Throughout many of the articles on this website, I have referred to mixed economic systems in which several large industries are socialized as “European-style socialism,” which is also commonly called “democratic socialism.” “European-style socialism” is a term regularly used in America to describe such schemes, although the truth is all or nearly all the world’s developed countries, including the United States, have at least one industry that is heavily socialized. This means that nearly every economy in the developed world is, to one extent or another, “socialistic.”
At what point is it accurate to call a country with a mixed-socialist economy “socialist,” “European-style socialist,” or “democratic socialist” as opposed to a “mixed-socialist,” “mixed-capitalist,” or “mixed-market” economy? There is no definitive answer to this question, which means the definition of a “socialist nation” is constantly shifting. Many socialists would say there are no “socialist” nations currently in existence, and if they are referring to Marx’s fully formed socialism, they are correct. However, the same argument could be made about capitalism. I’m not aware of a single country that has a truly libertarian free market. Most market economies are heavily regulated and taxed, and many operate alongside large government-run social programs. Thus, one could just as easily reason there’s no such thing as a modern “capitalist” nation, either.
Rather than thinking about “socialist nations” versus “capitalist countries,” it makes far more sense when evaluating modern European-style socialist nations to consider the morality of specific socialist government programs. Upon doing so, it will become evident that the same moral issues facing Marx’s pure communist-socialism plague all modern countries with socialist programs, which for our purposes can be defined as programs whose primary purpose is to socialize an industry through collective property ownership.
Collective Health Care
In America, the socialist program not currently in existence that has received the most support from the political Left in recent years—thanks in large part to self-described socialist Sen. Bernie Sanders (D-VT)—is a national single-payer health care program. Although there are many other socialist programs and policies the American political Left would like to implement as well, the problems with socializing health care, which I outline below, are very helpful in understanding how copious moral difficulties can arise from the socialization of a single industry, so I’ll spend most of my time in this article discussing health care and how morally complex this issue is.
During Sanders’ 2016 run for president, he outlined many left-wing policy proposals he pledged to enact if elected president. The proposal that received the most attention was his “Medicare for All” health care plan. According to Sanders’ website:
Bernie’s plan would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.
In Canada and Europe, there are a variety of single-payer health care models, and Sanders’ proposal features many of the same reforms used in those countries. A great deal could be discussed regarding the effectiveness of single-payer programs such as the one proposed by Sanders, but as I have done elsewhere on this website, the primary focus of the brief section below will be the morality of such programs, not their effectiveness.
Sanders’ pledge to “cover the entire continuum of health care,” while appealing to many, would undoubtedly create numerous, unavoidable moral problems. For instance, in a single-payer program like the one advocated for by Sanders, would abortion and contraception—birth control pills, birth control procedures, condoms, etc.—be paid for? According to Sanders, the answer is “yes.”
In a separate section on his website about “Fighting for Women’s Rights,” Sanders’ campaign stated:
Sen. Sanders has consistently fought against Republican attacks on the fundamental rights of women to control their own bodies. Sen. Sanders will fight to expand, not cut, funding for Planned Parenthood, the Title X family planning program, and other initiatives that protect women’s health, access to contraception, and the availability of a safe and legal abortion.
In a country in which the entire health insurance industry is socialized and the government pays for abortion and contraception, all taxpayers are required to pay for these services/products, including those taxpayers who believe such activities are extremely immoral. In the United States, numerous groups would fall into this category, but the one that often stands out among the rest, as I noted elsewhere on this website, is devout Roman Catholics.
In Roman Catholicism, both abortion and nearly all forms of contraception are forbidden by the Church’s Magisterium—the Roman Catholic Church’s authority on faith and moral issues. Those who knowingly and willingly use contraception, have an abortion, or encourage others to engage in these activities despite knowing such actions are considered “grave sins” are committing a “mortal sin”—a sin so severe that it’s said to make shipwreck of a person’s soul.
Requiring people to pay for contraception would force Roman Catholics, at least in part, to violate their beliefs. This is highly immoral, because no person in a free nation should be compelled to violate their sincerely held religious beliefs, and yet, this and other similar problems are inevitable in a socialized medical system.
Contraception and abortion aren’t the only moral controversies that arise when medical systems are socialized. Because health care, by definition, is deeply personal, it’s impossible to separate religious beliefs and other ethical concerns from the wider system.
For instance, one of the most hotly debated moral issues in health care is whether patients suffering from illnesses that will eventually kill them should be permitted to commit “compassionate suicide,” which requires assistance from a physician.
A 2015 Gallup survey found 68 percent of Americans support allowing physician-assisted suicide when “a person has a disease that cannot be cured and is living in severe pain,” although only 56 percent said physician-assisted suicide is “morally acceptable.”
You might be tempted to think of physician-assisted suicide as a personal issue that doesn’t affect anyone other than a dying patient and his or her family and doctor, but in a socialized medical system, everyone must participate in physician-assisted suicide, either directly or indirectly, because all taxpayers would be required to pay the physician and other health care workers involved. Taxpayers would also pay for the drugs used to kill the patient and for any materials given to the patient instructing him or her about physician-assisted suicide.
In a socialized medical system that permits suicide, it is, in a very real sense, the collective that kills the patient, not simply a single health care provider. The moral problems associated with such circumstances are apparent and deeply concerning for those who believe physician-assisted suicide is morally wrong.
Socialized medical systems also put many doctors in difficult moral situations. If “health care is a right,” as Sen. Sanders and others claim—and thus all people are entitled to abortion, physician-assisted suicide, and other controversial medical procedures—then what “rights” do medical providers have to choose not to perform these activities? What if a doctor’s objections aren’t based on religion but instead on non-religious, personal moral concerns? What if the collective decides doctors must perform abortions, physician-assisted suicides, etc.? What power would doctors have to say “no”? Could government regulations in socialized medical systems require hospitals to hire only those people who are willing to perform these procedures? Or perhaps only those doctors who agree to participate in the collective’s mandates would get paid by the collective.
All these important moral concerns—and many more, too—only arise when an industry is socialized. In a truly free-market model, all health care providers have the power to voluntarily choose which procedures they feel most comfortable with, and no one is forced by law to engage in or pay for activities they have strong moral objections to.
Health care providers aren’t the only ones who lose their ability to make important decisions in a socialist health care scheme. When health care is socialized, greater authority is granted to the collective, usually represented by the state, to make health care choices.
For instance, in countries with socialized medical systems, the collective decides whether to pay for elective health care costs for, say, an obese person, smokers, and drug users. In 2017, controversy arose when it was revealed some regions in the United Kingdom, which has a socialist medical system, planned to ration care by forcing people with a body mass index of 30 or higher and smokers to wait for at least a year for elective surgeries, a plan the head of the Royal College of Surgeons called “brutal” and the “most severe” policy “the modern [National Health Service] has ever seen.”
The bureaucrat advocating in favor of the policy explained, “Hospitals are being warned they will not be paid for surgery if they carry out operations on obese patients who are not exempt from the policy. This work will help to ensure that we get the very best value from the NHS and not exceed our resources or risk the ability of the NHS being there when people really need it.”
In socialized medicine, these kinds of rationing policies are common and likely unavoidable. When the collective makes health care choices, every personal health issue becomes inseparably linked to the ideas of the majority. So, if the majority decides it wants to compel obese people to lose weight, it can. If the majority decides it doesn’t want to cover the cost of back surgery on 80-year-old patients, it can. And, as the following case illustrates, if the majority decides some people’s lives aren’t worth living, it can do that as well.
In April 2018, Alfie Evans, a 23-month-old child, died in Alder Hey Children’s Hospital in Liverpool, England. Prior to his death, Alfie’s parents fought a lengthy legal battle to remove their son, who suffered from a degenerative neurological condition, from Alder Hey so they could bring Alfie to Rome for experimental treatments. The medical staff at Alder Hey determined Alfie’s parents could not remove him from his hospital and that he should instead have his life support removed.
The U.K. courts sided with Alder Hey and the government, eventually leading to Alfie’s death. In the ruling issued by the United Kingdom’s Supreme Court, the justices wrote it is “clear that parental rights are not absolute,” and that existing laws “make it clear that when any question of the upbringing of a child comes before the courts, the child’s welfare is the paramount consideration. As we explained in our earlier decision in this case, the best interests of the child are the ‘gold standard’ which is not only adopted by our law but also reflects the international standards to which this country is committed.”
The justices then added:
It is therefore clear law that the parents do not have the right to use the writ of habeas corpus to acquire the custody of their child if this will not be in his best interests. The decisions of the trial Judge clearly amount to decisions that the parents have no right to direct Alfie’s future medical treatment. This is not a criticism of them. How could it be? It simply means that they cannot take Alfie away from Alder Hey for the purpose of transporting him at some risk to other hospitals which can do him no good.
Here, the United Kingdom’s socialist medical system, supported by courts, determined it wouldn’t be in the best interests of terminally ill Alfie Evans to allow his parents to attempt to save the young boy’s life. And upon what basis did the court determine this? The claim that the collective, not Alfie’s parents, have the ultimate power to decide what should happen to Alfie.
In all socialized industries, moral concerns must be determined by the collective, leading to tragedies like the Alfie Evans case. These problems aren’t merely limited to socialized medical systems, but the life-and-death nature of health care makes these moral problems more evident and reveals just how horrifying collective decision-making can be.
Moral Forms of Socialism
Whether an entire nation’s economy is socialized or simply a single industry, socialism is almost always accompanied by moral problems, which often lead to minority groups in society being compelled to participate in activities they are staunchly opposed to.
With that said, it is possible to build societies that include socialist programs that are arguably not immoral, but only if those programs deal exclusively with uncontroversial public services. For instance, most of America’s roads are collectively owned, either at the local, state, or federal level, and, other than issues related to government fraud, waste, and abuse, there are few, if any, “public road controversies.” The same is true with many public works projects, such as collectively owned water treatment plants or sewage systems., (I’m not suggesting collective ownership of any industry is the most effective or efficient model. I’m simply pointing out that some socialized industries involve few moral controversies.)
Although these forms of socialism might be more morally acceptable, few self-described socialists believe societies should limit themselves to socializing industries that deal only with uncontroversial issues. For example, I’m not aware of a single socialist party in the world that advocates for the privatization of the health care or health insurance industries. In fact, demanding some form of government-run health care is practically a prerequisite for calling oneself a “socialist.”
PHOTO: Big Ben and Palace of Westminster in London, England. Taken from Westminster Bridge. Photo by Flickr user Kosala Bandara. Attribution 2.0 Generic (CC BY 2.0)
 “Medicare for All: Leaving No One Behind,” berniesanders.com, accessed June 8, 2018, https://live-berniesanders-com.pantheonsite.io/issues/medicare-for-all.
 “Fighting for Women’s Rights,” berniesanders.com, accessed June 8, 2018, https://berniesanders.com/issues/fighting-for-womens-rights.
 Andrew Dugan, “In U.S., Support Up for Doctor-Assisted Suicide,” Gallup, May 27, 2015, http://news.gallup.com/poll/183425/support-doctor-assisted-suicide.aspx.
 Hank Berrien, “Health Rationing In England: Obese And Smokers Banned From Routine Surgery,” The Daily Wire, August 1, 2017, https://www.dailywire.com/news/19204/health-rationing-england-obese-and-smokers-banned-hank-berrien.
 “Who was Alfie Evans and what was the row over his treatment?,” BBC, April 28, 2018, https://www.bbc.com/news/uk-england-merseyside-43754949.
 Note that I’m not arguing collective ownership is the most effective way to manage public works projects—or anything else, for that matter. I’m limiting my comments here to issues relating only to morality.
 Some pro-liberty, free-market advocates might argue that any form of collective ownership is immoral because in most forms, taxation is immoral. While I think most people agree excessive taxation is immoral, few Americans would likely argue all forms of taxation are immoral. My views on this matter are irrelevant for this work and have been omitted for the sake of brevity.
Justin Haskins is editor-in-chief of StoppingSocialism.com, a New York Times bestselling author, and the director of the Socialism Research Center at The Heartland Institute. Follow him on social media @JustinTHaskins.