Socialized medicine
Socialized medicine is a term used in the United States to describe and discuss systems of universal health care—medical and hospital care for all by means of government regulation of health care and subsidies derived from taxation. Because of historically negative associations with socialism in American culture, the term is usually used pejoratively in American political discourse. The term was first widely used in the United States by advocates of the American Medical Association in opposition to President Harry S. Truman's 1947 health care initiative. It was later used in opposition to Medicare. The Affordable Care Act has been described in terms of socialized medicine, but the act's objective is rather socialized insurance, not government ownership of hospitals and other facilities as is common in other nations.
Background
The original meaning was confined to systems in which the government operates health care facilities and employs health care professionals. This narrower usage would apply to the British National Health Service hospital trusts and health systems that operate in other countries as diverse as Finland, Spain, Israel, and Cuba. The United States Veterans Health Administration and the medical departments of the U.S. Army, Navy, and Air Force, would also fall under this narrow definition. When used in that way, the narrow definition permits a clear distinction from single payer health insurance systems, in which the government finances health care but is not involved in care delivery.More recently, American conservative critics of health care reform have attempted to broaden the term by applying it to any publicly funded system. Canada's Medicare system and most of the UK's NHS general practitioner and dental services, which are systems where health care is delivered by private business with partial or total government funding, fit the broader definition, as do the health care systems of most of Western Europe. In the United States, Medicare, Medicaid, and the US military's TRICARE fall under that definition. In specific regard to military benefits of a volunteer military, such care is an owed benefit to a specific group as part of an economic exchange, which muddies the definition yet further.
Most industrialized countries and many developing countries operate some form of publicly funded health care with universal coverage as the goal. According to the Institute of Medicine and others, the United States is the only wealthy, industrialized nation that does not provide universal health care.
Jonathan Oberlander, a professor of health policy at the University of North Carolina, maintains that the term is merely a political pejorative that has been defined to mean different levels of government involvement in health care, depending on what the speaker was arguing against at the time.
The term is often used by conservatives in the U.S. to imply that the privately run health care system would become controlled by the government, thereby associating it with socialism, which has negative connotations to some people in American political culture. As such, its usage is controversial, and at odds with the views of conservatives in other countries prepared to defend socialized medicine such as Margaret Thatcher. According to a 2018 Gallup poll, 37% of American adults have a positive view of socialism, including 57% of Democrat-leaning voters and 16% of Republican-leaning voters.
History of term
When the term "socialized medicine" first appeared in the United States in the early 20th century, it bore no negative connotations. Otto P. Geier, chairman of the Preventive Medicine Section of the American Medical Association, was quoted in The New York Times in 1917 as praising socialized medicine as a way to "discover disease in its incipiency", help end "venereal diseases, alcoholism, tuberculosis", and "make a fundamental contribution to social welfare". However, by the 1930s, the term socialized medicine was routinely used negatively by conservative opponents of publicly funded health care who wished to imply it represented socialism, and by extension, communism. Universal health care and national health insurance were first proposed by U.S. President Theodore Roosevelt. President Franklin D. Roosevelt later championed it, as did Harry S. Truman as part of his Fair Deal and many others. Truman announced before describing his proposal that: "This is not socialized medicine".Government involvement in health care was ardently opposed by the AMA, which distributed posters to doctors with slogans such as "Socialized medicine ... will undermine the democratic form of government." According to T.R. Reid :
The AMA conducted a nationwide campaign called Operation Coffee Cup during the late 1950s and early 1960s in opposition to the Democrats' plans to extend Social Security to include health insurance for the elderly, later known as Medicare. As part of the plan, doctors' wives would organize coffee meetings in an attempt to convince acquaintances to write letters to Congress opposing the program. In 1961, Ronald Reagan recorded a disc entitled Ronald Reagan Speaks Out Against Socialized Medicine warning its audience the "dangers" that socialized medicine could bring. The recording was widely played at Operation Coffee Cup meetings. Other pressure groups began to extend the definition from state managed health care to any form of state finance in health care. President Dwight Eisenhower opposed plans to expand government role in healthcare during his time in office.
In more recent times, the term was brought up again by Republicans in the 2008 U.S. presidential election. In July 2007, one month after the release of Michael Moore's film Sicko, Rudy Giuliani, the front-runner for the 2008 Republican presidential nomination, attacked the health care plans of Democratic presidential candidates as socialized medicine that was European and socialist, Giuliani claimed that he had a better chance of surviving prostate cancer in the US than he would have had in England and went on to repeat the claim in campaign speeches for three months before making them in a radio advertisement. After the radio ad began running, the use of the statistic was widely criticized by FactCheck.org, PolitiFact.com, by The Washington Post, and others who consulted leading cancer experts and found that Giuliani's cancer survival statistics to be false, misleading or "flat wrong", the numbers having been reported to have been obtained from an opinion article by Giuliani health care advisor David Gratzer, a Canadian psychiatrist in the Manhattan Institute's City Journal where Gratzer was a senior fellow. The Times reported that the British Health Secretary pleaded with Giuliani to stop using the NHS as a political football in American presidential politics. The article reported that not only the figures were five years out of date and wrong but also that US health experts disputed both the accuracy of Giuliani's figures and questioned whether it was fair to make a direct comparison. The St. Petersburg Times said that Giuliani's tactic of "injecting a little fear" exploited cancer, which was "apparently not beneath a survivor with presidential aspirations". Giuliani's repetition of the error even after it had been pointed out to him earned him more criticism and was awarded four "Pinocchios" by the Washington Post for recidivism.
Health care professionals have tended to avoid the term because of its pejorative nature, but if they use it, they do not include publicly funded private medical schemes such as Medicaid. Opponents of state involvement in health care tend to use the looser definition.
The term is widely used by the American media and pressure groups. Some have even stretched use of the term to cover any regulation of health care, publicly financed or not. The term is often used to criticize publicly provided health care outside the US, but rarely to describe similar health care programs there, such as the Veterans Administration clinics and hospitals, military health care, or the single payer programs such as Medicaid and Medicare. Many conservatives use the term to evoke negative sentiment toward health care reform that would involve increasing government involvement in the US health care system.
Medical staff, academics and most professionals in the field and international bodies such as the World Health Organization tend to avoid use of the term. Outside the US, the terms most commonly used are universal health care or public health care. According to health economist Uwe Reinhardt, "strictly speaking, the term "socialized medicine" should be reserved for health systems in which the government operates the production of health care and provides its financing." Still others say the term has no meaning at all.
In more recent times, the term has gained a more positive reappraisal. Documentary movie maker Michael Moore in his documentary Sicko pointed out that Americans do not talk about public libraries or the police or the fire department as being "socialized" and do not have negative opinions of these. Media personalities such as Oprah Winfrey have also weighed in behind the concept of public involvement in healthcare. A 2008 poll indicates that Americans are sharply divided when asked about their views of the expression socialized medicine, with a large percentage of Democrats holding favorable views, while a large percentage of Republicans holding unfavorable views. Independents tend to somewhat favor it.
History in United States
The Veterans Health Administration, the Military Health System, and the Indian Health Service are examples of socialized medicine in the stricter sense of government administered care, but they are for limited populations.Medicare and Medicaid are forms of publicly funded health care, which fits the looser definition of socialized medicine. Part B coverage requires a monthly premium of $96.40 and the first $135 of costs per year also fall to the senior, not the government.
A poll released in February 2008, conducted by the Harvard School of Public Health and Harris Interactive, indicated that Americans are currently divided in their opinions of socialized medicine, and this split correlates strongly with their political party affiliation.
Two thirds of those polled said they understood the term "socialized medicine" very well or somewhat well. When offered descriptions of what such a system could mean, strong majorities believed that it means "the government makes sure everyone has health insurance" and "the government pays most of the cost of health care". One third felt that socialized medicine is a system in which "the government tells doctors what to do". The poll showed "striking differences" by party affiliation. Among Republicans polled, 70% said that socialized medicine would be worse than the current system. The same percentage of Democrats said that a socialized medical system would be better than the current system. Independents were more evenly split, with 43% saying socialized medicine would be better and 38% worse.
According to Robert J. Blendon, professor of health policy and political analysis at the Harvard School of Public Health, "The phrase 'socialized medicine' really resonates as a pejorative with Republicans. However, that so many Democrats believe that socialized medicine would be an improvement is an indication of their dissatisfaction with our current system." Physicians' opinions have become more favorable toward "socialized medicine".
A 2008 survey of doctors, published in Annals of Internal Medicine, shows that physicians support universal health care and national health insurance by almost 2 to 1.