Bureaucracy in the complex future

When the Bush administration, in coordination with newly elected Barack Obama, nationalized giants of Wall Street, no one spoke about a socialist agenda. But when President Obama began his effort to provide all Americans with healthcare, a huge cry went up that he was trying to impose socialism on the country. Perhaps the reactions at the time of the banking crisis were muted because everyone was in shock and no one had any idea about how to start fixing the system. Perhaps reactions would have been different if the effort to prop up the system with state funds had not been started by a Republican president. But now that the responsibility of governing rests with Obama alone, the reaction to his proposed health reforms looks like a clash of civilizations, as if the very soul of the United States is at stake. Many of the right’s arguments are silly – such as the claim that Obama was born outside the United States and so cannot be president, that he plans to set up «death panels» to lighten the load of the proposed national health system by getting rid of granny, and so on. But those who do not want to see today’s system changed are playing with the very real fear that many people have of a bloated state sector – which in the mythology of the American right is always presented as a threat to the individual and his rights. It is difficult to understand how the sense of a possible threat could hold up the effort to provide health coverage to the estimated 46 million Americans who are without any health scheme whatsoever. But such is the hostility toward a centralized administration (and such the exploitation of this ideology by the insurance and health companies which encourage the protests) that Obama has been forced to retreat from his proposal for a state health system. (He is now talking about a hybrid, involving nonprofit health funds and private companies.) One of the battle cries of the reforms’ opponents is «We don’t want bureaucrats taking decisions on our health.» The resistance to «Big Government» is deeply rooted in right-wing Americans; it echoes the myth of the self-sufficient, solitary cowboy who is threatened by dark state forces which want to control him, to limit his freedom. The fear of black helicopters used by the UN’s «world government» to control the planet is one aspect of this paranoia. The terrorist attack on the federal building in Oklahoma City that cost the lives of 168 people in 1995 is another. So it was to be expected that a state health system (which would demand the payment of fees and take decisions on healthcare) would raise hackles. But what the protesters don’t seem to have an opinion on is that the health system in the United States today is both exorbitantly expensive and full of injustice. How can the richest country the world spend a huge 16.2 percent of its GDP (2.2 trillion dollars in 2007) on health but leave close to 50 million citizens without any cover whatsoever and allow the economic ruin of countless others? Some 50 percent of American bankruptcies are said to be the result of the high cost of treatment. And yet, in all the confusion and lunatic arguments we should not forget that a very real problem has emerged with the greater involvement of the state in markets: Which bureaucracies will be able control the banks, the insurance companies and the businesses which, one way or another, were propped up by state funding? The future of the markets, like that of the health and pension systems of many countries, demands ever greater state involvement and control. It will be much more complicated than the present. But – as we in Greece know only too well – bureaucracies already present very serious problems with regard to who manages them, how they are staffed and how effective they are. If these state mechanisms are allowed to become giants without first solving their problems, then the nightmares of mad Americans may become a reality for all of us.

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