Healthcare and Extra Legroom

The healthcare debate is a good example of the way that neoliberalism uses "choice" to hide its absence. The choice that's always offered is a choice between different insurance plans, where having more choice is somehow meant to be a good in itself. And this is an argument often deployed against a single payer/universal systems, i.e., that it eliminates choice. However, in Canada, I have no choice about my insurance plan, but I have unlimited choice in the doctors I get to see, i.e., I can go to any doctor without any out-of-pocket expense. That's the choice that matters. But this type of choice is antithetical to the other type of choice. If we had a universal healthcare system we wouldn't need any other insurance providers, because our one plan would cover every healthcare need for everyone. Reciprocally, having more than one insurance provider by definition means that the plans we have aren't covering our needs, so that we get to "choose" which of our needs is met. Consequently, in the United States, we get to choose what's covered, in Canada, we choose how it's covered.

In my classes, I sometimes use airlines as an example. An increasingly shitty air travel experience is often sold as meaning more choice. Extra legroom? Checked bag? Meal? Snack? Movie? Priority boarding? Quicker security? Now you can customize your experience! But the one choice that I want isn't available—an economy air travel experience that doesn't make me feel like cattle by the end of it.