Professor Donald Light responds to the Quote of the Day on Francis Fukuyama’s “The Future of History: Can Liberal Democracy Survive the Decline of the Middle Class?” (

Hi Don,

While I had not thought if it in this frame, the course on comparative health care in advanced capitalist countries at Stanford provides compelling materials for a coherent, liberal platform for the broad working and middle classes. (See STANFORD 2011 Syllabus on Kaiser web:

1) For individuals and families to be productive and thrive, they need easy access to good medical services to treat injuries, illnesses, disabilities, chronic conditions, or mental distress. One can make a strong conservative case for universal health care, as most conservatives outside the United States do, based not on solidarity or equity but on individual freedom and responsibility. (For a synopsis, see  For the article, see ttp://

2) For infants and small children to begin life feeling confident, trusting (Erik Erickson), and energetic, they and their parents need universal parental and child supports.

3) For children and adults to learn and gain skills for productive work, they need easy access to good, universal education.

4) For workers and managers to focus on productive work rather than on how to keep from being laid off, there needs to be reasonable (but not excessive) job protection and ways of handling recessions that minimize the high economic & emotional costs of unemployment.

5) For the seriously ill, injured, or disabled not to become a heavy financial burden on their families that drags them down towards poverty, they need free medical care and maintenance income. For the elderly and chronically ill not to become impoverished or impoverish their kin, they need universal long-term care.

Most of these services and supports are provided in most affluent countries. They can be called “welfare” or “socialism,” but they are paid for largely by the working and middle-classes through equitable forms of collection such as taxes or mandatory premiums. In a conservative country like the United States where only some of these services and supports are partially provided, much of the direct costs are paid out of pocket by individuals or families affected. This results in serious impoverishment. Far greater would be the indirect costs of skills not learned because they cost too much, opportunities lost because of family burdens, promotions not gained as individuals take up heavy burdens at home with little societal support, unsafe working and living environments, marital disruption and divorce, and higher levels of violence.

If a full empirical assessment were done of such direct and indirect costs not providing the working and middle classes with educational, economic, family, and medical supports, I suspect they would be much greater than the costs of providing.

In this way, I believe a coherent intellectual and societal case can be made for what might be called the “thriving state.”  Perhaps the single best article we read was by Doug Massey, who describes the costs of dismantling what supports the US had and provides some comparisons with other affluent nations. (For a free copy, type in Google: Massey “Globalization and Inequality” and a pdf link will appear.)

With best regards,


Donald W. Light
Professor, UDMNJ-SOM
Lokey Visiting Professor, Stanford University
Visiting Researcher, Center for Migration & Development,
Princeton University

Donald Light writes that “a coherent intellectual and societal case can be made for what might be called the ‘thriving state.'” As we think about Francis Fukuyama’s essay and about making the case for the “thriving state,” we should think about how we can move beyond simply “occupying” and then going home.

This will be no easy task. I would emphatically second the recommendation of Donald Light to read Professor Douglas Massey’s article, “Globalization and Inequality: Explaining American Exceptionalism” (link below). It discusses the new political economy of poverty, the political economy of affluence, and their roles in American exceptionalism.

After you read Massey’s article you’ll think, “And we thought trying to reform health care was going to be tough!” But it will be very difficult to gain consensus on health care reform until we can address the issues behind Massey’s explanation of American exceptionalism.

European Sociological Review
August 20, 2008
Globalization and Inequality: Explaining American Exceptionalism
Douglas S. Massey

Additional comment by Quote of the Day subscriber Richard Krasner:

Dr. McCanne,

As a student of American history and politics (BA in Poli Sci/History) and other Social Sciences, and an MA in American History, I am well aware of the ideological underpinnings of American society and why many Americans are loathe to support universal health care and deem it “Socialism”. It is the mere fact that in the late 17th and 18th century political discourse that serves as the basis of American, and even Western European democracy, health care was never mentioned, nor was the issue of caring for the sick, the poor, the orphan, the widow, the unemployed, etc.

Rather, the focus was on individual liberty and property rights, and on the free market, with all of its attendant low wages, low taxes and high profits for the owners of the means of production. It is not until the mid-19th century that Modern Liberalism, as opposed to the Classical Liberalism (i.e., Libertarianism) of the 18th century, argued strongly for a role for government in improving the lives of its citizens and protecting them from the ills of the free market.

Unfortunately, these arguments fell on deaf ears on this side of the Atlantic because the Founding Fathers had enshrined individual liberty, property rights, and the acquisition of wealth into our laws and social fabric. This was not the case for our neighbors to the north, as Canada received its nominal independence from Britain in 1867, while we made our revolution for independence in the late 18th century. That explains why Canada, and the UK have universal health care, and we don’t. Even the one of the most conservative Prime Ministers of 20th century Britain, Winston Churchill believed in a national health care system… “Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

But our conservatives believe just as many of the GOP candidates have said in the endless round of debates, that people who do not plan for getting sick deserve to die. This is not just cruel, this is part and parcel of the Calvinistic Puritanism that colored, and still colors much of the American mindset even now in the beginning of the 21st century. The Republican Party, and their Christian right allies, are reviving that old Protestant ethic, which never really died, it only migrated out of New England, and transferred from the Puritan church (i.e., Congregationalists) to the Southern Baptist and otehr fundamentalist or evangelical churches through the various Great Awakenings of the past two hundred years.

The only way I can see that this nation will join the other industrialized nations in providing all of its citizens with universal health care is when or if, the current system totally collapses, with or without the ACA being upheld by the Supreme Court later this year. I also recently received my MHA (Master’s in Health Administration) degree, and the ACA was an elective course I took over the summer 2011 semester, so our discussions included whether or not the ACA would be struck down or not. This was also a topic in my Health Law class that was taught by a practicing health care attorney in South Florida.

Fukuyama is known to me, and I find his “end of history” argument to be specious at best, because history never ends until time itself ends. He claims it has ended because we have won the individual liberty and freedom battle that has been part of much of human history for the better part of the last 5000 years. However, and I think you will agree, the one area where we have not been successful has been winning the battle against poverty, lack of adequate and affordable health care, disease, lack of a decent education and meaningful and rewarding employment for all that will create a harmonious and peaceful society and world. Until we accomplish that goal, history can never be said to have ended, because we are leaving millions of our fellow human beings in despair, hopelessness and suffering that will one day cause our civilization to fall, just as invasion or natural disasters did to Rome, the Mayans, Inca, and other ancient peoples.

Thank you for your comments.