To the U.S. variety of Americans, the word socialism is
like fingernails running across a blackboard. It runs contrary to our image of
the rugged individual. It smacks of equal opportunity morphed into the quest
for equal results. We saw what it did to Russia and the other Socialist
Republics of Eastern Europe, to Cuba, and to countries in South America and
Asia. It often turns into communism, and that ain’t good and most of us do not
like it.
In spite of our natural antipathy for the concept, we have
a Democratic-Socialist running for President for the second time. Bernie
Sanders got beat four years ago and it is too early to call this year’s result.
Why the attraction to the aversion?
Bernie Sanders self-labeling himself a Democratic-Socialist
is very scary to the Democratic Party elites; a non-Democrat is running for the
top spot on the ballot. If he wins, we will choose between a right-wing ultra-conservative
populist and a left-wing democratic-socialist populist. George Will, anything
but a quintessential liberal, deems it “the most repulsive presidential choice
in US history.”[i]
Sanders, like Trump, sees an opportunity to speak to the heart and the heads of
marginalized people in the richest country in the world.
Senator Sanders has not changed his views on the role of
government since he was mayor of Burlington, Vermont back in the ‘80s. He
believes in universal healthcare. That is not socialism. He advocates free
college. That is not socialism. He thinks rich people should pay more taxes. The
rich think that is socialism. And he goes on. His supporters, mostly younger
have seen the results of unfettered capitalism; to borrow a bit from Churchill,
capitalism may not be the best economic system, but it is better than whatever
is in second place. Sander’s supporters see too much going to the oligarchs and
not enough to the working stiffs. Only a few people own 90% or more of the country’s
wealth, the middle class is decimated, college is out of reach without the
weight of stifling loans, healthcare is too expensive for millions upon
millions, and low skill jobs disappear daily. He has a built-in audience for
whom the aversion is an attraction.
Most people I know strongly support the idea of universally
affordable healthcare for all. A whole bunch of the people I know have very
good affordable healthcare, generally for two reasons: their employer offers
insurance at a reasonable monthly premium, some pay for all of it, or they are
retired and use Medicare as their primary health insurance. Most retirees also
purchase an insurance plan that pays for the costs not covered by Medicare.
They fear any plan that might take their insurance away. So where is the
disconnect?
Senator Sanders has not done a good job of explaining how
we will pay for his programs. He and millions of his supporters want universal
health care; he fulminates about it, with arms raised, every chance he gets. I
agree that we should have it. He has not done a good job of telling us how we
will pay for his planned changes. Not one of his proposals, irrespective of how
much he wants it, can get a veto-proof vote in the Senate or the House. He
needs to tell us the numbers, what step he will take in each of the next four
years, and how he will get it implemented.
What the Senator proposes is not very radical: healthcare
for all; we are the only first-world country without it; free college; we
essentially had it until the 1990s; Harry Truman once said that any program
designed to help all the people is called socialism by the opposition. Social Security
was called socialism. Federal Deposit Insurance was called socialism. Medicare
was called socialism. Free education is called socialism. Chief Justice Warren
put it another way when he suggested that people think the things government
does for them to be social justice and what the government does for others to
be socialism.
If Medicare is socialistic, then nearly every retired
person in the US has good socialistic healthcare insurance, universally
available for anyone 65 years old or better. A number of friends tell me they support
Medicare-for-all, but only for those that want it, and they don’t want anyone
taking their insurance away. I’m not sure how one follows the other. I do
understand, however, even the thought of losing a health insurance plan is
spine-chilling. Bernie’s proposal is a plan that provides full coverage for
everyone for everything, with no deductibles, no copays, and no premiums. Sounds
too good to be true and it is. Sanders and his strong abettors don’t tell us
that “socialized medicine” in most other countries is not free, generally comes
with copays and very high taxes. He just won’t tell us how the money works out.
Logic is on his side on one issue, which is that the total overall cost should
be lower, since we pay so much for our insurance.
People in the US already pay twice the GDP for healthcare
compared to any other country in the world, for less desirable outcomes. We do
not have bad medicine; we have an ineffective delivery system. It surprises
some people that other countries have better health systems with better results
than we do, at half the cost. Any movement to a universal healthcare system
requires more than shutting down the insurance industry. We will have to change
dramatically how we deliver healthcare.
We have independently owned non-profit and for-profit
hospitals that control their own pricing, because they can. Today drug
companies charge what they want for their product because they can... The
government has little if any control over those prices of the two biggest
collectors of healthcare money. Even laisse-fair free-market adherents know
that market supply and demand don’t influence hospital and drug pricing. A
universal healthcare system will require a multi-year disruption of the entire
healthcare delivery system. Proposals akin to 1960 Nordic socialism, which
nearly destroyed the economies of those nations, are far from the reality of 2020.
France’s healthcare system is ranked among the best by the WHO. It isn’t cheap!
If you studied the French language in school or college,
you know there are at least ten exceptions for every grammatical rule. Their
healthcare industry has worked that cultural anomaly to a fare-thee-well. Nevertheless,
let us try. Healthcare coverage is mandatory in France and the healthcare tax is
21% of income. It covers about 70% of medical charges. Employers generally pay
for half or more of that premium for their employees. People can also purchase
a private plan to cover the other 30%. A person making $35,000 per year income
will have a charge of almost $7,300 for health insurance, half of it paid by
the employer. Seniors over 65 years old are fully covered. But in France, the
cost of healthcare is much less than in the US. A doctor's visit is about $30, of
which the patient pays about $9.00. A Root canal costs $100, so the patient pays
$30. One of the ways France keeps its costs under control is by owning many of the
hospitals and setting the payment schedule, and regulating the costs of
prescriptions. They have 5.98 hospital beds per 1,000 persons compared to the US,
which has only 2.77 beds per 1,000 persons, ranked 32nd in the world.
Most doctors are in private practice but are paid by the national health plan.
In other words, the universal health scheme determines the costs and
reimbursements for all medical charges.
We could also learn from South Korea, which the OECD[ii] ranks as the
best healthcare system in the world. Most folks pay 5.08% of their income to a
single-payer insurance plan. South Korea spends about 7.1% of GDP for its
outstanding health scheme compared to 12-15% in the US depending on the year
and the source of the data. Nearly all of South Korea’s hospitals are private but paid by only one plan. It works.
Our current spending on healthcare is out of control, and
our outcomes, after spending outrageous amounts of money, don’t rise to
acceptable levels. We are a large, rich nation. We should have the best
healthcare at the lowest price, but we don’t. Are we ready for real disruption
over a ten-year period to change the system? I’m not sure. But we need to start
somewhere.
I don’t want Senator Sanders to stop pushing for acceptance
of his plan. We need reform. I want him to tell us how it will work, and
how we will pay for it and how long it will take.
