“The past shows unvaryingly that when a people’s freedom disappears, it goes not with a bang, but in silence amid the comfort of being cared for. That is the dire peril in the present trend towards statism. If freedom is not found accompanied by a willingness to resist, and to reject favors, rather than to give up what is intangible but precarious, it will not long be found at all.” Richard Weaver

Once when I had some spare time in London, I decided to visit the British museum. Making my way to the Greek and Roman rooms, I was impressed to find an exhibit displaying various medical instruments used by the Ancient Romans.

The utensils fascinated me so I decided to read the caption underneath. It explained that although Roman doctors had developed a number of successful medical techniques, their practices could not even compare to the advances in British society under the nationalized health service.

Suddenly, standing before that exhibit in the British museum, a vision flashed before my mind’s eye. It was a vision of the slow evolution of medical advance: first I saw the primitive societies in which there was no medical knowledge at all; this was then replaced by societies that began to develop rudimentary knowledge for treating certain sicknesses; then the classical period came along when medical knowledge developed still further; and finally, after the long dark ages and the gradual enlightenment that followed, I saw human society reaching the pinnacle of medical achievement with universal, nationalized health service.

The vision passed and I thought nothing further of it until Obama’s victory speech on November 5, 2008. Standing before glowing crowds in Chicago, Obama told the story of American history, from its inception to its growth into civic maturity. The story climaxed with his own utopian announcement: “Our union can be perfected.”

I suddenly remembered my vision at the British museum. In an epiphany moment, I realized that the climax of this civic evolution could not be reached unless Obama brought in nationalized healthcare.

I soon found I was not alone in thinking this. Given the utopian cloak with which nationalized health service is so often shrouded, it was enviable that healthcare should play a crucial part of Obama’s perfectionistic platform.

The Utopian Temptation

All utopian schemes come at a price, and that price usually involves a significant number of people surrendering a significant level of freedom. As the utopian and disutopian novels of the 20^th century so poignantly reveal, societies that embrace utopian ideals can only function to the degree that all members of that society cohere. Once the greater good is allowed to be compromised by individual liberty, the entire project comes crashing down like a house of cards.

Now universal health care is utopian to the degree that it rests on the assumption that government is our provider. It is utopian in the sense that it presupposes the vocation of the state to be the constant improvement of civilization. And, like all utopian ideals, it can only be realized in a society where members are willing to surrender a considerable portion of their liberty.

At first glance, it may seem rather strange to suggest that universal health care threatens liberty. However, having spent ten years living in England, I have the advantage of being able to speak from experience.

When there is a direct ratio between the physical health of a populace and the nation’s fiscal integrity (which there obviously is when government promises to pick up the tab on everyone’s medical expenses), the state begins to have an economic interest in policing our health. And because every aspect of our lives can, in a general and indirect sense, be connected to our health, universal healthcare quickly becomes a blueprint for government to micromanage the minutia of our personal lives. It speeds up the inevitable progression from utopian ideals to totalitarian policy, culminating in the type of Mussolinian totalitarianism where everything is inside the state and nothing outside.

Those who are familiar with Britain’s “health and safety” cult will know exactly what I am talking about. Any behavior that might lead to disease or injury – from tree climbing to waterskiing to eating shellfish – becomes a matter not merely of private health, but of public “health and safety.” It is a concern because any health insurance system is naturally limited by its resources and must necessarily choose between competing demands. If the amount of competing demands can be reduced through preventative action, then it becomes a public duty to pursue such intervention. In short, there is no end to the interference that can be justified in the name of public health.

At first, this manifests itself in mildly intrusive ways, such as the UK’s campaign to get citizens to exercise while waiting for the bus. But it quickly accelerates into a full-scale policing of individual health.

Consider that British parents are routinely threatened with having their children removed if they are too fat, while the “health and safety” cult increasingly restricts the range of legitimate activities Brits may or may not perform. Increasingly parents find themselves labeled as “child abusers” because the environment they give their children fails to measure up with increasingly meddlesome health standards. Finally, free speech starts to be limited if the speech is in defense of any product or activity that the government has declared to be unhealthy. We have already seen this occur in America with the advertizing restrictions placed on the tobacco industry.

My Brother’s Keeper

I have a friend who once stayed at an Eastern Orthodox monastery. Although he enjoyed his time, it was tinged with grief at observing how unhealthy the monks were. They ate white bread every day and had very few fresh vegetables. My friend tried to correct the situation but found that, although the monks were quite open when the topic was apostolic succession or ecclesiological epistemology, their rationality congested when the topic was health.

When my friend returned to normal civilization, he couldn’t escape the memory of these unhealthy monks. Wherever he went, whatever he did, it was colored by the melancholy of knowing that out in a remote Midwestern monetary there were monks who were daily making themselves more unhealthy. Eventually it became too much for my brother to endure and he took the plunge: he walked to his local health store, bought a box full of vitamins and shipped it off to the monks.

My friend is quixotic. Most of us grant our neighbor the peace of not being overly concerned about his or her health. But imagine if everyone were like my friend, if everyone felt that it was his personal mission to make you healthier? That is exactly the situation that will exist when health care is nationalized since increased taxation is the eventual consequence of irresponsible living on the part of our fellow citizen. The economic burden created by institutionalized healthcare cannot help but blur the division between private health and public health, awakening an acute interest, not in the lives of others, but the lifestyles of others. When Obama told the democratic convention on August 28 that “the promise of America” is “the fundamental belief that I am my brother’s keeper; I am my sister’s keeper”, he was describing a situation that will be realized with relentless application in a state that offers universal healthcare. When an entire population begins competing for the limited resources that government has promised to provide, it cannot help but change the way we think of each other. Consider that the funds being allocated to treat your lung cancer and heart disease are funds not available for my grandfather’s surgery. Therefore, the person who puts cigarettes and red meat into his mouth is not merely unhealthy: he is being selfish. He is a parasite, acting against the common good since every meal and every cigarette unnecessarily sets him up to draw on resources that might otherwise be allocated to someone more worthy. My health and your health cease to be private matters, because the limits of economics ensure that all of our health is related in a web of connecting implications.

Socialized Food and the Common Good

If history teaches us anything, it is that when individual health becomes a matter of national economic integrity, it is a small step away from the Nazis principle of “Gemeinnutz geht vor Eigennutz” (“the common good supersedes the private good”).

The world’s oldest provider of government-funded healthcare is Germany, with origins dating back to Otto von Bismarck’s Health Insurance Act of 1883. The act was based on Bismarck’s belief that the state must “Give the working-man the right to work as long as he is healthy; assure him care when he is sick; assure him maintenance when he is old”, as he said in a speech to the Reichtag in 1862.

Initially Germany’s health insurance only applied to government employees and low-income workers but eventually it came to encompass all the citizens. The 25 point Nazi platform (co-written by Hitler in 1920) built on the ideals of Bismarkian socialism and urged the state to care for elevating national health. When the Nazis came to power in 1933, they put this into practice in a variety of ways, including their war on cancer, their campaign against alcoholism and Hitler’s emphasis on organic foods. The German beverage industry moved away from beer towards fruit juices and, in1936, the Nazis required special certification on beverages and foods specifying whether they were fit or unfit for children. In 1938, the head of the Reich Health Office declared sweet cider to be the official “people’s drink” of Germany. In a variety of other ways the Nazis attempted to “socialize” food and drink. Hitler Youth health manuals were published which contained the words, “Food is not a private matter!” and “You have the duty to be healthy!”

In his book The Nazi War on Cancer, Robert Proctor showed that public health law was at the core of the Nazi agenda. Proctor writes that “aggressive measures in the field of public health would usher in a new era of healthy, happy Germans, united by race and common outlook, cleansed of alien environmental toxins, freed from the previous era’s plague of cancers, both literal and figurative.”

The history of American socialism can be described as the relentless attempt to catch up with Europe and the politics of health is no exception. In his book Liberal Fascism, Jonah Goldberg shows that Woodrow Wilson (who wrote that Bismark’s welfare state was an “admirable system…the most studied and most nearly perfected”) embodied many of the same fascist tendencies of the German project, including an attempt to socialize food. Wilson’s food administrator (the future president Herbert Hoover) complained that “Supper is one of the worst pieces of extravagance that we have in this country” and asked children to sign a pledge card titled “A Little American’s Promise”, which contained the following promise:

At table I’ll not leave a scrap
Of food upon my plate.
And I’ll not eat between meals but
For supper time I’ll wait.
I make that promise that I’ll do
My honest, earnest part
In helping my America
With all my loyal heart.

In order that toddlers, who were too young to sign the pledge, wouldn’t feel left out, the Wilson administration provided the following nursery rhyme for them to sing:

Little Boy Blue, come blow your horn!
The cook’s using wheat where she ought to use corn
And terrible famine our country will sweep,
If the cooks are the housewives remain fast asleep!
Go wake them! Go wake them! It’s now up to you!
Be a loyal American, Little Boy Blue!

The justification for this federal interest in food was the costs associated with WWII. It is not hard to see how the costs associated with universal healthcare will result in a similar federal obsession over what goes in the mouth.

Confusing Freedom with Provision

Among those who value freedom, there should be something deeply counter-intuitive in these types of socialistic policies. A government that tries to control public health should strike us as just absurd as a government that tries to nationalize underwear. However, history shows that a population can be inured to these invasions of liberty through the frequent association of freedom with provision.

The confusion of freedom with provision was, in some sense, inevitable once the Declaration made the pursuit of happiness a self-evident universal right. Franklin Roosevelt built on the tendency to confuse freedom with provision in his 1944 State of the Union address when he justified what he called a “second Bill of Rights” on the grounds that “Necessitous men are not free men”. The state, he went on to argue, must provide a “new basis of security and prosperity” which included “The right to adequate medical care and the opportunity to achieve and enjoy good health.”

Of course, the corollary of believing that “necessitous men are not free” is that any measure of government control, provided it relieves necessity, is a sacrifice we should be willing to make for the sake of “freedom.” Consequently, we should welcome government intervention aimed at cutting public health costs, since the result is greater funds for the relieving of necessity.

When freedom is confused with provision and when intervention is necessary in order for that provision to be delivered, those individuals who resist intervention become the enemies of freedom. Like those in Rousseau’s utopia, they must be forced to be free: in other words, the state must force them to surrender those liberties which hinder the state from optimizing its provision potential. The end result is what Faith Fitzgerald, professor at the University of California at Davis Medical Center, suggested in The New England Journal of Medicine when he wrote that

Both health care providers and the commonweal now have a vested interest in certain forms of behavior, previously considered a person’s private business, if the behavior impairs a person’s ‘health.’ Certain failures of self-care have become, in a sense, crimes against society, because society has to pay for their consequences.

Health and the Totalitarian Temptation

The World Health Organization defines “health” as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” It is hard to imagine any area of physical and even intellectual life that would fall outside the scope of this broad definition. If my “homophobia” or “religious fundamentalism” has the potential to cause depression in my neighbour, and if the medication for that depression draws on the limited resources of the state, then my beliefs become a matter of public health and safety. This was anticipated by Robert Meenan, professor at the University of California School of Medicine in San Francisco, when he noted in The New England Journal of Medicine in 1976 that, “virtually all aspects of life style could be said to have an effect on the health or well-being of society, and the decision reached that personal health choices should be closely regulated.”

In short, nationalized health insurance cannot help but eventually lead to an institutionalized hysteria about health, lifestyle and all the social and intellectual decisions we make which may affect the health of ourselves and others. As the 1977 health textbook Principles of Community Health put it, “the entire spectrum of ‘social ailments’… includes problems appropriate to public health activity….The greatest potential for improving the health of the American people is to be found in what they do and don’t do to and for themselves. Individual decisions about diet, exercise, stress, and smoking are of critical importance.” Similarly, the 1978 manual Introduction to Public Health notes that the field of health, which once “had much narrower interests,” now “includes the social and behavioral aspects of life…and emotional instability.”

In the end, there is literally nothing that falls outside the concern of a government that has taken upon itself the mantel of public health. Even the books we let our children read and the movies we let them watch becomes the concern of the health-conscious state. Consider that in 2004 Hillary Clinton urged us to think about children’s entertainment “from a public health perspective.” In that light, she said, “exposing our children to so much of this unchecked media is a kind of contagion,” a “silent epidemic” that threatens “long-term public health damage to many, many children and therefore to society.”

By giving government the responsibility to provide for our health, we are handing the state authority over our health and, by extension, our very lives. What begins as a policy that promises to be beneficent and compassionate, ends up being intrusive, malignant and totalitarian. And that is the counter that totalitarian systems usually follow. When Mussolini first coined the word “Totalitarianism,” it was not a pejorative slur, nor was it something connoting tyranny. Rather, he used the term to refer to a humane society in which everyone was taken care of and looked after. It was a vision of a compassionate state that encompassed everything within its grasp. The problem is that compassion from the state is almost always a prelude to tyranny. C.S. Lewis put it well when he observed that

“Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busy-bodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience.”

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