Some words get in the way of themselves. Without question, the word “socialism” is a depth charge in the national conversation. For many, it resonates with “Communism” and the unrelenting darkness of socialist Russia. Even the sister term, “democratic socialism,” brings to mind NAZI as the acronym for National Socialism.
What then should we call universal social services paid by taxes in capitalistic democracies like Norway and Canada and Australia? Are fire departments, public libraries, police departments, hospitals that take Medicare and Medicaid, the military, and national parks socialist? What about the government providing 12 years of free education known as the public schools? What about highway construction? What about bridges and dams? What about the U.S. Postal Service? What about government employees, even elected officials, getting the best pensions and medical coverage in the country? Socialist? Is there a better word?
By definition, according to some -- and definitions vary -- true socialism requires government ownership and control of an industry. Is that the argument? The elephant in the room question remains universal health care.
We have a problem: In the industrialized world, we Americans are 35th in life expectancy, 34th in infant mortality, and we pay twice what other industrialized countries pay for health care. According to The National Health Expenditure Accounts, U.S. health care spending grew 3.9 percent in 2017 to $3.5 trillion or $10,739 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for 17.9 percent, twice more than any other country except the Netherlands.
As far as socialized medicine goes, we’re almost there. As the Tax Policy Center points out, the federal government spent nearly $1.1 trillion on health in 2018. Medicare claimed roughly $583 billion, Medicaid and the Children’s Health Insurance Program about $399 billion, and veterans’ medical care about $70 billion, not to mention more than $146 billion excluded from taxable income of employer contributions for medical insurance premiums and medical care. The federal government also pays for Congress and federal employees. The report projects that U.S. health care spending will surpass $5.9 trillion in 2027, representing more than 19 percent of the economy.
In “Sick Around the World,” a Frontline documentary, avilable online and free, Washington Post foreign correspondent T.R. Reid examines how five capitalist democracies -- the United Kingdom, Japan, Germany, Taiwan and Switzerland -- supply health care.
In the U.K., the government-run National Health Service (NHS) is funded through taxes. “Every single person who’s born in the U.K. will use the NHS,” says Whittington Hospital CEO David Sloman, “and none of them will be presented a bill at any point during that time.” Often dismissed in America as “socialized medicine,” the NHS is now trying “pay for performance,” where doctors are paid more if they get good results controlling chronic diseases like diabetes.
Japan boasts the best health statistics anywhere. The Japanese visit doctors three times as often as Americans, spend about half as much on health care per capita as the United States, and the average Japanese person lives to be 84. (We’re at 78.6) In Japan, by law, everyone must buy health insurance, and, unlike in the U.S., insurers are not allowed to make a profit.
Germany, the country that invented the national health care system, offers universal health care, including medical, dental, mental health, homeopathy and spa treatment. Professor Karl Lauterbach, a member of the German parliament, describes it as “a system where the rich pay for the poor and where the ill are covered by the healthy.”
In Taiwan, the government collects tax money and pays providers. Health care is left to the market. Every Taiwanese holds a “smart card” containing all his or her relevant health information; bills are paid automatically.
In Switzerland, in 1994, a national referendum approved a law that set up a universal health care system that restricts insurance companies from profiting on basic medical care. The Swiss example shows health care reform is possible, even in a highly successful capitalist country with powerful insurance and pharmaceutical companies.
Again, not one of these capitalist countries considers universal health coverage any more “socialist” than public schools or public libraries. It’s a matter of people getting something good for their taxes.
Google: “Sick Around the World.” It’s free on YouTube.
“Socialism is a scare word they’ve hurled at every advance the people have made. Socialism is what they called public power, social security, deposit insurance, and independent labor organizations. Socialism is their name for anything that helps all people.” --President Harry Truman, 1952
(Tony Scully is a former mayor of Camden and a contributing columnist to the Chronicle-Independent, Camden, S.C.)