Okay–consider this my Sunday Sermon….
We know that America has an equality problem. We also have a language problem that makes issues of equality more difficult to discuss rationally.
Pundits across the political spectrum, the so-called “chattering classes,” increasingly use words as epithets, rather than as a way to describe reality. Terms like “liberal”—which used to mean “open minded,” “generous,” or a follower of the philosophy of John Locke—have become a content-free insult to be hurled at anyone favoring a marginally more activist government or slightly more robust social safety net.
When “liberal” gradually lost its sting, partisans moved on to “socialist.”
The problem is, few people using the term these days seem to know what socialism is, and even fewer recognize that socializing the solution to a problem can often be very good for capitalism (another system which few can define with any precision), by ameliorating more savage inequalities and thereby avoiding social instability.
The Affordable Care Act—aka “Obamacare”—is unremittingly attacked for being “socialism.” And it is absolutely true that it’s an effort to socialize access to health insurance. But what does “socialism” in this context really mean?
Rhetoric to the contrary, the ACA is hardly an unprecedented departure from a purely market-based system. (Prior to its passage, governments at all levels were paying nearly 70% of America’s healthcare costs, albeit through a grossly inefficient patchwork of programs.) More to the point, ours is a mixed economy, meaning that over the years policymakers have determined that some services are more appropriately or efficiently provided communally–“socialized” through units of government–while others are best left to the market.
We socialize police and fire protection. Most cities have socialized garbage collection. Federal and state highways and city streets are public goods provided by governments and paid for through (largely redistributive) taxes—that is, socialized. Add publicly-financed parks and museums and public schools. Medicare, Medicaid and Social Security all offer “social insurance.” After some 100 years of policy debate, we have finally added health insurance to the list.
The ACA is far from perfect. Many Americans would prefer a single-payer system similar to those that operate in many European countries. Others fault the law’s complexity. Interest groups that stand to lose profits under the new accounting rules argue about the fairness of those provisions. Such complaints are to be expected when any major new program is introduced. Much as we saw with the evolution of Medicare, we can expect significant modifications going forward.
Policy debates are to be expected. What is much harder to understand is the level of hostility aroused by the suggestion that struggling Americans should be provided with access to affordable health insurance. Opponents of the ACA call it “socialized medicine” (it isn’t; at most, it is “socialized insurance”) as though the very label should be evidence that it is anti-American to use tax dollars to subsidize coverage for those who cannot afford it. People who live on their Social Security benefits and love their Medicare positively froth at the mouth at the notion that America has any obligation to extend the reach of such programs to less fortunate folks.
The irony here is that the very people who are fighting tooth and nail to bring down the ACA—bringing lawsuits, supporting candidates who vow to repeal it—are already among the Act’s beneficiaries. America’s previous non-system—the most expensive in the world by far—was widely acknowledged to be unsustainable. The cost of health insurance was a major impediment to job creation, and a drag on the whole economy. In the wake of the ACA’s passage, the indicators have all improved, benefitting all of us.
The ACA hasn’t just improved our economic health. It has also improved our moral health.
There is something very wrong with a society that rations healthcare on the basis of one’s ability to pay—a society willing to tell its most vulnerable members that they are expendable, that they do not deserve even the most basic medical care. Whatever we call this decision to even the playing field just a bit, to mend this major hole in the social safety net, it brings us closer to that elusive thing called civilization.
If that requires a bit of socialism, so be it.