Old Age: Reinvention vs. Reflection

GRAY MATTERS: Socialized Medicine?

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. Links to past Gray Matters columns can be found here. Saul's Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, also appears at Time Goes By twice each month.

I am not now, nor have I ever been a Marxist. But I studied Marxism in a philosophy class in college. I have visited communist countries (China and the old Soviet Union) and lived in semi-socialist counties (much of Europe) and have taken advantage of their socialized, government health plans when I got sick.

Obviously, I survived. But it has occurred to me that these experiences qualify me to recognize Marxism or socialism when I see it in the health insurance reforms that are about to become law.

Socialism means every provider in the health care system works for the government agency that runs the system. So let’s examine the reforms and see which ones, if any, are Marxist, socialist or in danger of destroying America.

ITEM: Within six months this year, young adults – like your kids in school – may stay on their parents’ health insurance until they are 26. The provision applies to all health plans and includes children under 26 who are married. Socialist? No, but it’s obviously paternalistic; critics could argue that children that age should be able to work and buy their own insurance.

ITEM: Also within six months this year, insurers will be barred from excluding coverage for children with pre-existing conditions. I don’t see anything socialist in this provision, but the administration did extend government power to insist that the insurance companies sell such policies at fair prices.

Later this prohibition will include adults but at least one Republican, Missouri Representative Roy Blount, opposes this on the grounds that adults should take better care of themselves. That may be government interference with the free market. But it’s not socialism.

ITEM: Another regulation that goes into effect in six months would prohibit group health plans and insurers of individual policies from rescinding or canceling a policy except in cases of fraud. It means once you sign up in good faith and pay the premiums, the insurer cannot cancel your policy even if you get very sick. Not socialistic, but another case of government telling a company it must assume the risk that some policy holders will get real sick, which may cost the insurer and stock holders a bundle.

ITEM: Under present law, the government just ordered Aetna, one of the largest insurers, to stop selling Part D drug and Medicare Advantage policies because it suddenly changed the drugs offered current beneficiaries. That’s a no-no. Aetna’s stock prices declined after the order.

ITEM: Similarly, the government is telling companies this year that it cannot set lifetime limits on benefits and in 2014, they will be prohibited from setting yearly limits on benefits. You might argue that that’s getting close to the government dictating and hurting business. Why should a company go on paying and paying even if the patient has some kind of incurable disease. What good would the medical help do? That’s not good for businesses, but it stops short of socialism.

ITEM: In what critics might call another government effort to bribe small businesses, many will be eligible this year for new tax credits to help them pay for their employees’ health insurance which they’ll be required to offer. The full credit will cover 35 percent of the cost of premiums this year and 50 percent in 2014.

This isn’t socialistic or a government takeover of the business but it is interference with an employer’s right not to offer health insurance. A tax break on 50 percent of the cost means the employer must pay the other 50 percent, which he may not be able to afford and besides, what if business is bad?

ITEM: Some critics believe workers should be able to take some responsibility and buy their own insurance or take their kids to an emergency room when they run a high fever. Again, not socialistic, and it’s far from Marxist for here the capitalists and workers help each other with the help of government.

ITEM: Another provision that supporters say is especially good for seniors would gradually close the so-called “doughnut hole.” There was a reason for the coverage gap which was deliberately created by the Republicans in their great Part D drug law in 2003 to help drug companies’ profits. When in that gap, beneficiaries must pay the full cost of the drugs, which will be going up if the companies are practicing the American way of business.

Did you know that the reason the gap was created is called “moral hazard?” Republicans wanted to be sure seniors didn’t overuse their benefit and buy drugs they didn’t need. So because some critics argue that closing the doughnut hole may encourage drug use, it’s probably good for the drug business that the hole won’t close until 2020.

ITEM: I see no ideological objection to another benefit this year touted by Obama - the elimination of cost-sharing (deductibles and co-insurance) for preventive medical screening exams such as colonoscopies, mammograms and prostate examinations and annual checkups. Maybe some people will take advantage of this too often and it can end up frightening people. But I do not think this benefit will bring America down.

ITEM: The primary health reforms come in 2014 with the establishment of state health insurance “exchanges” monitored by the federal government. Contrary to the belief that the government is taking over our health care system, these exchanges are supposed to offer a variety of competing private health plans with various benefits at various prices.

But there are to be standard benefits. And low income people will receive subsidies much the way Medicare helps people pay their premiums. All the companies will be private and so will most of the providers, hospitals, labs and doctors, so no socialism here.

In fact, the VA health care system will not participate in the exchanges because it is thoroughly socialist in that all providers work for the VA and it seems to work well, especially for lawmakers like Senator John McCain.

Sarcasm aside, why do people who do not know anything about Marxism or socialism toss those epithets at reforms that can only help them and millions of others? Perhaps the reforms may help the U.S. catch up to the 30 countries in the Organization for Economic Cooperation and Development, which includes most of capitalist Europe where they have been able to live comfortably with government-run health care. They are social democracies, with social (public) ownership of health care and other vital public services.

Bill Quigley, a Loyola University law professor and a director of the Center for Constitutional Rights has compiled some of the differences between the U.S. and counties that have adopted a modicum of socialism.

Their citizens pay higher taxes, but they get their money’s worth in health care and other benefits including education, transportation and paid leave for new mothers. Infant mortality in the U.S. is fourth worse among the OECD counties, better only than Mexico, Turkey and the Slovak Republic. Child poverty in the U.S. affects one out of five kids; that’s double the average in the 30 OECD countries. See for yourself at oecd.org.

“The facts say the U.S. is not on the path towards socialism,” says Quigley. And surely we are not close to Marxism which holds, among other things, that the rich get richer and the great corporations prevent the rest of the population from enjoying the fruits of their labor. (See, for example, the recent Massey mine disaster).

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Rep. Blount is right: Adults should spend that $1,000-1,500 a year they have lying around doing nothing on a Gold's Gym membership so that they can devote all of that spare time they have working out.

I'm reading an excellent book called The Heart of Power: Health and Politics in the Oval Office (Blumenthal and Marone). It's history of health policy from the perspective of each presidency from FDR to GWB. The current law most reflects a philosophy first articulated by Eisenhower, refined by Nixon, and haltingly implemented by Reagan through an extension of Medicare.

The new law is not only not socialist, it's what used to be known as "Republican" until the ultras hijacked the party. Incredibly, today's conservatives make Ronald Reagan look like Lyndon Johnson, at least when it comes to health care.

Hi Saul -- I think some folks have managed to piss you off. Go get them!

I, too, find the overuse of the word 'socialist' which many Republicans toss around so casually annoying as hell. It's become their mantra.

I like the idea of a social democracy for us -- would like to see us go one step further -- to a compassionate democracy. -- barbara

my concervative friends prefer freedom versus government subsidies. They'd rather be dead than be on the government dole. They think that's more American than cradle to grave care.
I really don't know, but that's how they feel.

A particularly good job clarifying reality vs. Far Right obfuscation. And, you're so right in your close: we are surely a long, long way today from Marxism by that definition!

I wrote on this subject recently, but failed to itemize each provision of the reform package. Thank you for clarifying each one.

I was told that by exercising I could extend my life by five years.

Now I have to save for that five years in a nursing home which is $10,000 and up in our area.

I don't think the new law covers custodial care does it? So the $350,000 that we paid for my husband's care before he died last year
is still a problem right?

Well I think the lunatic fringe (both sides) need to hold a cool-ad party. Then the rest of us can get back to actually solving some of the pressing problems in this country.

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