Back on the Safety Net

Here’s to healthcare—yesterday, apparently, marks the beginning of my health insurance coverage through the Freelancers Union, a fine internet-based organization that helps out the growing ranks of independent workers. It comes six months, just about to the day, from when my graduate school insurance cut off and I joined the 48 million uninsured Americans. My plan is a limited one, but at least I am back in the safety net. If I discover tomorrow that I have a rare disease requiring tremendously expensive treatments, it won’t be the ruin of me or my family. Things would have been different a week ago. I can even begin to consider going to the doctor if I feel a little ill.

The net is an odd metaphysical fact of modern societies, an imperceptible contractual reality that holds the scepter of life or death.

In his Homo Sacer, the Italian philosopher Gorgio Agamben explores the relationship between sovereign power and the capacity to define “bare life” from something else. Bare is the life that can be killed without committing a crime, yet cannot be sacrificed—a middle space between human and animal. He argues that the logic of European political power, since Rome at least, has revolved around the capacity to draw the line between bare life and human citizenry.

Being a citizen means having a net, or rather, being had by the net, being held in it. Killing a citizen is a crime, so citizens can consider themselves protected. The state serves as their divine, invisible bodyguard. A presence that can be felt but not seen, except in its works, on the lethal injection table.

Several years ago, I had a fascinating conversation with a friend in the Coast Guard about maritime law. He explained how utterly bare a ship without a flag is. In international waters, destroying it is not a crime. All that protects ships are the flags they carry and the web of treaty arrangements between countries that agree to recognize the sovereignty of one another. However beautiful your boat, without a flag, you are no longer a thing of intrinsic value (though your boat may be).

The net, Agamben makes clear, is the definition of citizenship—or more, of species. We stand as equals alongside those who share in the net that protects our lives from being mere flesh, that insists on its value and its worthiness of being saved.

In the United States, the healthcare net has been fashioned as an economic problem, even though the rest of the post-industrial world has shown it possible to make health a human right. This owes, in fact, to an historical mistake. The healthcare system developed in a postwar industrial culture that could depend on more or less stable employment. Benefits were distributed through employers, negotiated by unions, and regulated by government. Now, however, Americans can expect to work an increasing number of jobs over the course of their lives. Currently, I work three at once, none of which offers benefits. Though we have become a post-industrial economy, resting on the shifty ground of the service sector, the safety net has failed to keep up.

Politics has cast this historical mistake as a crisis of individual responsibility—the 48 million are apparently not responsible enough to put up for their healthcare costs. But of course the hurdles are innumerable and particular to every case. In my case, it took six months for me to assemble the paperwork I needed in order to join the Freelancers Union program, which, quite absurdly, was about a third the cost of buying the same policy directly from the insurance company as an individual. Some laziness was certainly involved, but it is amazing how little laziness it takes to be so utterly unprotected.

Politics then says the problem is economic. To keep the quality of care high, we need to ensure there is adequate market incentive for innovation and efficiency in the medical industry. By virtue of mathematical equilibria, there can be no better system than an open market. But an open market means that some people can lose.

No. The problem is metaphysical, which is to say a matter of human rights. If we are to be fellow citizens, protecting us from bare life must be the priority above all. The human problem must not be subjugated to the economic one. Just as free speech and the right to a trial must not be sold to the highest bidder, nor should the safety net that declares our fleshy, fragile lives worth protecting.