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Commentary :: Health Care
Governing against the People
The dream of 1989 that democracy and capitalism can be reconciled fades.. Elected governments orient their decisions in the interests of trans-national groups and global finance markets.
GOVERNING AGAINST THE PEOPLE
By Friedhelm Hengsbach
[This article published in: Frankfurter Rundschau, 10/28/2006 is translated from the German on the World Wide Web, . Friedhelm Hengsbach is the director of the Brunning research institute.]
200,000 dependent employees took to the streets in 5 cities to protest the growing poverty risk, the increasingly shaky working conditions and the political deformation of solidarity by the rulers. Their reaction mirrored a well-known pattern: there is no alternative to this policy. It is right and just. We have to explain it better to the people.
Does the black-red coalition govern against the people? Does it confirm the explosive word “post-democracy” used by political intellectuals?
“Post-democracy” is a code word for scattered perceptions. The dream of 1989 that democracy and capitalism can be reconciled fades. More and more citizens stay away from the elections. Elected governments cut rights of participation and freedom of the sovereign. Parts of their mandate are stored in commissions and experts as well as supra- and international organs. Their decisions are oriented in the interests of transnational groups and global finance markets. They act as “territorial entrepreneurs” called to make their own people fit for the global competition and urge and promote the output of a weakly motivated population without orientation. Women’s policy and family policy are connected to a population policy for producing more talented efficient children.
The emphasis on “post-democracy” in the political careers of Tony Blair and Gerhard Schroeder shows how a democratic spectacle can be staged in the media. However its analytical weight and normative power deserve criticism.
Firstly, the simplistic juxtaposition of direct rights of participation and representative procedures sounds romantically idealized. Majorities that come about at pleasure are not the people. Currents of public opinion foaming with rage are not the common interest. Professional analyses of functioning economic rules and feedback could reveal the unintended repercussions of political decisions.
Secondly, the powerlessness of national state organs in relation to the corporations and financial markets is not as true as it is often claimed. Actors and addressants of global competition are businesses, not states. Germany and France do not compete with one another like VW and Peugeot. Their choice of location is oriented more in market conditions than tax rates, wages and fees…
Thirdly, democracy is not a value-neutral subject. Whoever recognizes human rights grants a preferential place to democratic forms of rule and life. Therefore conflicts between social movements and the governing are necessary for a fair distribution of economic wealth and appropriate participation in economic decisions.
COMPETITIVE FEVER
By Friedhelm Hengsbach
[This article published in: Frankfurter Rundschau is translated from the German on the World Wide Web, .]
Twenty years ago a respected economist and financial manager from Frankfurt claimed the same laws were in force for the labor market as for flowerpots, oranges or aluminum scrap. Labor is only purchased by businesses when its value is higher than its price. This is not degrading since people fall out the window with the same velocity as flowerpots.
In the meantime, the public debate has changed from labor to health care. “More market in the public health system” mutates patients into come-of-age customers. Market radicals classify the need to be healthy in the scale of their needs, calculate rational costs and benefits of a medical treatment and determine autonomously what share of disposable income they spend for food, industrial goods and public health services. The sickness risk is estimated like the risk of an auto accident.
“More competition in the public health system” has become an appeal to hospitals, nursing institutions and treasuries. These institutions should get an unmistakable profile and compete for additional markets and customers. An administrative agency should force actors and institutions to adjust the costs of individual therapy to precisely defined treatment goals. Standardized diagnoses and therapies should make the decisions of the actors transparent. The expert competence of doctors should give way to a corporate economic management.
However the asset health hardly suits the current market- and competition games. Firstly, health is not an asset like many others. The modern enlightened person deals very irrationally with his health because it directly concerns his person. Being sick can be experienced as a brutal crash and existential threat through which balanced ways of life are completely impossible. The normal person underrates health as long as he or she is healthy and overrates it as soon as sickness strikes.
Secondly, the asset health belongs in the series of trusted goods. An unequal relation of competence and information exists between those offering this good and those demanding it. In a democratic society, a proper provision with health goods should be guaranteed independent of income and performance.
Thirdly, the ostensible health market is an extremely politically charged market. The competition between medical and therapeutic institutions can degenerate when the distribution of profitable risks is fought over, not better services or cost pressure is shifted to workers. The quality of personal services performed and judged according to the standard of industrial productivity has disastrous consequences. Hospitals and nursing stations are not homogeneous suppliers of goods any more than the insured are exchangeable customers with the same risks. The current wrangling over structural equalization of risks that must be continually calibrated around the risks of age and gender, the form of economy and the income situation, is evidence of these disastrous consequences.
Fourthly, health risks are among those risks caused by social conditions, not individual lapses. This is confirmed by the class-specific and income-dependent appearance of syndromes. As a result, market control in the public health system is secondary compared to solidarity protection from health risks.
RHETORIC OF RESPONSIBILITY
By Friedhelm Hengsbach
[This article published in: Frankfurter Rundschau is translated from the German on the World Wide Web, .]
Annette Schavan stuck the label “responsible community” on the Federal Republic of Germany. Does she know what she is talking about?
She may be recalling a book by Amitai Etzioni titled “Verantwortungsgesellschaft” (Responsibility Society). The “family” is stylized as a “responsibility community” with which Ronald Pofalla justifies a responsibility of well-off children for jobless parents.
A second impulse leads to the project “New Social Market Economy,” the mutuality of politics and come-of-age citizens which Angela Merkel promoted in 2001 with a quotation from Ludwig Erhard: “I will stand the test from my own strength. I will bear the risk of life and be responsible for my fate myself. Be concerned, O state, that I can do this.”
A third assumption leads to the middle class church milieu. In the summary of the 1997 Joint Declaration of the churches, the “priority of personal responsibility” annulling the subsidiarity principle was accepted. In an impulse paper of prominent Catholics published at the end of 2003, the welfare state was reproached for paralyzing personal responsibility.
Ms.Schavan found a beautiful and pleasant pen name for welfare state cuts and the withdrawal of the state from public necessities.
The word “Verantwortung” (responsibility) did not occur in the Duden dictionary of 1968. In the meantime, it has been promoted to the key term of moral communication. Some appeal to Max Weber who developed the responsibility ethic. Others refer to Dietrich Bonhoeffer who described the calling as the “place of responsibility” and designed a “structure of responsible life.” In 1984, Hans Jonas introduced the “principle of responsibility” for a necessary survival ethic of technical civilization.
Who bears responsibility? Responsibility was originally a personal category. Whoever assumes responsibility answers for the intended and predictable consequences of his conduct. To that end, he must have adequate alternative possibilities of action. The range of individual responsibility is different for the German government minister or the head of the commerce bank than for a worker in an auto plant, a physiotherapist in a clinic or a steelworker fired for operational reasons. Whoever speaks of responsibility should identify the subjects of responsibility. The Federal Republic of Germany is not such a subject.
For what does someone bear responsibility? The “individualization” of responsibility is obviously a moral trap. Much systemic feedback of individual conduct is unintended and unexpected. Conversely the careful waste sorter cannot stop the change of the climate. The patient who postpones a doctor visit does not relieve the public health system. Individual afflicted persons are not responsible for social risks like unemployment, grave illnesses, poverty and environmental destruction.
Should democratic societies be forbearing in dealing with risks due to individual lapses? A selective delimitation between individual and collective responsibility often fails. In case of doubt, solidarity protection has a priority over private provision. Did Ms. Schavan recognize the priority of social responsibility?
By Friedhelm Hengsbach
[This article published in: Frankfurter Rundschau, 10/28/2006 is translated from the German on the World Wide Web, . Friedhelm Hengsbach is the director of the Brunning research institute.]
200,000 dependent employees took to the streets in 5 cities to protest the growing poverty risk, the increasingly shaky working conditions and the political deformation of solidarity by the rulers. Their reaction mirrored a well-known pattern: there is no alternative to this policy. It is right and just. We have to explain it better to the people.
Does the black-red coalition govern against the people? Does it confirm the explosive word “post-democracy” used by political intellectuals?
“Post-democracy” is a code word for scattered perceptions. The dream of 1989 that democracy and capitalism can be reconciled fades. More and more citizens stay away from the elections. Elected governments cut rights of participation and freedom of the sovereign. Parts of their mandate are stored in commissions and experts as well as supra- and international organs. Their decisions are oriented in the interests of transnational groups and global finance markets. They act as “territorial entrepreneurs” called to make their own people fit for the global competition and urge and promote the output of a weakly motivated population without orientation. Women’s policy and family policy are connected to a population policy for producing more talented efficient children.
The emphasis on “post-democracy” in the political careers of Tony Blair and Gerhard Schroeder shows how a democratic spectacle can be staged in the media. However its analytical weight and normative power deserve criticism.
Firstly, the simplistic juxtaposition of direct rights of participation and representative procedures sounds romantically idealized. Majorities that come about at pleasure are not the people. Currents of public opinion foaming with rage are not the common interest. Professional analyses of functioning economic rules and feedback could reveal the unintended repercussions of political decisions.
Secondly, the powerlessness of national state organs in relation to the corporations and financial markets is not as true as it is often claimed. Actors and addressants of global competition are businesses, not states. Germany and France do not compete with one another like VW and Peugeot. Their choice of location is oriented more in market conditions than tax rates, wages and fees…
Thirdly, democracy is not a value-neutral subject. Whoever recognizes human rights grants a preferential place to democratic forms of rule and life. Therefore conflicts between social movements and the governing are necessary for a fair distribution of economic wealth and appropriate participation in economic decisions.
COMPETITIVE FEVER
By Friedhelm Hengsbach
[This article published in: Frankfurter Rundschau is translated from the German on the World Wide Web, .]
Twenty years ago a respected economist and financial manager from Frankfurt claimed the same laws were in force for the labor market as for flowerpots, oranges or aluminum scrap. Labor is only purchased by businesses when its value is higher than its price. This is not degrading since people fall out the window with the same velocity as flowerpots.
In the meantime, the public debate has changed from labor to health care. “More market in the public health system” mutates patients into come-of-age customers. Market radicals classify the need to be healthy in the scale of their needs, calculate rational costs and benefits of a medical treatment and determine autonomously what share of disposable income they spend for food, industrial goods and public health services. The sickness risk is estimated like the risk of an auto accident.
“More competition in the public health system” has become an appeal to hospitals, nursing institutions and treasuries. These institutions should get an unmistakable profile and compete for additional markets and customers. An administrative agency should force actors and institutions to adjust the costs of individual therapy to precisely defined treatment goals. Standardized diagnoses and therapies should make the decisions of the actors transparent. The expert competence of doctors should give way to a corporate economic management.
However the asset health hardly suits the current market- and competition games. Firstly, health is not an asset like many others. The modern enlightened person deals very irrationally with his health because it directly concerns his person. Being sick can be experienced as a brutal crash and existential threat through which balanced ways of life are completely impossible. The normal person underrates health as long as he or she is healthy and overrates it as soon as sickness strikes.
Secondly, the asset health belongs in the series of trusted goods. An unequal relation of competence and information exists between those offering this good and those demanding it. In a democratic society, a proper provision with health goods should be guaranteed independent of income and performance.
Thirdly, the ostensible health market is an extremely politically charged market. The competition between medical and therapeutic institutions can degenerate when the distribution of profitable risks is fought over, not better services or cost pressure is shifted to workers. The quality of personal services performed and judged according to the standard of industrial productivity has disastrous consequences. Hospitals and nursing stations are not homogeneous suppliers of goods any more than the insured are exchangeable customers with the same risks. The current wrangling over structural equalization of risks that must be continually calibrated around the risks of age and gender, the form of economy and the income situation, is evidence of these disastrous consequences.
Fourthly, health risks are among those risks caused by social conditions, not individual lapses. This is confirmed by the class-specific and income-dependent appearance of syndromes. As a result, market control in the public health system is secondary compared to solidarity protection from health risks.
RHETORIC OF RESPONSIBILITY
By Friedhelm Hengsbach
[This article published in: Frankfurter Rundschau is translated from the German on the World Wide Web, .]
Annette Schavan stuck the label “responsible community” on the Federal Republic of Germany. Does she know what she is talking about?
She may be recalling a book by Amitai Etzioni titled “Verantwortungsgesellschaft” (Responsibility Society). The “family” is stylized as a “responsibility community” with which Ronald Pofalla justifies a responsibility of well-off children for jobless parents.
A second impulse leads to the project “New Social Market Economy,” the mutuality of politics and come-of-age citizens which Angela Merkel promoted in 2001 with a quotation from Ludwig Erhard: “I will stand the test from my own strength. I will bear the risk of life and be responsible for my fate myself. Be concerned, O state, that I can do this.”
A third assumption leads to the middle class church milieu. In the summary of the 1997 Joint Declaration of the churches, the “priority of personal responsibility” annulling the subsidiarity principle was accepted. In an impulse paper of prominent Catholics published at the end of 2003, the welfare state was reproached for paralyzing personal responsibility.
Ms.Schavan found a beautiful and pleasant pen name for welfare state cuts and the withdrawal of the state from public necessities.
The word “Verantwortung” (responsibility) did not occur in the Duden dictionary of 1968. In the meantime, it has been promoted to the key term of moral communication. Some appeal to Max Weber who developed the responsibility ethic. Others refer to Dietrich Bonhoeffer who described the calling as the “place of responsibility” and designed a “structure of responsible life.” In 1984, Hans Jonas introduced the “principle of responsibility” for a necessary survival ethic of technical civilization.
Who bears responsibility? Responsibility was originally a personal category. Whoever assumes responsibility answers for the intended and predictable consequences of his conduct. To that end, he must have adequate alternative possibilities of action. The range of individual responsibility is different for the German government minister or the head of the commerce bank than for a worker in an auto plant, a physiotherapist in a clinic or a steelworker fired for operational reasons. Whoever speaks of responsibility should identify the subjects of responsibility. The Federal Republic of Germany is not such a subject.
For what does someone bear responsibility? The “individualization” of responsibility is obviously a moral trap. Much systemic feedback of individual conduct is unintended and unexpected. Conversely the careful waste sorter cannot stop the change of the climate. The patient who postpones a doctor visit does not relieve the public health system. Individual afflicted persons are not responsible for social risks like unemployment, grave illnesses, poverty and environmental destruction.
Should democratic societies be forbearing in dealing with risks due to individual lapses? A selective delimitation between individual and collective responsibility often fails. In case of doubt, solidarity protection has a priority over private provision. Did Ms. Schavan recognize the priority of social responsibility?
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