An idolatry is growing in the land and it could destroy our health. Idolatry is the worship of earthly things as though they were gods. In our case, the idol is the human idea of the sanctity of private markets. Evidence of this idolatry abounds in statements and images: “the invisible hand of the market”, “the magic of the market”, “the market is a bull”, “the market is nervous” or “exuberant” or “relieved.” Well-funded market missionaries use mass media, advertising, think tanks and, now, full-blown university programs to evangelize, to share their “faith in the market” and exhort us all to believe. The market’s high priests, the business news commentators, explain to us what the market is saying. We hang on their words because we are told that our well-being depends on it. This gleaming golden calf is compelling indeed.
But the “free” market is not a god to be worshipped. It is a tool which uses the supply-demand dynamic to allocate resources. It can be a useful tool. It has been used to accelerate economic growth and expand certain freedoms for many people. But it is only a tool. It must be harnessed and used in conjunction with other tools for the common good. Just as we need more than a power saw to build a house, we need more than private markets to uplift and strengthen our communities. Other essential tools include volunteerism, philanthropy, churches and other non-profits and democratic government. All are important. All involve human beings, so no tool is perfect. Yet, we are asked to believe that the market can do no wrong, that it is practically a sin to use the tool of our democratic government to regulate the market and provide health care for our community.
Due to the propaganda barrage promoting private markets as the solution, most Americans would never guess that Medicaid costs per beneficiary are much lower than for private insurance. Nor would they know that Medicaid cost growth is slower than that for private employer coverage. There is no evidence that relying more on deregulated private markets and less on government will move us closer to adequate health care for everyone. Yet, instead of evidence, the mantra of private market beneficence is continuously intoned.
The idea of private markets as idols is not new. Popes John Paul II and Benedict XVI, theologians Harvey Cox and Jim Wallis (evangelical) and others have warned about it. Currently, the struggle over our approach to health care illustrates more than ever the consequences of our idolatry and the stakes for society.
For our health care system, the United States already relies on the operation of private markets and profit-driven entities more than other developed countries. Yet, our health-care outcomes are among the worst and our costs are the highest by far. Now is not the time to compound these problems by cutting government programs and increasing our reliance on private markets. Yet, in repealing and replacing the Affordable Care Act and ending Medicaid as we know it, that is precisely what the proposed House and Senate bills will do.
On the altar of private markets we are being asked to sacrifice the health, security, wellbeing, and in many cases, the lives of “the least of these”: medically fragile children, children and adults with disabilities, pregnant women, low-income children, many millions of families who will lose much or all of the subsidy they receive for the purchase of health insurance, and many others. Over a short time period, all of these groups will or could have their access to health care reduced or eliminated. I say “will or could” because by severely limiting the funding available for health care, the system would be structured to force states to ration services. Thus, in each state the groups currently receiving benefits would be pitted against each other as they scramble to retain benefits. This hardly moves us toward the beloved community.
The proposed changes will hit older adults with particular force. In essence, the proposals would impose on age tax on those ages 50-64 by letting insurance companies charge five times more to cover older adults than younger adults on the individual market. Moreover, states would be able to let insurance companies charge much higher rates to people with pre-existing conditions. All of this will dramatically increase the cost of coverage and thus make it less available for older adults. Reaching the Medicare age of 65 might not save them. To add insult to injury, the bills would hasten the insolvency of the Medicare Hospital Insurance Trust Fund, by repealing the 0.9 percent payroll tax placed on persons with very high incomes.
Additionally, many middle-class families have spent down their resources to pay for expensive longterm care and now rely on Medicaid for home and community based services or nursing home care. These services are at risk. Home and community based services help people stay out of nursing homes. They are cost-effective and humane. The proposed replacement would eliminate current incentives for states to provide such programs. Moreover, because they are labeled “optional” to the states, these services would be the first to be cut as funding to the states is squeezed.
To what end would this massive sacrifice and tearing of the social fabric be made? Hidden behind, but inseparable from homage to the private markets idol is the real purpose: tax cuts for the very wealthy, hundreds of billions of dollars to be extracted from health care to further enrich those who already benefit inordinately from the workings of the private markets. Special interests hope that our attention will be diverted from that glaring fact by the empty mantra that the market will provide. It’ won’t provide. If we fall for that empty slogan, we will suffer greatly the wages of our idolatry.