by Julie Rovner
NPR Morning Edition
December 6, 2007
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In the debate over health care on the campaign trail, the term “socialized medicine” is getting thrown around more and more often.
It is almost never a compliment. But the politically loaded phrase means different things to different people.
For example, when Democratic Sen. Hillary Clinton unveiled her health plan in September, it included a requirement that all individuals have health insurance.
Republican rival Mitt Romney labeled the plan “socialized medicine” in his critique. “It’s a European-style socialized medicine plan,” he said. “That’s where it leads, and that’s the wrong direction for America.”
Romney’s fellow Republican candidate Rudolph Giuliani extends that label to all of the Democratic front-runners’ plans, even though Sen. Barack Obama’s wouldn’t require everyone to be insured.
“Whether it’s HillaryCare or ObamaCare or EdwardsCare, the idea that it’s not socialized medicine is a trick,” Giuliani said. “It’s a massive growth of government control of medicine.”
History of Term
But what is socialized medicine?
“The term socialized medicine, technically, to most health policy analysts, actually doesn’t mean anything at all,” says Jonathan Oberlander, a professor of health policy at the University of North Carolina.
Oberlander says the phrase actually dates back to the American Medical Association’s fights against national health insurance in the early decades of the 1900s.
“The AMA used it to mean any kind of proposal that involved an increased role for the government in the health care system,” he says. “They also used it to mean things in the private system that they didn’t like. So, at one point, HMOs were a form of socialized medicine.”
In terms of government programs, Oberlander says it was used against Medicare in the 1960s, and prenatal care in the 1920s and 1930s. “It really is a term that is very flexible, and because it means nothing precisely, you can define everything by it.”
These days, there is one potentially accurate use of the phrase, Oberlander says. It can be used to make the distinction between a so-called single-payer health care system — where the government pays all the health care bills — and a truly government-operated health system, he says.
“When you talk about Europe, and you talk about a British system where the hospitals are owned by the government and the doctors are directly employed by the government, then you might say that’s socialized medicine,” Oberlander says.
But that is different from what most single-payer proposals would do. “There, you would essentially have government financing, just like you do with Medicare, but you would continue to have private practicing physicians and private hospitals,” Oberlander says.
None of the leading Democratic candidates, however, has proposed anything like a single-payer system, much less a fully government-run program like Britain’s National Health Service.
One candidate, Rep. Dennis Kucinich, does support the leading single-payer proposal in Congress. But that bill would also give the federal government authority to determine the number and location of health facilities. So, it would go quite a bit further than other single-payer systems like Medicare in the U.S., or even like Canada’s system.
In a forum with health reporters earlier this fall, Kucinich was asked directly if that meant what he supports wasn’t more like England’s government-operated system than Canada’s single-payer plan.
“Is it like the U.K.’s? Somewhat similar. And it’s similar in form to many of the industrial democracies of the world where they provide health care to their people,” Kucinich responded.