With the kind permission of C.H. Beck Verlag, former German chancellor Helmut Schmidt, and Columbia University historian Fritz Stern, I am pleased to present here the fourth and last in a series of excerpts from the bestselling book Unser Jahrhundert – Ein Gespräch, in an original English translation.
health care and think tanks
schmidt: I have become sick in America. I have become sick in Japan. I even had an experience in England. You’ll get the best care in Germany! That would be the case for the great bulk of people.
stern: On the other hand you have to acknowledge that in the most serious cases involving surgery and the brain, American medicine–
schmidt: The pinnacle of American medicine is at the same time the best in the world, no doubt about that, more than half the medical research and innovation is due to the Americans. There is no doubt about that, but what benefit does it bring the ordinary man in the sick bed?
stern: But to come back to my point: the technological and scientific progress has made medicine less human than it was before.
schmidt: And it results in people living longer. Modern medicine, contemporary working conditions in factories and offices, modern hygiene, clean water and unadulterated foods, modern nourishment, all of these things work together to create a society that ages. People live longer and in the last five years of their sickness, they require more medical assistance than in the preceding 75 years, in which they were only sick from time to time. That means that the costs associated with the provision of medical care will rise, not simply in absolute numbers, but also in proportion to the net national product. That is unavoidable.
stern: I have told my wife that I’ll dispense with my last year. Especially in view of the cost and the pain. But this plan isn’t so easy to implement.
schmidt: As regards the health care reform proposals in America, I see a great deal of resistance to Obama.
stern: It will doubtless lead to a heavy conflict within society and will be a major battle for Obama.
schmidt: The initiative failed once already under Clinton.
stern: Correct. To a large extent perhaps because of Hillary’s mistakes. There is a strong opposition on the grounds that we have always managed it alone, we do not need the state. The smaller the state is, the better. On the other hand, it is completely clear that as regards medical conditions, we live in an unjust state. That has actually been completely clear since the time of the New Deal, and attempts to change the situation have been made ever since. The last attempt was made by the Clinton Administration. The strong forces of opposition focus on one hand around a group of doctors who are strongly opposed to state control–they speak immediately of “socialized medicine” as if it were the worst thing there was–and on the other hand on the pharmaceutical industry and the insurance sector. Both have an exceptionally powerful lobby.
schmidt: Yes, but also in the political world. There are certainly a large number of conservatives in Congress for whom all of this simply goes too far.
stern: Absolutely, yes. They all cry: this brings dependency –
schmidt: Freedom is imperiled –
stern: Freedom is imperiled and it leads to socialism. Without really having much of an idea of what socialism is, of course. Most people would support health care reform, but they have yet to be mobilized. This is exactly what the administration is attempting at this moment. With respect to health care reform I, probably like ten million other Americans, receive emails: Fritz, we need your help. Contact your congressman and your senator and tell them how important this matter is to you. It was always in the power of the American president to turn directly to the people and ask their support for a specific policy. But the capability to instantly send a personalized message to ten million people, that is something new.
stern: In America the quality of the think tanks has somewhat declined recently. One example that you know well is the Council on Foreign Relations, whose influence has receded, justifiably, because the quality of its work is not the same as it was before. It was a bastion of foreign policy education, but no longer.
schmidt: And at the same time a bastion of the East Coast elites.
schmidt: Discussion of practical politics by experts who are not subordinate to the laws of politics is an urgently needed support for any political leadership. In one area we in Germany have a surplus of advisory institutions: that is economic policy. In this area we have too many institutes that assume their own importance.
stern: And they partly reflect the interests of their funders.
schmidt: These economic research institutes – one in Munich, one in Berlin, one in Kiel, one in Hamburg, and I don’t know all the others – constantly present us with economic prognoses. Every year the council of economic advisors delivers us a six or seven hundred page thick report. That includes three doctoral dissertations and a half a postdoctoral work, all worked out by a large staff. To belong to this staff is a wonderful educational experience; but all of this is superfluous and terribly presumptuous. All these people have no sense that in a democracy, we operate on the basis of majorities –
stern: And that politicians must also reach decisions –
schmidt: Yes, even when they know nothing. – We have to stop. Fritz, at the end of these three days can you think of a particular wish you might have?
stern: Yes, I wish that the difference between communism and social democracy were more clearly defined in the consciousness of the Western world, that is, that the right-wingers were not left to define the difference by saying the two are more or less the same thing and an established failure.
schmidt: I agree with you. But it will not be so easy to accomplish. Look at the current conditions of the German Social Democrats.
stern: I only said that it’s my wish.
schmidt: I share your wish. I don’t have the sense that we’ve worked through our agenda, but I can’t say what we’ve missed. Fritz, one thing occurs to me. I wanted to ask you who wrote these lines: “The woods are lovely, dark and deep, But I have promises to keep, And miles to go before I sleep…”
stern: That is by Robert Frost, a great American poet of the twentieth century.
schmidt: Robert Frost, right, it’s wonderful. “And miles to go before I sleep, And miles to go before I sleep.”