Death and Taxes

by Corey Robin on February 14, 2014

Last year I wrote, somewhat tongue in cheek, that socialism is about converting hysterical misery into ordinary unhappiness.

This is what I meant.

Socialism won’t eliminate the sorrows of the human condition. Loss, death, betrayal, disappointment, hurt: none of these would disappear or even be mitigated in a socialist society. As the Pirkei Avot puts it, against your will you enter this world, against your will you leave it. (Or something like that.) That’s not going to change under socialism.

(Oh, by the way, Happy Valentine’s Day.)

But what socialism can do is to arrange things so that you can deal with and confront these unhappinesses of the human condition. Not flee from or avoid them because you’re so consumed by the material constraints and hassles of everyday life.

I was reminded of that post reading this wonderful piece by Anya Shiffrin about the death of her father.

Last spring, André Shiffrin, the legendary publisher, was diagnosed with pancreatic cancer (he died in December). A New Yorker through and through, he nevertheless decided to spend his last months in Paris, where he and his wife had an apartment and where he had been born. It proved to be a wise move, as Anya explains.

So imagine my surprise when my parents reported from Paris that their chemo visits couldn’t be more different [than they had been at Memorial Sloane Kettering in New York]. A nurse would come to the house two days before my dad’s treatment day to take his blood. When my dad appeared at the hospital, they were ready for him. The room was a little worn and there was often someone else in the next bed but, most important, there was no waiting. Total time at the Paris hospital each week: 90 minutes.


There were other nice surprises. When my dad needed to see specialists, for example, instead of trekking around the city for appointments, he would stay in one room at Cochin Hospital, a public hospital in the 14th arrondissement where he received his weekly chemo. The specialists would all come to him. The team approach meant the nutritionist, oncologist, general practitioner and pharmacist spoke to each other and coordinated his care. As my dad said, “It turns out there are solutions for the all the things we put up with in New York and accept as normal.”


One day he had to spend a few hours at Cochin. They gave him, free of charge, breakfast and then a hot lunch that included salad and chicken. They also paid for his taxi to and from the hospital each week.


“Can’t you think of anything bad about the French healthcare system?” I asked during one of our daily phone calls. My mom told me about a recent uproar in the hospital: It seems a brusque nurse rushed into the room and forgot to say good morning. “Did you see that?” another nurse said to my mom. “She forgot to say bonjour!”


As Anya notes, it wasn’t that her father “was getting VIP treatment or had a fancy private plan. Not at all. He had the plain vanilla French government healthcare.” She also points out that health care spending is much lower in France than it is in the United States.

I should acknowledge here that I know relatively little about health care policy, and the comparative merits of France versus Britain versus the US. So I can’t really comment on that element of Anya’s argument.

I want to make a different point.

French health care couldn’t stop André Shiffrin from dying; nothing in this world could. Instead it created a space for him and his family to deal with his dying, without the distracting mayhem of our system.

When my dad began to get worse, the home visits started. Nurses came three times a day to give him insulin and check his blood. The doctor made house calls several times a week until my father died on December 1.


The final days were harrowing. The grief was overwhelming. Not speaking French did make everything more difficult. But one good thing was that French healthcare was not just first rate — it was humane. We didn’t have to worry about navigating a complicated maze of insurance and co-payments and doing battle with billing departments.


Every time I sit on hold now with the billing department of my New York doctors and insurance company, I think back to all the things French healthcare got right. The simplicity of that system meant that all our energy could be spent on one thing: caring for my father.


That time was priceless.


In my Freudian (late Freud) moments of despair, I sometimes wonder if the madness of American capitalism isn’t one massive contrivance to avoid the sad finitude of the human condition. Filing our insurance claims, haggling on the phone, waiting for doctors, we don’t have time or space to deal with death. At least not properly. That’s what socialism—or whatever variant of state-provided/delivered/guaranteed/ensured health care we’re talking about—might help us do. Perhaps that’s why we don’t want it.

Patri Friedman, grandson of Milton, says that libertarian imago and Paypal entrepreneur Peter Thiel “wants to end the inevitability of death and taxes.” That seems about right. And a useful way to distinguish libertarianism from socialism, with taxes meant only as a signifier of the reality principle. Marx, at his most utopian, thought we were “suffering, conditioned and limited creature[s].” And that that was an essential part of our humanity, the necessary and productive delimitation of our liberation.

Socialism is not a flight from the human condition; it’s a direct and unsentimental confrontation with that condition.

{ 96 comments }

1

john in california 02.14.14 at 5:43 pm

Yeah, well … what about this??

http://www.ispot.tv/ad/7BkA/cadillac-elr-work-hard

pansy french!

2

Matt Regan 02.14.14 at 5:52 pm

Who is the character in Catch-22 that spends all his time playing cards because he hates it so; and thus the playing makes time drag on and on and on, giving the illusion of longer (if more dreadful) life?

3

JW Mason 02.14.14 at 5:55 pm

This is exactly right.

4

mw 02.14.14 at 6:01 pm

But health care for the elderly in the U.S. has long been socialized (Medicare) for half a century — so socialism or the lack thereof really can’t account for the differences in treatment of 80-year-old cancer patients.

5

Shelby 02.14.14 at 6:13 pm

As mw suggests, socialism/capitalism does not explain differences between healthcare in the US and France. Much of the US system is driven by government meddling in the system; certainly healthcare has become more bureaucratic and more subject to insurance-related payment hassles over the past few decades, even as government regulation and the market share of medicaid and medicare have ballooned. (This is of course not to say “government drives all that is bad about US healthcare!”)

6

krippendorf 02.14.14 at 6:18 pm

@mw
Yes, it can. It’s not like the “socialized” side of the US system is completely independent of the non-socialized side.

7

The Temporary Name 02.14.14 at 6:27 pm

Oh, by the way, Happy Valentine’s Day.

Thank you!

8

Jerry Vinokurov 02.14.14 at 6:36 pm

Who is the character in Catch-22 that spends all his time playing cards because he hates it so; and thus the playing makes time drag on and on and on, giving the illusion of longer (if more dreadful) life?

I believe it’s Dunbar, Yossarian’s friend.

9

Plume 02.14.14 at 6:37 pm

I’m more than ten years into cancer treatments. My chemo has increased rather dramatically with a recent change in corporate structure. It was roughly $29,000 for four sessions prior to the change. Now it’s roughly $19,000 for one. I am very fortunate to have insurance, obviously.

Millions of Americans aren’t so lucky, of course. And most bankruptcies in America are due to medical costs, and most of those people have health insurance.

Actual socialism would end that nightmare for millions. As Corey notes, it wouldn’t solve the problem of mortality, obviously. But it would at least allow people to die in some semblance of peace with dignity.

10

SoU 02.14.14 at 6:41 pm

@4
the post specifically makes note of the bureaucratic excesses and indignities of the US healthcare system. these are a product of a number of elements, but a major one is the lack of single payer. so much time and effort navigating the different plans and insurers and premiums etc. all that paperwork and pricing and such leaves less space for humanity to shine through.
the structure of the different markets has real effects on the institutions that provide care, and their incentives, self-conception, etc.

11

Plume 02.14.14 at 6:41 pm

mw,

One problem with our version of Medicare is it’s been partially privatized. There is really no reason why it should only cover 80/20 splits, for instance, other than lobbying by insurance companies for supplementals.

And, politicians made it impossible for Medicare to use its “economies of scale” to force drug prices down.

It’s okay for Walmart, but not for Medicare to use its size, etc. etc.

America is going to have to wake up, grow up and go all non-profit via insurance and health care delivery. An aging population will force this on us eventually. Our mish mash of for-profit dominance reduces the effectiveness of smart and humane programs like Medicare, and we’re just not going to be able to keep that up much longer.

12

novakant 02.14.14 at 6:47 pm

Good state-funded healthcare doesn’t have anything to do with socialism, France isn’t a socialist country – can we stop calling it socialism, just confuses matters.

13

emmryss 02.14.14 at 6:47 pm

You scarcely need “Socialism” to have socialized health care. Canada’s as far from socialism as can be imagined but we still have socialized health care. We still, should we so choose amidst the ten thousand distractions served up by the rest of the economy, we still get to contemplate the human condition.

14

roy belmont 02.14.14 at 6:55 pm

Happy Valentine pour tous les amoureux

15

Plume 02.14.14 at 6:58 pm

Of course you don’t need socialism to have aspects and semblances of it. But given that it’s common sense to let the people control their own economic destinies, and to have true democracy including the economy, rather than rule by the few, why wouldn’t we want to change systems?

Socialism is obviously more logical, rational and humane as a system than our current one. Our current system depends upon economic apartheid to function, and the willing complicity of most citizens to ignore that fact.

16

Alex K. 02.14.14 at 7:46 pm

I wish the people advocating socialism could have experienced in real life the numerous opportunities for meditating on the human condition present in actual socialism.

For instance, while standing in line for more than half a day to get milk, they could appreciate the opportunities to think of the dynamics of social interaction, and how they depend on whether most people believe that the milk will be enough for everyone or not.

Or, while trying to find someone who has a friend who knows someone at the meat department, who can then provide some extra meat under the table, they could meditate about how it’s possible that everything is not really connected, so maybe Hegel can not really reach the Absolute Idea only by the means of determinate negation.

Finally, they could make the interesting observation that having a mechanism that coordinates people to perform simultaneously a certain action does not really result in more social cohesion: the hot water is available only two times a week, at a certain hour, but this does not result in any particularly bonding religious bathing ritual.

So Corey Robin is indeed correct, as socialism presents plenty of opportunities for “unsentimental confrontation with [the human] condition.”

17

MPAVictoria 02.14.14 at 7:49 pm

I am a bad person to wonder how her father got access to French healthcare? When was the last time he paid taxes in France? How did he have a French insurance card?

All that said I 100% agree with the main thrust of Corey’s post.

18

Alex K. 02.14.14 at 7:50 pm

Also, let’s not forget about toilet paper!

http://www.bloomberg.com/news/2013-09-27/venezuela-is-running-out-of-toilet-paper-.html

http://www.washingtonpost.com/world/at-markets-chavez-successor-falls-short/2014/01/31/ac85c62a-8518-11e3-a273-6ffd9cf9f4ba_story.html

You would think that by the third millennium, socialists would gather together and come up with a simple plan:

“We know that some mispricing and mismanagement is inevitable in socialism, but by Marx and Engels, we will make sure that at least we price toilet paper right!
We’ve had enough of being the butt of *that* joke!”

But Venezuelans have had no such luck. Instead, they have to make do with exploiting the deep connection between profound meditations about the human condition and having to be economical with their toilet paper.

19

MPAVictoria 02.14.14 at 7:52 pm

“I wish the people advocating socialism could have experienced in real life the numerous opportunities for meditating on the human condition present in actual socialism.”

What is this actual socialism of which you speak? Where has it actually been tried?

20

Gerry 02.14.14 at 7:52 pm

Re #1 above, the Cadillac ad – I’ve never been more sickened by an advertisement. The line about going to the moon and then getting “bored” … so indescribably ick. So USA. And, as regards the OP, a profound illustration of capitalism as denial, yes.

21

geo 02.14.14 at 7:59 pm

Beautiful post, Corey. Where else but Crooked Timber?

22

SoU 02.14.14 at 8:00 pm

“let’s not forget about toilet paper”
ah yes, i seem to remember now, from the Grundrisse i think it was, right next to the stuff on collective ownership of the means of production, something about ‘and each shall only get 2 squares for number 1, 4 squares for number 2, and if higher than 2 ply, half.’

23

Plume 02.14.14 at 8:07 pm

Alex K,

Real socialism has never been tried. By definition. That would require true democracy, including the economy, with the people actually owning the means of production. Not political parties or dictators. The people.

You are confusing state capitalist experiments with the real thing. Lenin admitted that Russia needed to embark on a rabid program of capitalism in order to industrialize, and he actually implemented forms of primitive accumulation to force this upon the Russian people, especially in the countryside. The Soviet Union never transitioned away from state capitalism. Nor did China, Cuba, etc. etc.

Marx also said not to try actual socialism in a nation with scarcity issues, much less scarcity debacles. That, he said, would just socialize misery.

If, however, we switch to socialism in a healthy economy, or do this internationally (his other guideline), there are more than enough goods and services to fill all needs without those waits.

The richest 85 people in the world now hold more wealth than the bottom 3.5 billion. Obviously, if we spread that around, you don’t have long waits for bread.

Plus 85% of the production and resources go to the richest 20% of the world right now — leaving just 15% for the bottom 80%.

Do the math.

Obviously, if distribution and allocation of resources is done in a humane, fair manner, you don’t have waits for bread. Or medicine. Or shelter, etc. etc.

The problem of scarcity and long waits disappears with fair distribution and allocation of resources and productive energies.

24

Alex K. 02.14.14 at 8:08 pm

“Real socialism has never been tried.”

You never get tired of this bullshit, do you?

25

Plume 02.14.14 at 8:10 pm

In short, we don’t have an issue of too little for too many. We have an issue of a few people hoarding pretty much everything for themselves at the expense of everyone else.

Logically, reverse engineer this, and you’ve solved the issue of scarcity and “socialized misery.”

We have plenty. More than plenty. But that plenty is concentrated in all too few hands.

26

William Timberman 02.14.14 at 8:12 pm

Sometimes I think I’m waiting for Godot, sometimes for Das Schiff mit acht Segeln. Lucky Alex K, whose bliss has already arrived.

27

MPAVictoria 02.14.14 at 8:13 pm

“You never get tired of this bullshit, do you?”

Well where has it been tried Alex?

28

Plume 02.14.14 at 8:17 pm

Alex K,

I second MPAV’s question.

Where has it ever been tried?

Nowhere.

Here’s Chomsky on socialism, and the misuse and abuse of the word and the concept:

29

Andy Wilton 02.14.14 at 8:20 pm

Gerry @ 20: I found that ad fascinating. It’s clearly aimed at making rat-race occupants feel proud of their situation, but the argument is so flimsy it’s almost self-parodying. I mean, with real ads like that, who needs The Onion?

OP (or rather the second block quote within it): hey, “bonjour” is serious. It’s like “please” and “thank you” only more so.

30

mw 02.14.14 at 8:36 pm

Yes, it can. It’s not like the “socialized” side of the US system is completely independent of the non-socialized side.

That’s true — but the parts of the U.S. medical system that aren’t socialized at all are the ones that most resemble the French experience described in the article. I’m thinking of various kinds of elective treatments (plastic surgery, vision correction, cosmetic dentistry) that are generally not covered by private insurance or government programs. Also veterinarian care, which is delightfully friendly & convenient with costs that are a fraction of those of human medicine — despite the fact that current vet care is almost certainly superior to the human care of a couple decades ago, let alone when I was a kid. I mean, hell:

http://vetsportsmedicine.com/centers-services/orthopedic-surgery/arthroscopy.html

My tongue-only-slightly-in-cheek solution for the outrageous costs of medical care in the U.S. is simply to permit vets to treat humans.

31

bob mcmanus 02.14.14 at 8:43 pm

I don’t know why we are not France. My first guess was that the lucky countries lost a lot of their right wingers in wars.

Where else but Crooked Timber?

Why did it take me four days to find out that Stuart Hall had died? What is this thing called the American Left?

(In other not completely unrelated news, Richard Seymour and China Mieville (+ others) have resigned from the ISN. A Very Public Sociologist has the juicy details.)

32

SoU 02.14.14 at 8:44 pm

hey Alex – remember when we saw the first instances of actually existing capitalism? it forecasted such a bright and glorious future…

all those young children, being sent to work for basically pennies, because their cute little fingers were really good at getting between the gears in the machines. good thing they worked for so cheap, really saved on personnel costs, that did.
and the factories themselves – goodness! so warm and comfortable, if you enjoy working in a sauna for 10 or even 12 hours straight with little ventilation but the fumes from the dyes and chemicals used to treat the cloth. but you got to be close to your fellow workers – yes! the joy of solidarity!
unless of course they happened to be sick, then, well… i guess the rates of sickness were only about 4 times larger than they were for workers out in the fields. but the sickness was endured together- shared misery! – especially because your benefits schedule rarely include paid sick leave or an EPHI plan…
but then – that was just in the factories, where the death rates were 25% higher than before… out on the fields, yes , that was where capitalism truly triumphed! no longer were they cluttered by petty yeomen clutching to pitiful holdings not fit for a herd of sheep – no! capital had come, and those small farmers were where they belonged… in the streets! in the factories! and if they refused to work – to the institutions with them then! everyone in their proper place, which was not the fields, because those were for the sheep, who need much more space to live and roam than do silly peasants.
and the government, newly enriched by this novel force called Capital, think of all that it could do! now it could go abroad – all over the world! – and press-gang the locals into working for cash crops. they had the finances to install puppet states the world over – progress i say! teach those natives the value of hard work – they will thank you in 2 centuries when their ancestors finally escape the yoke of your imperial government and subsequent debt burdens and neoliberal restructurings and have the autonomy to discover for themselves the maxim of : an honest day for your honest pay.

ah- what a glorious birth capitalism did have…

33

mpowell 02.14.14 at 8:45 pm

If we extended medicare to everyone in the United States, we would not have French healthcare. There is a lot more going on here. I don’t know what exactly is meant by socialism (different meanings from different speakers), but if we want to talk about not having to deal with economic problems on top of normal human misery, greater wealth and guaranteed minimums are both valuable. Rawls’ claims about only the latter mattering never made any sense. And I don’t agree that it’s obvious what combination of social/economic policies are best to achieve these goals and also think it’s unlikely that the same solutions are best in every time and place. But they are worthy goals.

34

Corey Robin 02.14.14 at 8:52 pm

“Why did it take me four days to find out that Stuart Hall had died?”

I have no idea. I found it as soon as it was announced at The Guardian, and everyone on my FB page began re-posting it. What’s your excuse?

35

MPAVictoria 02.14.14 at 8:52 pm

“And I don’t agree that it’s obvious what combination of social/economic policies are best to achieve these goals and also think it’s unlikely that the same solutions are best in every time and place. But they are worthy goals.”

Oh I think we know what works; strong unions and strong social safety nets. We can do it but we (the big “we” not the we here) choose not to.

36

Tom Slee 02.14.14 at 8:55 pm

emryss #13: Canada’s as far from socialism as can be imagined but we still have socialized health care.

Unfortunately what we don’t have is the focus on home visits that the author writes about in the French system. It’s a focus that is also there (at least it was) in the UK system for post-natal care. I wish Canadian healthcare were much less hospital-centric.

37

PlutoniumKun 02.14.14 at 8:56 pm

There does seem to be something specify about the French system which makes it particularly humane. There was a Slate article on this last week:

http://www.slate.com/articles/business/dispatches_from_the_welfare_state/2014/01/french_socialized_medicine_vs_u_s_health_care_having_a_baby_in_paris_is.html

Anecdotally, I know an older Australian man who fell ill with a type of blood cancer while travelling in France. His wife, a good friend of mine, is a nurse with many years experience working in many different countries and lots of experience in oncology nursing. She immediately decided that he would not move from France. Although not French (he can’t even speak French), the hospital staff simply didn’t ask any questions about his right to receive healthcare in France. He received magnificent treatment for free and his wife insists that he would probably not have survived in almost any other country (including his native Queensland).

I suspect that its something to do with the combination of a well funded centralised system with a very demanding customer base.

38

bob mcmanus 02.14.14 at 8:58 pm

As far as the good post goes, well, path dependency and a chain of profit-making entities all getting cuts:medical schools, doctors, hospitals, insurance companies, drug companies. I presume France has cost control.

I usually go along with the standard definition of socialism as ownership by workers, but moving from top or elites down, creating a system where exploitation and profits are regulated, minimized or taxed away might accomplish the same thing. This would have be theorized as an extension of the understanding of “Capital” to personal ( a degree) and social capital and intellectual property (patents).

Jon Walker of FDL on the same Shiffrin article, with the usual lament about Obamacare and the great commenters. I also read this week, I think at Slate, a different article from an American expatriate in Paris who thinks she’ll stay.

39

Lynne 02.14.14 at 9:04 pm

MPAVictoria @ 17, I wondered the same thing. But it sounds like they had an apartment in Paris and if they owned it they’d have been paying taxes. It isn’t clear though how long they’d had the apartment.

Their experience sounds better than what they would get here in Canada. Here you still have to go to the doctors and sometimes wait a long time and you don’t have much choice in doctors, either. And that doesn’t even count the wait for an appointment. But we don’t have to deal with the bureaucracy that Americans do, thank God.

40

DaveL 02.14.14 at 9:05 pm

I too get pretty tired of “Where is this existing socialism?” (or “… communism?”). Its proprietors call (or called) it socialism or sometimes communism.

I hear all the True Scotsmen with bagpipes a’ piping when I’m told that the USSR, or China, or Yugoslavia, or any other “socialist” or “communist” country wasn’t “true socialism/communism.”* There’s a certain Platonism to it all. True Socialism shines like the isoceles triangle in the Hylaean Theoric World**, but not in our vale of tears, ever.

* One might as well ask where there has been a “true capitalist” state. I’ve never heard of one of them either.
** Gratuitous Anathem reference.

41

MPAVictoria 02.14.14 at 9:10 pm

” But we don’t have to deal with the bureaucracy that Americans do, thank God.”

Indeed! My interactions with the Canadian Health Care system have been pretty positive really plus I love my doctor!

42

MPAVictoria 02.14.14 at 9:11 pm

DaveL you can be as tired of it as you like but it is a valid point.

43

Andy Wilton 02.14.14 at 9:14 pm

While mpowell @ 33 is clearly right that different speakers here mean different things by the word “socialism”, can I just add how curious it is to hear dire warnings of queues for bread in the context of the French variety? I mean, you can certainly end up standing in line for 10 minutes or more on a Sunday morning in provincial France, especially if everyone in front of you wants cakes, but overall the process is both humane and efficient – and the bread is rather good too!

44

Plume 02.14.14 at 9:18 pm

DaveL,

It’s not a matter of purity. When something bears no relationship to the fundamental, essential and core principles of a theory, can you really give it that name?

No.

An analogy:

I’m not a fan of the West Coast Offense at all. Nor do I like an offense that runs the ball a lot more than it passes. I prefer the Air Coryell offense, and about a 65/35 split, pass to run.

Okay, so the local NFL team hires a new coach and completely changes over its offense and defense. The coach has a rep for using Air Coryell and being pass-happy.

But it turns out his team actually runs a hybrid West Coast and Ground Chuck offense, and they run far more than they pass the ball. It’s roughly a 35/65 split, pass to run. And they go 2-14 for the season. They’re lousy.

So you and I have this argument about this team, with you insisting on how rotten the Air Coryell offense is, and how it’s really stupid to pass the ball so much and how all this just ruined the local team. Look at their record!! I point out to you the facts, that they’re not using Air Coryell, that they never did, and that I don’t like their offense or their results either.

45

jonnybutter 02.14.14 at 9:47 pm

#1 omg that commercial! Throbbing pomo despair in a handy youtube take-along-pak. Hard to believe, which I’m sure is the point, or one of them. That wins the thread no matter what comes after.

46

mpowell 02.14.14 at 9:48 pm

MPAVictoria @ 35: “Oh I think we know what works; strong unions and strong social safety nets. We can do it but we (the big “we” not the we here) choose not to.”

I think those are generally good things, but they are pretty weak tea as far as socialism goes. Granted, they’re called socialist in the US, but that’s not saying much. Take French healthcare: the state pays for your care directly. That’s a lot more than the ACA (which is basically affordable private healthcare for all, unless your state is refusing to expand medicaid). The ACA is a safety net, but it’s hardly socialism.

I just disagree with the feeling behind the original quote by Corey. Is socialism a philosophy of how to organize your economy to achieve a certain set of outcomes? Then you can’t claim that other perspectives on economic organization don’t have the same outcomes as goals in mind. Is is just the outcome you are looking for? Well, I don’t think that’s really what’s meant. But if it is, say so.

47

Plume 02.14.14 at 9:58 pm

mpowell,

Is socialism a philosophy of how to organize your economy to achieve a certain set of outcomes? Then you can’t claim that other perspectives on economic organization don’t have the same outcomes as goals in mind. Is is just the outcome you are looking for?

The goal of capitalist organization is to increase capital holdings (and wealth in general) for individual business owners. There is no “social” component involved. That must come from outside that system. It’s an add-on, not baked in.

OTOH, the goal of socialism is all “social component.” If it’s the real deal, it’s not concerned at all with personal wealth accumulation. It’s concerned with meeting social need and providing social good. That’s all it’s concerned with.

To me, it’s so obviously the best way to organize a society, because it has the good of society first and foremost as goal — at least in theory. Capitalism doesn’t. Not in theory or practice. It’s not interested in societal good. Outside forces, like democracy are. But not capitalism. It’s strictly a mechanism to increase personal wealth accumulation.

And because math is math is math, this must necessarily come at a cost to others. There is no addition without subtraction.

All too many Americans confuse democracy and capitalism, merge them, which adds another problem in these discussions. People often compare our form of democracy + capitalism to socialism, when an apples to apples comparison wouldn’t allow that.

48

MPAVictoria 02.14.14 at 10:17 pm

“I think those are generally good things, but they are pretty weak tea as far as socialism goes. “

Well lets start with those two and move from there.

49

mpowell 02.14.14 at 10:22 pm

Plume @ 47: “OTOH, the goal of socialism is all “social component.” If it’s the real deal, it’s not concerned at all with personal wealth accumulation. It’s concerned with meeting social need and providing social good. That’s all it’s concerned with. “

It sounds like you want to define socialism based on economic outputs. But maybe not. If you think socialism implies certain forms of economic organization in a ‘math is math’ sense, then you have follow through with the work of demonsrating your economy will generate the results you claim, and that is certainly more difficult than addition and subtraction. In my observation people tend to want to define their preferred political approaches in terms of both their outputs and their methods. That’s invalid.

50

David 02.14.14 at 10:36 pm

“You never get tired of this bullshit, do you?”

I think we will get tired of it about the same time that self-righteous bourgeois commentators stop implicitly defending capitalism by comparison to the USSR. So, pretty much never.

51

Plume 02.14.14 at 10:41 pm

mpowell,

No. Socialism isn’t an economic system. It’s a political system, that contains the economic, but goes much further.

Capitalism “values” things insofar as they make more money for ownership. It doesn’t “value” things insofar as they benefit society — greater health, happiness, longevity, education, cultural access and horizons, clean environment, etc. etc.

Capitalism is just an economic engine. Nothing more. But because its cancerous by nature, it has grown to basically engulf every other life-sphere in our society, controls our politics, and threatens to destroy our environment outright. Its values are limited, narrow, opportunistic, self-centered. Personal accumulation of money, which leads to power, etc. Where math comes into play is there. A capitalist’s gain must come from loss elsewhere, or many elsewheres.

OTOH, an organizing principle that extends the meaning of “value” to encompass all life-spheres can act synergistically, not via subtraction only. It can create “gain” for society without loss, necessarily. If it’s only about economics, then you’re basically stuck with addition and subtraction.

52

Plume 02.14.14 at 10:50 pm

Also: distribution and allocation of goods, resources, access, etc.

Capitalism has as its goal the distribution of goods and resources to maximize monetary compensation for ownership.

Socialism has as its goal the distribution of goods and resources to maximize societal health, longevity and happiness. There is no need to worry about ownership’s personal accumulation of monetary reward in the process. In fact, it gains a massive advantage once it no longer has to send a big chunk of the surplus value back to ownership, and can, instead, devote it entirely to the populace. Once the concentration of wealth and power at the top is no longer a concern, society is free to distribute and allocate in a far more logical and beneficial manner. And, since it also no longer is held under the thumb of economic apartheid, access to the goods of society are open to all, which adds synergistically to the total impact.

Instead of a small minority of citizens enjoying the fruits of society — which capitalism can never break free from and still be capitalism — it “spreads the wealth” to all. “Wealth” no longer being narrowly defined in economic terms . . .

53

Chris Warren 02.14.14 at 11:07 pm

Last year I wrote, somewhat tongue in cheek, that socialism is about converting hysterical misery into ordinary unhappiness.

This is precisely the sort of junk our comfortable Western middle-class like to spoof across the internet. In the same coin, obviously capitalism is about converting ordinary unhappiness into hysterical misery.

So where is there “misery” with full employment, high wages, fair trade, and properly funded public services wrapped in a stable economy?

Socialism is not necessarily “workers owning production” because when this happens they may still operate their enterprise along capitalist lines.

Socialism is specified by a simple motto: “From each according to their ability, to each according to their contribution”.

Of course this only establishes a stable economics based on hard headed economic rationalism. Left alone socialist economic rationalism generates its own styles of social injustice echoing Reagan and Thatcher. However, provided there is no distortion and as there is no structural need to expropriate workers through locking them into wages, a socialist welfare state will develop.

54

mpowell 02.14.14 at 11:26 pm

Plume @ 52: I don’t think it’s a good idea to attribute output goals to capitalism. That’s just confusing what is going on. Perhaps we can say publicly traded LLCs are organization whose existence is state-sanctioned and are structured towards the pursuit of specific goals, but even that is context dependent. In somes areas of the Euro, corporate boards are required to seat labor representation. That leads to different corporate goals, though I think few would claim that economic structure is no longer ‘capitalist’. You’re effectively making an argument about what kinds of ends capitalist oriented economies produce and because you believe it so strongly, assert it as a definition. That’s fine as a belief, but making it a definition just ends the conversation.

55

Plume 02.14.14 at 11:43 pm

mpowell,

I’m actually trying to strip capitalism of its modifiers. Too many people confuse and conflate those modifiers and their results with capitalism. They then basically ignore what states, public sectors, intellectual inheritance, cultural legacies and even charities do to modify and mitigate the effects of capitalism.

These things generally reduce the cold slap in the face brought to us naturally by capitalism, if we’re not sitting pretty at the top. And those who cheerlead for capitalism typically just fold those things in with all the rest and credit capitalism for anything good that comes along.

That’s why you’ll often hear someone say “Capitalism has lifted more people out of poverty than any other economic system.” Which is, obviously, false. It actually forced more people into poverty and misery than any previous system, and only through those modifiers was it able to reduce those effects for some later. For the rest, it simply shifted the scene of misery to “out of sight, out of mind.”

(David Harvey is really excellent on the geographic cure.)

Of course, the dilemma in trying to establish any of the above is that capitalism can’t exist without the state. So I’m kind of experimenting with fish out of water stuff. Regardless, one of my goals would be an end to the credit taken so casually by capitalism’s fans, who all too often refuse to accept any blame when it goes bonkers again and again — as is its wont. That’s always “gubmint’s” fault, apparently.

56

LFC 02.14.14 at 11:54 pm

@bob mcmanus
Why did it take me four days to find out that Stuart Hall had died?

I found out about Hall’s death from Ben Alpers’ post about Hall on the U.S. Intellectual History blog. I don’t often read the Guardian and am not on Facebook, but I managed to find out in a lot fewer, I think, than four days.

57

Keith 02.15.14 at 1:37 am

Good state-funded healthcare doesn’t have anything to do with socialism, France isn’t a socialist country – can we stop calling it socialism, just confuses matters” at 12.

I mostly agree. This abstract discussion about socialism seems very american to me and not in a good way. The US right uses “scary” socialism and communism to elide the problems of the profit obsessed US health care industry and economy.

The French Health system is technically a mixed economy financed by state insurance and a tightly regulated private insurance top up. With most people and assets being in non state hands. It is a planned mixed economy if you like. You can debate the words to use as a description but it keeps coming out top in the comparative effectiveness or near the top in the world.

My only objection to 12 is that the president of France is a socialist who leads the French socialist party and was elected in a election by direct universal suffrage. This makes France socialist. France also has lots of right wing people and a history of Fascism but the French expect good public service what ever their ideology.

58

js. 02.15.14 at 1:46 am

Oh, great! Another thread devoted to the eternal No True Socialism question!

Look, obviously, if you want a narrow definition, “socialism” has something to do with social/public ownership of the means of production, etc. But it’s common and understandable practice to use “socialism” to refer to aspects of social democracy, in particular the public provision of goods that in more liberal (Brit sense) capitalist regimes might be left to market mechanisms. Like, not that hard. Do we seriously need to devote another thread to rehashing this?

59

Chris Warren 02.15.14 at 2:06 am

js

With the level of understanding you demonstrated – we may need more threads clarifying ‘socialism”. There is no need to be scared and bark in anxiety.

Capitalism has little to do with markets because firstly market socialism operates on the same basis, Marx was a market socialist – but not a market communist.

Secondly capitalism destroys the free market and maximises profits through cartels and degrees of monopoly.

If you follow free market theory to its logical conclusion, once all entry and exit has occurred, all profits are competed away, leaving only socialism or fuedalism.

The differentia specifica capitalism is not markets, it is the existance of capital accumulation based on wage-labour.

If you leave capitalism to markets you end up with over 100 trillion in debt. In dollar notes this would stretch all the way between the earth and the sun, and back 50 times.

This is the graveyard of capitalism, so any effort at finding an alternative should ne welcomed.

60

Anarcissie 02.15.14 at 2:07 am

js. 02.15.14 at 1:46 am @ 58:
‘… Look, obviously, if you want a narrow definition, “socialism” has something to do with social/public ownership of the means of production, etc. But it’s common and understandable practice to use “socialism” to refer to aspects of social democracy, in particular the public provision of goods that in more liberal (Brit sense) capitalist regimes might be left to market mechanisms. Like, not that hard. Do we seriously need to devote another thread to rehashing this?’

One problem with equating socialism (ownership and control of the means of production by the workers) with social democracy (the Bismarckian Welfare state) is that they are unequal — radically different. In fact, the purpose of the second was to prevent the first. Subsequently we get to hear about the lack of toilet paper in ‘socialist’ countries and other such conceptual mush.

61

js. 02.15.14 at 2:24 am

One problem with equating socialism (ownership and control of the means of production by the workers) with social democracy (the Bismarckian Welfare state) is that they are unequal — radically different. In fact, the purpose of the second was to prevent the first.

Yes, I’m aware of the origins of the welfare state, and you’re quite right. And I pretty explicitly was not suggesting that the public provision of goods in a welfare state should be equated with the communal ownership of the means of production. I was noting that (a) the broader, perhaps technically incorrect use of “socialism” is both widespread and understandable (cf. “social democracy”) and even more that (b) an endless back am forth on what “socialism really means” generally ends up being pretty unedifying. You may of course disagree, and frankly I find this topic fairly tiresome, which more than anything else is what my comment was expressing. (My views are probably about as far left as yours, by the way.)

I can’t make heads or tails of what Chris Warren is on about, but I’d humbly suggest that I don’t any lessons on Marx, nor am I inclined to give any.)

62

Chris Warren 02.15.14 at 2:44 am

js

I can’t make heads or tails of what Chris Warren is on about,

So what are you stumped with?

market socialism?

cartels, monopolies?

markets competing profits to zero?

capital accumulation based on wage labour?

over 100 trillion in debt?

the alternative?

the English language?

63

MPAVictoria 02.15.14 at 2:57 am

“If you leave capitalism to markets you end up with over 100 trillion in debt. In dollar notes this would stretch all the way between the earth and the sun, and back 50 times.”

So what? Really so what?

64

David 02.15.14 at 3:13 am

“But it’s common and understandable practice to use “socialism” to refer to aspects of social democracy, in particular the public provision of goods that in more liberal (Brit sense) capitalist regimes might be left to market mechanisms.”

It may be “common” (just as use of the term liberal for the Center Left is in America), but it enables the Right to attack welfare state initiatives through association with the gulag.

65

David 02.15.14 at 3:22 am

…and then once a technically incorrect term that is advantageous to one side comes into common usage, people insisting on clarity and correct terminology are treated like obfuscators, pedants, or political hacks.

66

Will Boisvert 02.15.14 at 3:53 am

“In my Freudian (late Freud) moments of despair, I sometimes wonder if the madness of American capitalism isn’t one massive contrivance to avoid the sad finitude of the human condition. “

Wait a minute, Cory–isn’t the chemotherapy Schiffrin received also just “one massive contrivance to avoid the sad finitude of the human condition”? Isn’t that what the whole French health-care system is? By your lights, would it have been even more “socialist” for the French to deny Schiffrin treatment and just have a psychoanalyst discuss with him the ineluctable realities of an indifferent universe?

I’m not sure about the philosophical distinction you’re making here. Socialism is like capitalism–just another in the chain of desperate improvisations we call life.

67

Chris Warren 02.15.14 at 4:33 am

MPAVictoria 02.15.14 at 2:57 am

What so what?

If debt accumulates, it does so in the expectation of economic benefit. Consequently the factor share to labour is incrementally destroyed, and the value of pensions and wages declines. This disrupts the circular flow. Smaller capitals, less able to increase debt, go bankraupt.

Also the GINI coefficient deteriorates and, finally, in a generation or two, social violence erupts.

Only the Tea Party celebrates.

68

Lawrence Stuart 02.15.14 at 4:46 am

The Great Khan contemplates an empire covered with cities that weigh upon the earth and upon mankind, crammed with wealth and traffic, overladen with ornaments and offices, complicated with mechanisms and hierarchies, swollen, tense, ponderous.

‘The empire is being crushed by its own weight,’ Kublai thinks, and in his dreams now cities light as kites appear, pierced cities like laces, cities transparent as mosquito netting, cities like leaves’ veins, cities lined like a hand’s palm, filigree cities to be seen through their opaque and fictitious thickness.

‘I shall tell you what I dreamed last night,’ he says to Marco. ‘In the midst of a flat and yellow land, dotted with meteorites and erratic boulders, I saw from a distance the spires of a city rise, slender pinnacles, made in such a way that the moon on her journey can rest now on one, now on the other, or sway from the cables of the cranes.’

And Polo says, ‘The city of your dreams is Lalage. Its inhabitants arranged these invitations to rest in the night sky so that the moon would grant everything in the city the power to grow and to grow endlessly.’

‘There is something you do not know,’ the Khan adds, ‘the grateful moon has granted the city of Lalage a rarer privilege: to grow in lightness.’

– Italo Calvino Invisible Cities

Socialism, if it means anything at all to me, is a way of naming the desire to ‘grow in lightness.’ And the key to this lightness is the question of why we build — what purpose do the spires of our cities serve? The great weight of productive empire, of all the heavy necessities of toil and organization and industry, bear upon the earth and become intolerable unless balanced by creating places ‘for the moon to rest.’

Paris, in Anya Schiffrin’s narrative, becomes for her family in time of difficult trial such a place. All the great edifices (and the weight of these is massive, to be sure) making possible the medical care her father receives are balanced by the space they create for undergoing the universal human experience of death and loss with grace and dignity.

This space, this lightness, is literally invaluable. Its benefits to individuals are manifestly apparent, perhaps because calculable in terms of utility. But its benefit to the city as a whole, the necessity of lightness in offsetting the heavy mass of productive utility, are too often obscure to our modern Kublais.

69

Reason60 02.15.14 at 5:43 am

Maybe piling on here a bit…but in speaking with my 23 year old son and 18 year old stepdaughter and her friends, I think we have finally reached the point where we can discuss public ownership of ,health care, infrastructure and production, without some sort of ritual denunciation of Stalin and all his evil works.

By comparison, capitalism, to these folks, is equated with the Wall Street plutocrats who created this misery that all the college grads are being thrust into.

Further, in reading Catholic social teaching, it is remarkable how nonchalant the papal encyclicals were regarding the socialisation of portions of the economy.

The constant jibes about the horrors of Communism now sound a bit tinny and musty, like an argument from generations past that doesnt have currency.

70

js. 02.15.14 at 8:06 am

It may be “common” (just as use of the term liberal for the Center Left is in America), but it enables the Right to attack welfare state initiatives through association with the gulag.

Well, sure. But the right (in the US, at least) will call anything left of, oh I don’t know, indentured labor, “socialist” anyway. After all, it wasn’t Obama that branded the ACA as socialist. Or see Robeyns’ last post on here. I just don’t see how continually arguing over the semantics of “socialism” helps anyone to the left of Pete Peterson. The people throwing gulag accusations will continue throwing them no matter what terminology the left (or the liberal (US sense) left) uses.

71

Soru 02.15.14 at 11:01 am

I don’t know, maybe it would help just a little bit . There are a relatively small number of polical positions, and a near-infinity of words; organising the allocation of positions to words is a problem with the charectistics of organising the allocation of beer bottles to guests in a brewery party,

If you can’t solve that simple problem of distribution, it hardly bodes well for anything more difficult.

In particular, if what you are suggesting is the continuation of a movement who’s results you are going to commit to at least partially defend, use one word. If what you are opposing is something commonplace in many countries, making them, you would argue, better in that aspect than yours, use another.

And if you have something new in the course of human history, that owes nothing to either, then perhaps you should take the effort required to come up with a new word.

72

Alison P 02.15.14 at 11:40 am

I think the problem with a completely socialist economy isn’t the socialism it’s the force or discipline needed to get to ‘completely’. So, socialism mixed with capitalism is better (in this world we have now) than pure socialism, not because capitalism is all that great, but because achieving purity of anything is oppressive.

Though – having said that – it seems to me that while capitalism is pretty awful at delivering medicine and infrastructure and education, it is pretty good at delivering coffee shops and handheld devices. Which are things I like, so whatever.

73

Petter Sjölund 02.15.14 at 12:57 pm

I don’t know, but I think the variety of coffee shops might be slightly larger if there was a law against corporations growing as big as Starbucks.

74

LFC 02.15.14 at 1:28 pm

W Boisvert @66
You’re ignoring the basic argument of the OP, which is quite straightforward and is that the bureaucratic/insurance hassles characteristic of the U.S. health-care system tend to occupy the time of patients and families that might have otherwise been spent ‘dealing with and confronting’ (the OP’s phrase), or coming to terms with (if you prefer that phrase) the terminal (in this case) illness. So the OP’s “massive contrivance to avoid the sad finitude of the human condition” means, when read in context of the entire post, “massive contrivance to avoid having to deal with or think about the sad finitude etc.”

75

bob mcmanus 02.15.14 at 4:05 pm

Guy Standing in The Precariat among many others, explains that the project of neoliberalism is to privatize and offload as many of the costs of production and social reproduction from business and the state onto the individual worker as possible, either as an attempt to increase profits or a desperate attempt to maintain them. Example:the recent SCOTUS decision about workers having to change into safety clothes on their own time.

The paperwork involved in American healthcare and the new additions from the ACA are mostly I think moving costs from industry and government to labor, and also an attempt to create new sites of exploitation and profits, like temp agencies and job search firms.

And yes, it has side effects beneficial to Capital, like diminishing the time and social space available for labor organization, increasing stress and insecurity etc.

But a good analysis of neoliberalism is sufficient without going metaphysical.

76

bob mcmanus 02.15.14 at 4:17 pm

And the US Steel vs Workers safety gear donning and doffing decision is the kind of thing I think is important. The workers were heavily unionized and worked within the legal system and got no results, in fact have lost gains they had years ago.

No more utopianism (the opium of the secular Left) or reformism or programmaticism.

The state is totally captured and unions are less helpful every day. This is the message Marxists and Leftists should be putting out, in order to create revolutionary consciousness.

77

JenR 02.15.14 at 5:39 pm

That’s a key insight there, that libertarianism is about not confronting death and taxes, but wanting to avoid or get rid of them instead. What other thoughts do you have on this idea?

78

Plume 02.15.14 at 7:20 pm

Though – having said that – it seems to me that while capitalism is pretty awful at delivering medicine and infrastructure and education, it is pretty good at delivering coffee shops and handheld devices. Which are things I like, so whatever.

Yes, capitalism is good at delivering certain goods and services to roughly 20% of the population, and it’s very good at somehow making that 20% feel like they are a totality. So they can say, “Capitalism is really good at providing X or Y or Z to people.”

. . . without ever really considering who falls into the category of “people.”

Those hand held devices and cups of coffee? Given the fact that 3 billion people live on less than $2.50 a day, capitalism obviously isn’t delivering those things to the majority. Or even remotely close to a majority.

We now know, thanks to Oxfam, that the richest 85 people hold as much wealth as the bottom 3.5 billion humans on the planet. So when we speak of the wonders of capitalism in general, it should never be a totalizing conversation. It should never just casually say, as if it’s a given, that the allocation of goods, wealth and natural resources extends beyond — or much beyond — that top 20%, give or take.

It is a narratives capitalists love, of course. That when our economic system is spoken of by the richest 20% (give or take), they’ve some how assumed that the bottom doesn’t matter. At all. Out of sight, out of mind. Not necessarily due to any bad intentions or evil thoughts. Necessarily. But likely due to the complete lack of alternatives and endless brainwashing. Capitalism as monopoly. Not just as a producer of monopolies. But as a monopoly itself.

79

Plume 02.15.14 at 7:32 pm

At best, one could say that capitalism is pretty good at allocating goods and resources to those who can afford them. IOW, the bar is set really, really low for “success” when one speaks honestly of capitalism.

And since capitalism necessarily thrives due to radically underpaying labor, it eats its own. Without governments subsidizing this process of forcing labor costs down, the numbers of people who could afford its products would be even smaller. And that number is already tiny as a percentage. If it couldn’t off-load (externalize) most of its costs onto the public, it would have an even smaller consumer base — and fewer capitalists as well.

The obvious contradictions inherent in its model would have crushed it long ago if not for states keeping it afloat. And they keep it afloat primarily because capitalists elect the people who run those states, etc. etc. An incestuous arrangement of mutual support and dependency never before seen, at least to this degree, prior to capitalism.

80

Collin Street 02.15.14 at 7:39 pm

So what? Really so what?

I’ve said this before, but: Word salad is a symptom of autism. Non-sequiturs likewise. Oh, there’s other explanations for both, to be sure. But if you’re coupling word salad with a resistance to change, rigidity of thought including a desire that things be rigidly divided with no intermediate boundary-blurring, and mental obsessions that you keep on dragging the conversation back towards…

… yeah. An awful lot of right-wing activists display unusual behaviour consistent with autism.

[The link between word-salad or non-sequiturs and autism is that knowing how to structure your comments so that they convey a message to the listener relies on building a mental model of what the listener thinks, which is precisely what autism does a number on.]

81

Will Boisvert 02.15.14 at 8:42 pm

LFC 74,

“You’re ignoring the basic argument of the OP, which is quite straightforward and is that the bureaucratic/insurance hassles characteristic of the U.S. health-care system tend to occupy the time of patients and families that might have otherwise been spent ‘dealing with and confronting’ (the OP’s phrase), or coming to terms with (if you prefer that phrase) the terminal (in this case) illness.”

LFC, I don’t think Schiffrin’s story really demonstrates a “coming to terms” with terminal illness. Pancreatic cancer is almost always fatal, and the best one can realistically hope to do with chemotherapy is eke out a few more painful and debilitated months, at great expense even under the French system. So for all its dignified ceremonial Schiffrin’s chemotherapy was still a reckless, costly gamble on a forlorn hope—just a last-ditch effort to fend off the Grim Reaper for a few more heartbeats. It’s a far cry from a philosophical acceptance of mortality, which in medical terms would call for palliative care to afford a gentle exit. In France as in America, health care boils down to a doomed struggle to keep death at bay.

That’s why Corey’s Freudian theory of the greater realism of socialized versus capitalist health care doesn’t ring true. Corey argues that the bureaucratic maze of American health care, the endless haggling and paperwork, stems in part from a neurotic desire to avoid confronting the reality of death by distracting ourselves with busywork. I’m not sure about that. At bottom the haggling does indeed confront the hard reality that there are competing claims on resources. And I’m not sure that American-style insurance wouldn’t lend itself quite avidly to a forthright acceptance of death: “You say you just want morphine instead of chemo? Great, we’ll pay for that—thanks for being so philosophical about your mortality!” But in any case, Corey’s distinction between capitalist health care’s neurotic denial of mortality and socialized health care’s accommodation of the Freudian/Marxian reality principle can’t be right, because socialized health care is all about frenzied, ultimately futile attempts to evade mortality, as in Schiffrin’s case.

I’m not defending capitalist health care. The French system is fairer, more humane, more efficient and more effective—better all around. But to critique capitalist health care as an anomalous psychopathology of denial is really a stretch. If death is an inescapable reality, so is the fact that humans do anything to escape it. Socialized health care’s virtues are pragmatic, not spiritual—it simply does a better job keeping us alive so we can whistle past the graveyard another day.

82

James Wimberley 02.15.14 at 8:44 pm

I wonder of André Schiffrin really got standard treatment. French healthcare is based in social insurance, and there is a large bureaucracy that checks on eligibility and reimburses claims. It’ s not a public service as in Britain or the Nordic countries. Some foreigners get free treatment under reciprocal treaties or EU law. American cancer sufferers should not think they can get on a plane to Roissy and be welcomed like M. Schiffrin. He was exceptional: French by birth, son of a distinguished father, a Jewish exile from Vichy France, and above all a Chevalier de la Légion d’Honneur in hi own right. In a sense he was treated as a VIP.

83

Plume 02.15.14 at 8:57 pm

The real problem with capitalist health care is that profits and massive executive salaries divert resources from patient care. The overhead for a for-profit health care insurance company is roughly 30% . . . . versus less than 3% for Medicare.

(Medicare could do even better, if it reversed its partial privatization and was able to bargain with Big Pharma, etc.)

It’s not rocket science. A truly public, all non-profit system can devote a much, much higher percentage to actual health care. Any business in business to make profits and pay large compensation to executives simply allocates far less to patient care.

It’s math, more than a different confrontation with mortality.

Though that math, that “bottom line” expectation and reality then brings in matters of morality and ethics, which alters that confrontation. There, too, socialist or any kind of truly public, all non-profit model is superior — if for no other reason than that it does focus primarily on patient care, instead of executive pay and bonuses.

84

Eli Rabett 02.15.14 at 10:57 pm

OK, so let us talk about why the French system works. For one thing the cost to medicalstudents is zilch, so the physicians, when they graduate, do not have a huge debt to work off, for another, since the government pays for the medical schools they can provide enough resources and places to train enough quacks and since the government is paying the freight, it can direct the training of enough primary care specialists as the system needs.

OTOH, the hospitals are government owned, so no matter what the cost, there is at least a 30% lower cost than the commercial hospital system in the US, plus there are no advertising costs for Cancer Centers of France, and then since there is single payer there is not an additional 20-40% profit and administrative cost for health insurance payments to the physicians and hospitals and nurses. Then, of course, since the hospitals are government owned, why hey, there is no issue about how many MRI, etc. instruments are needed and then we can get into the issue of pharma costs.

Not too hard to figure out.

85

Helen 02.15.14 at 11:58 pm

Keith is right. France is a “mixed economy”. I hardly ever hear that term these days and it’s time it was revived so that the unproductive arguments around “b-b-b-but SOCIALISM!” can be put to bed.

86

Helen 02.16.14 at 12:03 am

Here in Australia, my son injured one of his eyes with a homemade explodey science experiment. There was a trip to Casualty and then countless opthalmic examinations as an outpatient at our Eye and Ear Hospital until they determined his retina wasn’t going to settle down by itself. Then he had to have a procedure under anaesthetic to use some kind of freezing technology to glue the retina down. (I may have garbled this procedure due to my limited understanding.) Then annual checkups until they decided he was all good, some years later.
Direct Cost to us? $0.
Australians pay a Medicare Levy with taxes and those who qualify – under a certain salary/wage – don’t pay it.
Our out of pocket expenses are mainly related to dental, as the powers that be decided when Medicare was set up that the teeth weren’t part of the body.

87

Helen 02.16.14 at 12:03 am

Oh, and (sorry, clicked Submit too soon) we don’t have bread queues, except on the Surf Coast at the peak holiday period.

88

Anarcissie 02.16.14 at 12:31 am

A ‘mixed economy’ ought to be one in which the workers directly own and control some of the means of production, while other means of production are owned and controlled by private capitalists or the government. This situation is probably true of most capitalist polities; for example, there are many thousands of functioning cooperatives, partnerships, and single-proprietor businesses in the U.S., plus maybe 500 communes (last time I looked). However, as far as I know the governments of the states in which these instances of socialism exist are still capitalist in that their ruling classes are capitalist, and if they provide Welfare, it is capitalist Welfare, designed to support and strengthen capitalism, not replace it.

89

mds 02.16.14 at 12:35 am

we don’t have bread queues, except on the Surf Coast at the peak holiday period.

Even assuming this isn’t a tissue of lies, I notice you still aren’t being square with us, as you conveniently omit the toilet paper shortages, which are much less charmin’. And as long as you Australians continue in your socialist health care ways, you will never be able to put such things behind you. We Northern capitalist types need only bidet our time until you all finally come clean about how your system doesn’t pass the smell test.

90

garymar 02.16.14 at 2:02 am

mds, stop dumping on Australia!

91

Tim Worstall 02.17.14 at 10:52 am

“OTOH, the hospitals are government owned, so no matter what the cost, there is at least a 30% lower cost than the commercial hospital system in the US, plus there are no advertising costs for Cancer Centers of France, and then since there is single payer there is not an additional 20-40% profit and administrative cost for health insurance payments to the physicians and hospitals and nurses. Then, of course, since the hospitals are government owned, why hey, there is no issue about how many MRI, etc. instruments are needed and then we can get into the issue of pharma costs.”

Hmm, govt owned hospitals provide 65% of the French beds, the remainder comes from private for- and not for-profits. It is also not a single payer system. There is indeed tax run insurance but that normally only covers 70% of costs (depends a bit on the actual treatment) the remainder being out of pocket or covered by a private insurance contract.

And putting “Cancer Centers of France” into Google brings me to Unicancer, a “UNICANCER groups together 20 French Comprehensive Cancer Centers (FCCC), which are private, non-profit establishments with a threefold mission of patient care, research and oncology teaching. ” They might well advertise you know.

Oh yes, they do:

http://www.adforum.com/agency/14302/creative-work/34470250

The French system is indeed a very good health care system, better (certainly on equity grounds) than the US and better (in outcomes) than the NHS.

Perhaps it’s because it’s one of these mixed economy things?

92

Shirley0401 02.17.14 at 4:01 pm

@88
“A ‘mixed economy’ ought to be one in which the workers directly own and control some of the means of production, while other means of production are owned and controlled by private capitalists or the government.”
As an American, I’ve always been struck by how much resistance the idea of a mixed economy, as described, is to most of the people I know. Even allowing for your examples of exceptions (coops, communes, &c), most of them are seen by most of America as kooky philanthropic experiments, and/or something “hippies” do. It’s always struck me that it would make perfect sense to “socialize” services that serve the public good (health care, obviously, but this would also cover the de-privatization of all sorts of services [i.e. education] which have been handed over to the Market), while leaving what I would consider luxury/commercial/supplemental (restaurants, cars, elective cosmetic surgery, &c) to a regulated capitalist marketplace. When I raise the topic in conversation, I usually get some version of “We all see how great that works at the Post Office!” (Or MVA, or VA hospital, or what have you.) Which I get, on a certain level, but when one takes into account the fact that there are a lot of places that wouldn’t have affordable mail delivery available if it were left entirely up to for-profit companies, I do think it works kind of great. And of course the companies that get into those areas to turn a profit do a better job at turning a profit. They get to pick and choose what services are offered to whom, based on (surprise!) what can make a profit.
Sadly, I think much of the resistance to socialized anything (except for maybe law enforcement and emergency services such as fire departments) reflects the profoundly selfish mindset of a lot of people here (many of whom can be perfectly considerate, kind, and generous in their personal lives).
For all the talk of “efficiency” as some kind of golden ideal, I honestly think there are people who would rather pay $X/year for inefficient health care for themselves and their family than contribute $X/year to a more efficient system that also allows “takers” the advantages of same.

93

anon/portly 02.17.14 at 8:27 pm

French health care couldn’t stop André Shiffrin from dying; nothing in this world could. Instead it created a space for him and his family to deal with his dying, without the distracting mayhem of our system.

But American health care does exactly the same thing, all the time. It’s not as if everyone’s experience is similar to Shiffrin’s UES experience; many Americans get treatment that is much closer to his French experience. This isn’t to say that the French system isn’t vastly superior, on the whole, but isn’t their biggest advantage cost? For example, the American system will send nurses, physical and occupational therapists, hospice people, paramedics, etc., to a patient’s home, but not, so far as I know, doctors, but I would guess that this is because our doctors are so expensive – if we had French doctor prices, maybe we’d send them too.

Anyway many elderly Americans experience (or their loved ones) very little distracting mayhem from cost considerations in their final months and days. They do have to make some decisions and deal with bureaucracies at times, but I can’t beleive this doesn’t happen in France also.

Again, obviously there are at times bureaucratic nightmares that result from our peculiar health care system. But this doesn’t seem to result from a fundamental philosophical difference in provision (see 57 and 82). Why the French mix of public and market provision works better than ours is a good question, but what does it have to with “socialism?” I think I would rate this the single strangest post I’ve ever seen on CT – that’s amazing, considering how strange some of Belle Waring’s have been, at least to me. (Not that strange means bad, btw).

Socialism won’t eliminate the sorrows of the human condition. Loss, death, betrayal, disappointment, hurt: none of these would disappear or even be mitigated in a socialist society. (….)

But what socialism can do is to arrange things so that you can deal with and confront these unhappinesses of the human condition. Not flee from or avoid them because you’re so consumed by the material constraints and hassles of everyday life.

I’d like to add that it seems like there was a bait-and-switch here: instead of “loss, death, betrayal, disappointment, hurt” we get an anecdote about ill health. Sick people consume goods and services that embody a lot of human labor and are therefore expensive: therefore we have a question about whether to provide these goods and services with market or government provision. (And there is strong logic that favors government provision, not that a purely private system might not work, if only in theory).

But “loss, death, betrayal, disappointment, hurt” don’t strike me as fundamentally expensive, except for death, where the system of private/public life insurance seems to function without too many complaints, and therefore these things are not much about Socialism vs. Capitalism. I guess someone suffering from betrayal or disappointment might decide they’d like to take some time off work, and I can see that this circumstance would be difficult to privately insure for, but on the other hand is there a country in the world that provides for things like this publicly? In France, can you go to (say) a psychologist and somehow get a state-sponsored vacation, because you’re unhappy? You’d think not, because it would be subject to gaming….

94

anon/portly 02.17.14 at 8:30 pm

Last comment paragraph beginning with “But what socialism” is from OP – lost HTML formatting due to commenter incompetence.

95

LFC 02.18.14 at 12:40 am

Will Boisvert @81
Well, I understand what you’re saying. Much depends on the individual circumstances, I would think.

Sure, it’s possible to reject chemotherapy and opt for palliative care anywhere. But opting to stay alive a little longer doesn’t necessarily mean that one is deluding oneself. I haven’t read Schiffrin’s daughter’s piece and I don’t know the circumstances, so I think it would be presumptuous of me to speculate about the ‘coming to terms’ aspect in this particular case. Perhaps Schiffrin just wanted to spend a bit more time w/ his family; I don’t know. I’m not saying I completely accept the OP’s argument as a general matter, but in some cases I can see it being applicable.

96

Helen 02.18.14 at 10:53 pm

MDS@89: I’m flushed with joy at your response. Still think ours is the better cistern.

Comments on this entry are closed.