By PHILIP M. BOFFEY
The New York Times
Published: September 28, 2007
The epithet of choice these days for Republicans who oppose any expansion of government’s role in health care programs is “socialized” medicine.
Rudy Giuliani has used the “s-word” to denounce legislation that would enlarge a children’s health insurance program and to besmirch Hillary Clinton’s health plan. Mitt Romney has added a xenophobic twist, calling the Clinton plan “European-style socialized medicine,” while ignoring its similarities to a much-touted health care reform he championed as governor of Massachusetts. Other conservative critics have wielded the “s-word” to deplore efforts to expand government health care programs or regulation over the private health care markets.
Our political discourse is so debased that the term is typically applied where it is least appropriate and never applied where it most fits the case.
No one has the nerve to brand this country’s purest systems of “socialized medicine” — the military and veterans hospitals — for what they are. In both systems, care is not only paid for by the government but delivered in government facilities by doctors who are government employees. Even so, a parade of Washington’s political dignitaries, including President Bush, has turned to the National Naval Medical Center in Bethesda, Md., for checkups and treatment, without ideological complaint. Politicians who deplore government-run health care for average Americans are only too happy to use it themselves.
Nor are they eager to tar the vast array of government hospitals and clinics that serve our nation’s veterans. For one thing, the veterans’ hospitals, once considered a second-rate backwater, now lead their private sector competitors in adopting electronic medical records and score well for delivering high quality care at relatively low cost. Even when the veterans’ hospitals were rightly criticized this year for their part in the disgraceful failure to care adequately for soldiers injured in Iraq and Afghanistan, there was no clamor to junk or privatize the system, only demands to make it better.
Mayor Michael Bloomberg startled most New Yorkers two years ago when he asserted that the city’s public hospitals are “better than the great teaching hospitals” all around them. Although some deemed his praise hyperbolic, the city’s billionaire, entrepreneurial, free-market-enriched mayor thought he knew quality when he saw it, even if it was socialist at its core.
The country’s vast Medicare program is one step less socialized — a “single-payer” program in which the government pays for the care and sets reimbursement rates, but the actual care is delivered by private doctors and hospitals. When Medicare was launched in 1965 it was routinely denounced as socialized medicine, but it has become so popular that politicians deem it the third rail of American politics, sure to electrocute anyone who tries to cut it or privatize it. No politician is eager to brand 43 million beneficiaries as socialists at heart.
Meanwhile, the two current butts of the “s-word” are such hybrids of public and private elements that it is hard to know how to characterize them. The State Children’s Health Insurance Program, or S-chip, was denigrated by one Republican congressman this week as “a government-run socialized wolf masquerading in the sheep skin of children’s health.” It might better be thought of as a “double-payer system” in which the states and the federal government put up the money, the states take the lead in defining the program and the actual care is typically delivered through private health plans by private doctors and hospitals.
The “s-word” seems even less appropriate for Senator Clinton’s proposed universal health care plan, which seeks to bolster employer-provided health benefits and create new purchasing pools to help individuals buy private policies at low group rates.
True, her plan would expand government regulation, and she wants to make a Medicare-like option available to compete with private policies. But that would only lead to a socialized, single-payer system if everybody were to choose the Medicare-like option.
There is no special magic in government-run or government-financed health care. Medicare has serious cost-control and financing problems, and the veterans’ hospitals could take a turn for the worse, as they have in the past, should federal funding shrivel. Private health care systems have strengths of their own, are favored by many patients and often provide care as good as any.
The take-home message for voters is this: Look behind the labels to judge health care proposals on their merits. Whenever you hear a candidate denounce something as a step toward socialized medicine, it probably isn’t. More likely the politician is demagoguing the issue or is abysmally ignorant of the inner workings — and real, not ideological, failings — of the country’s multifaceted health care system.