Jan 28th 2024

We Already Have Effective Socialized Medicine: Now Universalize It

by Sam Ben-Meir

Sam Ben-Meir is an assistant adjunct professor of philosophy at City University of New York, College of Technology.

In the debates we hear about the significance of universal healthcare, there is something frequently left out of the discussion. A universal healthcare system is about providing a just and accessible healthcare system, the resources of which can and should be made universally available. It is also about ending a system which systematically reproduces health inequity, in a county which spent $4.5 trillion on health care in 2022—more than any other country in the world and twice as much as the average member of the Organisation for Economic Co-operation and Development (OECD). While we are spending far more, Americans generally have worse health outcomes than the citizens of rich European countries. Based on numerous benchmarks, we lag behind: for example, the US has the highest rate of infant and maternal deaths among the OECD countries; and one of the lowest rates of physician visits and practicing physicians. The Commonwealth Fund points out that life expectancy at birth in the U.S. was 77 years in 2020, three years lower than the OECD average. But what we tend to overlook is that we also have the foundational model of a truly universal system of healthcare right here in the United States, and while it can be improved upon it already functions quite well.

That basic model, which as explained below already exists in this country, should be expanded into a national healthcare system. To fully appreciate why this should be done, it is helpful to understand first that health disparity exists, and it has a racial, gender, ethnic, and socioeconomic structure: the empirical evidence is massive and overwhelming. Studies have shown that racial/ethnic minorities are “1.5 to 2.0 times more likely than whites to have most of the major chronic diseases.” Black women are three times as likely to die from pregnancy-related causes as white women. Furthermore, Black Americans, American Indians and Alaska Natives have a lower life expectancy than do whites. In fact, the health gap between minorities and non-minorities in this country has in some respects widened over the decades. For example, black men had an average life expectancy of 61 years in 1960, compared with 67 years for whites. The life expectancy of blacks and whites grew over the next few decades, but so did the gap: by 1996, the gap increased to 8 years, with white males having an average life expectancy of 74 years, but only 66 years for black men. According to the Institute of Medicine, “American-Indian men in some regions of the country can expect to live only into their mid-fifties.”

We should regard these disparities as what they really are; namely, forms of domination, ways of exerting power over bodies.  This is not to suggest some form of nefarious conspiracy; but simply to say that the adjustable dials on the economy (taxation policy, for example) are presently set to redistribute wealth to the topmost bracket of earners, and this affects the health and well-being of people of all races and ethnicities, although minority groups suffer disproportionately. Health disparity is a powerful weapon in the savage class warfare otherwise known as neoliberalism. (In 2020, the RAND Corporation did a study of the transfer of wealth over the last several decades from the working-class and the middle-class to the top one percent. Their estimate is a staggering $47 trillion – that is how much the “upward redistribution of income” cost American workers between 1975 and 2018.) Neoliberalism is a brutal form of labor suppression, which uses health as a means of maintaining and reproducing a condition in which wealth is constantly being redistributed upwards, and the middle-class is kept in a constant state of fear of sinking into the ranks of the poor. Medical expenses are the leading cause of bankruptcies in America – and that’s according to the American Bankruptcy Institute. The ballooning costs of healthcare serve to maintain a system marked by morally unacceptable health inequity and injustice.

Like economic inequality, health inequity is not a necessary feature of the contemporary world, but a political choice. We know this because such levels of health (and economic) disparity do not exist in many other countries. Need we remind ourselves that the United States is the only large high-income nation that does not provide universal health care to its citizens. England, Spain, Sweden, and Denmark, among many others, have universal healthcare systems. In some cases, such as England’s National Health Service (NHS), that system is socialized (although it has always maintained a private sector); while, in others it is not. While the British healthcare system is far from perfect, there is much we could learn from the NHS, the founding principle of which is that healthcare should be free at the point of service. The United States has, for the most part, opted instead to maintain a lucrative system of for-profit medicine, which treats healthcare as simply another commodity when it is clearly no such thing, but rather a basic human need. According to the World Health Organization, the United States spends on healthcare a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance. The United Kingdom, by contrast, spends just six percent of GDP on health services, and ranks 18th.

Although a system of universal healthcare does not require socialized medicine, we already have a working and effective model of socialized medicine in this country: the Veterans Healthcare Administration (VHA) – comprising the national network of VHA Hospitals, clinics and nursing facilities, and part of the US Department of Veterans Affairs (VA). In 2021, the VA maintained and operated 1,600 health care facilities, 144 medical centers, and 1,232 outpatient sites. According to the Rand Corporation: “By almost every measure, the VA is recognized as delivering consistently high-quality care to its patients.” To be sure, the VHA has had its problems, but following the Veterans Health Care Eligibility Reform Act of 1996, the VA began a systemwide reengineering which sought, first and foremost, to improve its quality of care – “the VA sought to reinvent itself by undergoing major structural and management reorganization, which resulted in its emergence as a national leader in health care within a decade.” A 2007 study observes that “VA care outperforms non-VA care on various dimensions, particularly process measures of quality that have been targeted for improvement. Patient satisfaction also appears to be higher within the VA than among those who receive care in the private sector. Numerous press accounts have extolled the VA system as a model of high-quality, efficient health care.”

Like every healthcare system, there are still challenges facing the VHA – and to be sure, the population it services is relatively small compared to the U.S. population. But it is disingenuous at best to claim that these challenges are insurmountable.  One of the biggest challenges facing the VHA today is that veteran healthcare is becoming increasingly privatized: It is clear, as the Washington Post observes, “that the dismantling of VA is desirable to Republicans because of what it represents: a successful, publicly funded, integrated health-care system.” As Paul Krugman put it in his NY Times column: The VHA is “free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense,” – and naturally, “Republicans are especially eager to dismantle government programs that act as living demonstrations that their ideology is wrong.” Doctors employed by the VHA are salaried and therefore without any financial motive to subject patients to avoidable healthcare procedures. Phillip Longman, renown economic journalist, and Schwartz Senior Fellow at the New America Foundation, makes a powerful case in The Best Care Anywhere: Why VA Care is Better than Yours (2007), for the VHA as providing the basic blueprint for rescuing America’s healthcare system, with its soaring costs, failure to meet significant health benchmarks, and deep structural health disparities. As many experts have observed, the VA can and should be used as a national model on which to build a system of universal healthcare, one that is just and benefits all Americans regardless of race, ethnicity, or socio-economic status. As the Rand Corporation stated, “’socialized’ or not, we can learn from the VA.”

We do not have a healthcare system in the United States, but a for-profit health insurance system which functions as a form of bio-domination, of exerting power over vulnerable bodies, of keeping the poor destitute and the middle-class in check for fear of falling into the ranks of the dispossessed. Yet a universal healthcare (or better, socialized medical) system would be to the advantage of every American, because this higher burden of disease and mortality among ethnic and racial minorities has significant consequences for all Americans, as it results in a less healthy nation and higher costs for health and rehabilitative care. While the utilitarian case for universal healthcare is clear enough, we can and should also make the case on deontological grounds: that universal healthcare is consistent with respect for human dignity, whereas the commodification of healthcare is not. As Joseph Crisp argues: “Since health has dignity, rather than value, it cannot be treated as a market good…. One might choose to buy an I-Phone, rather than a television set, or one might choose to buy neither. But one has no choice but to fix a broken arm, or to undergo treatment for a life-threatening disease.” Health is irreducible to mere exchange value. The patient is not merely a healthcare consumer, and to treat the patient as a mere consumer of health services is reductive and dehumanizing.

I have been teaching healthcare ethics to undergraduates since 2000. I always begin the course by taking Socrates, the father of moral philosophy, as our guide in terms of what moral philosophy should do. Socrates characterized himself as a ‘gadfly’ – and as we know was charged with corrupting the youth, and ultimately sentenced to death in 399 BC. But that is precisely our job as moral philosophers: to corrupt the youth if you will. ‘Corrupt’ has of course a negative connotation: from the conservative standpoint we are corrupting ourselves simply by questioning the claims that we are expected to take for granted. One basic claim is that any limitation on privatization is a limitation on capitalism, and any alternative to capitalism leads invariably to totalitarianism. This is for many Americans commonplace dogma. The prevailing ideology is that we don’t have to like capitalism, we just need to accept the fact that ‘there is no alternative’ (TINA)—a claim associated with Margaret Thatcher, but which is truly ubiquitous now. Consequently, we allow capitalism to infiltrate and colonize nearly every aspect of our lives, including healthcare, where, I believe, it does not belong.

Fast forward 2200 years to another gadfly, this time in France: the man generally recognized as the first communist revolutionary, Gracchus Babeuf demanded a universal healthcare service, which is free of charge at the point of need. He stated, “[t]hat doctors, apothecaries and surgeons should be paid wages out of public funds so that they can administer assistance free of charge.” This is now the NHS system that England enjoys, one of the world’s best. So much for Babeuf being a fanatical dreamer. Like Socrates, Babeuf was executed, guillotined in 1797.

Sam Ben-Meir is an assistant adjunct professor of philosophy at City University of New York, College of Technology.

Browse articles by author

More Essays

Jul 16th 2024
EXTRACTS: "Trump joins tens of thousands of Americans treated for non-fatal gunshot wounds each year. Such experiences can shatter people’s assumptions that they are living in a safe, understandable and controllable world, leaving them feeling unworthy, unsafe and unsure. As a result, survivors of non-fatal gun violence face increased risks of depression, anxiety, substance use and post-traumatic stress disorder (PTSD). PTSD can feel overwhelming." ---- ".... some trauma survivors experience post-traumatic growth. They may develop greater empathy, stronger relationships, deeper spirituality and find new meaning in life. After being shot in 1981, the then president Ronald Reagan’s trauma seemed to deepen his sense of empathy and humility. He felt God had spared him for a reason, spurring him to reduce nuclear tensions with the Soviet Union."
Jul 15th 2024
EXTRACTS: "Artificial sweeteners such as sucralose are not metabolised by the human body so they are excreted – this is what makes them low-calorie sugar alternatives. And that’s where the environmental problem begins. Current wastewater treatment plants are unable to remove these sugar mimics, meaning they end up in our environment – in our water, rivers and soil." --- "Forever chemicals are increasingly present in our streams, rivers and oceans – most notably per- and polyfluoroalkyl substances (PFAS) that don’t degrade. PFAS are synthetic chemicals found in many consumer products, including skincare products, cosmetics and waterproof clothing. PFAS can remain in the human body for many years, and some present significant risks to our health – potentially causing liver damage, thyroid disease, obesity, infertility and cancer."
Jul 3rd 2024
EXTRACTS: "Psychologist, James Hillman had concerns about what I like to call the 'loneliness-as-pathology' "---- "....Hillman went on to argue...: 'If loneliness is an archetypal sense built into us all from the very beginning, then, to be alive is also to be lonely. Loneliness, therefore, will come and go as it chooses in the course of a lifetime, quite apart from our efforts to deny or avoid this reality.' "
Jul 3rd 2024
EXTRACT: "How can we be at least 15 times richer than our pre-industrial Agrarian Age predecessors, and yet so unhappy? One explanation is that we are not wired for it: nothing in our heritage or evolutionary past prepared us to deal with a society of more than 150 people. To operate our increasingly complex technologies and advance our prosperity, we somehow must coordinate among more than eight billion people."
Jun 25th 2024
EXTRACTS: "What’s interesting about the entire Russia-North Korea showy display of camaraderie is China’s response: silence. China has misgivings about how things are unfolding, which reports suggest prompted Chinese president Xi Jinping’s call to Putin to call off the latter’s visit to Pyongyang. Obviously, Putin didn’t heed Xi’s request." ----- "The Sino-Korean animosity dates back centuries and took shape when Korea was a vassal state of imperial China. Unfortunately, this animosity extended to modern times when Mao Zedong decided to station Chinese troops in North Korea even after the conclusion of the Korean war, and when Beijing did not aid Pyongyang in its nuclear ambitions. It didn’t help either that the founding leader of North Korea, Kim Il-sung, was suspected of espionage and was nearly executed by the Chinese Communist party in the 1930s."
Jun 19th 2024
EXTRACT: "Ultra-processed foods (such as packaged snacks, sugary drinks, instant noodles and ready-to-eat meals) often contain emulsifiers, microparticles (such as titanium dioxide), thickeners, stabilisers, flavours and colourants. While research on humans is limited, studies on mice have shown that these ingredients alter the gut microbiome (the community of microorganisms living in the intestines) in several ways. These many microbiome changes can in turn affect the way the immune system functions."
Jun 9th 2024
EXTRACT: "Alzheimer’s disease can be split in two subgroups, familial and sporadic. Only 5% of patients with Alzheimer’s are familial, inherited, and 95% of Alzheimer’s patients are sporadic, due to environmental, lifestyle and genetic risk factors. Consequently, the most effective tactic for tackling Alzheimer’s is preventative and living a healthy lifestyle. This has led researchers to study risk factors associated with Alzheimer’s."
Mar 8th 2024
EXTRACT: "This study suggests that around 10% of people diagnosed with dementia may instead have underlying silent liver disease with HE causing or contributing to the symptoms – an important diagnosis to make as HE is treatable."
Jan 28th 2024
EXTRACT: "Health disparity is a powerful weapon in the savage class warfare otherwise known as neoliberalism. (In 2020, the RAND Corporation did a study of the transfer of wealth over the last several decades from the working-class and the middle-class to the top one percent. Their estimate is a staggering $47 trillion – that is how much the “upward redistribution of income” cost American workers between 1975 and 2018.) Neoliberalism is a brutal form of labor suppression, which uses health as a means of maintaining and reproducing a condition in which wealth is constantly being redistributed upwards, and the middle-class is kept in a constant state of fear of sinking into the ranks of the poor. Medical expenses are the leading cause of bankruptcies in America – and that’s according to the American Bankruptcy Institute. The ballooning costs of healthcare serve to maintain a system marked by morally unacceptable health inequity and injustice."
Jan 28th 2024
EXTRACT. "But living longer has also come at a price. We’re now seeing higher rates of chronic and degenerative diseases – with heart disease consistently topping the list. So while we’re fascinated by what may help us live longer, maybe we should be more interested in being healthier for longer. Improving our “healthy life expectancy” remains a global challenge. Interestingly, certain locations around the world have been discovered where there are a high proportion of centenarians who display remarkable physical and mental health. The AKEA study of Sardinia, Italy, as example, identified a “blue zone” (named because it was marked with blue pen),....."
Jan 4th 2024
EXTRACT: ""Tresors en Noir et Blanc" presents 180 prints from the collection of the Musee des Beaux-Arts de la Ville de Paris, also known as the Petit Palais.  The basis of the museum's print collection is 20,000 engravings amassed by a 19th-century collector, Eugene Dutuit, " ----- "This wonderful exhibition, the tip of a great iceberg, serves to emphasize how unfortunate it is that the tens of thousands of prints owned by the Petit Palais are almost never seen by more than a handful of scholars who visit them by appointment.  Nor is the Petit Palais the only offender in this regard,....."
Jan 4th 2024
EXTRACTS: "And that is the clue to Manet’s work. He paints painting, regardless of his subject: he paints the medium itself, it as if he is constantly reminding us that this is a painting," ..........."This is a new conception of painterly truth at play here, a new fidelity to truth. Manet is the Kant of painting because he initiates a similar kind of “Copernican revolution” – we do not see the world as it is but as we are. " -------- " Among the most remarkable but unfamiliar of Manet’s work on display are those depicting the bloody aftermath of the Paris Commune of 1871.There is no question regarding Manet’s condemnation of the Versailles government’s actions following the defeat of the Commune, when some 25,000 Parisians were gunned down, including women and children."
Dec 27th 2023
EXTRACT: "Think of our brain like a map. When we’re young, we explore all corners of this map, sending out connections in every direction to make sense of our environment. Before long, we figure out basic truths – such as how to secure food, or where we live – and the neurological paths that make up these connections strengthen. Over time, a network emerges that reflects our unique experiences. Regions we re-visit often will develop established paths, whereas under-used connections will fade away. ---- Conditions such as addiction, chronic depression and post-traumatic stress disorder (PTSD) are characterised by processes such as repetitive negative thinking or rumination, where patients focus on negative thoughts in a counterproductive way. Unfortunately, these strengthen brain connections that perpetuate the unfavourable mental state."
Dec 14th 2023
EXTRACT: "While no one was looking, France has become a melting pot of European peoples. Its neighbors have traditionally been welcomed, and France progressively turned them into French boys and girls in the next generation."
Dec 4th 2023
EXTRACTS: "Being rich is essentially about having more stuff in general, including bigger houses." "..... if SUVs had not become widely adopted largely as a status symbol for the global middle classes, emissions from transport would have fallen by 30% over the past ten years. For the largest class of SUVs, six of the ten areas of the UK registering the most sales were affluent London boroughs like Kensington and Chelsea."
Nov 11th 2023
EXTRACT: "By using these “biomarkers”, researchers have discovered that when a person’s biological age surpasses their chronological age, it often signifies accelerated cell ageing and a higher susceptibility to age-related diseases." ----- "Imagine two 60-year-olds enrolled in our study. One had a biological age of 65, the other 60. The one with the more accelerated biological age had a 20% higher risk of dementia and a 40% higher risk of stroke."
Nov 6th 2023
EXTRACT: "We are working on a completely new approach to 'machine intelligence'. Instead of using ..... software, we have developed .... hardware that operates much more efficiently."
Nov 6th 2023
EXTRACTS: "When people think of foods related to type 2 diabetes, they often think of sugar (even though the evidence for that is still not clear). Now, a new study from the US points the finger at salt." ...... ".... this type of study, called an observational study, cannot prove that one thing causes another, only that one thing is related to another. (There could be other factors at play.) So it is not appropriate to say removing the saltshaker 'can help prevent'." ..... "Normal salt intake in countries like the UK is about 8g or two teaspoons a day. But about three-quarters of this comes from processed foods. Most of the rest is added during cooking with very little added at the table."
Oct 26th 2023


In 1904, Emile Bernard visited Paul Cezanne in Aix.  He wrote of a conversation at dinner:

Sep 11th 2023
EXTRACT: "Many people have dipped their toe into the lazy gardener’s life through “no mow May” – a national campaign to encourage people not to mow their lawns until the end of May. But you could opt to extend this practice until much later in the summer for even greater benefits. Allowing your grass to grow longer, and interspersing it with pollen-rich flowers, can benefit many insects – especially bees. Research finds that reducing mowing in urban and suburban environments has a positive effect on the amount and diversity of insects. Your untamed lawn won’t only benefit insects. It will also encourage more birds, such as goldfinches, to use your garden to feed on the seeds of common wildflower species such as dandelions."