Socialized medicine

Socialized medicine or state medicine is a term used principally in the United States to describe health care systems which operate by means of government regulation and subsidies derived from taxation. Socialized medicine can refer to any system of medical care controlled and financed by the government. The term is often used to describe publicly administered health care systems such as the British National Health Service, In the United States, the term is often used pejoratively in political discourse.

The Canadian health care system is sometimes referred to as socialized medicine because it is funded and heavily regulated by the government. The Canadian system is more accurately categorized as single-payer health care because the government pays for most medical services for each citizen and health care is provided both publicly and privately.

Most industrialized countries, including the United States, and many developing countries operate some form of socialized medicine.

Relation to universal health care

Achieving universal health care is typically the goal of using public money to finance health care. The country most often cited as adopting socialized medicine to achieve universal health care is the United Kingdom.

Usage of the term

The term began as a pejorative phrase first popularized in 1920s and 1930s United States politics by conservative opponents of publicly operated health care with a hostility to programs similar in nature to socialism and communism. Publicly operated health care was first proposed during the administration of U.S. President Franklin Roosevelt and later championed by many others, but ardently opposed by the American Medical Association (including distribution of posters to doctors with slogans such as "Socialized medicine ... will undermine the democratic form of government.")

Hostility to socialism remains a common basis of objection to universal health care by those generally opposed to expansion of government social services and other redistributory policies. For example, Rudolph Giuliani, a Republican presidential candidate, in July 2007 in a campaign speech made a direct connection between socialized medicine and socialism, saying "the American way is not single-payer, government-controlled anything. That's a European way of doing something; that's frankly a socialist way of doing something. That's why when you hear Democrats in particular talk about single-mandated health care, universal health care, what they're talking about is socialized medicine."

Usage of the term "socialized" is inconsistent in the United States. It is often used negatively to describe health systems which most Americans have no personal experience of (e.g. the Canadian and UK systems), but is rarely used to describe popular socialized health care programs in the U.S. For example Veterans Administration clinics and hospitals and the Army Medical Service are proven to provide good quality care at low cost and popular programs such as Medicaid and Medicare are rarely described as socialized.

The term is widely used by the media and pressure groups. However, medical staff, most professionals in the field and international bodies such as the WHO tend to avoid its use. Outside the U.S., the terms most commonly used are universal health care or public health care and have wide public support. People in the United Kingdom, for example, are overwhelmingly supportive of the National Health Service.

Popular support for socialized medicine

Popular support for socialized medicine in the UK is evidenced by the policies of the main political parties and even the fringe parties. The UK's mainstream right wing conservative party says its policies are aimed at "Protecting and improving our health service by putting patients back at the heart of the NHS, and trusting the professionals to ensure that they are able to use their skills to make the fullest possible contribution to patient care.". Even the ultra-right wing British National Party says that "socialised medicine is not just a hallmark of a decent society, but economically rational as well. If one leaves behind capitalist-romantic theories about private-sector efficiency and looks at real-world privatised medicine, which may be observed in America, it is an obvious disaster. It is vastly more expensive and delivers mediocre results outside of luxury care. Britain spends about ⅓ (!) the money per person and we have public health statistics roughly equivalent to America. Except for the fact that the bottom ¼ of our population is vastly healthier."

A member of Margaret Thatcher's government, Nigel Lawson, once described the NHS as a "national religion" because everyone believes in it. The Thatcher administration made only minor changes to the system, and although many state industries were privatized, the state health sector was not one of them.

Criticism of socialized medicine

• Lack of Doctors

In countries with a socialized form of medicine there is typically a lack of doctors. This is due to the fact that the government is setting prices for the doctors. This government regulation of cost eliminates capitalism and competition in the market sector. Since the doctors are unable to set their own prices and are poorly paid they leave this job sector. The decline in the number of doctors leads to a decline in quality health care. The elimination of competition also causes a decline in the quality of health care. This decline is caused by the fact that doctors have no true competition which they need to perform better than in order to get clients. The elimination of competition causes a mentality of "why should I do my best if I don't have too."

• Higher Income Taxes

In countries with a socialized form of health care the average tax rate it higher. The marginal tax rate in a country with socialized medicine is 60% compared to the marginal tax rate in the United States of 26%. This is more than a 100% increase in tax rates.

• Waiting times

Critics often say that socialized medicine is characterized by long waiting times for treatment.

Reports about waiting times are the subject of much dispute. For instance the Manhattan Institute for Policy Research reports that

"More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months".

At first reading, the numbers seem horryifying, but one million people means that less than 2 per cent of the population are waiting at any one time, and the other figure is wrong by a factor of about 800.

"The number of hospital in-patients, for whom English commissioners are responsible, waiting over 26 weeks at the end of August 2007 was 250. Of these 250, 6 were English residents waiting in Welsh hospitals. The median waiting time of those still waiting at the end of August 2007 was 5.8 weeks." (UK Department of Health official information, Sept 2007) http://www.gnn.gov.uk/imagelibrary/downloadMedia.asp?MediaDetailsID=216856

The percentage of the overall English population waiting more than 6 months for treatment is miniscule, less than 0.0005%.

There is also waiting in free market medicine because the price mechanism determines whether someone is treated or not. Those that cannot afford their treatment at the price level determined by the free market because they cannot afford insurance premiums, are denied coverage by their insurer, or cannot afford to take out loans to cover their medical costs, or cannot obtain private charity, have to wait until they can afford their treatment. The numbers of people waiting in the free market is only known to hospitals and the insurance companies and is not recorded in governmental statistics. In socialized medicine, it is not the price mechanism but the relative need of the patient as determined by medical professionals that determines waiting times. In a socialized system, the numbers waiting are recorded in governmental statistics which informs the public debate about how much national funding should be provided for free health care.

Critics would contend that the patient's "need" as defined by a doctor constitutes an arbitrary criterion for the distribution of health care.

• Rationing

In any health system, there is no infintite resource to provide everyone with the care they need and health care respources must be rationed.

In socialized systems where health care is mostly free at the point of use and payed for by taxpayers, politicians and medical professionals ration the availability of health care. In such systems, the people, through the democratic process, determine how much of their money should be spent on health. Once the allocation of public funds has been made, it is then up to health professionals to determine their allocation to areas within the health sector (such as health education, mental health, GP services, community medicine, surgical) as well as to individual patients.

Both the allocation of overall funding to health and the allocation between areas and within an area to individual patients can become a topic of enending political debate. Withing the medical profession, professional bodies may established bodies (such NICE in the UK) which examine the cost effectiveness of treatments and set 'rational' guidelines as to how allocations should be made.

A person "rationed out" of the national health care service in the socialized system that they payed for, they may have to seek alternative treatment in the private sector (where such an alternative is legal). If they cannot afford private care, they may have to go without.

In free market health care, the price mechanism determines how health care is rationed. Those that cannot afford health care or the requisite insurance may also have their health care needs unsatiated.

• Cancellations

Critics of socialized systems say that cancellations are a feature of the system. Patients in socialized systems are usually tolerant of cancellations because it usually happens only when an emergency case requires a theater slot previously marked for a planned admission. Tabloid press reports about cancellations are often misleading and these are sometimes picked up by socialized medicine's critics. For instance the Manhattan Institute once reported

"One (British) cancer patient tried to get an appointment with a specialist, only to have it canceled -- 48 times"

What the article did not reveal was the explanation contained in the original tabloid news article which revealed this to be a localized problem with a new system for appointments.

"the patient received a letter apologizing for the cancellations and blamed the difficulties on a new appointments system" http://www.mirror.co.uk/news/tm_headline=my-cancer-appointment-was-cancelled-48-times-&method=full&objectid=18156184&siteid=94762-name_page.html

• Bureaucracy

Critics in the United States often claim that "socialized" or public medicine would introduce government bureaucracy to health and increase costs.

However, the U.S. (with a semi-socialized model) spends more per capita on health than any other nation and more than twice as much as the country with the next highest level of spending (which has a form of universal health care). Administrative costs in the U.S. health care system are higher than in other countries and an important factor in U.S. spending, and administrative costs in the private sector are higher than in the public sector health care system. One often-cited study by Harvard Medical School and the Canadian Institute for Health Information put the total administrative costs at 31 percent of U.S. health care spending.

• Choice

Critics sometimes argue that choice is restricted in socialized systems because individuals are not allowed a public sector alternative or are required to pay twice when one is available--once to subsidize the socialized system and a second time for their private care.

However, in the UK, patients have a choice of general practitioner, all of whom are self-employed or work in private partnerships employing all practice nurses, doctors and clerical staff. Many hospital services are sub-contracted to the private sector, patients can choose from a range of providers, and will soon be able to choose to use a private sector provider at public expense provided it matches NHS standards and prices. International comparisons of quality of care and health outcomes generally rank the UK above the U.S.

The degree to which waiting in a socialized system affects choice varies from country to country. In the UK for example, a person is free at any time to seek treatment faster in the parallel free market medical system, but they will have to pay the full cost of their private treatment on top of their contribution to the national health care service. In Finland, it is possible to get some funding from the National Insurance System to get private sector care. In Canada the right to jump the queue in this fashion is typically severely restricted by the government.

• Capacity

Critics argue that central planning is inefficient and under investment leads to capacity shortages and that a lack of willingness to invest in expensive technology leads to shortages in areas such as MRI scanning. Some would argue that only the price mechanism in free market health care can allocate resources efficiently and that political pressure often leads to shortages in socialized systems. They argue that central planning is inefficient and under investment leads to capacity shortages. Countries with socialized systems do seem to spend much less on health care than countries with free market systems but the reasons for this are not entirely clear.

It is true that investment resources in socialized systems are often used more intensively in socialized systems. Reports in the press and emanating from pressure groups are often distorted and misleading.

For example the right wing Centre for Policy Analysis says that - :"In France, the supply of doctors is so limited that during an August 2003 heat wave -- when many doctors were on vacation and hospitals were stretched beyond capacity -- 15,000 elderly citizens died." - ::The article connects two truths...that the hospitals were stretched in the heat wave and that an extra 15,000 elderly people died during this period. But these two truths are only connected to the heat wave, not to each other. These people died at home because they did not appreciate how important it is to re-hydrate and did not have air-conditioning to protect them. The scale of the deaths was not known about until the statistics were analyzed. There is no evidence of the deaths occurring in the hospitals for lack of capacity to treat them.

• Government role in health

This claim is often made that doctors and not the government should determine what health care is provided to the individual and what is not.

In most socialized systems, doctors and not administrators are the only decision makers about the care of patients and doctors and health professionals play a key role in determining how best to allocate funding within the health sector. The overall allocation of national budget to health is determined by government based on a wide range of political factors and political direction of health policies is part of the democratic process. Most countries with socialized health systems also offer a private sector alternative to the publicly funded system so people can opt for private care if they wish.

Critics would contend that the nature of socialized medicine forces doctors to act as administrators.

See also

Other types of health care systems

• Single-payer health care
• Two-tier health care
• Social health insurance

Related topics

• Health care politics
• Publicly-funded health care
• Welfare state