Having been given the impression as young Americans that China was “socialist,” providing abundant services and safety nets for its citizens, while the US was “capitalist,” leaving its citizens to fend for themselves, we were in for a surprise when we discovered that, relatively speaking, the United States is a socialist utopia.

Today on Based Camp, we explore the United States’ (admittedly unsustainable) socialist utopia Americans enjoy and the (put diplomatically) bare bones support provided to citizens—especially rural citizens—by the CCP.

If you’re a parent in the US looking to avail themselves of more of the United States generous services oriented around families, please refer to Pronatalist.org’s summaries of and links to State resources for parents.

Show Notes

I grew up thinking the USA was a land of pure capitalism, where people are on the hook for everything. Turns out that’s only the case if you’re middle class.

If you’re poor in the USA, you’re arguably living in the best communist world imaginable, because you’re enjoying socialist-style support (for food, childcare, healthcare, etc.) but getting capitalism-style goods and services (e.g. going to the same private hospitals that rich people go to; going to the same grocery stores that rich people go to, etc.)

Case in point: State resources for parents (We created detailed guides for Pronatalist.org)

* See Minnesota as an example

If “communism” means “this country has a significant social safety net”, then the USA is more communist than China.

Even China has disparities in its benefits: urban formal workers receive significantly better protection than migrants and rural residents.

Old-Age Income

* USA: Social security

* Going to stop working

* Based on what you contribute as a worker… sort of

* For a typical retiree claiming at full retirement age, Social Security is designed to replace around 40 percent of pre‑retirement earnings, with replacement rates higher for low earners (roughly 60–80 percent) and lower for high earners.

* The Social Security Administration indexes each year of your past earnings to national wage growth and takes your 35 highest‑earning years to compute your Average Indexed Monthly Earnings (AIME)

* For people first eligible in 2025, the formula replaces 90 percent of the first slice of AIME, 32 percent of the middle slice, and 15 percent of the top slice (with “bend points” around 1,226 and 7,391 dollars of AIME), so lower earners get a higher share of their prior income replaced

* The USA covers most seniors and low‑income households through Social Security, Medicare, and Medicaid, but non‑elderly adults without stable jobs or employer plans can still fall through gaps, especially as enhanced ACA subsidies expire.

* China:

* China now has a “three‑pillar” setup: a basic public pension (still the main source), employer/occupational plans, and voluntary private pensions with tax incentives.

* Resident pensions are low; national minimums have risen from 55 yuan per month at the program’s launch to around 143 yuan in 2025, with local governments often topping this up, but even average rural pensions of about 246 yuan per month in 2024 are only a modest supplement to other family or work income. Beijing, for example, set basic resident pensions for new claimants around 998 yuan per month in 2025, much higher than the national floor but still far below urban wages.

Medical Care

* USA

* Medicaid (for poor and disabled people)

* For full‑benefit Medicaid (the typical situation for very low‑income adults, children, pregnant people, and many disabled people), there is generally no monthly premium charged to the enrollee; the program is funded by federal and state governments.

* Some states can charge small premiums or use “share of cost” rules for certain groups with higher incomes (e.g., medically needy programs), but that is the exception, not the norm for the poorest enrollees.

* Medicare (for old people)

* Part A: $0/month for most people who worked and paid Medicare taxes at least 10 years

* Part B: Premium: $202.90/month for most beneficiaries, higher for high‑income enrollees.

* Access to top-drawer private medical care if you’re poor or old (due to Medicare and Medicaid)

* Functionally, this is paid for by not just the government, but by private citizens and corporations (paying for super high health insurance premiums)

* China

* China: Public “basic medical insurance” covers about 95% of the population via two main schemes (urban employee and urban–rural resident), but works as insurance with deductibles, coinsurance, and annual ceilings, plus optional commercial top‑ups.

* Even poor people in China usually have to pay something when they get medical care; public insurance and extra subsidies then reimburse part of the cost, often in several layers

* PEOPLE FEEL THE NEED TO BRIBE THEIR DOCTORS

* The most significant gap between China’s formal coverage promises and lived reality is the persistence of informal payments. Academic analysis of bribery in Chinese hospitals describes the normalization of “red packet” (hongbao) payments — cash given directly to physicians by patients seeking faster or better treatment. A peer-reviewed mixed-methods study using data from 3,546 judicial cases found bribery was the dominant form of medical corruption, with roughly 80% of bribe-takers being healthcare providers. More telling, an earlier survey found that one-third of 500 randomly sampled residents in China reported that they or family members had given red envelopes to doctors, rising to 50% when surgeries were involved

* The structural driver is well understood: China’s public hospitals were effectively defunded by the market reforms of the 1980s and have since been run on a quasi-commercial model, expected to generate much of their own revenue. Basic doctor salaries remain very low — sometimes as little as 800–3,000 RMB per month in smaller cities — creating systematic pressure to supplement income through pharmaceutical kickbacks and informal patient payments. Xi Jinping’s high-profile anti-corruption campaign launched around 2023 swept hospital directors across the country and publicly targeted this behavior, but structural underpayment remains the root cause.

* Universal basic medical insurance

* Nationally, basic insurance typically covers primary and specialist visits, inpatient hospital care, emergency care, prescription drugs, some mental health services, physical therapy, and traditional Chinese medicine, subject to local catalogs and reimbursement rules

* Patients face deductibles, copayments, and annual reimbursement caps; local governments define detailed benefit packages, and there is no national cap on out‑of‑pocket spending

* Even with coverage, serious illness can still cause heavy financial strain, particularly for rural, low‑income, and resident‑scheme enrollees, who are more exposed to catastrophic health expenditures

* There is real and acknowledged urban-rural healthcare disparity

* China’s approximately 300 million rural-to-urban migrant workers occupy a particularly precarious position. Although more than 90% of Chinese residents are nominally enrolled in basic health insurance, migrant workers face fragmented, non-portable coverage: insurance purchased under a rural scheme is often not reimbursable in the city where the worker lives and is treated, and employer compliance with providing urban employee coverage is widely evaded. Research has characterized this as a “covered but unprotected” dilemma — workers are technically enrolled but the insurance provides no effective financial safety net.

Aside: NHS Care in the UK

The UK has more socialized healthcare than China: In the UK, most medically necessary NHS care is free at the point of use, but there are defined areas where patients routinely pay charges (or go fully private), mainly prescriptions in England, dentistry, eye care, and some “lifestyle” or non‑essential services.

FULLY (or mostly) COVERED

These are generally free at the point of use for eligible residents (England-specific where noted):

* GP services and community care: GP consultations, practice nurse appointments, most community nursing and midwifery, and NHS 111/telehealth are free.

* Emergency and urgent care: 999 ambulance, A&E, emergency surgery, and emergency inpatient stays are not billed to patients.

* Medically necessary hospital care: Consultant appointments, diagnostic tests, elective and emergency surgery, inpatient and outpatient treatment for physical and mental health if clinically needed.

* Maternity and neonatal care: Antenatal and postnatal care, labour and delivery in hospital or at home, and neonatal intensive care when needed.

* Many vaccinations and screening programmes: Routine childhood immunisations, seasonal flu for eligible groups, cervical, breast, and bowel cancer screening, diabetic eye screening, AAA screening, newborn blood spot/hearing/physical exam, and pregnancy/fetal anomaly screening.

* Most mental health care: Community mental health teams, inpatient psychiatric care, talking therapie...