In today’s NYT column, Paul Krugman asks a question that is interesting only because it leads me to a broader question. First Krugman. He notes that the GOP budget proposal promotes reforms to “make government health care programs more responsive to consumer choice.” Krugman then asks: “How did it become normal, or for that matter even acceptable, to refer to medical patients as ‘consumers’?”
This question struck me not because it is in any way mystifying but because I was at the EPA’s website yesterday and ran across number references to “customers.” One charming document asks “Who Are EPA’s Customers?”The answer includes “the public.”
I could cite more examples (the EPA’s search engine reports 38,700 documents with “customer”). And the EPA is not alone. Even the CIA reports: “The Intelligence Community’s number one priority is to provide its customers with the best possible custom-tailored intelligence whenever and wherever they need it. Our ability to do so depends, in large part, on how well we understand and respond to customers’ needs and on how much our products help them do their jobs.” I didn’t bother to see if water boarding was available at the drive through window.
The shift to a “customer” orientation came in 1993, as the Clinton Administration embarked on its “Reinventing Government” initiatives. As you will recall, President Clinton and Vice President Gore initiated the National Performance Review and sought to bring the best lessons from the private sector to the public sector. As part of this effort, President Clinton issued Executive Order 12862, “Setting Customer Service Standards.” The EO had some charming directives, including:
Section 1. Customer Service Standards. In order to carry out the principles of the National Performance Review, the Federal Government must be customer-driven. The standard of quality for services provided to the public shall be: Customer service equal to the best in business. For the purposes of this order,”customer” shall mean an individual or entity who is directly served by a department or agency. “Best in business” shall mean the highest quality of service delivered to customers by private organizations providing a comparable or analogous service.
Are citizens really best understood as customers? If so, what are the ramifications?
This may seem like a trivial point, but there is a significant difference between being a citizen and being a customer. Citizenship, in its classical sense, involves obligations to the community and the need to engage in deliberation. It is infused with honor and virtue and is part of what it means to be truly human (in Aristotle’s words: “To take no part in the running of the community’s affairs is to be either a beast or a god!”). Customers, in contrast, are simply those who purchase a product or service.
When I see polls revealing that the vast majority of Americans do not want any entitlements cut nor do they want to pay higher taxes (of course, they always want the wealthy to pay their “fair share”), it troubles me. As citizens, they should reflect on the incompatibility between current levels of spending and taxation; they should choose honorably to make sacrifices to prevent fiscal imbalances from creating a dire situation for future generations.
But as customers, the logic is altogether different. Customers should demand the most they can get for their money and if services are being provided at a deep discount (e.g., subsidized by future generations of customers), all the better. And if customers seem unreasonable in their demand for products and services, the best one can do is mutter the age old dictum: “The customer is always right.”
Customers love a sale. Customers do not voluntarily request to pay retail. Customers also vote and one can expect that they will vote for those who are willing to extend the sale for two, four, or six more years.
PILEUS 
This point would be stronger if you had an example of “citizens” in the pre-customer era supporting tax increases on themselves and cuts in entitlements for themselves.
Bill’s right that the history of citizenship has revealed a lot of people voting themselves other people’s money, but as an ideal you are certainly right, Marc. This is a really nice point. As for Krugman, one wonders what he thinks a “consumer” is, or why he would imagine being a patient was incompatible with being a consumer. But then it’s easy to wonder why anybody would think much of what he says these days anyway.
Calling a citizen or taxpayer a customer does not make them a customer. A customer has a choice as to whether to pay and consume or walk away. Choice and freedom to associate are the predicates to being a customer. The relationship between citizen and government is not predicated on choice or freedom of association but on coercion backed by violence. What’s going on is not the state eroding the sense and responsibility of citizenship but the state using Newspeak to produce a more pliant and docile population.