Ruth Perry



It has gotten to the point where chills run down my spine when I hear the word "free:" "free" choice, "free" trade, "free" market, "free" enterprise. The word has come to mean something different in each of these contexts. "Free choice" usually means a choice among alternatives available to the consumer-and they are always pre-selected alternatives, carefully analyzed for their potential market niche, the sociological characteristics and self-image of their potential customers studied and counted, and the image of the products that they so freely choose managed and presented to appeal to them in their market niche.

Nor am I only talking about free choice among breakfast cereals or jeans-in which the freedom-to-chose is pretty trivial. I am also talking about free choice among doctors, hospitals, and schools-choices among professional services and institutions that determine one's chances for literacy, employment, for health, and even life itself. Despite the rhetoric about "free choice" of doctors and schools, the alternatives in these systems are also carefully managed, cost-counted, profit assessed, and regulated by what the market will bear-by the desire to maximize profit rather than by the effort to give the public the best possible quality at the least possible cost.

Let me give you a sense of how "free choice" works in managed health care. This is what is going on right now in New York State. State funds from Medicaid, public money collected in public taxes for decades, are turned over a private company--call it MedCo--to provide complete health services to citizens. MedCo wins the contract from the state on the basis of a competitive bid. They are signed on because they promise to deliver comprehensive medical services cheaper than other companies. They agree to give total medical care to the halt and lame, sick and needy, for $100 per month. So the state gives MedCo $ 100,000 to provide care for 1000 people a month. What MedCo skims off for itself and what it actually pays health workers is another matter. MedCo then subcontracts some of the health services for which it is responsible--say the mental health part of medical services--to Lostit Co. Lostit Co. gets the mental health carve-out. Now MedCo has budgeted $21.50 per patient for mental health, but Lostit Co. agrees to provide mental health service for only $11-50 a month. Thus MedCo saves $ 10.00 per client per month on the deal, or $ 10,000 a month. What they do with this windfall, I leave to you to imagine. But at least some of it will find its way into executive salaries and bonuses, rewards for business management.

The citizen who has been paying into Medicaid all his working life now has a choice-a move which, incidentally, turns him into a consumer and a client with free choices rather than a citizen with rights. He can choose between MedCo's health plan or some other private plan for which he pays through the nose. Or he can choose to go to a doctor when he needs one without a health plan. Or he can choose not to go to a doctor.

The meaning of the word "free" in free market is somewhat different from the "free" in "consumer's free choice." In the free market, the largest and most powerful industries are free to set the terms of commerce, to take advantage of their economies of scale to undersell smaller operations. In Eastern Europe, the "free" market means free access of big businesses from the west--Coca Cola, Ralph Lauren, etc.--to the cheap labor of trained technocrats to run their overseas operations. The free market means that the public is conceived of as a market--every man, woman, and child are potential customers before they are anything else. Any other conceptualization of the public--as a flock of poisoned birds, for example, as Rachel Carson suddenly imagined the public in the early 1960s--requiring regulation of pesticides in the air and water, is said to abrogate the rights of business to free markets.

Free trade, on the other hand, has come to mean something entirely different. It does not mean the right of consumers to spend their money to choose among pre-selected alternatives, nor the right of business to market goods freely to the public--without taking any responsibility for how the animal, vegetable, or mineral ecosystems from which they extract these goods or into which they release these goods, are affected. Free trade has come to mean, rather, an extension of these freedoms to the rest of the world: the right of manufacturers to hire the cheapest labor anywhere in the world to manufacture products; the right of distributors to sell to any market at any price they can get.


(This text is only a selection. For the complete essay please see our journal)