Is Medicare for All ”Socialist”?
by Martha Koester, first published in Fall 2018 Health Care For All – Washington Newsletter http://www.healthcareforallwa.org/
According to the traditional definition, no. It is a question about who owns the means of production, though socialists have never entirely agreed on who should own the means of production. The socialists who led the Russian revolution thought that the state should own them and operate them in the interests of the proletariat, which would supposedly eventually lead to communism and the dissolution of the state. But “left socialists,” now commonly known as anarchists, thought that ownership should be in the hands of small collectives of workers and that the state should have a minimal role in production. They thought that a centrally planned economy was a bad idea.
People who pay a lot of attention to public policy usually are familiar with these traditional definitions, but “socialism” as a modern meme is construed differently by various sub-populations. For people over 60 (or anyone old enough to have participated in school drills where you hide under your desk upon warning of a nuclear attack), the term invokes the Iron Curtain, suppression of dissidents in Eastern Europe, and the arms race. However, for the last forty years, conservatives in the US have commonly called any spending of money by governments for the benefit of the general public “socialist.” We live in a universe of discourse in which this has become, for all practical purposes, what socialism means.
There is a sense in which public goods really are socialist. “From each according to his ability; to each according to his needs” does indeed loosely describe how public fire departments operate. You pay to support the fire department according to how much your property is worth, but they don’t send out a truck unless you have a fire. This is a huge improvement over having several private fire departments waste time arguing about who has the right to put out a fire as your house burns to the ground—Benjamin Franklin had figured that out in the 1730s. Even if you don’t have school age kids, you benefit from living in a society with an educated work force and from having publicly financed transportation infrastructure. In fact, America was the first country in the world to treat elementary education as a public good. Most developed countries treat health care as a public good. By and large, market goods cannot even exist without solid investment in public goods—roads are necessary for people to have iPods, but not the reverse. That health care is not considered a public good in the U.S. costs our economy billions.
Since we are trying to sell the voting public on the proposition that health care should be a public good, replying to the question “Is Medicare for All socialist?” should never be “No,” even if this is the correct answer by historical definition. What we should do instead is immediately pivot to the issue of public goods, as in “What we are advocating is that health care should be a public good, like roads and public safety. Medicare for All will make this happen.”
When conservatives attack the idea of health care as a public good, we should explicitly defend all public goods by name, because public goods in general are under attack. While most understand the need to be taxed for things like roads, fire and police departments, and the military, there is less agreement on the need to be taxed to support public schools, universities, libraries, public art, and performance facilities. Only a few libertarians imagine that they can be entirely self-sufficient.
Note that the foundational nature of public goods allows plenty of room for all kinds of supplemental private augmentations. If your kid needs help in a particular school subject, you can hire a tutor. You might decide to add fire extinguishers in every room in your house in addition to the smoke alarms required by the building code. If the cops don’t cruise by your warehouse often enough, you are free to hire security guards in addition.
Promoting the idea that health care should be a public good also leads us to many potential coalition partners who also are involved in the provision of public goods.
It isn’t any surprise that Millennials have a favorable impression of socialism. They grew up in a world in which conservatives have defined all public goods as socialist, and if that’s socialism, then they want a nice big helping of it. Gulags and the Berlin Wall are things that they read about in history class and promptly forgot about after finals are over. As Cold War memories fade, more and more people will be making the default assumption that public goods are “socialist.” Why should people pay taxes to pay for health care if they are part of the 85% majority who account for only 15% of health care costs? For the same reason that they pay taxes to support the fire department even though very few people have fires.