The primary season is upon us, which means it’s time for Republicans to remind us of the grave perils of “socialized medicine.” One-time candidate Michele Bachmann accuses Mitt Romney of “put[ting] into place socialized medicine” when governor of Massachusetts. Newt Gingrich, rejecting Romney’s defense of the Massachusetts law as something other than socialist, declares that “Individual and employer mandates are bad policy leading down the road to socialized medicine, whether the mandates are adopted at the federal level or the state level.” Ron Paul, not to be outdone, derides our health care system as “overly corporate and not much better than a socialized health care system.” Rick Santorum mournfully announces that socialized medicine is “exactly where we’re headed.” And then of course there is that noncandidate and subtle political thinker Sarah Palin, who apparently tolerated Canadian single-payer health care well enough when it was available to her and her family members, but never fails to lambast the health care reform bill of 2010 (“Obamacare”) as the great evil, the capitulation to socialist medicine that will lead us straight into the bowels of socialist hell.
As a historian of ideas, I am confused. What exactly do these Republicans mean by “socialized medicine” and, more generally, by “socialism”? Are they referring to the utopian socialism of the early nineteenth century that arose in the wake of the French Revolution, the socialism of Charles Fourier, Henri Saint-Simon, and Joseph Le Maistre? Are they referring to Marxist socialism and, if so, which variant? The socialism of the early Marx, the Marx of the economic and philosophical manuscripts of 1844 and The German Ideology or the socialism of the late Marx, the Marx of Das Kapital? It is difficult to imagine the candidates rejecting the conservative socialism of Otto Bismarck, the German Iron Chancellor who, during the 1870s and 1880s, wed social reform to a conservative vision of society. But then again they might: Bismarck’s reforms, which included old-age pensions, accident insurance, medical care, and unemployment insurance, paved the way for the triumph, despite Bismarck’s own antisocialist laws, of Germany’s Social Democratic Party in the early twentieth century.
Perhaps the Republicans mean to impugn a broader swath of post-Marxist reformist socialism (also termed “democratic socialism”). Does their antipathy take in the British liberal welfare reforms of David Lloyd George that from around 1880 to 1910 constructed Britain’s social welfare state? After all, Britain’s National Insurance Act of 1911 provided for health insurance, and many of Lloyd George’s acts aimed at the health and well-being of British children. Child labor laws, medical inspection of schools, and medical care for school children via free school clinics were among them. Certainly all the candidates would repudiate FDR’s New Deal. Depression or no, it was a medley of socialist programs that culminated in a social security program that workers could not opt out of. But then again, perhaps the candidates do not understand socialism as the cumulative protections of democratic socialism. Maybe the socialism they impugn is only hard-core late Marxism and its transmogrification after 1917 into Soviet Marxism-Leninism, both of which now slumber peacefully in the dustbin of history. I don’t know. Does anyone? Maybe some of these candidates only see red when contemplating employment of physicians by the state.
When it comes to “socialized medicine,” just how far do the Republicans seek to turn back the clock? Does more than a century of social welfare reform have to go? Certainly they must repudiate Medicare and Medicaid, whose passage in 1965 was, with respect to the elderly and indigent, socialism pure and simple; for the AMA these programs sounded the death knell of democracy. But why stop there? If they really want to root out medical socialism, they can hardly condone Medicare’s precursor, the Kerr-Mill Act of 1960 that made federal matching funds available to states that underwrote the costs of health care for their indigent elderly.
And what of the FDA, that competition-draining, creativity-stifling offspring of Rooseveltian socialist thinking. Who is the government to tell medical equipment manufacturers which devices they may sell to doctors and the public? The 1976 Medical Devices Amendments to the Federal Food, Drug and Cosmetic Act of 1938 would have to go. The more than 700 deaths and 10,000 injuries attributed to defective cardiac pacemakers and leaky artificial heart valves by the Cooper Commission in 1970, not to mention the 8,000 women injured (some left sterile) by their faulty contraceptive Dalkon Shields – this was a small price to pay for an open marketplace that encouraged and rewarded innovation. The 1962 Kefauver–Harris Amendments to the Federal Food, Drug and Cosmetic Act of 1938, which arose in the wake of the thalidomide tragedy of 1961, would probably fare no better. After all, these amendments dramatically expanded the FDA’s authority over prescription drugs by requiring drug companies to conduct preclinical trials of toxicity and then present the FDA with adequate and well controlled studies of drug effectiveness before receiving regulatory approval. I wonder if principled antisocialists can even abide the FDA-enforced distinction between prescription-only and nonprescription drugs, as codified in the 1951 Durham-Humphrey Amendment to the 1938 Act. Before then, Americans did just fine self-medicating without government interference. Sure they did. Citizens of the late 30s could be relied on to decide when to take the toxic sulfonamides (which depressed white cell counts and led to anemias), just as citizens of the late 40s knew enough pharmacology and bacteriology to decide when and in what dosages to use the potent antibiotic “wonder drugs,” all of which could be obtained over-the-counter or directly from pharmacists until the 1951 Act.
But why stop there? Perhaps Republican political philosophy obliges the candidates to repudiate the Federal Food, Drug and Cosmetic Act in toto. After all, it authorized the FDA, a federal agency, to review the safety and composition of new drugs before authorizing their release. Yes, the legislation arose in the wake of 106 deaths the preceding year – many children among them – from sales of the Tennessee drug firm S. E. Massengill’s Elixir Sulfanilamide. The Elixir was a sweet-tasting liquid sulfa drug that – unbeknown to anyone outside the company — used toxic diethylene glycol (a component of brake fluid and antifreeze) as solvent. But, hey, this was free-market capitalism in action. Sure, hundreds more would have died if all 239 FDA inspectors hadn’t tracked down 234 of the 240 gallons of the stuff already on the market. But is this really any worse than having 10,000 or so European and Japanese kids grow up with flippers instead of arms and hands because their pregnant mothers, let down by the regulatory bodies of their own countries, ingested Chemie Grünenthal’s sedative thalidomide to control first-trimester morning sickness? A free medical marketplace has its costs, dead kids, deformed kids, and sterile women among them. Perhaps, in the Republican vision of American health care, this marketplace had every right to bestow on Americans their own generation of thalidomide babies, not just the small number whose mothers received the drug as part of the American licensee’s advance distribution of samples to 1,267 physicians.
If we’re going to turn back the clock and recreate a Jacksonian medical universe free of intrusive, expensive, innovation-stifling, rights-abrogating big government, let’s go the full nine yards. Let’s repudiate the Pure Food and Drugs Act of 1906, which compelled drug companies to list the ingredients of drugs on the drug labels. Sure, prior to the act most remedies aimed at children were laced with alcohol, cocaine, opium, and/or heroin, but was this so bad? At least these tonics, unlike Elixir Sulfanilamide, didn’t kill the kids, and the 1906 Act did put us on the path to government overregulation. And, anyway, it’s up to parents, not the federal government, to figure out what their kids ingest. Let them do their own chemical analyses (or better yet, contract unregulated for-profit labs to do the analyses for them) and slug it out with the drug companies.
And, while we’re at it, let’s roll back the establishment in 1902 of the brazenly socialistic Public Health and Marine Hospital Service, with its “big government” division of pathology and bacteriology. Okay, it did a few things Republican candidates would likely applaud, like preventing incoming immigrants from coming ashore with infectious diseases like cholera, yellow fever, and bubonic plague. But the Service couldn’t leave well enough alone. With its federal budget and laboratory of government employees, it went on to identify infectious diseases like typhoid fever, tularemia, and undulant fever. Then, during World War I, after its name had been shortened to the Public Health Service, it isolated the organisms responsible for epidemic meningitis and developed tetanus antitoxin and antityphoid vaccine. But, hey, private enterprise of the time would have addressed these issues better and more cost effectively, right? And it wouldn’t have placed us on the road to socialist perdition.
Compulsory vaccination for smallpox and diphtheria? State laws that beginning in 1893 required public schools to exclude from enrollment any student who could not present proof of vaccination? Forget it. States and municipalities had no right forcibly to intrude into the lives of children with their public health inspectors, followed by school physicians with their vials of toxin-antitoxin. What was this if not socialist medicine, with the state abrogating the rights of parents and school principals alike – the former with the right to keep their children unvaccinated, that they might contract infection and pass it on to classmates and family members; the latter with the right to keep school enrollment as high as possible without government interference.
Here’s the point of this exercise in conjecture: If we’re going to have a national debate about health care, then our candidates must cease and desist from using evocative words that incite fear and loathing but mean nothing because they mean anything and everything. You can’t have a debate without people capable of debate, which is to say, people who grasp ideas as something other than sound bites that mobilize primitive emotions. Debaters make arguments and cite evidence that support them; they don’t throw out words and wait for a primal scream.
It would be nice if we had presidential candidates willing and able to explain their take on specific ideas and then wrestle with the applicability of those ideas to the real-life problems of specific groups of Americans. It would be nicer still if all this explaining and wrestling and applying were informed by the lessons of history. I believe we will have such debates shortly after hell freezes over. Therefore, I offer my own ideational stimulus package to inch us toward this goal. I propose an Act of Congress that proscribes the use of certain words and phrases among all presidential candidates. Each time a candidate uses a proscribed word or phrase in a campaign speech, a TV commercial, or an internet posting, he or she, if nominated, forfeits one electoral vote earned in the general election. In the realm of health care, “socialism,” “socialist medicine,’’ “big government,” “death panels,” “overregulation,” “the people,” and “the American way” would top the list. Such terms cannot be part of a national debate because they do not promote reasoned exchange. They have emotional resonance but nothing else. In fact, they preclude debate by allowing the word or phrase in question to carry an implicit meaning that reaches consciousness only as a gut-churning abstraction. Gut-churning abstractions, be it noted, tend to be historically naïve and empirically empty.
So I end where I began: What exactly do our Republican candidates mean by “socialized medicine” other than a global repudiation of the health care reform bill of 2010? Do they mean that medicine was just socialist enough before the bill passed, but that specific components of the bill – like preventing insurers from denying coverage to people with preexisting conditions – take the country to a point of socialist excess serious enough to abrogate the new protections the bill affords uninsured and underinsured Americans. Or perhaps American health care, even before the legislation, was simply too socialist, so that it becomes incumbent on our elected leaders to turn back the clock, undo past legislative achievements, reverse specific governmental policies, and disembowel certain regulatory agencies. But if the latter, exactly which laws and policies and agencies must be sacrificed on the altar of a free and open medical marketplace? I don’t know what the Republican candidates have in mind, but I’m all ears – once they stop lobbing word grenades and actually make an argument.
Copyright © 2012 by Paul E. Stepansky. All rights reserved.
Medicine, Health, and History 