By Walter Sorochan, PhD, MPH, MSc, BPE
Emeritus Professor San Diego State University
Posted May 13, 2009; Updated April 26, 2016.
Having a single-payer insurance system is not socialized medicine. It is not any different than any other insurance carrier, like Blue Cross, Blue Shield, Aetna, or Kaiser Permanente.
One needs to shift from the political debate about socialized medicine versus national health care to understanding who pays for health care and how it is financed.
Health care reform in US Socialized health care is a meaningless hypocritical term that has outlived its usefulness! The term can refer to any system of medical care that is publicly financed, government administered, or both. This narrower usage would apply to the British National Health Service hospital trusts and health systems that operate in other countries as diverse as Canada, Australia, Latin American countries, 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.
Canada's Medicare system, most of the UK's NHS general practitioner and dental services, which are all systems where health care is delivered by private business with partial or total government funding, fit this broader definition, as do the health care systems of most of Western Europe. In the United States, Medicare, Medicaid, and the U.S. military's TRICARE fall under this definition.
In conclusion, United States has many examples of already functioning public subsidized health care systems that can be labeled as socialized medicine. So labeling a single-payer health insurance carrier as socialized medicine has just lost its knock out punch as an argument!
Lets face it, we are behind the rest of the world in providing responsible health care! Some advocates complement the American medicine as the best in the world but this is most disputable! It depends on what one chooses as the basis for these arguments. But for now, United States is the only country in the world that does not have national health care! Health care reform in US How do Americans feel about their health care future:
"But many Americans are ahead of the rhetoric. According to research reported in the Los Angeles Times on Feb. 25, few people are taken in by the boogeyman phrase. Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health, found that of the 67% of people who said they understood the meaning of "socialized medicine," 79% thought it was a good thing. He also found a political divide: 70% of Republicans thought socialized medicine would make the U.S. healthcare system worse; 70% of Democrats thought it would improve the system." Susan Brink Credit: Ed Stein / Rocky Mountain News, Socialized medicine and the presidential race, 3:49 PM, April 17, 2008
The bottom line in switching from a "for profit messed up group of insurance carriers" is money! Money as controlled by vested political entities.
Yes money or how to pay for a system that is financially broke and dysfunctional. When a for-profit insurance carrier is not providing health care in a responsible manner, then it does not provide a service to the people! This is the reason to change to a single payer carrier system. To understand and appreciate the gist of these statements, one needs a history background on how the current medical system came into being and the big idea behind insurance. Another aspect of the switch to single-payer insurance system has to do with the ethics of whether anyone should be allowed to make money on sick and disabled persons! And thirdly, who has the responsibility to provide care for all citizens in any country and how to do this. Each of these issues must be addressed from an ethical, philosophical and realistic points of view.
Issue of Money: The current health care system of United states is financially broke and it is bankrupting United States. Money would probably be of lesser importance if all the people were covered by the current helter-skelter system. But there are over 50 million persons, about one-sixth of the total population, that are without adequate or no health insurance.
Health and economics are inter-related. The health of citizenry is directly related to the economy of a country. Sick workers cannot produce as much Gross National Product [ GNP ] as healthy workers can. In the failing economy of today, where banks, auto companies, airlines and big business are going broke and asking for bailouts and out-sourcing jobs and manufacturing to foreign countries to save money, we need healthy workers to compete with workers in other countries. One of the major reasons the auto companies are unable to compete with foreign markets is because providing health care to auto workers in United States wipes out profit. In an attempt to save money, American auto companies out source building many autos to Canada, where auto workers are automatically covered by the single-health insurance carrier. Canadian produced autos cost less because the health care coverage is much lower than in United States.
But the real advantage of a single-carrier system is economics. It is based on the fundamental concept of insurance: "The more persons covered the less the cost of premiums to all those in the insurance umbrella." A national single payer can cover millions more at much less cost than for profit insurance carriers can; hence the cost of health insurance becomes affordable for everyone. Numbers do make a difference! [ What is health insurance? ]
We live in an ever-changing world and you better change with the times or become a dinosaur! The American wild west is full of such stories. The pony-express was replaced by the stage coach; in turn replaced by the train, in turn replaced and augmented by the trucking business. Read about the concerns conductors had in losing their jobs! The telegraph was replaced by the telephone system which has been augmented by the internet and e-mail and cell phones. Newspapers are now being replaced by the internet. The industrial era has being replaced by the electronic and information eras. And so it is with the old system of medical practice. Manual record keeping is being replaced by the paperless electronic patient record system. Entering patient information into the computer manually is very expensive and outdated. Indeed traditional medical practice is about to enter a new system of hybrid medicine. This system will use nanotechnology, cell stems and DNA technology to provide us with miracle magic healing. The 21st century will belong to medicine and the health fields that will allow people beyond the age of 100 years to lead productive lives. In summary, it is useless to fret over the trivial issues when the medical future brings a new way of keeping people healthy and doing business. We have more to gain than to lose in terms of health economics, wellness of people and staying competitive economically. There is more to changing the health care system than just making money and saving dead-end jobs! Health Reform USA
National health insurance in many countries allows competitive for-profit insurance carriers but subscribers find these to be much more expensive than the national health care option. These carriers will need to adopt and find other ways to make money. Likewise, medical workers will be retrained and recycled into useful and meaningful jobs. Pharmaceutical companies will also be forced to re-tool their research and development and how they provide medications.
Justification for government controlled medicine:When should a government program supercede a private one? This question can be resolved on a moral and ethical basis.
The moral basis for national health care is a very simple one. An analogy for this can be found in parenting. A father as a parent is responsible for taking care of his children. He provides the food and shelter for his children when his children are too young to do so. And so it is with a national government. A government acts in "loco parentis" or as a father of its citizens.
The economic basis for a government running a program can be illustrated with infrastructure examples.
There are several good examples of private funded versus government tax-funded projects to provide social, health and economic benefits to people. An early attempt in United States and Europe to provide safe drinking water to communities and cities occurred from 1800 to 1850. Private enterprises were unable to provide safe drinking water. Public distrust and alarm, and the deaths of many from water-borne diseases, forced the local governments to intercede and do what private enterprise could not. [ Colgrove, Ewbank, Flynn, Harper, McKeown, Patel, Quinn, Szreter ]
The reader needs to be cognizant that health of the public was a primary concern as increasing congestion in the urban environment heightened pollution of local water sources that resulted in the spread of typhoid, cholera and other water-borne diseases. Additionally, the provision of a city-wide water supply was important to many businesses and industries. Providing a safe water system became one of the most important ways that a city could demonstrate its commitment to economic growth. Industry needed healthy workers! This put pressure on local governments to provide a healthy environment for workers.
The shift of most cities, especially large ones, to put ownership of water systems as a public utility by the close of the 19th century was also motivated in part by negative experiences with private water suppliers. Private water companies “were notorious for choosing a water source that would minimize the initial investment outlay, and for ignoring the concomitant shortcomings in water quantity and quality.” Lacking incentives to complete ostensibly unprofitable projects, companies “preferred to lay their distributing pipes through the wealthier sections of the city and to hold back from carrying water into the poorer districts. Additionally, the public distrusted private companies when drinking water they supplied was unsafe and the supply unreliable. Private water companies were also more expensive than most municipal suppliers – by as much as 40% by the close of the century.
Government intervention: Protecting the general public from communicable diseases and providing a healthy work force to an expanding industrial economy: The government has stepped in, on numerous occassions, to resolve public benefit programs to ensure that services were provided without discrimination and at fair prices to masses of people in all areas of the country. Such government interventions became popular in resolving many infrastructures. Industry demanded that their workers be assured of staying healthy by having clean and safe drinking water. City governments realized that this could only be done by creating a public utility service; in other words, providing water as an infrastructure for a city and its residents. Public taxes subsidized urban public water and sewers, thus reducing mortality from waterborne diseases, improving the health of workers and providing a healthy work force. These were amenities that the private sector at that time was unable to do.
Public distrust of private companies during the early industrial expansion days fomented a public outcry for government intervention.
Supplying water to cities is not the only example of government intervention in subsidizing infrastructures. Railroads were another good example where the government, during the 1820-1900 era of booming industrial expansion, had to intervene in the private sector. The first railroad in United States, the Baltimore and Ohio, began running in 1827. Railroads, financed by private enterprise, expanded rapidly to transport freight and passengers. Fierce competition and political fighting among railroad monguls resulted in disruptive public services and railroad monopolies. Panariello: railroad history
Supplying electricity to the city of New York and surrounding areas in the 1920's likewise eventuated in public electric utilities. Building an electrical grid to transmit electricity has become a history of reoccurring blackouts and disputes. Our curent electrical grid to supply electricity to all sectors of the population and industry was built in the early 1920's. Although it is outdated and needs to be replaced with a "Smart Grid" current private utility corporations are reluctant to do so; primarily because of the enormous expenses in doing do. This presents a "who does it" dilemma for the government and utilities as the current grid cannot support an ever-increasing demand for electricity.
Then there is the Eisenhower super-highway building project that only the federal government could subsidize and build. [ Belleranti: birth interstate hyw Gold: New Grid system Panariello: railroad history The building of the first internet was an unknown and risky venture and was initially subsidized by the federal government. These are ample examples that illustrate the appropriateness of government to intervene when the private sector cannot take the risk.
Labelling national health care as socialized medicine is dispelled on the basis of moral and economic grounds. There has to be a central figure in overseeing the public good of a country. The private sector does not do this when it is motivated by making money. Government has a role in providing the spark for private enterpreneurs to participate in providing services to the public. Numerous infrastructure examples, mainly a safe water supply, are used to illustrate reasons why government intervention may be necessary. Today as in previous centuries, water must be seen to have economic value and not simply stand as a social good. This concept of a safe water supply having economic benefits needs to be transferred to thinking of national health care as being essential to providing a competitive edge to our industries and economy. What the private sector cannot do or unwilling to spend money on is left to the government to put in place! Government run programs have their flaws but related flaws are also found in the private commercial sector as well. There are no saints, only lesser evils!
A country is only as strong as its weakest link … the single citizen. It is essential for a country to provide opportunities for the majority of people and not just the few. The welfare of the masses is more important than that of just a few.
Belleranti Guy, "The 1950’s Birth of the Interstate Highway System," Rewind the Fifties. Belleranti: birth interstate hyw
Brink Susan & credit: Ed Stein, "Socialized medicine and the presidential race," Rocky Mountain News, April 17, 2008.
Colgrove James, "The McKeown Thesis: A Historical Controversy and Its Enduring Influence," Am J Public Health. 2002 May; 92(5): 725–729.
"The medical profession underwent a profound crisis of confidence in the 1970s, as advanced nations of the world, especially the United States and Great Britain, began to question large expenditures on sophisticated medical techniques that seemed to produce diminishing returns in quality of life. In contrast to the optimism and faith in medicine that had characterized the 1950s, the prevailing attitude toward the profession became one of cynicism, mistrust, and therapeutic nihilism."
Ewbank DC, Preston SH. Personal health behaviour and the decline in infant and child mortality in the United States, 1900–1930. In: What We Know About the Health Transition: The Cultural, Social, Behavioural Determinants of Health—Caldwell J, Findley S, Caldwell P, et al, eds. (1990) Canberra: Australia National University Press. 116–49.
Flynn Sean & Bourdouris Kathryn, "DEMOCRATISING THE REGULATION AND GOVERNANCE OF WATER IN THE US," RECLAIMING PUBLIC WATER: ACHIEVEMENTS, STRUGGLES AND VISIONS FROM AROUND THE WORLD, ŠJanuary 2005.
_______, "Health care reform in the United States," Health Reform USA
Harper, Sam, "Did clean water reduce black–white mortality inequalities in the United States? Water, Race, And Diseases," International Journal of Epidemiology.
Gold Jenny, "A Modern Electric Grid: The New Highway System?" NPR. April 27, 2009. Gold: New Grid system
McKeown T., The Modern Rise of Population, Academic Press, New York, 1976.
Morrison Bob, "High Speed Trolleys - 1: A Practical Solution for Today's Traffic Problems,"
Panariello Halina, "Social Studies: World History: Railroads of Asia, America, and Britain," Homework Help, May 07, 2009. Panariello: railroad history
Patel Kant & Rushefsky Mark E., The politics of public health in the United States, M.E.sharpe, December, 2005.
Porter Dorthy, Health, Civilization and the State: A History of Public Health from Ancient to Modern Times (Paperback)
"two key factors in the limited approach to public health reform in the United States: the public's distrust of the medical community and opposition by business leaders to expensive changes."
Quinn Timothy, Calif. Water Supply Crisis Affecting Economy,Water & Wastwater News, April 21, 2008. [ACWA Executive Director Timothy Quinn ]
"For the first time in a long time, California is losing income and jobs because our water supply system is in crisis," Water must be seen to have economic value and not simply stand as a social good.