On American Healthcare
Part 2 of 6: Socialized Medicine As A Possible Option
A note on socialism
People in America are generally opposed to socializing anything because the State has spent billions on anti-socialist propaganda. Anti-socialist indoctrination in America was so effective that Americans instinctively revolt at the mention of the words “socialism” or “socialized.” But, what is socialism? Socialism is an ideology that holds that all industries ought to be socially or publicly owned. In Marxism, socialism was expressed as government-ownership of all industry. The forms of socialism that were historically associated with Russia and China (i.e. Leninism, Stalinism, Maoism, et al.) really were far worse than capitalism. The hatred of that form of socialism led to a distaste for socialism in general, but other forms of socialism aren’t all that bad. In libertarian socialism, the plan is to establish worker-owned cooperatives and replace the centralized State with decentralized direct democracy―anarchism, where the people govern themselves without the intermediary of the State. There are dozens of types of socialism, some quite conservative and some quite radical. To make a long story short, the types of socialism that America has long opposed are those forms of socialism that hold that government ought to own all industry.
When people speak of socialized medicine or socialized health insurance, people naturally object because they have been brainwashed into hating anything socialistic. However, socialized programs are not socialism. The hallmark of socialism as an ideology is not that it advocates socializing some things but rather that it advocates socializing everything. “Socialized” just means government-run. Having some socialized programs doesn’t make a country socialist. All societies, no matter how libertarian or how conservative, have some socialized projects. Police, courts, and the military are all socialistic programs, as is Medicare and Social Security, but the existence of socialistic programs doesn’t make America socialist. In reality, it is almost universally recognized that some things need to be done socialistically. Very few people advocate privatizing police, courts, and the military. Advocating socialized healthcare or socialized health insurance is no more socialist than insisting that soldiers ought to be paid by the government.
On to the topic of socialized medicine…
We have heard a lot of rhetoric recently about “socialized medicine,” so it would be good to find out exactly what socialized medicine is. In this context, socialized means “government-run” or “government-owned.” Of all the countries with universal healthcare systems, very few of them actually have socialized medicine. Under socialized medicine, hospitals are government-run and doctors are government employees. It is worth noting that virtually no one in the United States is actually advocating socialized medicine.
While socialized medicine is certainly not the best option, it is far superior to the current American system. Critics of socialized medicine have argued that government bureaucrats would sit on “death panels” to determine who gets to live or die, putting a price on human life. The first thing to note is that this already happens in the American system, only it is private doctors and private insurance companies that call the shots rather than government officials. The only difference is that the American system has such decisions made purely on the basis of profits and the profit-motive incentivizes insurance companies to deny coverage to as many people as possible. Obviously, a democratic institution in charge of making such decisions on the basis of standard ethical criteria is actually better than the American system.
Insurance companies lose money when they do cover treatment, so the profit-motive drives insurance providers to deny as many claims as possible. Conventional insurance on the “free” market is actually self-contradictory in nature. The purpose of insurance is to make things affordable, cover as much as possible at the lowest cost possible, but for-profit private insurance companies are driven by the profit-motive to charge as much as they possibly can and deny as many claims as they possibly can. Conventional insurance is really inefficient and ineffective. It is almost always better to link insurance directly to the related service, as with concierge medicine where you pay a monthly fee directly to the doctor’s office. Socialized medicine is kind of like a centralized and statist version of concierge medicine, as healthcare services and insurance are both provided directly by the government. This is technically a “single-payer” system (since government is the single entity making payments), but it is misleading to call it that because advocates of “single-payer healthcare” do not advocate socialized medicine. Single-payer proper refers not to socialized medicine but rather to socialized health insurance. In this article, however, we are dealing with socialized medicine proper, which is not what is currently being debated in America.
The United Kingdom’s National Health Service (NHS) and America’s Veterans Health Administration (VHA) are the best examples of socialized medicine that we have to look at.
“The NHS is a rare example of truly socialized medicine. Health care is provided by a single payer — the British government — and is funded by the taxpayer. All appointments and treatments are free to the patient (though paid for through taxes), as are almost all prescription drugs. The maximum cost of receiving any drug prescribed by the NHS is $12.” — Eben Harrell, Is Britain’s Health-Care System Really That Bad?
While conservatives like to bash socialized medicine, the NHS provides far better services at a fraction of the cost. In the UK, healthcare costs $2,500 per person and covers everyone, whereas healthcare in America costs $6,000 per person and a large part of the populace is not even covered! The quality of healthcare in the UK is generally better too. Based on statistics, it’s safer to get a surgery in the UK than in the US. And even with socialized medicine in the UK, individuals can opt out of the NHS and utilize private healthcare in order to avoid waiting lists.
The NHS does have the National Institute for Health and Clinical Excellence (NICE), that dreaded “death panel” people talk about, but it is not nearly as bad as it sounds! NICE does not sit around arbitrarily deciding which individuals live or die. Instead, it sets standards for when the government will cover treatment and when it will not. One factor considered is costs. Just like private insurers, government can’t just cover everything. A general rule set out by NICE is that treatment which is predicted to extend a person’s life by one year will be covered up to $45,000. Thus, NICE is no different from committees and panels in private insurance companies that determine what will and will not be covered. You can call this a “death panel” if you want, but the truth is this: either socialized medicine does not entail death panels or else America already has death panels and this whole objection is a moot point! Additionally, it ought to be remembered that the UK still allows individuals to turn to the private sector for healthcare needs when the NHS does not cover them. So, this “death panel” never really denies individuals treatment but merely decides when the NHS will pay for that treatment―the consumer can always opt to pay for the treatment out of pocket, assuming that they have enough money.
There is a common myth that socialized medicine would discriminate against the elderly, denying treatment to older people in order to better cover younger people. In the case of the NHS, this simply does not happen. NICE uses citizens councils to make decisions on difficult ethical issues. Elderly retirees have more time to participate in such things, so they are well represented. As a result, NICE has ruled that age cannot be used as a factor in determining approval for medical treatment in the UK.
“What about the ad by lobby group CPR that interviews a British woman who developed cervical cancer after being refused a Pap test because she was too young, and another for a woman whose mother died while waiting for treatment for kidney cancer? Are these experiences typical?
“As mentioned above, cancer treatment is one area in which British patients probably receive inferior treatment to Americans who have comprehensive health insurance. However, Britain’s policy of beginning cervical-cancer screening at age 25 is in accordance with WHO guidelines, which are based on evidence that screening below that age produces false-positive results that can lead to unnecessary and dangerous surgical interventions. Overall, the WHO has found that the risks posed by false positives outweigh the benefits of earlier screening.
“It’s also true that Americans who have comprehensive health-insurance plans do, in some cases, have access to a greater range of cancer treatments, without waiting lists. The two British women used in the CPR ads have since told various newspapers that their views were inaccurately portrayed. While both have complaints about how cancer is treated within the NHS, they support the service as an institution. The woman who developed cervical cancer (it is now in remission) told the Times of London, ‘My point was not that the NHS shouldn’t exist or that it was a bad thing.’” — Eben Harrell, Is Britain’s Health-Care System Really That Bad?
People who utilize systems of socialized medicine generally report that they are satisfied with the care they receive, even though right-wing extremists tend to spread propaganda to make it seem otherwise.
Although no legislator in America is really advocating socialized medicine today, it’s not really unheard of in America. Veterans get access to socialized medicine through the VHA, which generally provides better care than the private sector does. While people on the far right have attacked the VHA, the VHA has been shown to outperform private healthcare on most points.
“The government is both payer and provider of care to the veterans, employing 19,000 salaried doctors in 153 medical centers and more than 900 outpatient clinics….
“Patients routinely rank the veterans system above the alternatives, according to the American Customer Satisfaction Index. Last year, the government program got a satisfaction rating of 85 for inpatient treatment, compared with 77 for private hospitals. The index, a University of Michigan project, found that veterans’ outpatient care scored 3 points higher.”―Kristin Jensen, Vets Loving Socialized Medicine Show Government Offers Savings
My father was overdosed on morphine in private hospitals on two separate occasions, during at least one of which his heart stopped and he had to be resuscitated. His horror stories about his experiences at private healthcare facilities stand in stark contrast to his appreciation of the quality of care he receives at VHA facilities. While the VHA did historically provide lousy healthcare, reforms that started in 1995 have greatly improved VA medicine. The VHA’s focus on a “whole person” approach and a “continuum of care” has made the quality of care much better than the private sector alternative. Better use of modern technology has also improved the VHA system. Currently, the VHA’s socialized medicine approach outperforms the single-payer approach of Medicare on nearly every point.
While most conservatives think socialized medicine is simply un-American, it was the American Founding Fathers themselves who first advocated and implemented socialized medicine in the United States. In 1798, John Adams’ signed into law an Act for the Relief of Sick & Disabled Seamen. This legislation established America’s first single-payer health insurance, mandating that all privately-employed sailers must purchase government health insurance, which was to be funded by a payroll tax. The legislation also established the Marine Hospital Service, a system of socialized medicine in which government-run hospitals would treat privately-employed sailors. This eventually morphed into the Public Health Service
“When a sick or injured sailor needed medical assistance, the government would confirm that his payments had been collected and turned over by his employer and would then give the sailor a voucher entitling him to admission to the hospital where he would be treated for whatever ailed him.
“While a few of the healthcare facilities accepting the government voucher were privately operated, the majority of the treatment was given out at the federal maritime hospitals that were built and operated by the government in the nation’s largest ports.”―Rick Ungar, Congress Passes Socialized Medicine and Mandates Health Insurance -In 1798
The establishment of socialized medicine in America was supported by Thomas Jefferson, John Adams, and Alexander Hamilton, so it’s hardly un-American. While socialized medicine does have downsides, and the VHA in America is far from perfect, its pros far outweigh its cons. One benefit is the centralization of information. If you are in an accident and rushed to a hospital, under socialized medicine your medical records can immediately be made available to any doctor that happens to be treating you. This greatly improves the quality of service and makes treatment much safer, as the doctor can determine allergies and such even if the patient is unconscious.
