Whole Foods CEO John Mackey and the Switzerland Conundrum

Whole Foods CEO John Mackey joined the “I’m in charge of a major company and want to say something silly about the Affordable Care Act” crowd in an interview with NPR this week. The money-quote:

“Technically speaking, it’s [PPACA] more like fascism. Socialism is where the government owns the means of production. In fascism, the government doesn’t own the means of production, but they do control it — and that’s what’s happening with our health care programs and these reforms.”

Mackey’s attempt at clarification as been dutifully shrugged off by those who know better. Yet some folks still took exception to comparing a law that regulates health insurance to the actions of say, Mussolini, thus prompting a clarification of the clarification on the Whole Foods Market Blog:

I made a poor word choice to describe our health care system, which I definitely regret. The term fascism today stirs up too much negative emotion with its horrific associations in the 20th century.

That’s all well and good, I suppose, and the rest of that paragraph is a boilerplate mea culpa “I care, I really do.” This would probably be a good stopping place for Mackey but he continues (emphasis mine):

I believe that, if the goal is universal health care, our country would be far better served by combining free enterprise capitalism with a strong governmental safety net for our poorest citizens and those with preexisting conditions, helping everyone to be able to buy insurance. This is what Switzerland does and I think we would be much better off copying that system than where we are currently headed in the United States.

Later in the post he finally decides — perhaps because he just can’t let it go — to call the post-ACA health care America “government controlled” as opposed to “free enterprise capitalist health care.”

As a general rule of thumb, if an individual is incoherent enough to confuse fascism with socialism and the comparatively moderate regulation of a privately owned industry then they are probably getting it wrong on other comparisons — like Switzerland*. The country whose health care system is oft-beloved by the political right can be something of an intellectual conundrum: They uphold it as triumphant free-market capitalism and yet that system also depends on concepts that some conservatives would otherwise describe as, say, fascist. Which is to say, the Swiss health care system features compulsory purchase (aka, an individual mandate) of private health insurance (who are required to provide basic coverage regardless of age and preexisting condition) and is heavily regulated by the Swiss federal government. If the purchase cost of a basic coverage plan exceeds eight percent of annual income, the government provides a subsidy to cover the difference.

Now if that sounds awfully familiar to you it should — in this country we now have something similar and it is called…the socialist fascist “government controlled” Affordable Care Act. I use the word similar because it is entirely different in one respect that I believe goes to the heart of its popularity with conservatives and libertarian-minded CEOs — businesses in Switzerland (with the obvious exception of health insurers) are left relatively alone in the framework of their health care system. The onus for coverage and purchase of health care is (almost) entirely consumer-driven. I would conjecture, then, that what concerns individuals like Mackey is nothing as fundamental as freedom from government tyranny, but rather freedom from having to worry about providing health care for their employees.

*See also: Uwe Reinhardt’s “The Swiss Health System: Regulated Competition without Managed Care” (PDF).


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