Harvard School of Public Health
February 14, 2008
A poll by the Harvard Opinion Research Program at the Harvard School of Public Health (HSPH) and Harris Interactive:
Q. So far as you understand the phrase, do you think that if we had socialized medicine in this country that the health care system would be better or worse than what we have now?
Overall:
Better – 45%
Worse – 39%
Republicans:
Better – 17%
Worse – 70%
Democrats:
Better – 70%
Worse – 16%
Independents:
Better – 43%
Worse – 38%
Young adults (under 35):
Better – 55%
Worse – 30%
Seniors (65+):
Better – 30%
Worse – 57%
And…
Are We Heading toward Socialized Medicine?
By Stan Dorn and John Holahan
Urban Institute
April 2008
With health reform at the forefront of the national campaign, some charge that proposals to restructure our health care system represent dangerous steps moving the country towards government-run health care and socialized medicine. Similar rhetoric was heard last fall when President Bush vetoed legislation reauthorizing the State Children’s Health Insurance Program (SCHIP). We find this rhetoric inapplicable to both the SCHIP bill and proposals from most presidential candidates. The core issues in health reform involve, not the size of government, but proposals’ effect on the number of uninsured, access to quality care, cost growth, and consumers’ health care choices.
The U.S. Health Care System Today
Medicaid and Medicare cover 42.7 million and 42.4 million people, respectively, with some poor seniors and people with disabilities receiving coverage from both programs. The government also provides publicly funded health care to almost 9 million current and former federal employees and dependents through the Federal Employees Health Benefits Program; 3.7 million veterans who receive health care through the VA; and the country’s active-duty soldiers and their dependents. Only 5 percent of the insured population in the United States does not receive some kind of government subsidy, either directly or through a tax benefit.
Pending Proposals for SCHIP and National Reforms
Some single-payer proposals would go much further; an example is that advanced by Congressman Kucinich (HR 676). While health care providers would nominally remain private, the government’s authority would be so all-encompassing that the system would be the functional equivalent of socialized medicine.
Market-Oriented Proposals
Proponents of these market-oriented proposals agree that a strong public-sector role is appropriate if it accomplishes important objectives. That is why these proposals retain most functions served by government today and, in some cases, embrace aggressive new government interventions.
Many market-oriented proposals would create problems of quality and access to care for some people — the very problems some argue are characteristic of publicly run systems.
Conclusion
The core issue in health reform is not specifically the role of government, but what policies yield the best possible consequences for the American public. Such results include the number of people with health coverage, consumers’ quality of and access to necessary care, health care cost growth, and consumers’ ability to make choices about their health care and health coverage. Rhetoric about socialized medicine and government-run health care is a distraction from these much more fundamental concerns.
http://www.urban.org/UploadedPDF/411648_socialized_medicine.pdf
“What Is Socialized Medicine and Is It Relevant to Health Care Reform?” For a link to an audio webcast of this Urban Institute forum:
http://www.urban.org/Pressroom/otherevents/socmed.cfm
Comment:
By Don McCanne, MD
For political reasons efforts often are made to obfuscate the definition of “socialized medicine,” but it is important to understand the meaning of the term. A socialized medicine system is one in which the government is the owner of the health care delivery system, and professionals providing the health care are employees of the government.
In contrast, social insurance is a government insurance program which pays for health care provided by the private health care delivery system. Social insurance programs may be government-administered programs, such as the single payer model, or they may be contracted through private insurers. Do not confuse these private, non-profit insurers in social insurance programs with the model of for-profit private insurance in the United States. The private insurers in social insurance programs serve primarily as administrators, but the tightly-regulated financing system functions basically like the single payer model.
The Veterans Administration health system is government owned, and the professionals within the system are employees of the government. Thus it is a system of socialized medicine. Medicare is a government insurance program that pays for services in the private health care delivery system. Thus it is a program of social insurance.
Even Americans who believe they understand the term “socialized medicine” are often confused. In the Harvard/Harris poll, only 47 percent believe that the veterans health care system is a system of socialized medicine (it is). In contrast, 60 percent believe that Medicare is a system of socialized medicine (it is not).
Stan Dorn and John Holahan from the Urban Institute warn us that “rhetoric about socialized medicine and government-run health care is a distraction.” Yet they state that the single payer proposal of HR 676 “would be the functional equivalent of socialized medicine.” Well, they do have an agenda. They state that policies yielding the best consequences for the American public would include “consumers’ ability to make choices about their health care and health coverage.” Throughout their report are many other comments that make it clear that they support the Clinton/Obama model of choice of private insurance plans while rejecting the single payer model. It’s clear that they want to insulate the Democrats’ proposal against the inevitable “socialized medicine” attack of the Republicans. (It should be noted that the Republicans’ claim of private market solutions rings hollow when they propose expanding government subsidies to a population in which 95 percent of the insured are already receiving some form of public subsidies.)
We must continue to stand up against those who obfuscate the issues by abusing the political rhetoric over socialized medicine, especially so when they come from our own camp. They are correct when they say that it is the policies that count, but they are wrong when they reject policies, for political reasons, that would provide the greatest benefit for the patients.