Health Care Reform Debate and Feminine Sexuation: Passage to the Act

(Dear reader, sorry for the delay in posting--this summer has been one long emotional roller coaster ride so far.)

Part 3 of “Health Care and the Community Economy: Towards an Ethics of Surplus and Geography of Sufficiency.”

Feminine Sexuation and Health Care Reform

So far we have learned what it is like to fail in relation to economic imperative—to fail to balance social reproduction and economic growth … My qualitative research alerted me that it is also possible to fail in relation to one’s ethical commitments.


One interview that stands out in this regard was with Dr. Norman Haug of Del Norte Colorado—driving force behind the creation of The Rio Grande Hospital. Del Norte is a remote town in South East Colorado with a mostly poor rural farming population and a seasonal tourism industry. Like a lot of poor rural communities access to health care was a real problem. Norman was able convince HUD to provide Del Norte with a loan type 242 that allowed for the construction of a critical care hospital to serve the local community. To obtain the grant he had to prove to HUD that the hospital was economically viable.

First Norman needed to raise a 1.5 million dollars in order to qualify for the loan—the first of its kind to be provided by HUD outside of the NY/NJ area. In addition to solicitations large and small the land for the hospital—valued at 400K--was also gifted by a land owner. To prove that the critical care hospital was viable one argument Norman made was that it would serve the tourists that came to the area for hunting and other excursions. The decisive point proved to be the hospitals designation as a critical care facility by Medicare.

This meant that Medicare—the insurance form for 70% of the patients—would reimburse the Rio Grande on a cost basis rather than according to capitated formularies—in the absence of this arrangement, the hospital would lose money. One of the rationales behind the critical care hospitals is that they provide care in sparsely populated areas that would otherwise fail to constitute a viable market.


This leads some to dismiss the Rio Grande as a state charity case but Norman disagrees on two counts: First, We would not argue for the centralization of police or educational services on the basis of market demand… nor should we argue for a centralization of medical services. Second, once transport and higher overhead in urban hospitals are figured into the equation—critical care facilities and rural hospitals are cost effective responses to definite need.

Situating the Rio Grande in the Diverse Economy

It is useful to situate the story of the Rio Grande hospital in the context of the diverse and community economy diagram, with its partial typology of economic difference in the dimensions of exchange, compensation and organization. For those of you familiar with A Post-Capitalist Politics, it will be unnecessary to go over the way in which this representation of the economy as a space of open-ended heterogeneity describes an actually existing diversity of forms of exchange, compensation, and economic organization (the dimension of class). The Rio-Grande is a state capitalist enterprise that exists to serve a particular constituency. While it has clearly been enabled by a generous state transfer from HUD and its designation as a critical care facility by Medicare, it’s also clear that it exists as a community asset because of the generosity of local citizens. In turn, it is a context in which Norman and the other physicians are able to generously serve the care needs of the local and transient population—including legal and illegal immigrants. (45% of care is free care) and the market of insured patients.

Thus the Rio Grande is “viable” because of the support that it receives and because its mandated purpose is to service a geographically finite need. There is, of course, a limit to Rio Grande’s capacity but it no longer needs to be read in relation to infinite demand and self-interested practitioners.

Lacan’s counter-posed feminine logic becomes relevant here. In this view there is no constitutive exception—all are subject to the law, and yet no one is completely subjected. In the world of feminine sexuated logic limits remain, including limits to care, but they are seen as provisional. Here “scarcity,” and the need for “economic growth,” no longer act as over-arching imperative. In my view, it is this move towards the relational possibilities (and constraints) of a feminine logic rather than the fixed miserly injunction of masculine logic that allows us to re-imagine the politics of health care reform in relation to sufficiency.

Feminine logic, as Copjec says, “obliges us to recognize the finitude of all phenomena, the fact that they are inescapably subject to the conditions of time and space and must therefore be encountered one by one, indefinitely, without the possibility of reaching an end, a point where all phenomena would be known. The status of the world is not infinite but indeterminate.”

Health care reform will continue to fail us, but we will fail to arrange and allocate care in relation to an ethical imperative rather than a miserly economistic imperative. We need a language of partial subjection in order to produce a politics of ethical possibility. A sufficient response to definite need is something that is intelligible in the spatio-temporality of needs encountered “one at a time.” Likewise, the range of existing assets, and the generosity of the community—and here I include the state as simply a part of community—needs to be encountered in their particularity also. While this indeterminate mobilization of social surplus, generosity and ethical commitment is what allows for the Rio Grande to succeed—the success of community health centers elsewhere would depend on the identification of definite resources (and constraints) that occur in any given area.

Fifty years ago people took the risk and they built these hospitals, we need to do it again. And we just need to get it done… Get the hospital built and let the person whose going to be here ten years from now worry about it. I mean that sounds callous but that’s what it amounts to. (Norman 2005)

Derrida taught us that an act can only be considered ethical when the outcome of the act is uncertain. What is clear from his statement here is that Norman truly is not clear what the outcome of his efforts will be but he is willing to act anyways. Perhaps Norman’s status as an ethical agent—his willingness to take the risk in order to “get it done”—allows us to see the typical mainstream approach to health care reform, as mired in a masculine sexuated logic of impossibility, as an imaginary solution whose elegance and inevitable failure leaves things exactly as they are. The imagined social harmony between the conservation of capital and the equitable allocation of care is never arrived at and this failure is symptomatic of a castrating approach to health care reform.

In contrast, Norman’s capacity to meet the needs of the immediate community, his adoption of the standard of a sufficient response in relation to definite pressing needs, is sustained not by the idea of a final/fantastic end point but a spirit akin to what Zizek describes as “enthusiastic resignation.” Through Norman we can come to see the difference between the failure to embody (the reconciliation of equitable health care allocation and continued economic growth) versus a failure in relation one’s ethical principles (to care and accept whatever comes as a result of this commitment).

How is that Norman came across this affective disposition, this willingness to pass to the act?

labor unions in the U.S. fight for apartheid!

a recent story in the forward reports that leaders of american labor unions are stepping up to support israeli apartheid by undermining opposition to it by british unions.

many union leaders have signed on to a letter by the jewish labor committee bashing* the growing movement for anti-apartheid divestment, boycotts and sanctions by the british labor unions. these signatories unfortunately include ron gettelfinger, the head of my old union, the UAW. it also includes major unions like the AFL-CIO, right-wing unions like the IBEW and the teamsters, and some allegedly progressive unions like UNITE-HERE. notably absent are the SEIU and the left-wing unions such as UE, who tend not to join the frenzied mob when israel gets challenged.

my old local, by the way, UAW local 2322 in western mass, overwhelmingly - in fact, unanimously, if i recall correctly - approved a resolution to support divestment back in 2003. unfortunately, in the UAW the wishes of the rank-and-file bear little resemblance to what's expressed by the leadership.

this wrongheaded approach by U.S. unions contrasts with their positions during the apartheid era in south africa, where unions worldwide took a stand against apartheid. it also contrasts with union attitudes in the rest of the world, even the english-speaking world. in britain, a number of unions have passed resolutions calling for private sanctions against israel, or for encouraging their branches to consider sanctions. in canada, a major public-sector union in ontario, CUPE, voted unanimously for sanctions.

and of course, south african trade unions, whose membership has directly experienced apartheid and remembers the solidarity of international unions, is far in the lead in opposing israeli apartheid. as willie madisha, president of COSATU, south africa's congress of trade unions, says:

As someone who lived in apartheid South Africa and who has visited Palestine I say with confidence that Israel is an apartheid state. ... workers and democrats of the world ... heeded our call when we struggled against apartheid. Boycotts, disinvestments, and sanctions against the apartheid regime in South Africa hastened our march to democracy. Why should it be different for Palestinians?

--------
* otherwise normal people often go crazy when israeli racism is challenged. at some point i may tell the instructive story of the hysterical reaction to the umass divestment campaign, including by many people who are considered respectable and who consider themselves progressive.

Iraqi workers strike against the new Oil Law

The following is an excerpt from the interview that Amy Goodman conducted with Antonia Juhasz, the author of The Bush Agenda: Invading the World, One Economy at a Time. The interview is aired on Wednesday as the 600 pipeline workers in southern Iraq began a strike on June 5 to protest the new oil law for Iraq. You can follow the news pertaining to the Iraqi labor movement and the growing number of strikes across the country from the website of the General Federation of Iraqi Workers.

AMY GOODMAN: First, talk about this strike, Antonia.

ANTONIA JUHASZ: Well, the strike is critical. It’s been a long time building. There had been some negotiations between the strike leaders and Prime Minister al-Maliki. There are a number of demands, basic working conditions, wages, as you say, but also a seat at the table and opposition to the attempt to turn over Iraq's oil to foreign oil corporations and the -- as more knowledge has been brought to Iraq, it’s been very difficult for Iraqis to even learn what this oil law was about, just like it’s been difficult here. As more information has spread, the opposition has spread, as well, and now the workers have taken the situation into their own hands and struck.

AMY GOODMAN: And what is this US-backed proposal?

ANTONIA JUHASZ: It’s a Bush administration, US corporate, very simple attempt to figure out: if you’re going to wage a war for oil, how do you get the oil. Does Exxon come in on a tank with a flag and stick it in the ground, or do you have a more careful process? The careful process is very simply: write a law, get a new Iraqi government in place, have the Iraqis pass the law, and then turn the oil over to US oil corporations.

The Bush administration designed the law. Last January, President Bush announced that it was a benchmark for passage by the Iraqi government. It was the same day that he announced the surge. And in the language of the administration, the surge was meant to provide the political space so that the Iraqis could discuss the oil law and other benchmarks. The Democrats then adopted this language of the benchmarks and said in the supplemental war spending bill, again, that the Iraqis have to pass this benchmark. And it very simply turns Iraq from a nationalized oil system, essentially closed to US oil corporations, to a privatized system in which potentially two-thirds of all of Iraq’s oil could be owned by foreign oil companies, and they can control the production with as long as thirty-year contracts.

AMY GOODMAN: Now, what about the news coming out of Iraq that Raed Jarrar has reported on, talking about the significance of the vote for the US to get out of Iraq by the parliament?

ANTONIA JUHASZ: It’s very significant. The United Nations mandate for the US occupation of Iraq gives ultimate authority to the Iraqi parliament and the Iraqi cabinet to determine if the occupation can continue. So, theoretically, if the Iraqi parliament, joined by the cabinet -- and that’s critical -- say that the occupation cannot continue, theoretically it would have to end. That stands in vast opposition to the plans of the Bush administration and now, apparently, the plans of the Democratic leadership, as well.

AMY GOODMAN: Couldn't it give Bush an out?

ANTONIA JUHASZ: It could give Bush an out, if he wanted an out. I don't think he wants an out.

AMY GOODMAN: Because?

ANTONIA JUHASZ: Well, I think there’s many ways in which the war is not going all bad for the President and for the administration. The only thing that’s truly going bad is the instability. But what has worked is a government in place that is more amenable to US interests than the last ten years of the Hussein regime, a government in place that is willing to negotiate in a dramatic fashion on the nature of Iraq's oil regime, and being on the precipice of a transfer of Iraq, a fundamental transfer, in its oil policy. We have US oil corporations engaging daily in negotiations with the Iraqi oil ministry, waiting on the sidelines. If the law passes, US corporations have the potential to own a true bonanza of oil and, if the US military stays, protection to get in and get it. Now --

AMY GOODMAN: Which companies, in particular?

ANTONIA JUHASZ: Chevron, Exxon, Conoco, BP, Shell, Marathon.

AMY GOODMAN: Are all now working intensively with the oil ministry.

ANTONIA JUHASZ: Yeah, they absolutely are, and have been from the beginning.

AMY GOODMAN: And if they don't pass this law?

ANTONIA JUHASZ: If they don't pass the law, it’s a big strike at the heart of the agenda. I would say that the game wouldn't be over, and the fact that the administration is talking publicly about this Korea policy, the idea that the United States would maintain some sort of military presence similar to the US presence, quote/unquote, "keeping the peace between South and North Korea," that’s a permanent military engagement, which could last as long as fifty years. The thirty-year contracts, the length, the extended length of the occupation, leads me to believe that this is the idea that the administration wants to pursue.

AMY GOODMAN: And what do you think of this comparison?

ANTONIA JUHASZ: It’s incredibly disturbing. First of all, the conditions are completely dissimilar, except for the desire of the United States to maintain a presence and to use the misunderstanding, I think, of the American public as to the role of the US military in Korea, to say, “Well, we’ve created peace for fifty years in one situation. We can create peace for fifty years in this other situation. Oh, and by the way, our military will be really well situated to move forward across the region to spread peace across the Middle East, where, oh, by the way, there also happens to be two-thirds of the world's remaining oil.” It’s a terrifying proposition.