young people; and 2) he has come from the lower classes himself and knows what that life is like. He is not speaking from theory but from experience. For the record, Russell Brand – asshole, womanizer or not – did not come from privilege. He came from the lower classes and was lucky enough to joke his way out of it. He personally knows the struggles that the underclass face. He knows the streets, the hopelessness, the drugs, the feeling of beaten down and not able to get out.

Let me state something else quite clearly. You cannot erase class no matter how many swank hotel rooms you stay in. Class sticks even if your bank account is lined with greenbacks. I know firsthand how it feels to wear my class like a coat of anxiety. No matter how far you climb on the cultural or economic ladder, if you come from the underclass, you never stop feeling your inferior position. With elitist Leftists slamming you at every turn, the anxiety is amplified to the Nth. Not only do you feel awkward and anxious occupying a strata where you don’t feel you belong, but you get critiqued by people who think they know more about class than you do when you live with the burdens of your class background every day. Class manifests itself in a person’s entire psycho-social biological being, and it is not simply erased because one becomes successful of the surface.

It is clear from reading Brand and watching him in his movie, that he is fully aware of the vulnerability of his position because of his class background, so he exploits his class origins for humor in ways that Leftists often find offensive. (e.g. The “African Child” video in Get Him to the Greek  which is an overt critique of Hollywood centrist leftists like George Clooney, Ben Affleck et al.) Also, Brand isn’t just funny. He is self-reflexive and serious in his humor. He understands how his drug addiction and other “personality flaws” are connected to class, and he uses his experience to formulate his ideas into terms that can connect with those who are “in it” and not just outside observers.

My general position has always been that getting “the masses” to think politically outside the box is a good thing, and popular culture is an effective way to do that. This goes back to my early days with Bad Subjects whose “manifesto” promotes Political Education for Everyday Life. Academic left elitists and closed circles of politically correct secular Leftists only preach to the choir. They rarely accomplish a damn thing except stroking each others’ egos. Regardless of Brand’s celebrity, his words and repurposed Marxism will reach many more people than those Posh Lefties sitting in their ivory towers. I’m a populist at heart, and you aren’t going to reach the populace with a lot of high fallutin’ language and discourse that no one but your elite club can understand. Brand’s writing reads like a pop song with punch that will get people riled and thinking.

The text I included on my drawing is cut-up text from Brand’s New Statesman essay and reads as follows:

Ambling towards oblivion. Whores, virtueless horses and money-grabbing dicklickers. Young people have been marketed without the economic means to participate in the carnival. Apathy is a rational reaction to a system that no longer represents, hears or addresses the vast majority of people. Mechanised indifference and inefficiency. Apathy is the biggest obstacle to change. Zeroes lining up three wide. Planes falling from the sky. This is serious, you cunt. The devil has all the best tunes. No obstacles to the agendas of these slow-thighed beasts. Blithering chimps, in razor-sharp suits, with razor-sharp lines, pimped and crimped by spin doctors and speech-writers. The feeling that you aren’t being heard or seen or represented isn’t psychosis; it’s government policy. (Pieces of Russell Brand, 24 October 2013)

Those words have some bang behind them. Brand is not going to start a revolution, and he openly says as much. However, his language packs revolutionary punch, not unlike the Beat poets but for the new millennium. Speaking out politically in terms that the general populace can understand and relate to has its merits. What good does analyzing Marxist theory in a closed club of Left elitists provide for the general population on the streets? The answer is easy. None. Brand is a pop figure speaking in a language the general population can understand. Regardless of the opinion of well-credentialed Left Elites or the PoshLeft as Mark Fisher (author of Capitalist Realism) refers to them, Brand is not stupid or uninformed. He has done his homework even if it wasn’t in the halls of higher education institutions.  If you read Brand’s essay closely, he’s wielding some pretty straightforward Marxist theory, but it’s packaged like a pop song not a dissertation.

We live in times of great apathy and hopelessness. To quote one of my favorite recent phrases, kids “could give a flying fuck” about a bunch of intellectual snobs citing their source material and stroking each other’s egos while excluding the vast majority of the population from their discussion. For those of us with children, it is very hard to imagine a future for our kids, and very hard for them to imagine one for themselves. Kids are not going to listen to the PoshLeft or aging hippie activists. Sorry, it’s just not going to happen. Idealism is well and fine, but reality is reality. Kids see a big wall of hopelessness facing them down in their future. The voices they are going to listen to aren’t the voices of their parents, intellectual elites, or old school Lefty activists. What will stir them out of their numb hopeless slumber are the voices they are familiar with — the voices of pop culture, voices like Russell Brand, which can have tremendous ability to stir young people out of their state of apathy and into a state of political agitation.

When the PoshLeft isn’t excluding the general population, they get their kicks deriding people like Brand and those who are brave enough to publicly take Brand’s side. People like me, for example. I have no doubt I will come under fire for writing this essay. Maybe Brand has a Messiah Complex. Maybe he is full of shit while he sits in his posh hotel and spouts revolutionary catch phrases, but he is stirring the pot using the everyday language of the streets. Brand agitates, and it’s better to agitate than do nothing at all.

Brand has gotten a lot of shit for being a hypocrite and being a known “womanizer” flying high on his celebrity. But he never denies the hypocritical position he occupies. Brand pokes fun at himself all along the way. When he said that he took the assignment of editor for the New Statesman because “a pretty woman asked me,” clearly he is poking fun at himself and the Left media’s representation of him. It is ludicrous that people take this so seriously. Brand is obviously jibing the politically correct left who want to place everything in terms of race and gender while excluding consideration of class, as if somehow being a white man exempts someone from the underclass. Identity politics are just another form of Left Elitism. So what if Russell Brand likes women? So what if he fucks a new girl every week? Who’s to say they’re not enjoying it to? Sex happens. Focusing on Brand’s sexual activity as a reason to dismiss his overall message about class is just a sign of how identity politics are part and parcel of the problem, not part of the solution.

It’s not just Brand who has been reamed by the Left, Right and everyone in between, but more importantly Leftists who have taken Brand’s side have been put under the gun. It’s not surprising that the PoshLeft are so rigid and judgmental about Brand and anyone who supports Brand’s Brand of politicizing the masses since the PoshLeft is even less tolerant on many levels than the extreme Right. They criticize the Right Wing and they criticize any part of the Left that does not follow the rules of their elite club. As Brand states in his essay, “The right seeks converts and the left seeks traitors. This moral superiority that is peculiar to the left is a great impediment to momentum. It is also a right drag when you’re trying to enjoy a riot.”

I understand what it feels like to be against the wall and under the firing squad of the Posh Left. I am not part of them, nor will I ever be. I don’t fit the mold. Don’t hold the credentials. But I am as much a populist and political champion than the best and worst of the Posh Left. I have lived in the trenches, dug my way out, did my “book learning,” and helped a whole hell of a lot of underclass disenfranchised people in the process. I have been very “lucky” to gain some cultural capital that has put me on the map in some capacity. My writing has been published in books and journals internationally. I have articles in academic presses. I have been blessed by recognition for what I do by many people.

But being “under the radar” of the Left Elite (whether secular or academic) comes with a great deal of stress and tension. Class is hardwired into you. It doesn’t go away just because you transcend your origins. You don’t fit in with the people you came from, nor do you fit in with the place you occupy now. There is a constant sense of inferiority that can lead to actual physical anxiety, headaches, and nausea. Class is embodied, and it does not just leave the body because you publish a few articles. In fact, class tension is only amplified.  I am much more anxious and unnerved by The Left than I am by The Right as I frequently feel literally tied in knots being under their scrutiny.

I have had to develop a pretty thick skin writing for CounterPunch. While the very large majority of the readers support my work for which I am grateful, there are always those left elitists who feel the need to “set me straight.” It’s funny how many of them feel compelled to sign their name with a “Dr” or “PhD” and include their academic position, just so they’re sure I understand that they are somehow more equipped to pontificate on class than I am. Who am I? I woman with an eighth grade education, who spent her teen years getting a “street education” and who eventually got a B.A. from UC Berkeley through sheer will and the strength to fight that I learned from my working class origins. Still, I have spent my whole adult life working day jobs to make ends meet while squeezing some writing out in between. Where are these academic leftists real life class credentials, the ones they got from life in the trenches and not the classroom?

I am the daughter of an ironworker, a child of the blue collar working class, yet these “class theorists” – the academic Left elites and their secular equivalents –  somehow think that they understand class so much more than me or Russell Brand, because they have the credentials. Well they don’t understand. Their exclusionary practices make me feel sick, furious, and invisible all at once. The Left Elite is a society of privilege. They have had their way paved and paid, and their self-righteous approach to class doesn’t benefit anyone but themselves.

I guess I am lucky that my working class origins instilled in me an urgency to produce work as a way of surviving and not failing or falling back into the hole I climbed out of. I would guess that Russell Brand feels somewhat of the same pressure which is why he was able to “get out.”  The pressure of our class origins doesn’t go away. I’m no Russell Brand, but my hard work writing and producing for all these years has given me some public presence as a writer and a thinker who has gotten some recognition from the Left. Interestingly this recognition and acknowledgment comes double-edged. On the one hand, I feel empowered that my hard work has given me a voice that people listen to. On the other, I constantly scrutinized by the Elite Left, and I feel self-doubt and “marked” by the class I came from despite what cultural capital I have attained.

Interestingly, Russell Brand’s essay and the debates that arose from it inspired me to embrace my own voice and feel empowered by my ability to have faith in myself, rise up and say “Fuck you oppressors!” And I’m not talking about the oppressors from the Right, but the Left Elitists who think they are the only ones who have a right to talk about class. I’m here to inform you that they are not. Russell Brand came from the lower classes, and fought his way out with a sense of humor. Even if he is rich and famous now, he has just as much right to talk about class as anyone else. And so do I. His words matter because they are words that people can understand. So are mine. Use the language of the people to speak to the people. Use pop culture to change culture. Fuck fear inspired by class. Fuck fear of failure. Fuck those who sit in their insulated clubs of privilege and criticize for the sake of criticizing.  Russell Brand’s words are as valid as the next guy’s. They’ve got the street cred, book cred, and writing cred to go with them. And so do mine.

Kim Nicolini is an artist, poet and cultural critic living in Tucson, Arizona. Her writing has appeared in Bad Subjects, Punk Planet, Souciant, La Furia Umana, and The Berkeley Poetry Review. She recently published her first book, Mapping the Inside Out, in conjunction with a solo gallery show by the same name. She can be reached at knicolini@gmail.com.

By Oleg Artyukov