John Mackey, the CEO of Whole Foods, recently came under fire when he told NPR that Obamacare is a fascist program. Mackey said of the health law, which he had previously suggested was socialist:

Technically speaking, it’s 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.

A day later Mackey retracted his comments, which is a shame because he’s absolutely right.

There was much fear when Obamacare was being debated several years ago that it was going to turn American health care into socialized medicine. In 2009 Mackey, too, compared it to countries with socialized medicine, such as the United Kingdom.

Of course, Obamacare did not deliver us socialized medicine, in which most hospitals would be owned by government and most doctors would be government employees. The majority of hospitals in America are still privately owned and so are insurers and drug companies. Many doctors are in private practice.

But though our health care institutions are privately owned, they are most certainly not free to be privately run. Take health insurance, for example. Obamacare dictates to health insurers the policies they can sell, what they may charge, to whom they must sell, how they must organize their finances, how much profit they can make–and this is just the tip of the iceberg. Doctors must prescribe government-approved treatments, or suffer financial penalties. Hospitals and drug companies have their own set of controls they must work under.

The government is the one calling the shots in health care today, dictating to those in the industry how they must run their businesses. And what’s crucial to know is that the government’s entrenchment in health care precedes Obamacare—health care has been a mostly controlled industry for decades.

A social system in which property is nominally privately owned but property rights can be overridden by government dictate is properly described as fascist, a term that became widespread in the 1920s to describe the system of state control in Mussolini’s Italy. According to one encyclopedia:

Under fascism, the state, through official cartels, controlled all aspects of manufacturing, commerce, finance, and agriculture. Planning boards set product lines, production levels, prices, wages, working conditions, and the size of firms. Licensing was ubiquitous; no economic activity could be undertaken without government permission.

This description is not far from the state of American health care today.

Mackey was criticized for calling Obamacare fascist, and on the surface, it’s understandable such a characterization may appear as an exaggeration. There are some very real differences between the fascist states of twentieth century Europe and America today.

The most commonly cited difference is that our government has no racist agenda. But racism, in fact, is not a fundamental aspect of fascism—Hitler preached anti-Semitism, while Mussolini did not.

Another difference, which Ayn Rand herself identified, is that America’s is not “a militant kind of fascism, not an organized movement of shrill demagogues, bloody thugs, hysterical third-rate intellectuals and juvenile delinquents.” Rand characterized America’s fascist elements as “a tired, worn, cynical fascism, fascism by default, not like a flaming disaster, but more like the quiet collapse of a lethargic body slowly eaten by internal corruption.” (Read more about Rand’s view in “The New Fascism: Rule by Consensus” in Capitalism: The Unknown Ideal.)

And yet another difference between the fascist nations of twentieth century Europe and America today is that American society as a whole is not totally subject to government dictate, as were the societies in Europe. There are parts of our economy, such as the technology industry, that are left far freer than health care. And in private matters, the government is certainly not as intrusive as those of the fascist European nations, where individuals were persecuted for, among other things, their religion, race, ethnicity and sexual orientation.

But going beyond the surface differences, there remain fundamental commonalities. (Rand wrote about this and so did her longtime associate, Leonard Peikoff, at length.) One is that the economies of fascist European states were heavily controlled and commanded by government—and so are certain sectors of the American economy today, including health care.

It is accurate to say American health care is under fascist control.

Image: Whole Foods CEO John Mackey by Joe M500 from SOUTH LOOP CHICAGO via Wikimedia Commons used under CC BY-SA 2.0 / Cropped from original