Free Market Is Bad For Education

Imagine that you are in the hospital for a major bit of surgery. As you go under, you notice that there is a big timer next to the anesthesiologist's seat. 90 minutes later, the surgery is under way with just a few minor blips, when the anesthesiologist announces, "Okay, that's it." Then he cuts off the anesthetic. You didn't see the timer hit zero, but you will soon. 

Your health insurance must come from Anthem Blue Cross Blue Shield, which has announced that they will pre-determine the amount of time the patient gets anesthetic for the operation, and they won't pay for anything beyond that pre-set time. 

It's the eleventy-gazzilionth reminder that the problem with free market human services is simple-- every dollar spent taking care of the humans is one more dollar that the business and its investors don't get. 

I am not anti-free market. The free market and capitalism have enabled some great things, many of which I happily benefit from. But when free market operators lose their way, bad things happen for all of us. 

Do you miss Sears and K-Mart? I sure do; our community no longer has either, and yours probably doesn't either. This is not because of the internet or economic slumpage or a lack of support from your local shoppers. It's because venture capitalists bought them up and stripped them for parts. This is misguided free marketry, a late-stage capitalism problem of people who have lost all sight of who they serve. 

When this disease hits, the customer is not the people who shop at that business, but the investors. The customers are just resources to be drained of as much money as possible. They are not humans; they are just little backpacks full of cash.

Anthem has become, in Cory Doctorow's very useful coinage, enshittified. They have made their product deliberately worse for purposes of harvesting larger profits. Maybe the backpacks full of money that we are tapping would tolerate just this much less useful service without actually firing us, thereby allowing us to better serve our real customers--the investors.

Twisted free marketry is one thing when we're talking about, say, burgers or surfboards; the business can be made to face the consequences as the public decides it can just do without that stuff (though the last election suggests that when the market starts gouging too much, people other than the investors pay a price). 

But when the "product" is a necessary human service, like health care or education, and you cease to see the humans being cared for as customers and instead view them just as couriers carrying backpacks full of cash that you want to collect so you can give it to your true customers-- well, that's how you get a product that is increasingly enshittified. 

We can already see some of the results. I've talked to cyber-school teachers who complain about being vastly understaffed not because staff is hard to find, but because management figures a couple of hundred students per teacher is good enough. Charter and private schools that refuse to accept students who would require too many resources, keep too much of the money in those backpacks from getting to the real customers.

It's true that public schools make tough choices, but those are based on the question "How much money do we have" and not "How much money can we get away with holding back from what is supposed to be our main mission." 

I don't want to wake up mid-operation, my spleen hanging out of my body, because the insurance company is trying to make its numbers for stockholders this quarter. And I don't want to see students cheated of all the education they could have because somebody's hoping to buy a bigger mansion this fall. 

[Update: Hammered in the court of public opinion, Anthem just reversed its policy. "Honest folks, we were never not going to pay for medically necessary anesthesia," they protested. They did not go on to say, "And we will decide what is medically necessary."]