The New Totalitarianism: How American Corporations Have Made America Like the Soviet Union
Continued from previous page
This constriction of choice is most virulent when it comes to media. Big-box stores have very limited shelf space for each product category they carry; yet they are far and away the nation's biggest purchasers of things like toys and video games. For the past 20 years, this fact has dominated decision-making in both those businesses: manufacturers know viscerally that if the buyers at Walmart aren't interested in your toy or game, there's probably no economic point in even making it. So everything is made with these buyers' sensibilities, prejudices and cost requirements in mind. This became a de facto form of centralized control, where a handful of buyers in Bentonville ended up dictating what the entire country got to play with.
Increasingly, the corporatization of our consumer landscape has meant that there's less choice and variety in our marketplaces than there used to be. Centrally planned franchise and chain stores have been stripped of quirkiness, uniqueness, local color, and anything that might be challenging to the most easily upset among us. The result is that we're left with a bland, santized, Disneyfied set of choices in goods, experiences, entertainment, and ideas that's a far cry from the lively, authentic Main Street scene those stores killed -- and which has brought us several steps closer to the scary stereotype of the limited and poorly stocked state-controlled Soviet shops we were constantly threatened with during the Cold War. Yeah, it's still better -- but not as much better as it should be.
The Sovietization of malls and big-box stores has launched a couple of backlashes. Online shopping is the new refuge of people who are looking for a broader set of options. Local producers of food, clothing, grooming supplies, furniture, and other goods are stepping up to scratch our itch for things that are unique and special. These are both end-runs around the corporatized retail order that's been systematically stripping away consumer choice for decades. But they've got a long way to go before they'll supplant the neighborhood hegemony of Walgreens.
The Supreme Health Care Soviet has also done a number on the kind of health care we get, how we get it, where we get it, and who we can get it from. Again: there was a time not so long ago when health care was in the hands of a doctor, who was usually in independent practice (often in a partnership with a couple of other doctors, but that's it), and who had wide leeway to dictate patient care without being second-guessed. The doctor got sound, reliable information on new treatments from respected peer-reviewed journals, and insurance companies generally paid for most of what he or she ordered without further ado. This extreme level of autonomy notoriously led to doctors who overestimated their capacities; but it also meant that whatever happened in an examination room was -- to an extraordinary degree -- left in the hands of the doctor and the patient, and nobody else was entitled to interfere. The result was that, in the struggle between science and the doctor's profit motive, science stood at least a fighting chance of prevailing.
Now, the profit Politburo has had its way with almost every aspect of this interaction. Two-thirds of primary care doctors don't own their own practices anymore -- in no small part because the administrative cost of dealing with
Soviet bureaucrats insurance company overseers is so overwhelming. Now, they're salaried employees of some large corporate entity, where they're subject to constant pressure to shorten visits, rack up billable hours, stick to narrow protocols of accepted treatment and churn patients through.