Health care is a commodity in the modern world; that is, it is something to be purchased despite its status as a basic social right in European societies. The capitalist approach was to establish a fee-for-service system. National health insurance programs, based largely on employee-employer contributions and reinforced by tax revenues, paid the costs. The care itself was generally free for patients. The socialist approach, conversely, was to co-opt health care as a state commodity, paid for out of the central government’s budget and provided as a free social benefit to the people. Neither system has worked perfectly, but it is clear from the discussion in this book that the socialist system did not deliver on its promise and the capitalist system, despite its many inequities, did. Western European populations rank among the very healthiest in the world; the former socialist countries generally rank toward the bottom of industrialized nations in health.
The evolution of this situation is rooted in the European concept of the welfare state. During the early twentieth century, when European society was still grounded in imperialism and competition for political, economic, and military domination, many governments and industrialists desired healthy populations whose productivity could be translated into economic power. Greater economic power, in turn, meant greater political and military power, as well as securing a higher standard of living for the nation and increased profits from trade and manufacturing. In some capitalist countries, providing state-sponsored welfare was also a means to reduce discontent and the threat of revolution from the working class. Social insurance programs were essentially designed to protect