Socialized Medicine

Apparently we've reached a point where the term "socialized medicine" actually polls well. See Ezra Klein for further discussion. I would only note that the leading Democratic candidates are not, in fact, proposing to deliver medical services on a socialized (i.e., public sector) basis. Nor are they really proposing to deliver health insurance on a public sector basis (the way Medicare works).

Which is all too bad, because socialized medicine is, in my view, a good idea. Democrats have various reasons for not putting actual socialized medicine proposals on the table, but at least one reason is a desire to rebut the charge that they favor "socialized medicine." But if "socialized medicine" sounds good to people, then they may as well propose it.

Comments

Among other things, though, what's sad is that more people think that Medicare is "socialized medicine" than think that Veteran's Administration health care is "socialized medicine".

One thing that we can count on is that 90% of Americans know fuck all about this issue. Or any other, for that matter.

Posted by Keith M Ellis | February 16, 2008 5:22 PM

My guess is that only voters over 50 or so remember the Cold War well known to "know" that "Socialism is Bad". The rest think that "Socialism" is what Paris Hilton and Britney Spears do at nightclubs.

So long as the politicians don't propose enacting "Islamic Medicine" nobody will care a bit...

Posted by RKU | February 16, 2008 5:25 PM

Every sane person knows that single payer universal coverage is the only way to solve the crisis of health care costs, and yet the most progressive figures of the Democratic party are afraid to even mention it. The chance that either Hillary's or Obama's grotesque plans would, even if enacted, make the slightest bit of difference, is virtually nil. They both, in fact, add extra layers of bureacracy that will both cost more and piss people off more.

This is what I like to think of as the "locking cabin doors" principle. The Dems and Reps propose multi-trillion dollar defense buildups. Nader proposes locking cabin doors on airliners. Nader is the crazy one.

Why, I wonder, are we supposed to keep on voting for people who promise not to do anything about our real problems?

Posted by Alan in SF | February 16, 2008 5:30 PM

The poll is meaningless. Maybe most of the people who said they think "socialized medicine" would be "better" are the same people who said they understood the meaning of "socialized medicine" either "not very well" or "not at all." It's hard to know what useful conclusions the authors of this study think it supports.

In any case, what people say they want in the abstract is not a reliable indicator of what they will support when an actual, real-world plan is presented to them and put through the political process.

Posted by Mixner | February 16, 2008 5:39 PM

Not to throw too much water on those stats, but that graph only represents about two-thirds of the respondants. The other third said that they didn't understand the term 'socialized medicine.' It seems to me that the battle over health care will be heavily affected by how the term is defined/framed for that last third.

Posted by Adam | February 16, 2008 5:41 PM

Alan but the pilots would get lonely, don't you see?

Posted by burning flock | February 16, 2008 6:03 PM

Every sane person knows that single payer universal coverage is the only way to solve the crisis of health care costs,

No, denying sick people care is the only way to solve the crisis of health care costs (in particular, denying care to those who are going to die within 1-3 years). Single payer insurance will cut costs largely to the extent that it can accomplish this.

Which is all too bad, because socialized medicine is, in my view, a good idea.

So, Matt, you don't just want single payer, you want the government to actually be the health care provider, as in the UK?

Posted by Glaivester | February 16, 2008 6:20 PM

in particular, denying care to those who are going to die within 1-3 years

Furthermore, we can test for this by generally denying people care for a year, and then seeing if they're dead or not. Dead = bad investment, alive = time for health care.

Posted by Barbar | February 16, 2008 6:26 PM

The problem is that what these democrats are offering is not socialized medicine, but it will be called that. What they're offering is a giveaway to insurance companies. We need a single payer system.

I think that we need to build a super majority and force a single payer system through.

http://www.politicalinaction.com

Posted by Brian | February 16, 2008 6:54 PM

Matt,

This may sound snide, but I am honestly curious: have you ever lived in a country with socialized medicine?

It certainly has its benefits, namely the peace of mind afforded by never having to worry about paying the hospital bill when you’re sick.

That said, it is still a bad system and certainly not an improvement over what the U.S. currently has (which also stinks). In fact, I believe Americans would last about a year under socialized medicine before rebelling against the long lines, the rude bureaucrats and the inability to make their own medical decisions. If Americans hated HMOs, why would having one giant state-run HMO be a better choice?

France, Spain, the United Kingdom and even Canada look nice from a distance, but how many Americans really understand what the socialized medicine experience is like?

(My reference is Spain, where I lived for eight years. My wife is Spanish and my two daughters were born there.)

Posted by Murraymises | February 16, 2008 7:14 PM

Single payer would be the only answer except for the fact that the administration of health care payments is a significant chunk of GDP. Off the top of my head I would say at least 3% Around 30% of all health care costs are taken by administrative costs.

If by some magic a single payer system started tomorrow hundreds of thousands of jobs would be lost. Thousands of companies would cease to exist. Instant recession.

And that's the easy part.

Posted by rapier | February 16, 2008 7:19 PM

Mixner is right. You can only get meaningful results on a poll like this is you first accurately identify those who understand the phrase "socialized medicine." But it is very doubtful that the class of people who actually do understand the phrase very well, somewhat well, or not very well is the same as the class of people who self-identify as people who understand the phrase very well, somewhat well, or not very well.

Posted by Dan Kervick | February 16, 2008 7:30 PM

Maybe most of the people who said they think "socialized medicine" would be "better" are the same people who said they understood the meaning of "socialized medicine" either "not very well" or "not at all."

Well, given that Republican opponents of health care reform are not going to hold a multi-state seminar on what, exactly, "socialized medicine" is, but rather are going to scream about how the Democrats are "trying to shove socialized medicine down our throats!", this poll gives us a good indication about how well those tactics are going to work, which is to stay, not well at all.

Posted by Tyro | February 16, 2008 7:36 PM

Without disagreeing with Mixner / Kervick, it seems that the poll does at least show that the words "socialized medicine" aren't the surefire political suicide they have frequently been assumed to be. And I think this limited point is most of what Matt and Ezra are pointing out.

Posted by hum | February 16, 2008 7:41 PM

... or, what Tyro said, pretty much. Sorry, didn't see yours before I posted mine.

Posted by hum | February 16, 2008 7:46 PM

If by some magic a single payer system started tomorrow hundreds of thousands of jobs would be lost. Thousands of companies would cease to exist.

And that's why I have taken the trouble to devise the
Incremental Socialized Medicine Plan :

Medicare and Medicaid, our current major government healthcare programs, concentrate their benefits near the end of the insured's life, when costs are high, and the marginal utility to society of better health for the insured are at their lowest.

We could achieve far more for our society by providing comprehensive health coverage for the vulnerable persons at the other end of the age spectrum.

I propose that every pregnant woman and every child in its first two years of life should be covered in the Plan. This is the highest-leverage investment we as a society can make in healthcare insurance: it has been shown quite convincingly that many of the social costs of poverty and of ill-health later in life can be ameliorated by adequate pre-natal and early-childhood health care.

(Those who oppose legal abortion should be pleased: the plan should as a side-effect reduce the total number of abortions, and it cherishes those born and unborn children that are the ostensible special concern of the "pro-life" movement.)

Predictable consequences are life-long better health for many Americans, an improvement in school performance in poverty-stricken areas, an eventual nationwide reduction in crime and antisocial behavior.

The economic boon to America's corporations, freed from paying insurance premiums for prenatal, childbirth, and early-childhood health care, would be huge.

A further provision of the Plan raises the age at which a covered child exits coverage by six months every two years. Under this provision, the private insurance companies would know exactly where they stand, and would have time to plan and execute an orderly exit from the health insurance field.

Posted by joel hanes | February 16, 2008 7:47 PM

Gee, Tyro, considering that fewer than half of respondents who claimed to have any idea of the meaning of the phrase "socialized medicine" think it would be "better" than our current system, I'd say the tactic you describe would probably work pretty well.

But as I said, this kind of abstract polling doesn't tell you anything useful about how a real-world health care reform plan is likely to fare when it is subjected to the political process. A New York Times poll in early 1993 found that 63% of Americans favored universal coverage. An NBC News poll around the same time found that 66% of Americans would be willing to pay higher taxes so that everyone could have health insurance. Sounds pretty favorable for "universal health care," right? Remember what actually happened?

Posted by Mixner | February 16, 2008 7:55 PM

rebelling against the long lines, the rude bureaucrats and the inability to make their own medical decisions

Isn't that pretty much what's going on now? And folks in that category are the lucky ones. They get to pay through the nose to get abused.

Posted by justinb | February 16, 2008 8:48 PM

Isn't the whole point of Matthew's post that when used to modify "medicine", the term "socialized", regardless of how it is defined, is no longer a bugaboo?

Posted by harold | February 16, 2008 9:01 PM

But as I said, this kind of abstract polling doesn't tell you anything useful about how a real-world health care reform plan is likely to fare when it is subjected to the political process. A New York Times poll in early 1993 found that 63% of Americans favored universal coverage. An NBC News poll around the same time found that 66% of Americans would be willing to pay higher taxes so that everyone could have health insurance. Sounds pretty favorable for "universal health care," right? Remember what actually happened?

Well, that's because the Republican attack - "Do you want the government to pick your doctor?" - was effective enough to overcome the positive feelings toward universal care. The lesson here seems to be that we should poll the resonance of the attacks on universal care.

And that's what they did! That's what the post is about.

All the Republicans have been attacking the "socialized medicine" that the Democrats support. This poll suggests that such an attack will not be effective, because that term is actually viewed mildly positively by the electorate.

If the Republicans want to stop universal (or near-universal) health care, they're going to need a better tactic.

Posted by DivGuy | February 16, 2008 10:28 PM

considering that "socialized" systems tend to rank almost as poorly as our own according to rankings Ezra considers reliable, why would we do that model when there are better models in continental Europe that get better results?

Why copy Canada when we can copy France, or Germany?

Posted by Adam Herman | February 16, 2008 10:42 PM

rapier:

I am glad someone else has brought this up. Much of the American economy is tied to buearacratic paper shuffling and legal complexities. Honestly, if we were to:

- Convert to a single-payer health-care system
- eliminate the IRS
- Reduce regulations and rules over a whole course of industries..

Many, many of America's decent paying jobs (which are based on the expertise developed to guide people or enterprises through all of the rules) would be gone. It is why I sudder whenever I hear that less regulation is good.

No - less regulation is great for owners, since it frees up their capital to either save or invest (overseas). I look at the Sarbanes-Oxley 404 provision. So many people want to get rid of it, but, it really has been a great boon to providing jobs in America, rather than freeing up capital to go to overseas investments.

Posted by Brad | February 16, 2008 11:10 PM

Isn't the whole point of Matthew's post that when used to modify "medicine", the term "socialized", regardless of how it is defined, is no longer a bugaboo?

Er, was it ever a "bugaboo?" Your meme here seems to be "people aren't so scared by the phrase 'socialized medicine' anymore," implying that they were once more scared by it. Got any evidence of that?

All the Republicans have been attacking the "socialized medicine" that the Democrats support. This poll suggests that such an attack will not be effective, because that term is actually viewed mildly positively by the electorate.

I don't think HillaryCare Part 1 failed because its opponents called it "socialized medicine." The point of the 1993 polls is that they show that Americans have long favored "universal health care" in the abstract. But the devil is in the details. When they find out its costs--higher premiums or taxes, lower quality and reduced choice--they strongly reject it. Maybe it will be different this time, but I'm inclined to doubt it. This silly poll certainly isn't evidence that "universal health care" is any more likely to survive the wringer of the political process than it was 15 years ago.

I would also point out that when single-payer universal health care was put directly to the voters as a ballot proposition in Oregon and California, voters overwhelmingly rejected it. Buy margins of 3-to-1. If it fails so miserably in two of the bluest states in the country, it doesn't seem terribly likely to succeed at the national level.

Posted by Mixner | February 17, 2008 12:40 AM

I am glad someone else has brought this up. Much of the American economy is tied to buearacratic paper shuffling and legal complexities...

Wow, that's a beautiful argument. Who knew that labor productivity growth was the beast threatening America's future?

Posted by beowulf | February 17, 2008 3:05 AM

Whippersnapper lefty bloggers miss an obvious -- and most likely, insurmountable -- political obstacle to a single-payer health care system: senior citizens here have a good deal with Medicare Parts A, B, and D, plus their private insurance. For any single-payer system to produce the promised cost savings, it would have to cut back on health care for seniors. So why would seniors want to risk getting a worse deal under a single-payer system?

Not to mention that nursing is one of the few attainable careers by Americans with average-or-better intelligence that currently pays well and is in no danger of being outsourced. In a single-payer system, physicians would get paid what our nurses make now, and nurses would get paid what customer service reps make. Single mothers would have to aspire to become Ivy-educated political bloggers instead.

Posted by Juan | February 17, 2008 3:53 AM

Go back to Cuba, filthy hippie.

Posted by abb1 | February 17, 2008 4:28 AM

The core weakness in the UK's NHS was the assumption that there is a finite demand for health care. As the British have themselves noted, there is not. However, there is a limited willingness to pay for health care, with the result that there are lines at NHS facilities and a backlog for surgery. So, the UK controls costs chiefly by consciously rationing service so that public funds are available for other priorities.

The public side of the US system works under the same constraints. The private side limits health care consumption with a mix of tiered pricing, and rationing service to insured premium payers.

It can be argued that the UK (and France, Scandinavia, etc) are making more efficient use of capital, in that they are getting pretty much the same health outcomes as the US, while speading a much lower share of GDP. I would suspect the difference is the added US cost in the form of private administration and shareholder dividends.

The idea that these added costs are desirable for reasons of added R&D and non-outsourced investment don't hold water. Most private R&D go into replacing expired patents with marginally different products. Paying armies of insurance adjusters and hospital clerks isn't going to save us if virtually every other value added activity is off-shored, or cheapened by importing undocumented labor.

Posted by cmholm | February 17, 2008 5:56 AM

Your meme here seems to be "people aren't so scared by the phrase 'socialized medicine' anymore," implying that they were once more scared by it. Got any evidence of that?

No, the idea is that this is the attack that the Republicans are currently leveling on both Hillary and Obama's health care plans. Are you really disputing that?

The attack on the '93 bill was not "socialized medicine", it was the far more effective, "the government will take your doctor away from you." Now that there is absolutely no chance that could happen to anyone under the new plans, the Republicans have fallen back on shouting "socialized medicine." And it turns out, that won't be particularly effective.

Posted by DivGuy | February 17, 2008 9:42 AM

"It can be argued that the UK (and France, Scandinavia, etc) are making more efficient use of capital, in that they are getting pretty much the same health outcomes as the US, while speading a much lower share of GDP."

The health care outcomes aren't the same; the life expectancies are similar (or better). That is a result of different populations and different lifestyles. 12% of Americans are black. They don't live as long as other races typically. A much larger percentage of Americans is obese. Ditto. An American with cancer or another serious illness will typically get better, and quicker treatment than someone in the UK or France, and will have a much better health outcomes.

"Most private R&D go into replacing expired patents with marginally different products."

Nonsense. Young and healthy people have little perspective on this. There are forms of cancer for which there were virtually no effective treatments a decade ago, and now patients have a fighting chance, due to new drugs from companies you've never even heard of (e.g., Onyx Pharmaceutical's Nexavar, for advanced kidney cancer). These companies and these drugs wouldn't exist if it weren't for our private health insurance market.

Posted by Juan | February 17, 2008 12:08 PM

No, denying sick people care is the only way to solve the crisis of health care costs (in particular, denying care to those who are going to die within 1-3 years). Single payer insurance will cut costs largely to the extent that it can accomplish this.

Using a much shorter time frame would work just as well. All we'd have to do, in order to save a fortune, is withhold care from people who are 100% certain to die in the next 1-3 months or even weeks.

Posted by Peter | February 17, 2008 12:43 PM

Re: The core weakness in the UK's NHS was the assumption that there is a finite demand for health care. As the British have themselves noted, there is not.

Nonsense! There is no such thing as an infinite demand for anything because A) the population is finite and b) time (as in time within a human lifespan) is finite. You would do better to say that the British system grossly underestimated the demand for healthcare. That would be true. But it is not true that that demand is literally infinite. Please learn the mathemaical meaning of that word before slinging it about carelessly.

Re: When they find out its costs--higher premiums or taxes, lower quality and reduced choice--they strongly reject it. Maybe it will be different this time, but I'm inclined to doubt it.

The big difference this time is that the plans touted by both Hillary and Obama allow individuals to keep their current arrangement unchanged if that's what they want. Hence these proposals are not vulnerable to charges that they will wreck what people have.

Posted by JonF | February 17, 2008 1:28 PM

"The big difference this time is that the plans touted by both Hillary and Obama allow individuals to keep their current arrangement unchanged if that's what they want. Hence these proposals are not vulnerable to charges that they will wreck what people have."

They are when people realize that the ultimate goal is to use a public system to eventually drive the private and not-for-profit insurance providers out of business.

Posted by Juan | February 17, 2008 1:36 PM

A few experts that have experience in the health care reform space have pointed out that America needs to change its health care delivery system, not just our finance system. Former Oregon Governor John Kitzhaber and Dr. Ezekiel Emanuel at NIH are among those pointing to the need for broader reform.

Issues like lack of primary care, prevention, screening, focus on chronic care management are some of the areas that are pointed to for reform.

Posted by Terry | February 17, 2008 3:55 PM

If someone knows where to find a set of fact-based but not-too-wonky talking points in support of universal healthcare, I'd appreciate a quick email with the link(s). My father is a doctor, and he's really not too political, but he's dead set against universal healthcare (and thus, Democratic candidates).

Posted by Jeremy | February 17, 2008 4:05 PM

oops, thought my name would be linked to my email address; guess not. It's jraines -at- gmail dot com

Posted by Jeremy | February 17, 2008 4:07 PM

The big difference this time is that the plans touted by both Hillary and Obama allow individuals to keep their current arrangement unchanged if that's what they want.

Nonsense. Under an individual mandate, people who currently choose to pay for their health care out of pocket rather than buy insurance will be forced to buy insurance instead. That is obviously not "keeping their current arrangement unchanged."

And community rating and guaranteed issue will cause higher premiums for healthy, low-risk individuals because they will be subsidizing sick and high-risk people more.

Posted by Mixner | February 17, 2008 4:54 PM

Jeremy,

Have you considered that your father might be right? The older you get, the more that turns out to have been the case.

Posted by Fred | February 17, 2008 4:59 PM

Re: They are when people realize that the ultimate goal is to use a public system to eventually drive the private and not-for-profit insurance providers out of business.

Ah, but that can only happen if that is what a large majority of the people want. If people really want to keep private insurance then private insurance will survive. It will in fact probably survive even if a majority do switch to public insurance. Consider public education: most people school their kids in public school, but this has not driven private schools out of business.
Just why are you so afraid of reform here? You're now assured that you can keep what you currently have after all. why try to limit the choices of others?

Re: And community rating and guaranteed issue will cause higher premiums for healthy, low-risk individuals because they will be subsidizing sick and high-risk people more.

That's how the system should work! Good grief! We all pay the same to educate our childen (even those of us with no children at all). In fact, is there any other product or service in existence apart from insurance where people are charged different prices for the very same product? Seems to me that practice is what is a profound betrayal of normal market principles. Oh, and did you know that community rating was the long the norm in health insurance? The departure from that sensible and ethical system is when the healthcare system began to go off the rails. If we had kept to it there would be no great hue and cry for nationalizing the healthcare system. You should support it, Mixner. if you don't want socialized medicine. Because in the end that will be the only other alternative.

Posted by JonF | February 17, 2008 8:32 PM

Jeremy: I'm guessing your father doesn't want the gov't reinbursement rates that he fears will be lower than what he gets from private insurance companies. Here in MA we have that issue with dentists, who refuse to take clients from medicaid.

Of course, I say screw 'em, they're rolling in dough either way. But they convince themselves otherwise. And given their packed schedules/appointment requests, they are correct in a sense.

Still say screw 'em, they're friggin' doctors, not hedge fund managers.

Posted by Andruw | February 17, 2008 9:03 PM

Aloha,

Two comments. First my ex-girlfriend, escaped from Communist Czechoslovakia some years ago. She was forced to return to her home land, The (now) Czech Republic, in order to recieve medical/dental care. She worked 40 hours a week and still unable to obtain the care she needed in America.

So,last year I went with her to the Czech Republic. I suddenly found myself in immediate need of knee surgery. My American insurnace would not cover any part. I paid cash for the entire operation. Including the surgeon, the anesthesiologist, the x-rays, medications, hospital stay, nursing care, ect, ect---the entire bill will somewhat less than $2000.

Does Socialized medicine work??? Hell, yes, I am walking happy proof. I do pray that sooner rather than later our country can join the civilized nations (almost all others) in providing health care for our own citizens, instead of attacking, occupying, bombing and murdering others. I am quite sure if we were to produce a few less weapons of mass destruction and using them indiscriminantly upon innocents---we could use that windfall for our own peoples' health and the falling bridges and other infrastruture crumbling in our own country.

Daniel Skomp, RN,CPN

Posted by Daniel Skomp, RN | February 17, 2008 11:24 PM

Re: "There is no such thing as an infinite demand"

Your pedantic correction is duly noted.

Re: Efficiency of private medical R&D

Granted, advances in care and therapeutic compounds have occurred. For a contrary look at whether the advances are the exception or the rule, you might review this 2004 article from the New Yorker. Abstracted, big pharm sucks at R&D.

Posted by cmholm | February 18, 2008 3:17 AM

Point of clarification here: are we talking about socialized insurance, or socialized care? It's an important distinction. Britain has both; unless you are lucky enough to pay for a private doctor in Harley Street, everything comes from the NHS. This is generally considered to not work very well. Canada has the former; everyone's insurance is public (and free), but doctors/hospitals/clinics etc. are independent (though hospitals are non-profit). Thus a doctor in Toronto is essentially an entrepreneur, although with only one paying client--the Ontario government, which covers all of his/her patients. In this regard our Torontonian doctor is actually a lot closer to what Americans seem to picture as the ideal family-doctor situation than a counterpart south of the border, who is probably beholden to an insurance company or HMO in making treatment decisions/taking on patients, etc.

As the US goes kicking and screaming toward some further assumption of public responsibility for health provision it's important to keep in mind the different flavours of 'socialized' medicine.

Posted by Matt C | February 18, 2008 8:27 AM

Matt C,

In Canada's case, this is a distinction without a difference. If, by law, all your wages are set and paid for by the government, then for all intents and purposes you work for the government.

Posted by Fred | February 18, 2008 12:41 PM