Senator Lindsey Graham, referring to the latest Republican attempt to undo the Affordable Care Act, was quoted in The New York Times as saying that the choice for America is “Socialism or federalism when it comes to your health care.” Now, I don’t know whether Senator Graham is really ignorant of what socialism is, or was deliberately misusing the term, but the Affordable Care Act is federalism, not socialism.
Socialism is defined as public ownership of the means of production. When it comes to health care, that means no private hospitals (whether for profit or nonprofit) and no independent physicians. It means a national health service running the hospitals and employing the physicians. The Affordable Care Act is nothing like that. It isn’t even a single payer system, in which government pays private hospitals and independent physicians to treat individual patients. It’s an organized, subsidized system of private insurance.
Federalism is a system of government in which sovereign states delegate certain governing powers to a national government. It’s what the United States has now. When the U.S. Constitution was being written, federalism meant delegating more powers to the national government. Now, it means delegating less power to the national government. Leaving health care in the hands of the individual states means that your health insurance might not be valid if you move to another state, or even if you visit another state. There’s no need to repeal or even weaken the Affordable Care Act in order to have “federalized” health care, because that’s what it is.
What could Senator Graham possibly mean by saying the choice is “socialism or federalism”? He certainly isn’t proposing socialism, and his idea of “federalism” is less organization, less subsidy, and more people without health insurance.