The Ghost of Mussolini

The blurb in Time magazine looked like a joke: "How many government employees does it take to change a light bulb in a British National Health Service hospital?" The answer is six-and it's not a joke. The number is based on official statistics. The British Audit Commission reports that changing a light bulb requires six people, involves 17 different steps, and takes 20 minutes to organize. What a sobering lesson in what bureaucracy can do to a nation's health-care system. Bureaucracies have a life of their own: They always grow bigger, more expensive, and more cumbersome than expected. The latest printed version of the Clinton health plan is four inches thick and weighs nearly six pounds. And if passed, the Clinton reform may create a system even more cumbersome than the British system-because its roots actually go back to another time and another European country: namely, Italy. The key component of the president's plan is a National Health Board of seven people. This board would oversee the activities of government-created Regional Health Alliances. Under the president's plan, only these government-recognized alliances would be allowed to purchase health insurance. Prices, budgets, and regulations for the alliances would be set by the National Health Board. Where have we seen a plan like this before? Several years ago, the Italian government organized many of its industries on precisely the same model. A National Council of Corporations was established as a federal overseer over regional alliances, which were called "confederations." In certain industries, only these government-recognized confederations were allowed to do business. Prices, budgets, and regulations were set by the National Council of Corporations. The Italian government promised that this state-controlled system would cut waste and make the economy more efficient. But instead it became a typical, cumbersome bureaucracy. An article in The Economist argued at the time that Italy had created "a new and costly bureaucracy," marked by "the worst kind of monopolistic practices." The system I am describing is not a recent invention. In fact, it is the corporate state instituted in the 1930s under Benito Mussolini's Fascist government. Most of us equate fascism only with concentration camps and SS troops. But as Thomas DiLorenzo explains in a recent Wall Street Journal article, fascism was also an economic philosophy-known as corporatism. As DiLorenzo says, the Clintons "have adopted 1930s-era corporatism as the organizing principle of their health reform." Critics say the Clinton plan is socialist-but remember that fascism was also called National Socialism. Whether we call it fascist or socialist, the essence of the plan is to give the federal government the right to dictate what choices we have in health coverage. The Clintons say they're willing to negotiate on the details as long as America accepts the overall philosophy. But the West has already had experience with this philosophy-with both fascism and socialism-and, as we all know, the experience is not one we want to repeat. So I have only one question: If the president's plan passes, how many people will it take to change a light bulb in an American hospital?

11/22/93