Crowdfunding As Socialized Healthcare

Charity, ostensibly a central moral and social American institution, is alive and flourishing–online, on crowdfunding sites, as thousands and thousands of perfect strangers and sometimes acquaintances and friends and family, line up to donate to the latest plea for help. (Perhaps someone needs a vital organ transplant, extended chemotherapy and radiation, or a new, life-saving alternative therapy; or perhaps, like most Americans, they went into a hospital hoping to emerge healthier, and instead, found themselves facing a foreclosure-inducing medical bill.) As Bloomberg reports in an article unironically titled ‘America’s Healthcare Crisis Is a Gold Mine For Crowdfunding–later changed to ‘American Health Care Tragedies Are Taking Over Crowdfunding’:

Crowdfunding platforms such as GoFundMe and YouCaring have turned sympathy for Americans drowning in medical expenses into a cottage industry….Business is already booming, and its leaders expect the rapid growth to continue no matter what happens on the Hill. “Whether it’s Obamacare or Trumpcare, the weight of health-care costs on consumers will only increase,” said Dan Saper, chief executive officer of YouCaring. “It will drive more people to try and figure out how to pay health-care needs, and crowdfunding is in its early days as a way to help those people.”


Growth has been rapid….one million campaigns set up over the previous year had raised $1 billion from nearly 12 million donors. By February 2016, the total was $2 billion. In October 2016, it was $3 billion, from 25 million donors….GoFundMe had indicated that $930 million of the $2 billion raised in the period the study analyzed was from medical campaigns….medical fundraisers made up 70 percent of GiveForward’s campaigns. The combined companies have 8 million donors who have contributed $800 million to a wide range of campaigns. A big part…was donated to medical campaigns…It was approaching 50 percent of all fundraisers at YouCaring before the acquisition, and the growth rate is set to triple this year.

Indeed, no matter what the flavor of the current healthcare system, it will not take care of most Americans, and neither will it do anything to drive down the rising costs of healthcare. Short of progressive taxation, a national single-payer system, and extensive structural reform to bring the American healthcare system into line with the ‘best practices’–both financial and clinical–of the best national healthcare systems in the world, Americans look destined to continue pay the highest rates for healthcare in the world, while receiving outcomes that can be described, at best, as ‘mediocre.’ In these conditions, the success of crowdfunding campaigns is entirely unexpected and unsurprising; ‘look to private resources’ is the fairly explicit message of the current healthcare system, and it is there that Americans have turned. ‘Private resources’ are normally taken to mean financial support from family; Americans seem to have found a much larger family of sorts; a blessing of a kind, one supposes.

But mostly, reactions to this state of affairs can hardly afford to be sanguine. Such methods of paying for healthcare costs suffer from too much contingency; some campaigns succeed, yet others fail. Perhaps your pitch was not ‘moving’ enough; perhaps you did not include the right pictures of cute families; perhaps potential donors were financially exhausted. The health of the citizens of any country, let alone one with pretensions to greatness, should not be riven by so much uncertainty, so much dependence on the unpredictable largesse of others.

Talking Philosophy With Kids At The Brooklyn Public Library

This Sunday afternoon at 4PM, I will be participating in a Philosophy for Kids event at the Grand Army Plaza branch of the Brooklyn Public Library (in the Info Commons Lab); the event is sponsored by the Cultural Services Office of the French Embassy. I’ll be functioning as a kind of Philosophical Advice Columnist taking on, and considering, the following question with an audience made up of six to twelve-year old youngsters):

A friend of mine has a three-year old daughter. Every piece of clothing he buys her is pink and floral. Every toy is a doll or makeup kit. He’s already started joking about how she won’t be allowed to have a boyfriend until she’s 30. This all makes me incredibly uncomfortable, but I don’t know whether I’d be crossing a line if I said something. Can I let him know how I feel?

After I posted this announcement on my Facebook page, a friend asked the following question–in what seems a rather irate tone of voice:

The bigger question is why someone should think that they have a right to even think about how someone else is raising their children in the first place, let alone believe that have a right to interfere.

This is a very good question. The straightforward response to it is that because we live in a community, a society, our actions always carry the possibility of bearing on the welfare of others, no matter how self-directed or ‘personal’ they might seem; it is a libertarian and liberal fantasy to imagine that we are isolated islands in the social sea; we are caught up, inextricably, in the lives of others, and they in ours. A family bringing up their child in a sexist or racist environment is raising someone who might very well inculcate those pernicious doctrines and then act on them–to the detriment of someone else’s child. We form political communities directed toward the common good, even as we strive to maximize our individual welfare; the challenge of figuring out how individual freedoms and self-determination can be safeguarded and enhanced while ensuring the rights of others are not infringed on is a central challenge to political and moral philosophy.

To make this discussion a little more personal: I’m the father of a four-year old daughter, and I try my best to bring her up as well as I can to prepare her for the challenges that will undoubtedly confront her in a patriarchal society. My task would be made incomparably easier if the parents of male offspring brought up their children to be sensitive to such considerations as well; it undoubtedly takes a village to raise a child.

This afternoon, I will not pretend the question raised above has a straightforward answer, and will not attempt to provide one to my ‘discussion group’; instead, I will try to draw out some of the central issues involved, perhaps by engaging in some level of abstraction so that the general form of this particular query can be exposed, and the difficulties of answering it can be confronted directly. I’m looking forward to it.

The ‘Hire-And-Fire’ Fantasy Of The Libertarian

A central plank of libertarian (and neoliberal and conservative) opposition to organized labor, to collective bargaining, to workers acting collectively is something I term the ‘hire-and-fire fantasy’: that employers should be able to initiate and terminate their employees’ employment at will. (This power would presumably be written into the contracts they sign with their workers.) Let bosses hire and fire as they please; they know best how to run the company. At this stage, a few anecdotes about the onerous bureaucratic delays involved in getting rid of a spectacularly incompetent worker are introduced: terrible tales of how disgruntled employers were made to run from pillar to post, all in effort to take the most obvious of decisions, the taking out of the trash. Unionized workers it seems, are complacent and lazy; they know they cannot be fired; they do not work as hard as those who know the boss can, you guessed it, hire and fire them at will. The union, the workers’ collective, then stands exposed as sand in the wheel; it appears as a burden, a terrible economic and performative inefficiency getting in the way of the smooth deployment of ‘human resources.’

The problem with this argument–and it is a familiar one–is that it compares the worst of the unionized workplace with the best of the non-unionized workplace. In the former, the incompetent worker is protected by a venal union, even as an exasperated boss, who only wants to get the job done as expeditiously as possible, tears out his hair; in the latter, the same virtuous boss is able to summon the incompetent worker to his office, summarily dismiss him or her, and then get back to work. All virtue resides in the employer; the union and the worker are only imbued with sloth and insufficient motivation. This argument does not, of course, bother to examine the situation created by an incompetent boss who decides to peremptorily dismiss a blameless worker, perhaps one with a long and distinguished service record, on arbitrary and trivial grounds (perhaps a secretary did not smile broadly enough, perhaps a junior pointed out an embarrassing blunder in the boss’ presentation, pricking a thin patina of pride; the list goes on.) There is no court of appeal; there is no redressal possible; here is a paycheck for two weeks; clean your desk, and then the security guard will escort you to the elevators. Here is arbitrary and opaque power indeed; the boss can act, but the worker may not. (On the many occasions that I’ve discussed this argument with my students, there are those who will enthusiastically back the ‘hire-and-fire’ claim till I point out to them just how arbitrarily that power may be exercised by employers; then, expressions of dismay set in; I suspect the situation they had in mind was the one I described first above.)

The union’s contracts for its members seek to put in place a procedure for investigation of complaints, for workers to be granted the privilege of answering charges laid against them; they seek to shield the worker from the most arbitrary exercises of the boss’ undoubted power. The stakes are high; the worker’s livelihood is at stake. The power of the employer (sometimes a corporation) is always greater than that of the worker; collective bargaining and action and worker-protective contracts aim to address this imbalance. Those who criticize the worker’s collective body, accuse it of wielding too much power, both recognize and fail to recognize power: they notice that the workers united, cannot be defeated, but they fail to acknowledge the power the boss may wield over his employee. This blindness is not accidental; it is ideological, for its true motive is not the protection of the economic efficiency of the workplace–arbitrarily firing competent workers can very often be economically counterproductive–but the power of the boss, the maintenance of a very particular hierarchy, one that allows for certain pleasures only to be found in subjugation and the exercise of one’s will over another.

Groundhog Day: The US Government Shutdown Version

One of the most bizarrely naïve expressions of hope in the aftermath of the 2013 US Government Shutdown Fiasco has been a variant of ‘perhaps the Republican Party’s extremist faction will learn from this crushing public relations defeat–as evinced by opinion polls and the public statements of their fellow party members–and not engage in similar brinkmanship again.’

This is naive because as the 81-18 and 288-144 vote margins in the Senate and House of Representatives reveal, eighteen Senators–supposedly the Wise Old Men of the American Polity[tm]–and, count ’em, one hundred and forty-four Congressfolks, not the supposed Gang of Forty, did not think, even on October 16th, two weeks deep into a cripplingly expensive shutdown of the federal government, that the Senate bill to resolve the standoff was worth signing.

To be sure, they might not have thought their votes were actually going to derail the passing of the bill, and were instead intended as signals to their constituencies that they intend to continue fighting the good fight, but that fact does not provide any reassurance. If their constituents need such mollifying even in the face of overwhelming evidence that their representatives in Washington had engaged in catastrophically irresponsible behavior damaging to the US economy and the practice of legislative politics,  then there is good reason to believe they will need similar coddling the next time budgetary negotiations take place. Which is not a year or even six months away, but right around the corner in the new year.

What seems to have forgotten in the rush to castigate the Gang of Forty and John Boehner–who seems to be early frontrunner for the title of the Most Incompetent and Cowardly Speaker of the Twenty First Century–as reckless extremists is that these folks are merely doing the bidding of those ballot box battlers who believe a Muslim lives in the White House, who consider federal employees parasites, who regard every branch of the government as a force of active oppression, and some of whose members who, at their most ‘intellectual’ moments, proudly proclaim themselves to be infected by an incoherent political philosophy which I will term ‘American libertarianism’. (This ahistorical and intellectually vapid brand of political hogwash, which possesses no discernibly meaningful conception of power as far as I can see, is alarmingly popular in many reaches of American life.)

Such an electoral constituency will have learned no lessons from the disaster that has been temporarily halted last night. Instead, I presume, a fresh batch of half-baked conspiracy theories will be making the rounds, explaining the capitulation by the Republican Party as a strategic and tactical regrouping, an opportunity for the mustering of forces, just in time for the next assaults. Like hostage-takers everywhere, their elected representatives will have appreciated the extensive media coverage and the attention paid to their pathetic rodomontade.

They are, I can assure you, already looking forward to the next showdown, prepared to dig in even deeper, eagerly awaiting that drive off the cliff edge so that they can proceed–and take us all with them–to their version of the inhabited-by-seventy-two-houris-paradise that they think awaits them.

Pistol-Packin’ Professor: A Day in the Life

In honor of those–like libertarian law professors, the last defenders of the faith–who have attempted to point out the silliness of keeping faculty unarmed in our school’s classrooms, I offer these recollections of a day in the life:

The alarm went off at 6. I sat up, swung my legs off the bed, and reached for the Glock 30 SF. There it lay, cold, implacable, loaded, right next to the stack of unread New York and London Reviews of Books. I tucked the cold steel into my pajama pocket and rose. It was time to get cracking. Brooklyn lay outside. And a full day of walking on its mean streets, lecturing in its even meaner lecture halls, and worst of all, meetings with fractious faculty, awaited.

After I had showered and shaved, the Glock visible and within reach at all times (getting jumped while I was all soaped up and vulnerable in the shower had never appealed to me), I changed into my work clothes. As always, my holster went on quickly, and I packed two spare clips of ammunition into my jacket’s roomy pockets. (I had these enlarged for easy access to the clips in case of an extended gun battle.)

Emerging from my building, I quickly checked the streets, scanning left and right, looking for concealed shooters, ready to roll to the curb and squeeze off a quick covering volley of fire if needed. All was quiet. A few schoolkids walked past and I kept them visible in case any of them reached into their backpacks. Crossing Coney Island Avenue required similar caution; the Pakistani bodega owners could never be trusted not to reach for the AK-47s that are  so common back in their land.

I arrived at the campus in time for my class. The students filed in, shuffling past me with that usual mix of insolence and boredom manifest, as I kept a wary eye on them. As always, I had the clear angles of fire for the lecture hall worked out. Contingency plans at the back of my mind, I began the class. As I paced up and down, I kept one hand on the Glock, feeling its heft even as I evaluated argument after argument. It was oddly reassuring, letting me know that not even a fallacy or two could diminish its ability to bust a cap in some philosophy major’s ass. (Only in self-defense.)

The afternoon faculty meeting went off without incident. I kept the Glock on the table in front of me in case any of the usual objections over curricular changes needed speedy resolution. I kept my chair pushed back just a little, so that I could spring to my feet, squeeze off a round or two before executing the classic ‘roll-and-rock-upright’ move into a more favorable shooting position. Thankfully, the votes went off without incident, though I had my eyes on the beady-eyed Continental type in the back. I got your Nietzsche right here, pal. This one will kill ya; it won’t make you stronger.

As evening fell, the winds sharpened, and darkness closed in, I packed up, locked the office, and headed out for the walk back home. Every day called for the same challenge: negotiating dozens of traffic crossings on the walk back home, as cars loaded with potential shooters pulled up next to me, and hooded teenagers strolled past, their baggy pants bulging suspiciously.

And then, I was home. I sprinted up the stairs, avoiding the confinement of the elevator (those kinds of enclosed spaces aren’t conducive to the quick draw), and moved into the apartment. After checking all the rooms, it was time for dinner. I ate, as I always did: the Glock next to the salad, my chair well away and out of line with the windows.

And then, time for bed, and the necessary letting down of the guard for some shut-eye. I checked to make sure the Glock was in its place, and went through my usual bedtime ritual: the quick roll-out of bed, the taking of cover next to the dehumidifier, the clip reload with the lights off.

Finally, lights out. I drifted off, as the glowing green light of the clock-radio threw into sharp relief the metallic outlines of the SF, my companion and keeper, my torch, my flame, my lodestar.

Bosses Call For Mass Harakiri In Event of Obama Victory

In what some election observers are terming an ‘extreme, possibly misguided–and certainly un-American in its excessive Japaneseness–response’ to the US Supreme Court’s Citizens’ United decision freeing companies from restrictions on using corporate funds to endorse and campaign for political candidates, several large American employers have called for mass, public harakiri in the event that Barack Obama wins the US presidential election on November 6th.

Major companies–including Fox News, Coors Breweries, and various NASCAR sponsors–have sent detailed letters and information packets to their employees explicitly recommending that employees, as one letter put it, ‘not just off themselves but do it in a way that sends a message to future generations.’ Some employers have rejected criticisms of these letters as ‘unfair and imbalanced.’ A senior executive at Fox News said:

If Barack wins, the economy will crash, new taxes will be levied, our children will be forced into labor camps, we will be forced to grow beards and memorize the Koran. Life as we know it will be over and certainly not worth living anymore. Our employees have a choice between being forced into humiliating subjugation, or doing what a true warrior would do under the circumstances, namely, kill themselves before Death Panels decimate them and their families. We intend to facilitate and encourage such behavior. There is no coercion here.

A letter sent by Fox News to their employees included explicit instructions:

In event of Barack Obama being elected on November 6th, we call on our employees to gather in the company parking lot on the morning of November 7th (Pearl Harbor Day Minus Thirty) and disembowel themselves with stainless steel katana swords supplied by management. We will pair off employees–into samurai and kaishakunin–based on lots drawn by their group managers. After the ‘samurai’ has disemboweled himself, his kaishakunin will carry out the decapitation. The kaishakunins will be dispatched by special Corporate Disposition Matrix Squads. The parking lot will be cleaned up by groups of Hyatt Hotel housekeepers prior to their deportation.

While some employees found the call for mass seppuku ‘a little over the top’ and an ‘over-reaction,’ others were entirely unsurprised. A foreman at Coors Breweries said, ‘They get our Facebook, Twitter, Pinterest and FourSquare passwords before hiring, make us piss in bottles and take hair samples to test for drugs, scan our emails, search our hard drives, regulate our toilet and meal breaks, tell us what clothes to wear, make us attend–and bring our children to–company picnics, specify when we have to come in to work, when we can leave, and how long we have to work on weekends and national holidays, so it makes eminent sense that they should be able to tell us when our time on this planet is up, when our lives aren’t worth living. A job  is a cradle to grave kind of thing, and the bosses knows best. People who don’t like it always have the option to exit the labor market.’

Gary Johnson, the US Libertarian Party candidate for president, said he was pleased the US government had not attempted to intervene in ‘what is essentially a workplace issue.’

Richard Epstein’s Overdetermined Critique of the Roberts Ruling

Richard Epstein offers an interesting critique–based on the alleged inseparability of the power to regulate commerce and the power to tax–of John Roberts’ ruling in the ACA case. If it’s not an activity the government can regulate, then it’s not something the government can tax either. Thus, Justice Roberts should have struck down the individual mandate:

As a matter of constitutional text, legal history and logic, the power to regulate commerce and the power to tax should not be separated. It is not good for the court or the country that the chief justice’s position in such an important case is confused at its core.

Epstein finds ample precedent for his understanding of the inseparability of the power to regulate and the power to tax:

In the Child Labor Tax case of 1922, the Supreme Court refused to uphold a tax equal to 10 percent of the net profits of any firm that shipped goods into interstate commerce if the firm used child labor anywhere in its plants. Chief Justice William Howard Taft noted that…Hammer v. Dagenhart (1918) forbade Congress to use its commerce power to prohibit outright the shipment of ordinary goods across state lines because they were made in factories that used child labor. A heavy tax…could not be used to mount an end run around this constitutional obstacle to its own power.

The same point was reinforced in 1936 in United States v. Butler, which struck down a tax on agricultural commodities because it sought to achieve the then unconstitutional regulatory aim of reducing the total acreage in agricultural production. After the 1942 case Wickard v. Filburn, when the Commerce Clause was held to permit such regulation, the tax became just as permissible as direct regulation. Wickard expanded the scope of federal power, but it did nothing to upset the constitutional parity between the taxing and commerce powers.

So Epstein only needs the inseparability doctrine for his argument to work. For having found the activity in question–non-participation in the healthcare market–was not something the government could regulate via the Commerce clause, then it failed to be an activity the government could tax either.

But Epstein seems to also think that the tax argument fails on its own merits. For he offers us an ‘originalist’ reading of the relevant Constitutional clause:

By giving Congress independent powers over taxation and other revenue sources, the Constitution ended that dependency. But as a quid pro quo, the Constitution also restricted the use of these revenues to classical public goods — benefits that must be given to all citizens, if given to any — like paying off national debts and paying for the nation’s defense. General welfare, mentioned in parallel with these two phrases, is best read as covering only matters that advance the welfare of the United States as a whole. The redistribution of income, or “transfer payments” among citizens, like those mandated under the Affordable Care Act, doesn’t qualify for taxation in this originalist reading of the Constitution.

This is a curious business now. Remember, this supposedly optimal reading is not required for Epstein’s argument to work. It does however, let him deploy some additional ideological machinery.  It suggests that ‘healthcare’ is not a ‘classical public good’ like the payment of national debts or the budgetary requirements of national defense.  It suggests that ‘healthcare’ cannot thus, be understood as ‘general welfare,’ which rather is to be understood in more abstract terms as that which might benefit the nation–but presumably, not its people–‘as a whole.’ (Note that provisions for healthcare are defined as ‘redistribution of income’–the horror!)

The real problem, it emerges, is not the separation of the powers to regulate and tax for which, in fact, there is a great deal of precedent; witness, for instance, the greater reliance on taxation, as opposed to direct regulation, of alcohol and tobacco consumption. The substantive issue for Epstein is that Roberts has suggested that ‘healthcare’ might have something to do with ‘public goods,’ with ‘general welfare.’ In short, it might be a business that government could concern itself with.