France’s Tax Revolt

A Fiscal Revolution?

by TOM GILL

France is in revolt over tax. In recent weeks the protagonists have ranged from drivers of heavy goods vehicles, wealthy cereal farmers, and even the equestrian lobby . And, almost everybody in the depressed north western region of Brittany, it seems.

The narrative is that Socialist France is ‘over-taxed’. As soon as he was elected President 18 months ago, Francois Hollande came under sustained attack by the global ruling class and their tribunes in the press for promising to soak the rich with a 75% tax.

In recent weeks the anti-tax hysteria has returned with the footballers’ threatened strike against this imposition on their zillions, followed closely acts of highway sabotage and near riots in the regions over a levy on heavy goods vehicles designed to curb pollution.

The French do indeed pay a lot of tax, relatively speaking. At 44.2% of gross domestic product, France’s overall tax burden is one of the heaviest in the world, behind only Denmark and Sweden.

But these taxes are to pay for the things that make for a civilised society. Like health, education, a welfare system, decent infrastructure, an efficient bureaucracy, and protection of the environment. On most of these criteria, the country scores highly in the global league tables. But civilisation has a cost. And what the papers and TV would have us believe is the French can no longer afford it.

Clearly a major factor is the dire state of the economy, which has brought mass lay-offs, poverty and collapsing business sales. And France, chained, through the Single Currency, to an aggressively beggar-thy-neighbour Germany – Brittany’s woes are in part down to cut-throat competition from abattoirs on the other side of the Rhine that employ cheap eastern European labour – and a punishing EU-set public deficit regime, has walked into an almost permanent austerity trap.

The French government’s solution so far has been to plug the hole in the public finances primarily through taxes. The alternative to this, short of exiting European monetary union, is to kick start growth by regaining ‘competitiveness’; that is, following the route of its southern neighbours, like Greece, Spain and Portugal where workers are being forced to become more ‘flexible’, that is see their wages, welfare and other key rights slashed. Which, growing numbers believe, is ultimately the game plan of austerity, and the European project.

This week the French Government, forced into a series of humiliating retreats over its tax policy, tried to get a grip. It kicked off talks with unions and business on ‘reforming’ the system. Prime Minister Jean-Marc Ayrault has made clear, however, that there would be no over-all change in the tax burden, given commitments to Brussels over the public finances. Which begs the question, who, or more precisely, which class will pay more tax?

The tax rebellion has been led by big business and the wealthy, the same bunch who did splendidly before the global crisis in 2008, and who have been doing pretty well since it kicked in.

A colossal 100 billion euros was pocketed by fat cat shareholders of France’s largest companies in the three years to 2011 alone. And the government has already promised corporations 20 billion euros tax break.

As for the rich, despite the headlines about the 75% tax on those earning seven digits or more, it has yet to be implemented, after being shot down on a technicality, and was in any case designed to be in place for just two years. And while the government dithered, that exclusively coddled club has just got bigger, with some figures showing that last year France gained almost 300,000 more dollar millionaires, as measured by household wealth.

Workers, unable to dodge taxes like the 1%, hit by closure after closure, record 3.29 million unemployment and falling purchasing power, are not having a good crisis. Unions key gripe is with the plan to hike sales tax on 1 January, not only because it will hit their members in the pocket, but they know it will soon cost them their job as it hits consumer spending – that is French people will buy fewer French goods and services. And all, not to protect public services, but to fund the 20 billion-euro corporate welfare cheque to employers.

Last weekend, unions sought to regain the initiative from employers and the well-healed, bring out as many as 10,000 workers onto the streets of Brittany. It was impressive response to the protests a few weeks ago where, bizarrely, bosses and workers were marching together in what some fear heralded a revival of the ‘Poujadist’ anti-tax protests in France after the Second World War – or rather, when factoring in the massive protests against gay marriage earlier this year, the emergence of a Gallic version of the Tea Party.

On Sunday 1 December, another popular march is planned in Paris, led by the radical Front de Gauche, an alliance of the communists and other groups left of the Socialists. The rallying cry, as articulated by their fiery former Presidential candidate Jean Luc Melenchon, will be a ‘Fiscal Revolution’. The manifesto for the Left’s tax revolt fuses union demands- including a broader pro-jobs and growth economic strategy – with a plan aiming for a complete and genuinely progressive overhaul of the tax system – including a broad based wealth tax and a serious campaign to tackle tax evasion and avoidance – to respond to social crisis facing the country, and longer term environmental goals.

The kind of vision the President Hollande and his Socialists appeared to be presenting to the electorate as they collected the winning vote in May 2012. But seem now to have all but forgotten.

_{Tom Gill blogs at www.revolting-europe.com}

Will The Hunger Games: Catching Fire“stir up” revolution?

By Christine Schofelt and David Walsh, wsws.org

The Hunger Games: Catching Fire

The Hunger Games: Catching Fire, the sequel to The Hunger Games (2012), opened with a weekend box office take of more than $161 million in the US, and approximately $308 million worldwide.

With the trilogy of novels by Suzanne Collins, on which the films are based, also selling in the millions of copies, it is clear that some sort of a chord has been struck. Issues raised by The Hunger Games, including social inequality and the build-up of police-state measures, certainly weigh on the minds of many, especially young people, all over the world.

The first book in the science fiction series (The Hunger Games), released in 2008, ignited a controversy as to what exactly was being argued, with both left- and right-wing commentators claiming the stories for their own. Collins has indicated that her outlook is a left-liberal one; she is concerned with the environment, war, and economic deprivation. Her stories inspired a following, however amorphous their message is.

The overarching motif is the emergence of Katniss Everdeen (Jennifer Lawrence) as a symbol of revolt in Panem, a post-apocalyptic North American nation ruled by a violent dictatorship. In the first film, she survives her involuntary participation in the “Hunger Games,” an annual event in which 24 young people between 12 and 18 (two from each District, chosen by lottery) are pitted in a fight to the death against one another as punishment for their Districts’ rebellion against the wealthy Capitol some 70-odd years earlier. Katniss’s acts of kindness and solidarity toward her fellow “Tributes” during the Games are considered a dangerous flashpoint by the authorities, which give “hope” to the angry and oppressed masses, who to commence rioting.

Katniss is unaware of this, through a combination of her isolation by government design and her own self-absorption. Her main concerns, at least initially, are solely for the safety of her family and her own continued survival. As Catching Fire (directed by Francis Lawrence) opens, Katniss and her District partner, Peeta Mellark (Josh Hutcherson), are about to embark (unwillingly) on an officially sponsored Victors’ Tour—for the first time a plural, since only one Tribute is supposed to survive. That two did survive, through Katniss’s unwillingness to kill Peeta, has incurred the wrath of President Snow (Donald Sutherland), who threatens to destroy everyone Katniss loves if she does not come to heel and participate in the pacifying of the population.

While Katniss wants to flee, those around her are apparently starting to stand up and think about their situation, in the form of the “Mockingjay revolution.” As the authorities proceed with the tour, she is horrified and frightened by the violence of the ever-present riot police.

Ultimately, angry at the continuing calls for rebellion and “hope” inspired by Katniss—however unwittingly—President Snow calls for a “Quarter Quell.” This involves another lottery-type reaping from among the surviving Tributes of each district. As Katniss is the only female Tribute from her district, she is forced back into the Games. The second half of the film treats the competition among the 24 competitors, as well as the machinations of Snow and his associates, who are determined to discredit Katniss in the eyes of the rebellious population and, ultimately, exterminate her.

Veteran actor Sutherland told the Guardian recently, “I want Hunger Gamesto stir up a revolution.” Leaving aside what Sutherland, prominent in the radicalization of the late 1960s and early 1970s and now aged 78, might precisely mean by a “revolution” (he also admits in the interview to being a supporter of Barack Obama), and taking him at face value, we socialists are entirely in favor of works that will encourage such a vast social transformation. The question that needs to be asked, however, is: Will The Hunger Games: Catching Fire, in fact, help to bring on a social revolution?

No doubt, the intimations of a mass social response to poverty and authoritarianism have a certain significance. It is difficult to envision a film like this emerging two decades or perhaps even a decade ago. That a major Hollywood blockbuster depicts a popular revolt erupting on American soil suggests that something about the current situation is sinking in. Moreover, there is a growing recognition that the powers that be promote celebrities, brutal entertainment and other forms of spectacle to divert the public’s attention from the ills devastating society. Stanley Tucci is effective as a dreadful television host, grinning and glad-handing his way through human tragedy.

The chief difficulty with the film is that its supposed central concerns, inequality and political repression, are not the driving force of the drama.Catching Fire is constructed, to a large extent, as a series of red herrings, dead ends and arbitrary elements. The very fact that, according to the logic of the film, a presumably historic, world-changing social revolution is to be staved off by the ability of two young people (Katniss and Peeta), at the peril of their lives, to pretend to be in love with another in public provides some indication of the level at which the work is operating. In any event, once the Games get under way, this element is largely forgotten about.

The Hunger Games: Catching Fire

The Games themselves are something of a red herring, or come from a different film. The competition is tedious and relatively pointless. The question of who survives and who doesn’t has little to do with the social and political issues supposedly fueling Catching Fire (except in the meager sense that the competitors learn the virtue of cooperation). How does Katniss’s skill with a bow and arrow relate to the problems of poverty and dictatorship? Or the structure of the game as a clock, which is disposed of almost as soon as it raised? These are simply action film ingredients, which don’t enlighten anyone about anything.

What if Spartacus (1960), the historical drama about the famed first century BC slave revolt against the Roman authorities, had spent half its time focused on the various encounters among the gladiators (and, incidentally, Catching Fire makes numerous reference to ancient Rome)? What would it prove if Kirk Douglas’s Spartacus were victorious in every conflict?

The brutality of the training and contests in Spartacus is a subordinate element, meant to give some indication of the rottenness of the entire social order. The film then moves forward to the social conflict between the oppressed and the authorities, the rich. There is a coherence in Spartacus, whatever its degree of artistic success, and the various elements make sense in relation to the social picture as a whole.

There is no such coherence in Catching Fire. The filmmakers strike at certain social realities (poverty, hunger, the games as social diversion), but they leave out or avoid critical elements. The film makes reference to wretched economic conditions, even “starvation,” but provides almost no evidence of these conditions, and they are not, in any important sense, what advances the story. Those circumstances are not the principal source of interest to the filmmakers. Family, personal relations, various machinations take center stage.

Indeed, even in relation to the first book and film, inequality and hunger seem to take a back seat here. Although the preparations for the upcoming Quarter Quell are lavish, there is not the pointed contrast to the poverty in the Districts offered in those previous works. The audience, like Katniss, is largely isolated from the oft-referred-to growing rebelliousness against these conditions, portrayed in brief glimpses of television footage and hurriedly exited situations.

Moreover, Catching Fire and the entire series depict a reactionary, almost fascistic regime, but emerging from which social process and serving which economic interests? We see people going to work in the mines. But who owns the mines, who owns the corporations, what is the content of the social relations? This is entirely sidestepped. We simply have an evil president and his henchmen. But who gives the (real) orders to them? Where are the bankers and corporate chiefs? Collins, consciously or otherwise, has accommodated herself to anti-socialist prejudices in avoiding this. And this is one reason why even the extreme right can lay claim to the film. It is not a criticism of capitalism. It is a criticism of authoritarianism existing in mid-air somewhere. Presumably, a political coup or putsch, removing the evildoers, will right things.

The one glimpse we get of the Capitol, in a party scene, does little to suggest the gap between rich and poor. The sated guests, who drink some sort of cocktail allowing them to vomit and eat more, seem more representative of the Hollywood high life than the financial-corporate elite, although Peeta does point out with quiet disgust that there are people starving in their home District while the Capitol’s denizens engage in such behavior. But the sequence as a whole could easily fit into the propaganda of right-wing populists inveighing against “cosmopolitan,” immoral, out-of-touch “big city” folk.

The performances are perhaps superior in Catching Fire as opposed to the first film. Elizabeth Banks’s portrayal of Effie Trinket’s transformation from perpetual cheerleader of the Games into someone who realizes the unfairness of the Tributes’ forced return to the arena, and into an active conspirator in the effort to overthrow the system that has provided her a good living, is well done and convincing. Likewise, Woody Harrelson’s Haymitch goes from being just a battle-scarred alcoholic to someone who has a reason to fight, in a powerfully wrought performance. His discussion of the other Tributes that Katniss and Peeta will face is done with enough bitter humor to bring out the horror involved in the very idea of being forced to kill to survive.

The array of personalities involved in the Quarter Quell, who range from the very young to the aged and possess varying intellectual and physical abilities, suggests what is lost in war and repression. Their reactions to being called back to the Games vary from glee on the part of the more psychopathic to fear, resignation, and in a few cases, open hostility.

One of the film’s strengths and the source of much of its appeal, in addition to its references to social problems, is Jennifer Lawrence. Lawrence is one of the most sincere, expressive performers currently working in the film industry and has a genuinely riveting, commanding presence. One fears what may come of her in the Hollywood meat grinder, where even the limited social concerns of Catching Fire are still an exception. Jena Malone, Jeffrey Wright, Amanda Plummer and Lenny Kravitz, among others, acquit themselves with dignity.

Sutherland hopes the film will “stir up” a revolution. However, even if one were to grant Catching Fire a degree of social insight that it lacks, it is a serious misunderstanding of the process of social revolution to suggest that a work so banal in much of its dialogue and many of its relationships could contribute to the sort of critical-revolutionary climate conducive to social upheaval. The greatest possible contribution to such a climate would be the encouragement of complex thinking about complex problems. A revolution is something more than the combination of harsh conditions and a secret salute.

It would be wrong and unnecessary to mistake the initial, confused fumblings about big social questions, well-intentioned or otherwise, with the sort of artistic work that can enlighten and galvanize masses of people in a historical instant. Such works still lie in the future, although perhaps not so distant.

The authors write arts and film criticism for wsws.org, information arm of the Social Equality Party.

Stephen Colbert and Jon Stewart Have Destroyed Satire — Chris Hedges

Please make sure these dispatches reach as many readers as possible. Share with kin, friends and workmates and ask them to do likewise.

Dennis Trainor
Creator of Acronym TV/ Director- American Autumn: an Occudoc

Originally posted on AcronymTV

In this wide-ranging interview, Pulitzer Prize winning journalist Christopher Hedges talks with me about class war, nonviolence, The Great Gatsby, and about the lost art of satire.

"Satire becomes destroyed in essence in the hands of figures like Colbert, Jon Stewart and others," Hedges asserts. "They will attack the excesses or the foibles of the system, but they are never going to expose the system itself because they are all millionaires, they are commercially supported. You have very few people (George Carlin was one) who will stand up and do it. If you do that, it is tough to make a living. Carlin maybe being the exception. But if you really use satire the way Swift used satire, to expose the English barbarity in Ireland because culture, like everything else in the society has been completely corporatized."

Follow Dennis Trainor on Twitter: www.twitter.com/DennisTrainorjr

An Interview With Muqtada al-Sadr

“The Near Future of Iraq is Dark”

by PATRICK COCKBURN, Counterpunch

Muqtada al-Sadr

The future of Iraq as a united and independent country is endangered by sectarian Shia-Sunni hostility says Muqtada al-Sadr, the Shia religious leader whose Mehdi Army militia fought the US and British armies and who remains a powerful figure in Iraqi politics. He warns of the danger that “the Iraqi people will disintegrate, its government will disintegrate, and it will be easy for external powers to control the country”.

In an interview in the holy city of Najaf, 100 miles south-west of Baghdad – the first interview Mr Sadr has given face-to-face with a Western journalist for almost 10 years – he expressed pessimism about the immediate prospects for Iraq, saying: “The near future is dark.”

Mr Sadr said he is most worried about sectarianism affecting Iraqis at street level, believing that “if it spreads among the people it will be difficult to fight”. He says he believes that standing against sectarianism has made him lose support among his followers.

Mr Sadr’s moderate stance is key at a moment when sectarian strife has been increasing in Iraq – some 200 Shia were killed in the past week alone. For 40 years, Mr Sadr and religious leaders from his family have set the political trend within the Shia community in Iraq. Their long-term resistance to Saddam Hussein and, later, their opposition to the US-led occupation had a crucial impact.

Mr Sadr has remained a leading influence in Iraq after an extraordinary career in which he has often come close to being killed. Several times, it appeared that the political movement he leads, the Sadrist Movement, would be crushed.

He was 25 in 1999 when his father, Mohammed Sadiq al-Sadr, a revered Shia leader, and Mr Sadr’s two brothers were assassinated by Saddam Hussein’s gunmen in Najaf. He just survived sharing a similar fate, remaining under house arrest in Najaf until 2003 when Saddam was overthrown by the US invasion. He and his followers became the most powerful force in many Shia parts of Iraq as enemies of the old regime, but also opposing the occupation. In 2004, his Mehdi Army fought two savage battles against American troops in Najaf, and in Basra it engaged in a prolonged guerrilla war against the British Army which saw the Mehdi Army take control of the city.

Patrick Cockburn

The Mehdi Army was seen by the Sunni community as playing a central role in the sectarian murder campaign that reached its height in 2006-7. Mr Sadr says that “people infiltrated the Mehdi Army and carried out these killings”, adding that if his militiamen were involved in the murder of Sunnis he would be the first person to denounce them.

For much of this period, Mr Sadr did not appear to have had full control of forces acting in his name; ultimately he stood them down. At the same time, the Mehdi Army was being driven from its old strongholds in Basra and Sadr City by the US Army and resurgent Iraqi government armed forces. Asked about the status of the Mehdi Army today, Mr Sadr says: “It is still there but it is frozen because the occupation is apparently over. If it comes back, they [the Mehdi Army militiamen] will come back.”

In the past five years, Mr Sadr has rebuilt his movement as one of the main players in Iraqi politics with a programme that is a mixture of Shia religion, populism and Iraqi nationalism. After a strong showing in the general election in 2010, it became part of the present government, with six seats in the cabinet. But Mr Sadr is highly critical of Prime Minister Nouri al-Maliki’s performance during his two terms in office, accusing his administration of being sectarian, corrupt and incompetent.

Speaking of Mr Maliki, with whom his relations are increasingly sour, Mr Sadr said that “maybe he is not the only person responsible for what is happening in Iraq, but he is the person in charge”. Asked if he expected Mr Maliki to continue as Prime Minister, he said: “I expect he is going to run for a third term, but I don’t want him to.”

Mr Sadr said he and other Iraqi leaders had tried to replace him in the past, but Mr Maliki had survived in office because of his support from foreign powers, notably the US and Iran. “What is really surprising is that America and Iran should decide on one person,” he said. “Maliki is strong because he is supported by the United States, Britain and Iran.”

Mr Sadr is particularly critical of the government’s handling of the Sunni minority, which lost power in 2003, implying they had been marginalised and their demands ignored. He thinks that the Iraqi government lost its chance to conciliate Sunni protesters in Iraq who started demonstrating last December, asking for greater civil rights and an end to persecution.

“My personal opinion is that it is too late now to address these [Sunni] demands when the government, which is seen as a Shia government by the demonstrators, failed to meet their demands,” he said. Asked how ordinary Shia, who make up the great majority of the thousand people a month being killed by al-Qa’ida bombs, should react, Mr Sadr said: “They should understand that they are not being attacked by Sunnis. They are being attacked by extremists, they are being attacked by external powers.”

As Mr Sadr sees it, the problem in Iraq is that Iraqis as a whole are traumatised by almost half a century in which there has been a “constant cycle of violence: Saddam, occupation, war after war, first Gulf war, then second Gulf war, then the occupation war, then the resistance – this would lead to a change in the psychology of Iraqis”. He explained that Iraqis make the mistake of trying to solve one problem by creating a worse one, such as getting the Americans to topple Saddam Hussein but then having the problem of the US occupation. He compared Iraqis to “somebody who found a mouse in his house, then he kept a cat, then he wanted to get the cat out of the house so he kept a dog, then to get the dog out of his house he bought an elephant, so he bought a mouse again”.

Asked about the best way for Iraqis to deal with the mouse, Mr Sadr said: “By using neither the cat nor the dog, but instead national unity, rejection of sectarianism, open-mindedness, having open ideas, rejection of extremism.”

A main theme of Mr Sadr’s approach is to bolster Iraq as an independent nation state, able to make decisions in its own interests. Hence his abiding hostility to the American and British occupation, holding this responsible for many of Iraq’s present ills. To this day, neither he nor anybody from his movement will meet American or British officials. But he is equally hostile to intervention by Iran in Iraqi affairs saying: “We refuse all kinds of interventions from external forces, whether such an intervention was in the interests of Iraqis or against their interests. The destiny of Iraqis should be decided by Iraqis themselves.”

This is a change of stance for a man who was once demonised by the US and Britain as a pawn of Iran. The strength of the Sadrist movement under Mr Sadr and his father – and its ability to withstand powerful enemies and shattering defeats – owes much to the fact it that it blends Shia revivalism with social activism and Iraqi nationalism.

Why are Iraqi government members so ineffective and corrupt? Mr Sadr believes that “they compete to take a share of the cake, rather than competing to serve their people”

Asked why the Kurdistan Regional Government had been more successful in terms of security and economic development than the rest of Iraq, Mr Sadr thought there was less stealing and corruption among the Kurds and maybe because “they love their ethnicity and their region”. If the government tried to marginalise them, they might ask for independence: “Mr Massoud Barzani [the KRG President] told me that ‘if Maliki pushes on me harder, we are going to ask for independence’.”

At the end of the interview Mr Sadr asked me if I was not frightened of interviewing him and would not this make the British Government consider me a terrorist? Secondly, he wondered if the British Government still considered that it had liberated the Iraqi people, and wondered if he should sue the Government on behalf of the casualties caused by the British occupation.

PATRICK COCKBURN is the author of Muqtada: Muqtada Al-Sadr, the Shia Revival, and the Struggle for Iraq. Cockburn has just won the Editorial Intelligence Comment Award 2013 for Foreign Commentator of the Year.

Health Care in the US as Seen From Down Under: “Mens Sana in Insanus Patriae”

By Niall McLaren, Op-Ed

(Photo: Alex Proimos / Flickr)

Article 25 (1) of the Universal Declaration of Human Rights, adopted by the UN in 1948, states: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including . . . medical care . . . and the right to security in the event of . . . sickness, disability . . . “

These days, most people would say that an adequate standard of living includes readily available health care of a proper standard, that “health care delayed is health care denied.” Most people would also expect that citizens of a wealthy country should be able to expect better health care than the benighted citizenry of a poor country. So it comes as something of a shock to learn that the United States, which spends almost 50 percent of the world’s total health expenditure, ranks way down on most health statistics. Let’s start with the World Bank Health Indicators, which show that, in 2009 (latest available figures), Germany, for example, spent $4,724 per capita, some 11.7 percent of GDP, for which citizens received 8 hospital beds per thousand people and a princely four doctors per thousand. Germans are generally pretty healthy, but they pay for it. My tightwad country, Australia, spent $4,118 per capita, 9.0 percent of GDP, to get four beds and one doctor per thousand patients for slightly better standards of health than the Germans. Since then, our government has committed to spending 8.0 percent of GDP on health, and we are on course to get that (now down to 8.4%).

However, when we look across the Atlantic, we find that the United States spends $7,990 per person, an astounding 17.7 percent of GDP, to get only three beds and two physicians per thousand population. To make things worse, US figures are rising rapidly, now thought to be over 18.0 percent of GDP, but where are the standards of health? In a word, they’re nowhere. In fact, they’re worse than that, as the statistics conceal a grossly inequitable distribution of health expenditure. A Hollywood starlet’s boob job, at $65,000, crowds out any number of poor people from even a look at a clinic, as Joe Bageant’s biting reportage shows. Health costs are the biggest single cause of bankruptcy in the United States, while disabled veterans can be seen on street corners in any city, begging for money, not to mention all the mentally ill people crammed in prisons, the new asylums.

But the most bizarre fact is, alone among the world’s hundred or so wealthiest countries, the United States does not provide health care for its most vulnerable citizens. Oh sure, the wealthy can book into some very fancy, ultra-high-tech institutes to have a total body rebuild, but that’s the sort of stunt that got Prince Grigory Potemkina bad name: Behind the facades, the poor are warehoused in the charity wards, if at all. Anybody with an interest in the health game (and that’s all of us) knows perfectly well that the true measure of a nation’s health is not the tiny heads of rich old people getting heart transplants, whose expenditure drags the national average up, but the very large tail of poor children who drag the health statistics down, because their untreated throat infections end up as rheumatic heart disease, perforated eardrums, chronic bronchitis etc. What counts is not expenditure, but what that money achieves. Now the interesting thing is that, if we look at the very large, naturalistic experiment going on around the world, the one called “health care delivery and funding,” it would seem that providing treatment for all those poor people does two things: it actually lowers the total cost to the country and it yields improved health standards.

Why is the United States playing hold-out when everybody else has jumped on the national health-service wagon? That’s a difficult question, so let’s look instead at what they are missing. We can use my miserable excuse for a developed country as an example, since our economy and social structure are fairly similar to America’s in many respects. With a few blips, we’ve had a national health service since about 1971. It provides universal health care at practically no cost to the patient. Those who want more, such as my unworthy self, pay for the pleasure. Medicare is partly funded by a 2 percent levy on each person’s taxable income, but that gets buried in your income tax so you don’t notice it: I don’t know what I pay. For additional private insurance, my family of four pays $3,980 a year additional to the Medicare levy. This gives all sorts of benefits like your choice of doctor and private hospital, one pair of spectacles a year, dental care, physiotherapy, psychology, chiropractics, hearing aids, wheelchairs and so on. If you’d like to get a quote on your own case, go to Medibank Private and insert your details in the box, then click “Go” to see what benefits you get for your payment. Remember, there are no arguments about this. Even if you have a serious chronic illness, you can’t be rejected by an insurer. You can’t be disqualified after the event unless you really cheat. It may happen, but I’ve never heard of it.

There are “incentives” to encourage people who can afford it to take private insurance, which amount to penalties for those who don’t (go here for details; click on FAQ). A single person who has not joined an insurance plan by 31 years old will have to pay a penalty for the rest of his life. This is to stop “free-riders,” because people of that age are unlikely to make a claim anyway. A national health service is a bit like a conscript army in a national emergency, it only works properly when everybody is in.

I’ve always thought we got our $4,000 back by about February each year. My wife had two emergency caesareans; both babies were in neonatal intensive care (my son for eight weeks), and we paid a total of $430 for some stray fees. Pathology tests, optometry, hearing tests and the like are free, but some radiology tests are charged extra. In the past 15 years, I’ve had three hernias repaired, two cataracts replaced, a cervical fusion, and the total cost was . . . nothing. That varies, of course; you have to choose a doctor who charges by the book. If you don’t, you can end up with a large bill, like some unhappy women in Sydney who complained their obstetricians charged them $10,000 for a confinement, but the insurers would only pay about $3,000 (actually, the women were all warned in advance). The Medicare rebate is fixed by a committee in Canberra, but private practitioners can charge what they like. However, it doesn’t do to stand out too much from the crowd: Word very quickly gets around. Having fixed universal fees for services keeps costs down very significantly.

An excellent article in Care2 says it all: “. . . the total average cost of having a baby (in the US) is $37,341, making the United States the most expensive place in the world to have a baby. This covers prenatal care ($6,257), birth ($18,136 on average), postpartum care ($528) and newborn medical care ($12,419). . . . America has one of the highest rates of infant and maternal death among industrialized countries. Insurance doesn’t necessarily help: 62 percent of private plans come with no maternity coverage.” Those prices are outrageous; prenatal care simply does not cost $6,000.

The net effect of health care as a human right under Australian Medicare is that every person in Australia gets the same standard of health care. Rich and poor alike get renal dialysis and kidney transplants . . . if they need them. My elderly mother was knocked down by a car recently, sustaining quite a nasty fracture of her neck. She was in hospital for several weeks, treated by the spinal surgeons, and has had many visits to the physiotherapist since. All her costs were covered by the Motor Vehicle Insurance Trust, which automatically pays all medical costs for any person injured in a car accident, even for a drunken driver. We didn’t have to pay anything. MVIT is funded by a levy on the vehicle’s licence, so the fund will never go broke. Regardless of the cause, anybody injured at work, or traveling to or from work, is fully funded by the compulsory workers’ compensation insurance and is paid their salary for the time off work (it drops to 75 percent after six months). A worker doing something stupid at work, who is left with a long-term disability, may have his benefits reduced, but he will still get something. There are people who try to cheat on this type of insurance, but even that’s not easy. And for every worker cheating, there are two insurance companies trying some fast move.

Rich people can buy cosmetic surgery as Medicare doesn’t pay for it, but anybody with bad scars or significant blemishes can get them repaired under Medicare if they are prepared to wait. There are caps on some forms of treatment, including some outpatient psychiatric treatment. Unfortunately, this has led to an increase in cases of people being admitted to private hospitals when they didn’t actually need it, but Medicare operates a highly sophisticated data analysis system that watches that sort of thing closely. That’s another advantage to a national health service. The statistics are excellent just because they are so comprehensive. But don’t worry, they are protected by layer upon layer of privacy (well, we thought they were, thank you, NSA).

Medications are subsidized by the Pharmaceutical Benefits Scheme, which has been around forever. Anybody on a pension, unemployment or parenting benefits, students, or anybody who just doesn’t earn enough, can get a Health Care Card, which entitles them to cheap medications. They have to pay a maximum of $5.20 per prescription, regardless of the drug. If you don’t have a Health Care Card, the maximum is $37.50 a script. I was once prescribed antimetabolites for a peculiar arthritis. The drugs cost $360 for 100 tablets, but I paid only $37.50 – which was lucky, as they gave me tinnitus, so I had to stop them after a few days. Medication costs are capped for a family at about $1,050 per year; after that, the price drops to $5.20 while, for pensioners, it cuts out altogether. I see where one of the core features of Obamacare, the caps on copayments ($6,350 for a single, $12,700 for a family), has just been deferred as “too difficult for insurers to implement.” As though they didn’t already have nifty caps that worked in their favor – reach the limit and the insurers don’t pay.

How does a doctor fare in this socialist paradise? Actually, we do quite well. There are some who charge what they like as there are always patients who will pay to get to the front of the queue. I once sat in the waiting room of an ear, nose and throat surgeon and heard the fees as they were loudly announced to each new patient. He was pulling in about $1,000 an hour, which struck me as a bit gross as they earn very good money operating. As a psychiatrist, I can comfortably earn about $400,000 a year (49 weeks at 45 hours per week, no nights or weekends) seeing all patients on Medicare and charging private rates for legal cases. For military cases and veterans, the Defence Department pays private practitioners about 50 percent more than Medicare. Government psychiatrists can earn more, but working for the government isn’t my idea of fun.

In our hybrid private/public system, there’s room for everybody. Nobody in this country goes without. We provide full health care to every citizen, regardless. I have worked in the remote north, on the edge of the desert, and Aboriginals leading fairly traditional lives in their own communities get the same care as anybody else. Their health isn’t as good; they still die younger than white Australians, but that’s the subject of a massive drive by state and federal governments to “close the gap.” People who enter the country illegally, which has been a hot topic for the past 15 years, are all provided with health care from the day they arrive. I’ve seen quite a number of them myself, as well as approved refugees who are given Medicare cards as soon as they land.

It may seem like rubbing salt in the wound, but pets can also be covered at a moderate price. This advertisement landed in my in-box the other day: “Pet Insurance from just 33c a day! Medibank Pet Insurance offers . . . Coverage from 8wks of age; with generous annual limits from $8000 up to $15000 a year; and up to 80% off the cost of vet consultations, surgery and medicines.” For a one-year-old dog, based on $200 excess (ie owner pays first $200), the scheme costs $117.50 a year. I’m sure a lot of Americans would be pleased to have that sort of coverage. They never will, because health insurance is tightly held by private insurance companies, who made over $100 billion profit in 2005. That was money the insurers took out of the system that should have stayed in it to provide better care.

There’s more, but this gives you the basic idea: Without too much effort, any country can have a national health service providing world-class care for a moderate price. Universal health insurance does not bankrupt the country. I often see complaints from the Rabid Right in the United States that having universal health care will make people irresponsible about their health, but this doesn’t make sense. When a community decides they want universal health care, they are being highly responsible about their health. They have talked it over and agreed that this is the best way to go. They are taking perfect, democratic care of their health. How could anybody object? It’s like conscription: Armies and universal health care only work when everybody chips in. My advice is: Just ignore the screechers, they’ll get over it because the good thing about socialism in this country is that it’s optional.

That’s right. Once you pay your tax (that isn’t optional, but I’m not aware that paying taxes is an option in the United States, either), you’ll get your green Medicare card. If you’re too poor to pay taxes, you’ll still get one, but whether you use it or not is entirely up to you. You can be as socialist or as “privatist” as you like. If you don’t want to stand in the queue at the public hospital with all the olfactorily challenging people, you don’t have to but I know plenty of rich people who do. Or you can pay a bit extra and see one of those nice private doctors. You may be treated in a lovely private hospital, but you won’t be treated any better. That’s our boast. We have leveled health care up, not down.

ABOUT THE AUTHOR

Niall McLarenJock McLaren is an Australian psychiatrist who worked 25yrs in the remote north of the country. He occupies himself delving into the philosophical basis of psychiatry, only to find there isn’t one. This has not helped his popularity with his colleagues, now well into negative territory.