In Part One of this series, I dissected the “socialism” versus “capitalism” labels to demonstrate that four major governmental programs with long-standing conservative support are “community” endeavors, and lean more toward a classically-socialist approach than a classically-capitalist one, even though conservatives detest the “S” word. In this second part of the series, I will do a deeper dive into a few of the proposals from the Sanders/Ocasio-Cortez slate of candidates, mostly running as Democrats. Where do they fit on this scale? Here is my take on a three economics-oriented planks of the platform from Alexandria Ocasio-Cortez, which are not that far from ideas proposed by Bernie Sanders.
“Medicare for all”
There is no doubt that the American way of “doing health care” has been a disastrously-expensive hodge-podge of government, private not-for-profit and for-profit entities, often working at odds with one another. The best argument one can make for this mess of a system is that it has spurred innovation (along with some obscene profit-taking on old technologies). Relatively-speedy access to profitable but elective medical procedures such as knee replacements, if one is well-insured, has also been a feature of the U.S. system, even while access to affordable urgent care is often lacking in many communities.
While I support the continued reform of medical insurance to improve upon the first Affordable Care Act attempts (currently being kneecapped by the Trump Administration), I like to point out that there are at least a dozen successful universal health care systems, mostly in northern Europe, that exist arrayed on the ideological spectrum between our current state and “Medicare for all.” There is more than one way to tackle this problem.
Back in January, I shared my experience living under the U.K.’s National Health Service in a post called “Here is how to compare U.S. and British health care.” My first recommendation was DON’T compare them, not because the British system is bad, but because our system has so little in common with theirs, while other systems, like Germany’s, are achievably-close to the U.S. system and could work better than the current system or many alternatives.
Like my beef with ideological conservatives, I would assert that there is a fine line between ideological purity and “a bad idea.” The primary, but hidden, cost-containment feature of “Medicare for all” is a set of requisite and complex controls on prices charged for medical procedures. The private insurance system attempts cost controls as well, but since they are at a higher level and less effective than Medicare reimbursement caps, the private market acts as an important “safety valve” on the “supply” part of the healthcare equation.
We have a dozen good healthcare models to study and pick from in these other successful models around the world, and many of their features could be field-tested in incremental ways before widespread adoption. However, our American arrogance on either side of the political divide seems to preclude learning from success. Among that set of systems are different approaches to cost controls, service supply shortfalls, and paperwork inefficiencies ready to be incrementally adapted to the American healthcare market, but the demands of ideological purity from either side seem to prevent that innovation. I suggest that you read up on Germany’s universal multi-payer system as a starter, and tally the similarities and differences from either the current U.S. system or the proposed “Medicare for all.”
Fully funded public schools and universities. I noted in a February post how Republican governor George Romney of Michigan (and his successor William Milliken) managed to get a massive wave of baby boomers through fast-expanding Michigan public universities at a very low student cost during the 1960s. His method was first to tie tuition reductions to merit-based “scholarships” in the original sense of the word. Second, he dealt with room and board costs through family need-based grants. My personal tuition plus room and board cost through three state universities over five years was nearly zero.
I recognize that we are in a different world from Romney’s, and his approach would also require increased funding today, but I have two other objections to the Sanders “college for all” proposals. First, the plan ignores the contributions and challenges faced by the extensive network of high-quality private universities, many established with religious roots, even if those roots are less visible today. Finding a “free college” plan that does not either kill this market or run into church-state separation issues would be a major challenge, and little has been written on this conundrum.
My second issue concerns whether we are funding the right types of higher education. We suffer from a lack of good post-secondary vocational-technical alternatives that could potential address the skills gap plaguing American manufacturing, while at the same time we are graduating too many students in weak or “tough market” disciplines. Germany also has a model worth exploring here, but like healthcare, Americans don’t seem to want to explore European alternatives.
The too-close tie between American universities and athletic programs has also distorted the best mix of academic programs required to meet current and future job market requirements, but that is another issue few Americans are willing to honestly explore. Let me simply suggest that, absent university subsidies for sports programs, the mix of degree programs offered would be substantially different. There are better ways, I contend, to deal with educating the economically disadvantaged in a more equitable manner.
Universal jobs and housing guarantees. One “fatal flaw” of American socialist thinking is in getting to an understanding about how jobs and affordable housing are created. I wrote back in March about a concept I call the “casualties of culture.” Chronic unemployment and poor living conditions are not solved by just making up jobs or building housing. We live in a complex, always changing culture, and we will continue to have individuals and families “fall off the curve” of what it means to live a “normal” life in a modern culture.
Conservatives are quick to label this “falling off the curve” as the fault of the individual, a viewpoint that may assuage some guilt, but doesn’t reflect the on-the-ground reality of many struggling communities. On the other hand, liberals often underestimate the effort required to “save everybody.” There are no “magic bullets” here for fixing the problem, but there is a lot of room for improving the safety net for the “casualties of culture.” It most likely involves a lot of incremental actions and tests, including in the areas of employment and housing, but there will be a lot of failure along the way. I interpret the quote attributed to Jesus, that “You always have the poor with you,” to be more about the mathematical probability than an excuse for non-action. 
In short, my take on many current “capitalists” is that they are really capitalists only until it comes to challenges to their own wealth; they will then be first at the government trough. On the other hand, self-branded “socialists” often let their zeal hide their lack of understanding of economics or the practical actions required to get from “here” to “there.”
Best that we work together to recognize that we are unavoidably in “community” with one another, at different levels of association, and we won’t solve the most critical of our problems through economic ideology alone.