Thursday, July 5, 2012

Why Liberals Like ObamaCare

Last week I picked up a copy of James C. Scott's Seeing Like a State on my way from Seattle to Ashland, Oregon.  It had been on my Amazon Wish List and so when I went into Powell's I was looking for it.

But how had it got on my Wish List?  I checked and I see it's because I read a piece by Jonah Goldberg back in April.  Now that I have read it, I can say that, like Jonah, Seeing Like a State has "left a lasting impression on me."

Let's have Jonah tell the story.
If there were one thing I could impress upon people about the nature of the state, it’s that governments by their very nature want to make their citizens “legible.”...

The premodern state was “blind” to its subjects. But the modern state was determined first to see them, and then organize them.
Sound familiar?  This legibility project involved a host of efforts, from mandatory surnames to changing land tenure from communal to freehold.  Why?  Because a person with a surname is easier to find.  A freehold is easier to tax than a village with a word-of-mouth understanding of who owns what and why.

At a basic level, the state need to be able to "see" its subjects in order to tax them and conscript them.  An Asian state with rice cultivation needs to identify and control the people working in the paddy fields.  A modern industrial state needs to know all about its economy so that it knows how much it can spend on buying peoples' votes, or how much national debt it can afford.

There is no end to this.  The state pretty soon decides it needs to run the education system so it can generate productive workers--and also make sure that they learn the right history.  It decides that it needs to vaccinate to control infectious diseases and know who has and who hasn't been vaccinated.  From there, it decides it needs to provide basic health care to keep its workforce (and possible soldiers) strong and healthy.

Pretty soon you get to Obamacare where the government wants to monitor and control everything about healthcare.  Here's what is in store for doctors under ObamaCare according to Daniel Henninger.
[It's the] Physician Quality Reporting System (PQRS), lodged in the Centers for Medicare and Medicaid.

Here's the Centers' own description of what PQRS does: "The program provides an incentive payment to practices with eligible professionals (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]) who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS)."
See what is going on?  The physicians will be required to report their activities to the government so the government can figure out what is going on in healthcare--make it "legible"--and control it.

It is exactly as Scott writes in Seeing Like a State.  In Scott's view, the way this government imperative works in the modern state is that it wants to reduce everything to a rational system, like mass production in the industrial corporation.  Only, of course, these days the huge bureaucratic corporation is going out of style.  People talk of rapid-response, flexibility, print-on-demand, etc.  And there is F.A. Hayek who argued that big bureaucracy was inherently flawed because it could not know as much as thousands of workers or millions of consumers.

If the government is not to be all-seeing and all-powerful, then we need to restrict its right to know everything about us.  Our liberal friends talk a lot about "privacy," but they usually restrict it to sexual and political matters.  They don't want the government to know what they are doing in the bedroom or in the activist group.

But liberals don't care about privacy in economic matters.  That's why they support massive centralized systems to control pensions, healthcare, education, and welfare.  That's because liberals are the modern ruling class and that makes them "see like a state."

When conservatives call for strengthening civil society they are calling for reducing the legibility and visibility of individual citizens.  That's why Berger and Neuhaus wrote about "mediating structures" to shelter individuals from the "megastructures."   All they are proposing is to restore the protections that village communes and medieval guilds used to provide.  But the modern state did away with the old mediating structures precisely because they prevented the central government from knowing about individuals and controlling them.

Of course, the horse has left the barn on that, centuries ago.  But it is clear that individuals need to be protected from the power of the state.  What other way is there than a civil society that restricts the visibility of the individual to the state and restricts state control?

We also need to see that the market reduces the need for the state to make the individual visible and legible, because the market economy is a system where economic actors produce and serve and buy and sell.  We don't need to see inside the head of a trader, and we don't need to see inside the boundaries of a corporation.  We just need to be able to trust them.  In the market economy it is perfectly OK to have companies and corporations that throw a veil over many of their internal activities.  But certain facts need to be public, such as income, equity, debt, etc.

Back in the Soviet Union they pretty well destroyed the Russian peasant world in a crazed effort to make it organized and visible and to tax it with grain seizures to pay for its forced industrialization.  But many social activities just cannot flourish if they are organized like a bureaucracy and simplified down to one-size-fits-all.

If we learned anything from the Soviet Union it is that an individual that is completely visible to the state is an individual that is completely in the power of the state.

Conservatives have the answer, of course.  It is that the government welfare state should be broken up and returned to civil society institutions.  Government really shouldn't do anything unless it absolutely requires force: national defense and internal policing.  And when it sticks to that it doesn't need complete visibility and legibility, to know everything about every single individual.

The problem is how to persuade the American people, especially those hooked on "free stuff."  Which is just about all of us.

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