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Nazis and Health Care

• September 09, 2009 • 12:00 PM

Some opponents of the president’s health care efforts liken it to totalitarian states. But what was health care policy like under, say, the Nazis?

Germans in the last few weeks have noticed the radioactive arguments leaking from the United States over the prospect of national health. “Bizarre Debates Over U.S. Health Reform,” read one headline on Deutsche Welle, running a picture of Obama defaced with a Hitler mustache; and in the Frankfurter Allgemeine Zeitung, “American Health Reform: Stalin, Hitler and Obama.”

Germany is one of the few nations in the world where large numbers of living people can recall both major forms of 20th-century totalitarianism. They know what tyranny looks like, and they know when they’re not living under it. The idea that Obama is about to inaugurate an age of American totalitarianism by building a European-style national health system frankly makes the exploiters of those arguments — “fear-mongering Republicans” — sound like fools.

But why does this rhetoric work? Why does the slightest whiff of Rooseveltian social policy get Americans on the bandwagon, hollering about fascism, state control, Hitler and Stalin? One answer is Jonah Goldberg’s demagogic book Liberal Fascists, which explains to his astounded readers that the word Nazi comes from “National Socialism.” Hitler was a Socialist! There it is in the name of his party!

Uh, right? Not really.

Hitler’s party did call themselves “National Socialists,” because when Hitler found the ragtag outfit in the 1920s, it was a fringe movement of provincial, patriotic, largely unemployed workers. The 1920s and ’30s were the heyday of socialism, remember, and you could hardly have a grassroots party without using the name. The Weimar Republic in Germany was an unloved government, and the National Socialists were just a mixed group of malcontents easily moved by Hitler’s speeches against Jews (who were bankers, businessmen, artists, urban professionals, “cosmopolitans” and Marxists — almost everything except German workers and farmers) and against the weak social democrats in Berlin.

At the head of the Nazi Party, Hitler paid lip service to “socialism” to attract workers. But everything he uttered served his right-wing vision of a pure new Germany, self-sufficient and uncorrupted by (among other forces) international communism, international finance, the Allies of World War I, immigrants in general and, of course, Jewish blood. He moved the party away from its early social platforms until it served this fascist vision. He was, in other words, a liar.

Neo-Nazis are the same: They beat the drum for “German values” and “German soil,” against immigrants and against the social democrats in Berlin, while they lie about their intentions in the very name of their party. The largest group of neo-Nazis in Germany call themselves the “National Democrats.” A smaller group is called the “Republicans.” Anyone in America who believes Hitler was a socialist based on the name of his party should be forced to explain why his political heirs are likely to guarantee universal suffrage if they ever win power.

It’s true the Nazis had health care. They inherited the tradition from Bismarck, who set up the first national health system in the world (after unifying Germany in 1871).

But there was a difference between Nazi health care and the systems under the German Empire and the Weimar Republic. Hitler rearranged the system under a strict regime of central government control, so all insurance-scheme managers reported straight to Berlin. Later — and not through the insurance companies — Hitler started his infamous T4 program, which ordered doctors to euthanize tens of thousands of institutionalized patients, people who didn’t fit his vision of a pure new German Reich — immigrants, the old and weak, the mentally ill. That was evil. But it was part of an evil mechanism that extended far beyond the medical system: By 1939 Germany was a brutal dictatorship, and Hitler managed to kill millions of people in his own country regardless of whether they had health insurance.

When I was a kid, a high-school history teacher gave us a summary of 20th-century politics: He said the spectrum from left to right wasn’t flat, but curved, and the extremes on both ends — fascism, communism — bent around to meet in totalitarianism. It was a simple idea that explained recent history but still kept distinct ideas (fascism, communism) distinct.

After the war, East Germany became a stifled and shuttered Communist nation with a mediocre state-run medical system. “West Germany,” meanwhile, according to an assessment of the German health system from the Library of Congress, “moved away from Hitler’s central state direction and returned to decentralized administration and control. Social insurance and social protection programs under labor and management control, which were characteristic of the Weimar period, were restored.”

Some health schemes are more monolithic than others. They all involve a lot of government hassle — this blog will look at a couple of problems in Europe over the next few weeks — but the result, if it’s done right, is a freedom to choose among hospitals and health plans that Americans can only dream of.

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Michael Scott Moore
Michael Scott Moore was a 2006-2007 Fulbright fellow for journalism in Germany, and The Economist named his surf travelogue, "Sweetness and Blood," a book of the year in 2010. His first novel, "Too Much of Nothing," was published by Carroll & Graf in 2003, and he’s written about politics and travel for The Atlantic Monthly, Slate, the Los Angeles Times, and Spiegel Online in Berlin, where he serves as editor-at-large.

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