Some approaches to the Market State: I
[I'm going to sticky this because it's the first post in what could be a long series... -lambert]
So if you are the big tree
We are the small axe -- Bob Marley and the Wailers, Small Axe
As an inadequate substitute for a lead or an actual thesis statement--
I have had a "theory of everything" post on Phillip Bobbitt's "the market state"* fermenting for months (placeholder post with linky goodness), but what with one thing and another (site relaunch, Campaign Countdown) I have never been able to, as it were, condition, filter, and bottle it. And I don't think Bobbitt -- three Bs, two Ts -- defines his central concept all that clearly. That said, market state is such a suggestive term, so evocative of "goodness of fit" for present circumstances, that I can't help but think "That's the market state in action!" when curating material on such seemingly disparate subjects as charter schools, nudge theory, ObamaCare, the end of the rule of law (at least as we have understood it), and plasma donation.
The portion of Bobbitt's thesis that concerns us pragmatically today can be simply stated, although the terms are going to take a lot of unpacking, the concepts must be critiqued, and Bobbitt's work generally should not regarded as descriptive but as a work of elite prefiguration. That thesis:
The constitutional order of the United States is now in transition from nation-state to market state.
Now, I'm not sure this thesis is true, and I'm also not sure it's true in the way that Bobbitt -- who is, after all, a Episcopalian über-insider thought leader for the Empire with a smile like a crocodile's -- means it to be true, or would prefer it to be true. However, I am sure that if the change in the constitutional order that Bobbitt theorizes is coming true, it can have no legitimacy: The people who, even in Bobbitt's view, are sovereign, have not been consulted, or even informed.**
So here I begin the first of an open-ended series of long-form posts on the market state; and I don't know what the outcome is going to be. However, I think that if I am lucky and right, the market state, as a fully fleshed-out concept, will subsume "neo-liberalism," "privatization," and even "kleptocracy," as well as "contractors" and "mercenaries" (descriptive and accurate though those concepts are). Q.v. Elephant, the blind and the. We shall see!
Here's the example where I first thought "That's the market state!" From Waupaca Now, in Wisconsin:
For years, Jim Barry relied on Waupaca County’s volunteer drivers to take him to his medical appointments.
The 67-year-old Weyauwega man needs dialysis three times a week. He is struggling with cancer and can no longer drive himself to his health care providers.
"The county drivers were never late and I never missed an appointment," Barry said. "Since the new guys took over, I have missed seven appointments. Their service leaves a lot to be desired."
In the past, the local program for non-emergency medical transportation (NEMT) was run by the Aging and Disability Resource Center, using local volunteer drivers recruited by the Waupaca County Department of Health and Human Services (DHHS). The drivers provided elderly and disabled Medicaid recipients rides to their medical appointments.
On July 1, LogistiCare, a private, for-profit corporation based in Atlanta, Ga., became Wisconsin’s sole broker for NEMT.
Pat Enright is the aging and disability resource manager for Waupaca County DHHS. He has logged dozens of complaints from patients who have missed their medical appointments due to their rides arriving late or not showing up at all.
"These people don’t understand that I get really sick when they’re late picking me up," Barry said, noting that being late for an appointment can result in his being at the clinic for eight hours as he waits for the dialysis equipment to become available again. And missing his dialysis treatment means toxic wastes are not being removed from his body. A Logisticare driver also failed to pick Barry up for a scheduled ride to the clinic for a CAT scan.
"I feel like they’re trying to kill me," Barry said. "Yesterday, I made my funeral arrangements."
You feel like that because they are. And for profit, too.***
Barry said his problems with LogistiCare began the day the company took over the program.
"It took me an hour and a half just to get my first three appointments," Barry said.
To schedule a ride, callers have to obtain a confirmation number from LogistiCare.
Callers are questioned about whether they have a car, whether they are able to drive and whether they have relatives or friends willing to drive them to their medical appointment without reimbursement. They can be denied rides if they answer yes to any of the questions, according to a copy of logistics call script obained by the County Post.
If callers do not have their doctor’s phone number at hand when they call LogistiCare, they will be denied a ride and told to call back later with the number.
"They are trying to talk the callers out of getting a ride," Enright said.
That's because they profit by denying care.
After LogistiCare repeatedly failed to send a driver to Barry, he and Enright attempted to make a conference call to the WMR number.
"I called their number and the phone was not answered after 35 minutes," Enright said. "I called again and waited 20 minutes."
After finally getting through to LogistiCare, Enright was assured that Barry’s rides would arrive on time in the future.
"They then missed four rides in a week and a half," Enright said.
Complaints with LogistiCare are being reported across the state, according to Carrie Porter with the Greater Wisconsin Agency on Aging in Madison. She said Barry’s problems making it to his dialysis appointments are not uncommon.
"It’s not an isolated case," Porter said. "Just missing one appointment is a huge health concern for a dialysis patient."
Porter added that missing dental appointments are especially a problem "because there are few dental clinics willing to take Medicaid patients. If they miss an appointment, they are at risk of losing their providers."
"LogistiCare does not provide the transportation, they just broker it," Enright said.
LogistiCare contracts with vendors to provide rides, then receives calls for rides and schedules the rides with vendors.
"They are not paid by the ride, they are paid a per capita rate based on the number of Medicaid clients who are eligible for rides," Enright said. "A cynical person might wonder if they’re making their profit on every one of those rides that they don’t provide. This is privatization at its finest."
No, it's not "privatization." Or it is, but it's also something larger: A change in the constitutional order. If we treat LogistiCare in Waupaca County as a paradigmatic case, we have:
1. Nation-state: The role of the state
is was to provide services for its citizens. In this case, its role was to provide provided a space for volunteer drivers to coordinate delivery of non-emergency medical transportation, to meet the requirement that their appointments not be missed.
2. Market state: The role of the state is to determine which provider shall collect rents for delivering a service to consumers. In this case, its role was to select a broker to co-ordinate paid drivers for non-emergency medical transportation, to meet the requirement that rental extraction be maximized. (Here's more linkiness on Logisticare.)
Judging by performance, we can conclude that human life is not the uppermost concern for the provider collecting the rents in a market state regime.**** If the Waupaca NEMT example is truly paradigmatic, that would have interesting policy implications, especially for disciplines like MMT that take "public good" as an object of study.
* * *
[To be continued...]
NOTE * Concept? Phrase? Meme? Unclear.
NOTE ** One might, however, regard Obama as the custodian or manager of some of the key threads that make up the transition. There's a very good reason why ObamaCare "mandates" participation in a market. Eh?
NOTE *** LogistiCare provides a more heightened, transparent, and vicious example of the business model that health insurance companies also use: They profit by taking payment for services they later deny. And yes, it's still going on.