Why Healthcare (and a lot of other things) Need to be "Socialized"

Why Healthcare (and a lot of other things) Need to be “Socialized”

 

This post is the second in a series about healthcare.

 

Part 1: Americans Claim to Hate "Socialized Medicine" - but they Actually Depend on It

***

 

This fact should not be controversial: 

 

Healthcare NEEDS to be “socialized” in order to work. Otherwise, you - whoever you are - will likely not receive healthcare when you need it. 

 

“The Market™” and its profit-seeking economic motive has never and will never create a system where the ill and injured get treatment when they need it. 

 

Throughout history - and particularly since modern science-based medicine was created - every single functional healthcare system has been “socialized” to some extent. 

 

Market forces create other things, namely non-universal care where the rich are treated and the poor are left to die. And also, medical charlatans and snake oil selling “treatment” to the poor, who have no other options. 

 

And if you think that somehow YOU will be lucky enough to get care while others die, well, I have a quarter century of legal experience to tell you that in fact you are likely one serious illness, one serious injury, or even just a certain number of years away from depending on socialized medicine. Without it, you will be left to die. 

 

And it isn’t just healthcare - a great many things are functional only because they were “socialized” - that is, created in large part by government funding and regulation, as part of the public sector. 

 

Let’s start with these facts:

 

There has NEVER been a successful universal healthcare system created by market forces.

 

There has NEVER been a successful universal education system created by market forces.

 

There has NEVER been a successful transportation infrastructure system (roads, rail, canals, ports, airports) created by market forces.

 

There has NEVER been a successful sanitation infrastructure system (sewers, water treatment) created by market forces. 

 

Every single one of these has been created because people agreed that the government would collect taxes from everyone - particularly those who could most afford it (the rich) - and build infrastructure that benefits everyone. 

 

Aka: the Public Sector, social infrastructure, “socialism.” 

 

There is a reason that the private sector, acting on market forces alone, has never, and will never build these things. 

 

That reason is that the benefits are “socialized” - that is, the benefits are for everyone, while the costs are “privatized” - they are borne by the person or company paying for the infrastructure. 

 

[Note: here in the US particularly, we instead have the opposite - many industries where the risk and cost is “socialized” - borne by everyone - while the profits are “privatized” - they go to rich individuals and corporations. A great example is the way that drugs are developed using significant public funding, but the drug companies retain the patents and the profits. This is one factor in why the US pays twice as much for healthcare. There are many other examples.]

 

When everyone benefits - particularly when it comes to necessities, things everyone needs - the private sector will never fund the improvements. To create this kind of infrastructure, public funding and regulation is needed, even if the specific services are provided by the private sector. 

 

You can literally look around the world and see that there are exactly zero countries in which “the market” created a universal healthcare system. None. At. All. Instead, you will see desperately poor countries and failed states in which “the market” provides care to the ultra-rich, leaving the poor to die. And even then, the “care” the ultra-rich receive typically involves flying to functional countries that have socialized medicine. 

 

Instead, you will see that functional healthcare systems are created by the public sector. Even here in the US, the most functional parts of the system are those created and funded by the public sector, while private insurance is increasingly unaffordable for most people without some degree of subsidy from the public sector.

 

Note as well in each of the examples I have given and will discuss, the specific people who benefit cannot pay directly for what they need. I cannot afford to build a water treatment plant, a rail system, or even a road. Children cannot afford to pay for education. 

 

And, for the most part, sick people cannot afford to pay for their care when they get sick.

 

What this means is that we need a system where people pay in during their working years, and everyone pays in proportion to their ability, so that when they do need these necessities, they are available. 

 

You can call this “socialism” if you like. Or you could call it “infrastructure” or “the public sector.”

 

***

 

Let’s look at a few of the examples I gave:

 

Transportation

 

The Roman Empire is often praised for its system of roads, which connected the vast distances, enabling trade, migration, and military transportation. One can argue that this idea is often stretched beyond its reality (the Roman roads would not stand up to modern vehicle traffic better than our modern roads, for example), what is true is that the road system was a marvel of infrastructure that greatly added to the wealth of Rome, and benefitted its population in many ways. 

 

Who built those roads? 

 

The Roman government built the roads, of course. 

 

Imagine what happens without the government building roads. Okay, you don’t even have to imagine. Take, for example, Sierra Leone, where the transportation infrastructure was all built to benefit colonialist powers, facilitating the quick and cheap removal of natural resources for transportation to Europe. 

 

This is precisely how profit-seeking builds things. To maximize profit, not benefit the population. And hence, third world countries around the globe have lacked true transportation infrastructure. 

 

You can also see this here in our modern United States. Why do we have the Interstate Highway system? The Federal Government taxed the rich and built it. Why do we have the Railroad system? The Federal Government subsidized it and granted land on which to build it. (That is a whole sordid story of grift and corruption - which is all too common where private industry stands to benefit from government contracts. But the infrastructure still benefits us today.) Likewise for all public transit systems. And indeed nearly all roads. Our tax dollars built them and maintains them. And we all benefit. 

 

The list will go on too: canals, airports, the air traffic control system - however you get where you are going, you will see government-created infrastructure that makes it all happen. 

 

Without “socialism,” you wouldn’t be able to walk out your front door without paying some rich fuck for the privilege of walking to your job or grocery store. After all, can you afford to build a road from your home to your workplace? 

 

Almost certainly not. What you need is a system in which we all pay for our transportation infrastructure, and we all can use. 

 

Sanitation

 

The other great accomplishments of the Roman Empire were the aqueducts and the sewers. And really, these remain amazing today. 

 

Without public infrastructure, the wealthy (and those upstream) would own all the water. Infrastructure both regulates water use and provides it to everyone, safe and clean. We fail to appreciate this all too often in our own time, and also fail to be concerned when a certain administration chooses not to regulate pollution of our water. 

 

Likewise, the big issue with clean water is keeping the shit out of it. (Literal shit, and the figurative shit of toxins.) 

 

And building sewers is something that really can only be done as public sector infrastructure. The cholera outbreak in London, which led to the giant sewer project - by the government - is a great case in point. 

 

If you leave things to the private sector and the profit motive, the rich might get toilets. Although history would indicate that rather than treating the sewage, they would just pipe it away to where the poor live. 

 

And, of necessity, the poor would shit in the streets. 

 

[Totally related: the most immediate reason that our unhoused population shits in the street is that we have an appalling lack of public toilets. As anyone who has ever had small children in an unfamiliar city can tell you. Businesses have become increasingly hostile to providing this service, because they bear the cost, while the public receives the benefit.] 

 

So, can you afford to build a water treatment plant? Sewer lines to it? Almost certainly not. What you need is a system that we all pay into, and all receive the benefits. 

 

Education

 

It is often difficult these days to remember that white Americans weren’t always hostile to public education. I could write a whole post on Segregation Academies, the homeschooling movement, and white panic about integrated schools. That is incontrovertible history that drives the present push for vouchers, private schools, and neighborhood segregation. 

 

But there is another history that is worth remembering. 

 

Education has always been a fraught subject. The ultra-wealthy would prefer to only educate their own children, preserving a permanent ruling class, and keeping the masses ignorant and illiterate - the better to exploit them. 

 

However, one of the truly admirable Christian movements of the 17th Century was the public education movement. 

 

In 1647, the Massachusetts legislature passed the delightfully named “Old Deluder Satan Act.” It was so named because of its preamble, that stated that one of the tools that old deluder, Satan, used to keep people mired in sin was to prevent them from reading the holy scriptures. 

 

To counter the schemes of the devil, therefore, the act required all towns of 50 or more families to create a public school, and towns of 100 families to create higher level schools as well. Thus, all the children would learn to read and write - and be able to read the Bible for themselves. 

 

Yep, it was the Puritans and other religious folk in New England that created our Public School system - and they should be proud of it. 

 

The fact of the matter is, we all benefit from an educated population. Our strides in science, math, medicine, art, literature, and so many more were made possible because we educated our kids. 

 

You can in fact predict the wealth and advancement of a nation by its literacy and education system. There is no more sure way for a nation to become innovative and prosperous. You must invest in future generations. 

 

But of course, this cannot happen without “socialism.” People living paycheck to paycheck cannot afford to pay for education. And the rich, if they are not forced to, will not pay for it voluntarily. (And, as I will discuss in a future post, all too many white people in this country are averse to paying to educate “those people’s” children.) 

 

Education requires that the government - aka taxpayers - pay so that everyone receives an education. Without that, you cannot have a functional universal education system. 

 

Were you able to pay $18,614 per year for your kindergarten when you were age five? If you are a parent, did you have this much available per child to educate your children? That’s more than a full-time job at the federal minimum wage, by the way. 

 

Do you really want to live in a country where most children go without an education? Or are you willing to put up with a bit of “socialism” so that everyone’s kids get educated? 

 

Healthcare

 

Nowhere, perhaps, is the need for “socialism” than in the area of healthcare. 

 

First, let me talk about a real problem: 

 

“Insurance” is the wrong term for our healthcare coverage system. And, what we need isn’t insurance per se, but healthcare infrastructure.

 

Insurance is a way of hedging risk. For example, I purchase term life insurance, which is essentially making a bet with my insurance company that I hope to lose. I bet them that I will die within a certain 20 year period, hoping I don’t. If I win, they pay my wife and kids a bunch of money. If I lose, I will have paid them annual premiums for 20 years and get nothing in return. 

 

That is what actual insurance is. 

 

Similarly, I make a bet with my auto and home insurance companies that I hope to lose. If I win, by getting in a collision or losing my house to fire, then they pay me. Otherwise, I pay them for the coverage. 

 

That’s how actual insurance works. It hedges the risk of a financially catastrophic event, such as a house burning down or a death of a parent of young children. 

 

Healthcare isn’t like that. 

 

We all need healthcare, and we need more as we age.

 

When I was a kid, I was sickly, and am alive now only because of antibiotics. (And probably because of vaccines as well.) But these were relatively low cost events. I joke that I am not athletic enough to have broken a bone. And it’s not entirely a joke. I am naturally cautious physically.

 

That said, in a careless moment as a kid, I came within a literal foot of being hit by a car. I’m sure I gave the driver a heart attack. (Figuratively speaking.) I’m glad he had good reflexes. A split second more and I would have landed in the hospital. Which would have been expensive. 

 

But overall, young people don’t need that much healthcare. Ongoing vaccines, checkups, and maybe a few injuries. They are fairly inexpensive to cover. 

 

As we get older, however, the risk of needing more expensive care grows. 

 

I am nearly 50, and already on some medications to treat family issues: high cholesterol from my dad’s side, and low thyroid from my mom’s. I am likely to need blood pressure medications eventually. And my eyesight is suffering from O.L.D. Syndrome. 

 

In the next decade, it is possible that, like my dad, I will have additional heart issues that require intervention. (It runs in the family for sure…) In the next two decades, this becomes even more likely. By the time I turn 80, if I am fortunate enough to live that long, I will be almost certain to have had more expensive issues. 

 

This is why, if left to the market, no insurer would cover 80 year olds. They would be left to die, because they don’t create profit.

 

But something to keep in mind: 

 

All of us could become “unhealthy” at any time.

 

Both personally and professionally, I have seen this happen. We are all temporarily healthy, and our bodies are fragile. Our health can disappear in an instant. 

 

Like my cousin-once-removed who was in a horrible auto accident and required surgeries and therapy to regain her ability to move. 

 

Like a friend who got colon cancer in his 30s. 

 

Like another friend who got ovarian cancer while she had teen kids. 

 

Like a friend’s kid who had a freak fall at home and spiral fractured her arm. 

 

Like the client who developed a serious autoimmune disease in their 20s. 

 

Like my mother-in-law who had her first stroke in her mid-40s. That’s younger than me. 

 

Like my father who needed a pacemaker in his 50s. 

 

Like my friend who gave birth to a disabled child, who needs and will always need ongoing (and expensive) care, surgeries, and other healthcare. 

 

Like my client who has long covid. 

 

Like so many of my clients who develop dementia as they age. 

 

Shit happens. None of us are “safe” from having an illness or injury that requires care. NONE OF US. 

 

Sick and injured people do not create profits for the insurance industry. 

 

Which is to say that the incentives are to find ways of denying you care when you need it. Any of us could find ourselves without the care we need, unless there are systems in place to guarantee that we do. 

 

How the “Free” Market would function:

 

Insurance companies make money by taking in as much as they can in premiums, and paying out as little as they can in claims. That is the basic economic reality. 

 

Now, imagine an unregulated market for health insurance. 

 

Companies would make money by charging healthy people premiums, and avoiding covering less healthy people. In practice, this means insurance companies want to have young customers without existing health issues. And they do not want older people, or those with existing conditions. 

 

See where this is going? Let’s say that insurance companies, like car insurance companies, renew on a yearly basis. As a healthy 20-year-old, of course they will cover you. But what if you get cancer? The next year, you are a known liability, so they drop you. Too bad. 

 

Okay, so maybe we need some regulation. If you get sick, your carrier cannot dump you. Let’s see if that works.

 

Well, the same market forces still exist, so, the company needs to make money. They need more young people. So they recruit them. But people get older, so gradually, the people covered need more and more care, causing premiums to rise. 

 

Well, the healthier people look around and see cheaper plans from another company, so they leave. This starts the “death spiral” where only sick people remain in the pool. 

 

Plus, as anyone who has worked in healthcare - or even paid attention a bit - knows, few people keep the exact same coverage all their lives. 

 

What if you lose your job, and thus lose your health coverage. Now, you have to buy on the market. Let’s say you are age 60, and have known heart disease. No insurance company will take you. That’s a fact. What do you do? Just agree to die of treatable disease?

 

Okay, so maybe we have to have more regulation: insurance companies must accept all applicants, and cover pre-existing conditions. 

 

That’s what the Affordable Care Act (aka Obamacare) did. And it was a literal lifesaver for many of my clients after they lost their jobs. Naturally, eliminating this mandate has been a goal of the Republican Party since the ACA was enacted.

 

The other part of this, however, needs to be an individual mandate. Without younger and healthier people paying in, you get that death spiral. The young, healthy people look for cheaper insurance, leaving the older, sicker people behind, which means that companies have to raise prices to pay for it.

 

Unfortunately, Trump and the Republican Party eliminated the individual mandate effective 2019. With predictable results. More recently, they eliminated the subsidies for ACA plans for mid-income people (between 125% and 400% of the poverty level), which further fuels the death spiral in ACA plans starting next year. 

 

Okay, so what do we do now?

 

What we need for healthcare to work is some form of universal coverage - we guarantee that people can get care when they need it, even if they are old, or have preexisting conditions, or are otherwise a “bad risk” for profit-based coverage. 

 

We also need, in order to pay for it and avoid the death spiral, some way of having everyone pay in, at least what they can afford, so that we have a broad funding base. 

 

How on earth do we do that?

 

The answer is…..[drum roll please!]...

 

Socialized Medicine

 

Again, refer to my prior post for my inaccurate colloquial definition of "socialized medicine.” What I mean by that is the following:

Guaranteed issue - everyone gets care regardless of income, health, age, etc.

Subsidized to be affordable - for everyone.

Paid for by everyone at the rate they can pay.

 

This sure sounds a lot like….Universal Healthcare. And like programs such as Medicare. Or the various single-payer and other truly universal systems the rest of the first world uses.  

 

It’s pretty simple in concept: all of us pay taxes, at a rate that we can afford. Which means progressive taxation - the rich pay more and at higher rates. Our tax dollars are then used to fund healthcare for everyone. 

 

And remember, this literally works all around the world, in societies and cultures as different as Japan and Italy, Sweden and Botswana, Algeria and Cuba. 

 

Why is the United States so uniquely resistant to this? 

 

That will be (I hope) the subject of the next post in this series.