What’s Wrong with the World

I largely agree with the analysis here.

Question of clarification - do you consider the conservative talk-show pundits typically to be of the "economic wing" of the Republican party? I have my doubts about that, but I think that might be because there are so many talking head pundits out there.

It might be instructive to conduct an exhaustive analysis of the legions of conservative radio personalities, parsing their unprepared remarks upon economic themes in an effort to classify them - but I'm afraid that the undertaking would act as a soporific, with my mind and hands long since paralyzed by the sheer, stupefying ennui of the task.

Generally speaking, though, if you listen to Limbaugh and Hannity, particularly, you'll find that the proposals of the Democrats on the issues mentioned by Buckley will be ridiculed as socialism or other cognate terms. Glenn Beck, who, I will concede, is not nearly the paint-by-the-numbers ideologue that the former two personalities are, has even employed the term 'communism', which seems to be a particular realm of incomprehension, since he also seems to believe that the Soviet Union still exists. So must the Caliphate, I surmise.

In summation, bad policy is bad policy, not central planning, five-year plans, and the Politburo. As the husband of a woman who grew up in the Soviet Union, I can assure the reader that authentic communism is a distinct category in the political taxonomy, distinct from European Social Democracy, which is the real inspiration of all of these Democratic proposals; and it is embarrassing, as a man of the right, to hear notable public conservatives making such dubious, invidious, and dishonest conflations. They either know better, or have no excuse for not knowing any better.

Maximos writes: "such policies, were they to be implemented, would emphatically not constitute the reduction of the 'whole latticework of a free economy (to) the control of the federal government.'"

Well. If "such policies" means just the three policies that Buckley cites, perhaps not - though "universal health care" would be an absolutely gigantic (and probably irreversible) step in precisely that direction.

But if "such policies" means the sum total of *all* such stuff, then I think that Buckley is quite right.

I seem to recall that someone published something on-line a few years ago showing that all or nearly all of the American Communist Party's goals as stated in some long-ago year like 1948 or something like that have in fact been fulfilled. For example "guaranteed minimum income" is now that Earned Income Credit thing. It's entirely possible, even likely that the U.S. Communist party had more moderate goals, esp. back then, than the Real-live Communists of the USSR, but I thought that the post had a good point. Didn't save the URL, though. One person who lived under that regime, Balint Vaszonyi, did not hesitate to call American liberals Communists. In fact, he insisted on it in one of the last columns he wrote before his death. He expressly urged Rush Limbaugh to stop using the word 'liberal' and use 'communist' instead. To be sure, he was including speech codes and hate crimes and stuff in his whole concept, but I wouldn't be at all surprised if the liberal's "Social Democracy" economic and healthcare plans were part of his point as well. And in any event, these things are, as Steve points out, _examples_ of typical liberal economic goals, not limited and discrete ideas.

P.J. O'Rourke said of Sweden something like, "They've harassed the goose that laid the golden egg, but they haven't killed it," which sounds about right. And in any event, what's wrong with "soft socialism" or something like that, if you don't like the unqualified term "socialism" or, still less, "communism"? Or even "European socialism," which I, for one, would certainly use as a derogatory term.

I strongly disagree with the idea here, if this is indeed what you mean to say, Jeff, that one cannot refer to the economies of Europe as "socialist." For goodness' sake--people do that *with approval*. Liberals do it. Since when can "socialism" be used only to mean "USSR-style communism"? That's a new one one me. So we can talk about "socialized medicine" or "socialized daycare" or "social security," but not "socialism" as maybe somehow being a guiding star--sometimes referred to as Nanny Statism--that binds these things together? That makes no sense. As to "serfdom," well, yes, some of us do think that it would be unpleasant *in the sense of being too government-controlled* to live in Europe. Taxes too high, sometimes way too high to the point of being confiscatory, government controlling too much of the GDP (healthcare being a biggie here), too much regulation of the market. Should the nature of this objection come as a surprise? Does it automatically mark people who make that type of objection as stupid? I object both to the notion that "socialism" must never be used in this context and also to the notion that it's somehow a category error to invoke whatever free-market or semi-libertarian impulses still flutter in the breasts of American conservatives to criticize bio-fuel mandates, national health care, and the like. People with such instincts _will_ dislike those policies and will think them bad in part _for_ such reasons. How is this some sort of simple analytical error?

Kinda-sorta-like seems to be the common preface to socialist when used in policy terms. When thrust into socialist/libertarian dichotomies, there's hardly a policy that can't be dismissed as socialist. For those not subscribing to either philosophy, it can make for an uninteresting debate.

The writer that you have in mind, Lydia, is Deroy Murdock; and I agree that it was a column that left an impression. His strongest point, as I recall, was the tax structure of the West, which was nearly blueprint Marxism in principle if not degree.

But I think I agree with Jeff, to the extent that I would insist, in any definition of Socialism or Communism, on the cultural aspects of the program. The Long March radicalism, the inevitable "free love" delusion, the rebellion against the tradition family, the antipathy for all sources of independent liberty, above all the church. I would distinguish the Socialist from the Communist thusly: the former is not a moral monster, more precisely, not a stone-cold consequentialist. More poetically, the former has not capitulated utterly to despair.

Socialism, to the extent that it is voted for by the people, tends towards Christianity.
Capitalism, whether voted for by the people or not, tends away from Christianity.

"The Long March radicalism, the inevitable "free love" delusion, the rebellion against the tradition family, the antipathy for all sources of independent liberty, above all the church."

Well, first of all, all of those are present in spades in Europe, and our American liberals like those along with expanded government regulation of the market and provision of cradle-to-grave services. So if it's Europe our liberals want to emulate, they're aiming for and to some extent getting those cultural aspects of something-or-other, whether we call it "socialism," "communism," or "Social Democracy."

Second of all, even granting the comparatively positive things you are saying, Paul, about socialists--that is, their being comparatively not as bad as communists--I understand Jeff to be objecting to either term, even the milder "socialist," as a negative descriptor of various additional government regulations or government takeovers of sectors of the country (e.g., healthcare) being proposed by American liberals. If I understand him correctly, we're allowed to criticize these policies but not to use even "socialist" as a criticism of them. Nor, again, if I understand him correctly, are we even supposed to invoke concerns about big government, centralization, and government intervention as part of our critique! The ban on the term 'socialist' seems to me highly unjustified, and the objection to critiques based on a desire for smaller government, etc., seems to me...well, just crazy. That _is_ one understandable objection to such proposals, so why can we not make it?

To the extent that the United States has implemented all of the measures recommended in the 1948 platform on the CPUSA, what that demonstrates is, obviously, not that the US is now communist in any analytically valid sense of that term, but that a programme constructed so as to nudge the United States in a direction more compatible with European social democracy - or soft socialism, socialism without the all-encompassing economic planning, but with a few calculated, large-scale market 'interventions' - succeeded. The masters of the CPUSA - the Central Committee of the Communist Party in Moscow, basically - would not have been so daft, in the wake the exposure of so many of their intelligence assets, as to propose their ideological vision in its fullness. No, the intention was merely to soften, by gradualist means, the United States, on the assumption that social democracy would prove more hospitable than capitalist liberalism to communism; and while the turbulent political histories of some European nations seemed to vindicate this judgment during the Cold War, what the aftermath of the fall has shown is that this was not really the case. European social democracy more or less established its balance-points, and that was that. The third way may not be so wonderful by American standards, but it's not lurching towards communism; what increasingly ideological and authoritarian tendencies it exhibits owe nothing to the economic doctrines, and everything to the multiculturalism that has metastasized in the wakes of both the failure of Real Socialism and the negational labours of globalist capitalism, to which multiculturalism and all of its works are the doppelgangers.

The problem with the utilization of 'socialism' as a description of European realities, in the American context, is that the term is freighted with ideological baggage that effaces relevant distinctions. Americans hear the term 'socialism', and their minds turn inevitably towards things like the Politburo, the Gulag, and the omnipresent NKVD, or something like that, whereas European soft socialism, if shorn of its increasingly aggressive anti-national multiculturalism, is really a soft smothering embrace, if anything - quite far from the bootheels and starvation rations of Real Socialism, aka., Communism. There is, considered under the economic aspect, no overarching ideology of regimentation - though there is a variant of the same dubious ideology of progress that has marred American political discourse, perhaps irreparably - and no central planning; there is merely a higher degree of managerial organization under the auspices of state bureaucracies, as opposed to corporate bureaucracies, and there exists no terroristic enforcement of the ukases of the state. Where the thoughtcrimes and shibboleths of multiculturalism are concerned, one would have a case; but, as for the economics, not so much. There, we're concerned with degrees of regulation in an increasingly homogenous neoliberal, managerial capitalism, and there's nothing like the consciousness of relatively small differences to stoke the fires of resentment.

As regards the specific policies, I'd prefer that conservatives articulate specific, concrete critiques, if anything at all, rather than intoning or bellowing that it is all socialism and bound to destroy us. Some Americans of a libertarian bent have the - to my mind - somewhat unhinged idea that, say, any attempt to regulate the functioning of capitalism for any conception of the common good, as opposed to the aggregate of already-expressed consumer preferences, constitutes socialism. Hence, sane things such as growth boundaries - sane because farmland is not an infinite resource and the centralization of agricultural production is bound to impose massive externalities and costs in an era of rising energy prices - are denounced as socialism, and debatable proposals, such as inducements to invest in alternative sources of energy (look, path dependence is a problem, and markets are not uniformly self-regulating), are caricatured as way-stations along the path to Hayek's total state. Finally, it is worth observing that energy, finance, and health care, industries heavily regulated on the one hand, and dependent upon all manner of lobbyist-purchased perks on the other - to the extent, in the cases of the former two, that they are integral to American foreign policy in ways to which most people remain oblivious - are hardly examples of the unfettered capitalism of myth and legend; they are creatures of positive law in large measure, and the controversies between Wall Street bagmen and apologists and pseudo-populists such as John Edwards differ only insubstantially from intra-siloviki infighting in the former Soviet Union. They are controversies involving two or more factions within a largely cohesive caste of managers and technocrats, concerning which methodology best promotes the utilitarian end of maximal material happiness for the maximal numbers. I find such debates unilluminating and, quite frankly, deathly dull. Because both systems are essentially utilitarian, I believe that both tend toward the enervation, exhaustion, and hollowing-out of Christian faith.

For the nonce I will just say that I've never been moved by the argument that "such-and-such is hardly going according to the free market now, so why are you critiquing this new proposal from a libertarian perspective?" Very often part of my objection is that the area is far too governmentalized and socialized already and needs to go in the opposite direction, so you can bet your bottom dollar I'm going to criticize _further_ centralization and government bureaucratizing. Healthcare is an example.

I've no objection to the philosophy of small government; I am, after all, fond of Jeffersonian republicanism and distributism. What I would censure, however, is the invocation of the serfdom meme and the rhetoric which suggests that some policy with which we disagree is a slippery slope to the Total State. We were discussing, specifically, economic policy proposals, most of which I find undesirable, and anticipate being deleterious in their consequences; but if these were implemented, what we would have would be an American version of the European social model, which, if it is trending toward the Total State is doing so, not on account of the regulation of corporations or the provision of public health, but on account of cultural radicalism.

At times, I fear that the reason American conservatives, dominated as the movement has become by interventionist and globalist cranks in foreign policy, and mammonists in economic policy, bleat so loudly at the suggestion of such things is that the powers-that-be find the din a useful distraction from the real threat of social regimentation - this, because countering the genuine threat would entail an emphasis upon our civilizational particularity, and this they regard as retrograde for their own reasons. The regimented homogenization of cultural depravity, and the relentless assault upon a common, Western culture and history are alike resonant with the objectives of economic and foreign-policy post-nationalism. An American National Health Service would be a dreadful institution; but it would not be the death of us.

"An American National Health Service would be a dreadful institution..."

I completely disagree with this. What it would do is make healthcare available to persons for whom it is now--shamefully--out of reach. Such persons should not exist in a society with the vast resources that are available to us. Europeans, to their credit, have collectively decided that their countrymen should not do without, so long as they possess the means to provide what is needed. Americans who take stubborn pride in "I got mine!" are morally bent. The existence of "socialized medicine" would not prevent people of means from obtaining their healthcare privately by paying for it out-of-pocket.

"An American National Health Service would be a dreadful institution; but it would not be the death of us."

Well, of course, unlike Rodak, I totally agree that it wd. be a dreadful institution. I'm not quite sure what you mean by "the death of us," though, and why you're so sure it wouldn't be. I mean, is anything really "the death of us"? How would we define that, and where do we draw the line? America is vastly different now from what it was fifty years ago, and many of those vast differences are economic and have to do with greater governmental regulation and intrusion. Is this "the death of us"? I guess not, but it's a big change for the worse. And a national health plan would be the death of plenty of individuals. Ask the elderly people dehydrated to death against their families' wishes in Dutch nursing homes. I know you deplore that as much as I do, Jeff. What I don't understand is why you seem to think either a) that we have to say "it's not as bad as" something else (global capitalism?) or b) we can't see its problems as in no small part a result of the same urge to meddle and micromanage, to treat all money as "ours," as a big pot that Nanny must spend "rationally," that characterizes so many other European policies. Is national health care really just "economic"? In a very important sense, no. It is as ideological as state-subsidized daycare, as various policies that assume and pressure women's full-time work, or as heavy restrictions on home schooling (all European characteristics). And these things would have been ideological fifty years ago, too, even before anyone had ever heard of multiculturalism.

For myself, I consider the statement "this is trending towards European-style socialism" to _be_ a damning criticism, and I think you might be surprised at how many of Buckley's audience would agree with me. That's "state-ish" enough for me, even if it is, as you say, a smothering blanket. There's plenty of iron inside Nanny's soft glove. I wouldn't live in Europe if you paid me.

"The existence of "socialized medicine" would not prevent people of means from obtaining their healthcare privately by paying for it out-of-pocket."

This is far less true than people who say it think. I guess it depends on what you mean by "people of means." In the UK system, doctors must strictly be _either_ NHS _or_ private. They cannot treat both kinds of patients. Most doctors, of course, work within the system. Hence even an ordinary person with somewhat-more-than-average-means cannot get better private healthcare with his own dollars, because it's too hard to find a "totally private" doctor to provide it.

We are trending that way now already in the U.S., and it's a bad thing. When you reach the age of 65, no doctor who has accepted any Medicare patients in the last two years can charge either more or less (let that second phrase sink in) for your treatment than the Medicare-set fees, and this applies even if you have private insurance. It applies regardless of whether you are willing to pay more yourself. Medicare fee-schedule governs the treatment of all "medicare-eligible" people in this country.

Lydia--
The kind of thing you cite is a problem because we have a mixed system. So long as it's partially "socialized" and partially private, and partially unavailable, these inequities will result.
If, however, you can show me a system in which the poor have access to a full range of healthcare services, and don't need to rely on Emergency Rooms in publicly-funded hospitals to get any care at all, while the rest of us go on as before, I'll listen.

Rodak, I was merely addressing your statement that the "people of means" could always spend their own money to get other or better care. This is not as straightforward as that statement makes it appear where most doctors are not permitted to give such care for money outside the socialized or even semi-socialized system. Those who run socialized systems are absolutely determined that you can't have a situation where a patient gets X amount of or type of treatment at taxpayer expense and then pays more than that for such-and-such more or better. What private healthcare for the rich exists is strictly segregated from the public system. This is in part to prevent what is seen as bribery of public-system doctors, but its net result is that only the very rich can afford to access the fairly rare and strictly non-public medical care. The ordinary person who is willing and able to spend his own money cannot "top off" the public system's contribution. That is forbidden.

The business about not being able to charge less is also one of the perversities of heavily bureaucratized healthcare. Cost-shifting is prohibited. This arises even with semi-governmental big healthcare providers like Blue Cross. A doctor who participates with Blue Cross cannot give any patient a procedure for free or for a reduced price or he risks being successfully sued. I see no reason why this would not continue under a _more_ regulated and socialized system. Everything is standardized, preventing even mercy or charity.

I can't speak for Maximos, but for me I don't see a gross difference between a public trust and a private trust. I don't see how the latter, particularly in our present system, gives the individual greater freedom. The median worker is confined to working for a large company in order for his wife to see a doctor, since market incentives make most private insurance unavailable for an affordable cost. My personal concern over freedom is not that the man making $250,000/year will still be able to get treatment at the Mayo Clinic. My concern is that the guy who only makes $30,000 a year has the freedom to open a shop to support his family and still have his wife get treatment.

"I was merely addressing your statement that the "people of means" could always spend their own money to get other or better care."

Lydia--
I understand that. We will observe that problem with the British system and write a better law.
I would propose something along the lines of newly-minted physicians pledging to serve X-number of years in the "National Health Service" following their residencies in exchange for loan forgiveness. (Just one possibility)
Tbis is done now in my state to encourage physicians to work in medically underserved (i.e. inner-city or rural) areas.
My point: there are ways to set things up that will get better results than we now have, with regard to making healthcare universal and affordable.

I'm sympathetic to the view that big corporations, especially where regulation and subsidy heavily influence their prosperity, are hardly much better than the State. Bureaucracy, alas, seems our lot no matter where we turn.

Still, even as solid a Distributist as G. K. Chesterton did not neglect to point out the lunacy of the old Socialists who denounced monopoly while calling for even larger monopoly in the form of nationalized industries.

Health care seems a particularly troublesome problem. In my view one of the big complications is the absurdly heightened expectations. The fact is that while we can offer every American very good health -- care better than 95% of the world -- we cannot offer every American the very best health care possible: not without bankrupting the country at least.

My other view is that we must grant a wide compass to those dreaded market forces. Doctors must be allowed to prosper according to their skill, and not be reduced to another version of the ubiquitous Bureaucrat. There must be a visible price structure. The check on innovation must be ethical, not economic. Etc.

"Doctors must be allowed to prosper according to their skill, and not be reduced to another version of the ubiquitous Bureaucrat."

The major problem with this principle, under our current system, is that doctors will then all gravitate to those places where they can prosper. This means big cities and their relatively affluent suburbs. Rural areas, which lack the population, and inner-cities which lack the affluence, to allow a specialist to get rich by practicing there, go without. Such areas are lucky to be able to attract a sufficient number of osteopaths or foreign medical graduates to provide needed primary care. Seriously ill individuals are trucked away to distant cities, separated from their families, and treated by physicians in public wards who don't know them. And who pays for this?
Health is not a "product." And healthcare is not a marketing technique. There are few middle-class citizens who have not discovered already the pitfalls of a healthcare system that is more and more being conducted on a business model--and failing to deliver.

Myself, I think we'd be better off if healthcare were conducted more on what *would be seen as* a "business model"--e.g., with doctors setting their own prices, ad libbing forgiveness of bills for needy patients, cost-shifting to the more wealthy patients who would be charged "full price," and so forth. Removing the mandate on emergency rooms to act as de facto doctors for the poor, and setting up more charities and private free clinics actually to _pay_ for healthcare for the poor. Actually I'm not sure that "business model" is the best phrase for this, though that is perhaps what would be said.

I've thought for a long time that a big reason all of this is so expensive is because individuals are not paying for more of their care directly to the provider. The constant involvement of the middle-man, including here private insurance companies, drives up the cost a lot. I mentioned on Zippy's thread on this same topic that this seems to obtain in less emotionally fraught areas, like body work for cars. Very expensive because usually paid for by third-party payer--comprehensive insurance.

The reason for the distinction upon which I am relying in this discussion is simply that a national health service, while fraught with all manner of perils for the body politic, would result in some people not receiving the health care that they desire; off at the end, there exists the probability of rationing, which, as anyone conversant with the Canadian and British situations knows, often involves grievous injustices.

On the other hand, our present system of corporately-administered managed care is hardly a rousing testament to the superiority of market principles, amounting as it does to rationing by for-profit corporations. It is not difficult to ferret out horror stories as ghoulish as any originating with the national health services of other nations; George McCartney's review of (the loathsome) Michael Moore's Sicko cites numerous private-sector atrocity stories, and then proceeds to lambaste Moore for taking the low road of pro-Cuban-medicine (!!!!) propaganda and endeavouring to cover with indiscreet silence the analogous tales from NHSs worldwide. Even someone like myself, suffering from chronic pain and nervous conditions, fares poorly under even the better private insurance schemes, such as Blue Cross Personal Choice: were I to ingest heavy doses of anti-inflammatory medications, or narcotic pain relievers, those medications and the visits to the prescribing physicians would be covered, with only a co-pay required. However, my condition is, as it were, structural, having to do with cervical discs and vertebrae, necessitating chiropractic treatment - to return the spine to a normal alignment, even if only for three days - and accupuncture - which assists in balancing a nervous system that becomes discombobulated by pinched nerves, stress, and so forth. The insurer, however, will not cover the latter, and only provides coverage for a limited number of visits to the chiropractor; they will, however, cover attempts to mask with useless drugs, as opposed to manage, my actual conditions. I easily spend upwards of $500 per month, out of pocket, merely to manage my condition.

That said, a national health service would result in limitations upon the disbursement of health services - and this will be, off at the margins, a grievous thing. However, the post-nationalism of our political and economic establishments is literally and gradually subverting our capacity to exercise the virtues and achieve the substance of self-governance, politically, by means of the incremental integration of legal and regulatory frameworks, and economically, by means of the creation of a new, internationalist "meritocracy" which, because it is the linchpin of the entire economic regime, essentially names its favoured policies. He who pays the piper calls the tune. A national health service would engender numerous particular evils; the internationalist/globalist trends of political and economic affairs are literally transforming the de facto regimes by which we are governed, and in a wholly unrepresentative direction. Contrary to the mythology of countless tomes of corporatist propaganda, consumer decisions are neither equivalent to acts of public deliberation in a representative government, nor concerned, fundamentally, with matters of the same nature or gravity, let alone superior thereto.

There is, nevertheless, one way in which health care policy will arrive at an ominous confluence with the consequences of globalization: the new eugenics. This is how. America will, eventually, even if incrementally, establish a national health service of some type; this is virtually inevitable given the salience of the issue and the calamitous mismanagement which has characterized the reign of Bush the Lesser, leaving the Democrats poised to achieve dominant majorities, and perhaps a realignment. The national health service, whether as an integrated bureaucracy or a patchwork of administrations, will provide health care to the masses. Simultaneously, the wealthy will be able to access networks of private physicians, since this ability will never be taken from them; it is inconceivable, under any plausible hypothetical scenario, that they will be stripped of this opportunity, privilege or no. In time, as the eugenic therapies promised by recent researches become available, the wealthy will avail themselves liberally of their prophesied benefits, all the while providing an increasing share of the tax revenues requisite to sustaining the political system, thanks to the wealth-concentrating effects of globalization. No prizes to anyone who can divine the sociological devolution of such a society, not to mention the evils which will become systemically endemic.

Cheers!

Myself, I think we'd be better off if healthcare were conducted more on what *would be seen as* a "business model"--e.g., with doctors setting their own prices, ad libbing forgiveness of bills for needy patients, cost-shifting to the more wealthy patients who would be charged "full price," and so forth.

This is, in large part, the way the system functioned prior to WWII and the creation of employer-provided health benefits, which were developed as a means of increasing compensation outside the structures of controlled wage-scales during the war. Getting back to that arrangement, however, would entail much more than simply de-linking health insurance and employment. Much more.

"Myself, I think we'd be better off if healthcare were conducted more on what *would be seen as* a "business model"--e.g., with doctors setting their own prices, ad libbing forgiveness of bills for needy patients..."

Lydia--
Dream on. Under that system, doctors just wouldn't see "needy" patients. They would never take them on in the first place; just as doctors in private practice won't see patients now who don't have insurance; or, in some cases, who are on Medicaid.
Would you think it cynical of me (as a person who has worked in two different medical schools, for a total of over 20 years) to say that most physicians are in it for the money?
Did you know that over the last 20 years an ever-increasing percentage of new physicians are women? And that the reason for this is that, while being a physician will still provide a better salary for most women than they can make in business, this is no longer so true for men.

Here is an article I quickly found to substantiate what I posted above. I'm sure that I could find something more "official" if I had the time right now

Would you think it cynical of me ... to say that most physicians are in it for the money?

Not at all. But I would like to see how you propose to abolish this fact of human nature.

"But I would like to see how you propose to abolish this fact of human nature."

Paul--
I was merely scoffing at Lydia's suggestion of physicians waiving fees for needy patients. I don't expect to be able to change human nature. There was a time when most doctors didn't get rich, or expect to. But doctors didn't know nearly as much in those days. And those days are gone forever.

Heck, Rodak, I had a physician waive a fee just two years ago for a minor therapeutic procedure done while the patient was already under anesthetic for a different procedure. And I'm not even a needy patient. But it had to be hush-hush so the doctor wouldn't get in trouble with Blue Cross. That's why I'm not going into more detail, because there was nothing weird or dishonorable about it. But it was this big secret thing. When we spoke to the scheduler and mentioned it, she shushed us up. I'm quite sure that doctor _would_ waive fees for needy patients. Some 17 years ago when I was a poor graduate student with only semi-catastrophic insurance, I was charged a fee for doctor's visits that I'm quite sure was less than his usual fee. Doctors do try to waive and lower fees. They still try to do it now, but now it's treated like a crime.

I can confirm, from my personal experience, that doctors will, in fact, do precisely this. I'll refrain from saying more, given that this is ongoing.

All--
I don't mean to suggest either that all physicians are money-grubbers, or that no physicians will work pro bono. I do, however, suggest that there are not enough of such types to base national healthcare policy on the expectation of that becoming the norm, despite your anecdotal evidence to the contrary.

Doctors and hospitals will also gladly send you to collection agencies. Let's not kid ourselves here. If it wasn't for health insurance being a benefit at near every respectable job, many people wouldn't have it. My grandparents didn't have health insurance until their 3rd child. Doctors and hospitals enjoyed limited immunity in previous times. I don't doubt that it would be possible to move to a completely private model; however, the standard of care in such a model would be drastically lower than it is today.

Needless to say, the original point of Jeff's piece is right, any government action is not a priori a step toward socialism. Disagree with a public health care plan on prudence if one must.

"[A]ny government action is not a priori a step toward socialism..."

I'm not sure what this means. Jeff has stated in so many words that the government actions urged in these cases are moves towards European-style government, which I for one think should be called at least "European socialism." It's obvious that that's what's aimed for. This is often admitted openly by the advocates of various plans, socialized medicine especially, and not considered a problem. Disagree with it on prudence? Well, couldn't we perhaps say that we disagree with socialism itself on prudential grounds? What's the point?

What bothers me is the idea that we can't take it as a strike against something in itself that it involves nationalizing an entire area of endeavour and human action in the economy and turning it over to being run by the government! Somehow we're not allowed to take that to be problematic by itself. Well, I wd. say that if one is among a group of people in which one can't assume agreement that this is at least somewhat of a strike against a policy proposal, then that group of people has what _I_ would call "socialist sympathies." So sue me.

I've no objection to the the "big-government shouldn't get bigger" line of argumentation, especially when it is framed in terms of antique preoccupations such as the Constitution. However, what I find objectionable is the equivocation on the meaning of the political category of socialism, which allows conservative rhetoricians to convert benign, but not on that account desirable, European social democracy into a nascent Total State, replete with all the accoutrements of tyranny. I find this move dishonest, as Europe is becoming more statist, not because it regulates corporations more stringently, but because they have begun to enforce PC with the apparatus of the law.

As regards privatizing health care, while I've no real idea as to how we might reform the present mess, I've no doubts whatsoever that attempts to move to a purely private, market model, given the institutions now in place, will be at least as bad as the disease. This one will require patience and intensive deliberation.

"...benign, but not on that account desirable, European social democracy..."

Without even talking about where Europe is going, do you really consider their present social and economic system is best characterized as "benign"? I've already mentioned several areas in which the European system has not been benign but which have been in place since before multiculturalism--cradle-up child care and strongly-enforced public schooling. (The Prussian system was a model for American advocates of mandatory public schooling about a hundred years ago.) Is this changing the subject? I don't think so, because I think it is artificial to try to draw a line between the much larger welfare system and economic attitudes of Europe, including socialized medicine and, nowadays, "green" policies, and the *overall* European tendency towards greater deference to government, greater insistence on everybody's "joining in," greater willingness to accept regulation and to impose it, and so forth. Here our roles are perhaps reversed from the usual: I'm the one suggesting we look at the bigger picture. Can you really say that, for example, European cradle-to-grave welfare and socialized medicine are "economic" while European restrictions on home and private schooling are "cultural" and that these are not significantly related to each other as part of an overall anti-private European mindset?

Europe was more statist than it should have been before multiculturalism, though of course every era has its own version of political correctness. The Swedish ban (for example) on parental spanking is not a creature of the 1990's.

I, myself, would be chary of lumping together the phenomena of European senescence under one category of error, having ultimately to do with offenses against privacy, or the individual, or what have you. I would state, generally, that the causes and the phenomena themselves are variegated, with some being outright offenses against certain human goods - such as the family - and others being distortions of other obligations under justice - such as the obligation to forestall vast concentrations of wealth and power. Collectivism, as a category, given the individualist, liberal (in the historical sense) political assumptions of Americans, simply lacks sufficient nuance for this task.

However, even were I to concede this point, regarding the manifestations of European declension as variations on a theme, species within the same genus, I'd be dubious that this would apply to the American context, which, after all is remarkably different, whatever the fantasies of American admirers of the Scandinavian model. The differences between the political histories of America and Europe, as well as the persistence of religion in America, are sufficient to ensure that the same policies will not have the same significance on both continents. Europe, on the whole, is wedded to an overtly technocratic politics; America, by contrast, prefers to confine open technocracy to economic affairs, opting for a more therapeutic approach to the softer areas of public policy. In general terms the difference is that between the myth of state competence and the myth of the state as the helper who enables you to realize your own competencies. The mythic contexts are different, and the devils lie in the details.

It would be wonderful if private charity could provide for need, whenever and wherever it occurs.
But it can't, or it doesn't; it never has, and it never will.
According to my concept of Christianity, need creates obligation. Need creates obligation, and that obligation is unconditional.
To the extent that Maximos is correct that a major difference between American, and most European societies is "the persistence of religion in America," it does not seem (to me) to be at odds with the American character to resort to governmental means to meet the needs that exist in our society.
I see no coalition of charities forming with a vow to end hunger in America by such-and-such a date. I see no organized, comprehensive effort in the private sector making any real attempt to meet existing need.
Now, Americans are not obligated to address and meet these needs at all. Not unless Americans want to characterize themselves as "religious," that is.
I don't see why it is any less "religious" to use the already existing, comprehensive organization of government to distribute charity, than it is to use what historically have been even less efficient means.
You see a lot of secularization in Europe; and a lot of cheap grace in America. Which is more honest?