Medical Marxism: wave of the future?

"Karl Marx may have suffered a second death at the end of the last century, but look for a spirited comeback in this one," predicts Harvard economist Kenneth Rogoff in the January/February issue of Foreign Policy. "The next great battle between socialism and capitalism will be waged over human health."

At present, U.S. health care costs have reached 15 percent of annual national income and could exceed 30 percent by mid-century. When that figure reaches 25 percent, Rogoff writes, "Americans would see their tax bills more than double.... With oppressive tax burdens and heavy state intervention in health--already the largest sector of the economy--socialism would have crept in through the back door."

As grim as things may be in the U.S., where health care is largely cartelized through quasi-socialist HMOs, things are much worse abroad. "In Canada," Rogoff points out, "the horrific delays for elective surgery remind one of waiting for a car in the old Soviet bloc. And despite British Chancellor Gordon Brown's determined efforts to rebuild the country's scandalously dilapidated public hospital system, anyone who can afford to go elsewhere usually does. With public health care systems fraying at the edges, many countries outside the United States increasingly face the need to allow a greater play of market forces."

But even if those state-run systems were opened up, the increasingly statist nature of U.S. health care may choke off avenues of medical innovation. Socialist health care systems in Canada and Europe are heavily dependent on "advances in health technology that are driven largely by the allure of the profitable U.S. market," notes Rogoff. "If the United States joins other nations in having more socialized medicine, the current pace of technology improvements might well grind to a halt."

After building a case for freeing medicine from state control, Rogoff--predictably enough, given his affiliations--ends his essay by endorsing more state control.

"Ultimately, the case for some government intervention and regulation in health care is compelling on the grounds of efficiency (because costs are out of control) and moral justice (because our societies rightly take a more egalitarian view of health than of material possessions)," he asserts. "The issue is precisely how much redistribution of income and government intervention is warranted."