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Healthcare ­ Fighting The Socialism
Myth And Mindset

By Terrell E. Arnold
The American republic had been in operation for 190 years before it effectively dipped its toe in public healthcare. Suggested to some at the time of the creation of Social Security, and brought to light by Harry Truman shortly after World War II, Medicare languished for two decades because some people thought it might be communism in a period when the Cold War was born and reached its heights. Lyndon Johnson overcame that objection by signing Medicare into law in 1966, and we have now had two generations of experience with this groundbreaking program. Primarily available to Americans at age 65 or older, this program now serves more than 40 million people. As Americans on average live 18-20 years beyond eligibility, Medicare has become important to a growing band of senior citizens. It is in fact our country's largest single health insurance program. There are deductible and coinsurance costs for Part A and monthly payments as well as copayments for Part B, but for all that it remains more economical than the competition. In that context, it is perhaps not surprising that proposals to expand public healthcare would evoke such objections as: "It is socialism."
Nearly two hundred years ago the basic political-economic concepts that came to be called socialism began to develop. They were emerging in a period that probably represented the last grand fling of royal family/elite centered monarchies, but the socialism tenets were not as unlike actual practices of the time as they were made to sound. The basic ideas of socialism were that governments would own and/or administer the systems for producing and distributing goods in the economy of a country. Meanwhile, political/economic systems in much of Europe were based on heavy monarchial and associated elite-they called it noble-ownership of most land and productive systems, and the word that often comes to mind for this system is paternalism.
Moreover, the grand experiment of the American Declaration of Independence actually had been initiated mainly by leaders of the American colonial agricultural elite that owned the most extensive means of production of the time. The system combined plantation agriculture and slave holding. The real kinship to socialism was actually apparent, but the ideas, expressed as a political philosophy rather than as a rural and aristocratic economic operating system, did not resonate.
Rather more egalitarian concepts, perhaps brutally advanced in France, carried the day, and socialism as such remained to be picked up in what became controversial economic experiments in Eastern Europe. The clash between the so-called "Capitalistic" system of the West and the "Communistic" system of the East was launched. From there the distinctions rose staunchly upward to arcane levels of practical irrelevance.
As societies developed, the sheer complexity of management issues evolved. The baseline needs of all humans were food and water, and, for reasons that may or may not be obvious, a system evolved in which the production and distribution of foods and other goods were capitalistic enterprises. However, the provision of water and such conveniences as roads was a public service, a societal if not a socialistic function. The farm or the town mill belonged to and was run by somebody. The town pump and the community road were common property and were cared for by everybody. Such were the roots of private enterprise and local governance.
The rise of democratic governments in the 18^th century and their subsequent spread appeared to bury the idea of socialism, but that was because democratic societies tended to look in the mirror and see an illusion. The image was private enterprise, private capital accumulation, prosperity, and a government that stayed out of the way. There were no government redistributive or compensatory schemes. All men may have been created equal, but it was every man for himself.
Those rules led to the first great round of excess economic power concentration that drove Teddy Roosevelt to go in for trust busting. He only slowed the train, however, and it staged a high speed wreck as our country moved through the 1920s. The great depression of the 1930s said vital things for America's future. First, the capitalist system needed effective regulation to keep its greed from getting out of control. Second, the country needed income redistributive devices to avoid the human consequences of excessive concentration of wealth at the top. Third, capitalism was not actually designed with taking care of the weakest members of society in mind. Progressive income taxes, Social Security and Medicare were all children of such insights.
The important fact to hold onto is that those advances were made, perhaps with some noise, but without an ideological fixation. As both economic needs and community management tasks became more complex, both evolved to create functional delivery systems. Real work needed to be done. Real people did it. Real communities developed and prospered. More and more employments were created by businesses and industries. More and more functions were assumed by local, state and federal levels of governance. We cottoned to the idea of "democracy", but we considered labels far less important than results.
Our numbers since have grown to the point where we need results far more than labels. In response we invented the welfare state, actually putting feet under the intentions of the Declaration of Independence.
In this mode we approach the problems of healthcare. Our country now has more than 300 million people. It is pushing toward 400 million in the next few decades. For that population our most demanding problems will be food, clothing, shelter, water, and healthcare, along with education and employments to sustain the people and the systems involved. We simply cannot afford a debate about what ideological format fits our essential functions. We need reliable delivery systems. We must have those systems for the benefit of all our people. We need them on a scale that matches the foreseeable dimensions of our country. We need them at costs that can reasonably be met by the weakest as well as the strongest members of our population. We simply cannot afford a healthcare system that contributes more to gross concentrations of wealth than it contributes to the health of our people.
There can be no debate about the coverage of any system we eventually achieve. It must effectively serve everybody. Other developed societies now manage these requirements more comprehensively and less expensively than we do. Governments play active and necessary roles. In a system where all available resources are increasingly stressed by human numbers, we must adopt reliable economies of function and scale. Our acceptance of the extent to which the Federal Government must be directly involved has been slow in coming, even as Medicare has become an essential part of our healthcare system.
It is a myth to argue that any system that uniformly and fairly meets the needs of our people is "socialistic" in some derogatory political sense. It is blind bias to argue that a government that steps in to cover gaps in the care of its people has undermined our economic system or exceeded the needs of governance. The work required to achieve the system we need must be carried out by millions of people in many different but related functions. Some will necessarily be in government administration. On the ground delivery functions are scientific, technical, humanitarian, and eminently personal, and they can be carried out by many private entities.
Our immediate need is to change the hostile mindset that interferes with development of the systems we ultimately must have. The notion that we cannot have comprehensive medical services for all our people because to do so would invoke some disagreeable "ism" is simply not sensible. That we cannot have such a system because it will be "socialistic" if it serves everybody is patent nonsense. We must face the fact that our profit-centered system is a flawed model. Other countries do better than we by delivering a wide range of medical services to more of their people without exorbitant administrative and profit overheads. Their technologies are no better than ours. Their delivery systems are simply more humane.
The debate on healthcare has brought onto the table some long-standing shibboleths that capitalists and individualists harbor against government. The most common one is "if government does it, it won't be done well, and it will be too costly." In far out complaints of this sort, a few evidently unthinking complainers have said: "Keep the government's hands off my Medicare." The reality is that in terms of societal, environmental, public order and common services our governing bodies do more vital work than the whole of private sector systems combined.
In the long run, practically speaking, we have a choice. We can bring healthcare costs down by rigorous regulation of private providers to restrain their costly profit taking, terminate their selective client acceptance systems and expand their services. Or, we can meet those needs by providing publicly supported lower cost alternatives that compete with or supplant the private providers. We don't necessarily need to adopt the systems of other countries, but we need to borrow extensively from their experiences in broadening and updating our system.
We already have demonstrated conclusively that a healthcare system based centrally on profit-making is too expensive, insufficient and unsustainable. We have no choice but to adopt a system that serves everybody at affordable cost. We do not have that now, and we will not achieve it without adopting the best of what we and others are doing and diligently improving on it. Two of our most protective and pervasive systems are Social Security and Medicare. In them the basic framework already exists for expanding public healthcare programs. Given supportive decisions, more extensive public healthcare can be added to our roster of protective systems with enormous benefit to the health of our people.
The writer is the author of the recently published work, A World Less Safe, now available on Amazon, and he is a regular columnist on rense.com. He is a retired Senior Foreign Service Officer of the US Department of State whose overseas service included tours in Egypt, India, Sri Lanka, the Philippines, and Brazil. His immediate pre-retirement positions were as Chairman of the Department of International Studies of the National War College and as Deputy Director of the State Office of Counter Terrorism and Emergency Planning. He holds an AB from Stanford and an MA from San Jose State University, and he is a graduate of the National War College. He will welcome comment at
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