- 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
- 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
- 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
- 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
- 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