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Rich Barlow

Health reform’s conservative roots

By Rich Barlow
November 18, 2009

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TALK RADIO is in a lather over “socialized’’ medicine. So are Republican leaders. Protesting the percolating reforms in Congress, House Republicans recently sponsored a rally at which some held signs decrying “National Socialist Healthcare.’’ Some conservatives even insist that mandatory health insurance envisioned in the congressional bills would be unconstitutional.

Time for a history lesson: Mandatory national health insurance was invented by an anti-socialist conservative in Germany during the laissez-faire Gilded Age.

In 1883, Otto von Bismarck instituted the world’s first compulsory health care scheme, requiring workers to get insurance from private carriers through their employers, paid for by a payroll tax. Sound familiar? The similarities between the Iron Chancellor’s vision and the broad outlines of the proposals in Congress - and, indeed, our current employer-based system of health care - offer valuable lessons.

Bismarck was Fox News’s kind of guy. He loathed socialism, to the point of banning socialist meetings and literature distribution. His social reforms, including mandatory health insurance, were meant to deflect socialism, not enact it.

Bismarck harbored the conservative notion of government’s limited role, providing a safety net for the needy. “The actual complaint of the worker,’’ he said, “is the insecurity of his existence; he is unsure if he will always have work, he is unsure if he will always be healthy and he can predict that he will reach old age and be unable to work.’’ He stiff-armed those who confused concern for such people with socialism. “Call it socialism or whatever you like,’’ he said.

Would a German-style system work here? Whether it’s constitutional to require that all Americans have health insurance may have to be thrashed out in court. Philosophically, though, the libertarian argument - in a free country, we shouldn’t force people to buy something they don’t want - deserves a two-word Bismarckian retort: national security.According to the Kaiser Foundation’s Commission on Medicaid and the Uninsured, people without insurance are less likely to get preventive care than the insured and “are more likely to be hospitalized for avoidable health problems and experience declines in their overall health.’’ If many Americans were sickened by terrorist tampering with, say, our water supply, we’d all agree that protecting them from that preventable attack was a matter of national security. Protecting them from preventable illness, and its potentially ruinous financial consequences, is as well.

2009 isn’t 1883, of course. Bismarck’s law mandated coverage only for certain low-income workers. Today, with expanded coverage, Germany wrestles with escalating health care costs - as do we and all industrialized nations, including those with single-payer systems so beloved by liberals. That’s an argument for pursuing cost controls that the current bills don’t include. It’s not a good argument for inaction.

Our reform may include a public plan to compete with private ones - a bane to many conservatives. But even the Democratic House could muster votes only for a neutered public option. It’s possible, as Cornell economist Robert Frank argues, that passing reform will bring the conservative, and valid, ideal of price-cutting competition to American health care. Frank reasons that insuring millions of additional people will only ratchet up the pressure to curb costs by emulating the United States’ most efficient health care providers, like the Mayo Clinic - plans that operate their own hospitals and put doctors on salary, rather than pay them for every test and procedure they order, regardless of medical value.

Indeed, one major difference between German health care and our system, including the reform proposals, is that their insurers, while private, are non-profit. Germans are happy with their system, and why not? Care is excellent, while premiums and administrative costs are well below ours. German doctors do complain about being underpaid. Still, they’re making a solid middle-class living, as a report on “Frontline’’ about different health care systems noted earlier this year.

The health care reforms before Congress aren’t perfect. But they clearly aren’t socialist. Conservatives who insist otherwise share something with liberals who insist that only single-payer systems can work. Both should have stayed awake during high school history class.

Rich Barlow is a freelance writer from Cambridge.

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