Who's Afraid of Socialized Medicine?

There are two good responses to people, who, when discussing the government’s current attempt to hatch health care reform, start screaming about “socialized medicine.” The first is “You don’t know what you’re talking about.” The second is “What’s wrong with socialized medicine?” Both responses are attempts to help the conversant to reach an epiphany, although, admittedly, if rendered without a touch of gentle humor, the first is likely to earn you a pop in the nose.

The people who are worried about “socialized medicine” aren’t generally scholars, political or otherwise. They are generally reacting viscerally to leftover propaganda from the Cold War. To them “socialized medicine” conjures up images of what they were told to imagine about Soviet health care: dingy offices equipped with World War I era instruments and elixirs and staffed by drunken doctors and ugly nurses. They’re mostly speaking in code to signal to others, who might be like-minded, that they never miss Sean Hannity and that they agree with Brother Limbaugh on just about everything.

What does it mean to say that something is socialized? In broad terms it means that the responsibility for something has been transferred from an individual level to a group level.

To really zero in on this concept, it’s helpful to think about the world in pure terms. Let’s start by imagining a world in which nothing is socialized. In fact, such a world did once exist in the country—about 200 years ago. In that world, each man (women weren’t discovered in this country until about 150 years ago) would, as the Great American Myth has it, go off into the vast expanse of this continent with his axe, his shotgun, and his horse. He’d find a tract of land nobody else had claimed, clear it of trees and other inconveniences, and build himself a little cabin. He’d live off the land, perhaps by growing crops, by raising livestock, by fishing or hunting. If he wanted something he couldn’t raise, kill or make himself, he’d just trade for it. In that world, there could be no tragedies of the commons because the commons was huge and the demands being placed on it would have been infinitesimal.

A small fraction of the crowd that lives in deathly fear of socialized medicine actually believes we’d all be better off if we could return to those simpler days of yesteryear. At least they’re being consistent. The guy who’s about to pop you in the nose, though, is probably not one of them.

He probably lives in a city, town or suburb just like you do, and recognizing that is how you help your discussion buddy to have the epiphany. Unlike Daniel Boone, this guy probably has kids he sends to a public school. He only bears a fraction of the cost of educating them through the property taxes he pays. Using a public school system is sensible because economies of scale make it more efficient for communities to pool their resources and provide for a centralized way of educating children. Even if he sends his kids to private school, and pays full tuition, the logic of economies of scale prevail. True, your conversation partner doesn’t have as much say over what his kids learn in school as he might have if he were home schooling them, but his costs for the service are much lower and the quality of the education his kids receive is likely to be higher. The point is that by transferring his responsibility for educating his kids to the community, he’s participated in socializing education.

In addition to education, we’ve socialized almost everything else our conversation partner comes into contact with, and, for the most part, he’ll probably be darned happy that we’ve done so. Professional firefighters, police, air traffic controllers, food and drug inspectors, soldiers, letter carriers and other people who make our lives safer and more comfortable are all the result of socializing costs, as are roads, parks, and public libraries.

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The foregoing are examples of how we have transferred private costs to the government. The concept of socialized costs, though, extends to the private sphere as well, and the best example of this is what’s started the argument in the first place: insurance. With insurance, a large group of individuals each pay a small amount to transfer risks he or she ordinarily doesn’t want to bear to a counterparty who will bear the loss if the risk materializes. The system works because, ordinarily, the payment from each individual is small in comparison to the contemplated loss, and because the thing the individual fears may happen to him, ordinarily doesn’t. In fact, without insurance our modern economy would not be possible.

To the backwoodsman described earlier, the concept of insurance is repugnant. In his mind, your bad luck is, well, your bad luck. To him, a person should pull his own weight and not burden others. That’s a nice theory, fully consistent with the American mythic credo of self-reliance. Too bad it doesn’t really work.

Suppose our discussion buddy has a heart attack while screaming about socialized medicine. Without having socialized the risk through health insurance, he’d probably die, basically because he wouldn’t be able to afford what our system currently charges for the care required to save his life. On a broader basis, without having socialized the risk of major health problems, our medical system probably would not have been able to develop the required technologies or surgical know-how; because there would not have been enough people who could afford to utilize breakthrough medical technologies, it would not have proved profitable for doctors, pharmaceutical companies and medical equipment suppliers to develop these capabilities in the first place.

If you really press your conversation partner—gently, of course—you’ll both see that the issue really isn’t “socialized medicine” at all. Once you strip away the Cold War lore and the right-wing code, except for the survivalist crowd, everyone can probably see that socializing certain costs—and health care costs in particular--is not such a bad thing. The real issue is control, a topic I’ll turn to in a later post.

As always, your comments are welcome.