This will be a pretty short one. First, health care reform proposals that offer a “public option” alternative do not provide “socialized medicine.” That is, all medical care in such proposed systems would be provided by private sector Doctors, hospitals, and other other health care institutions. Government in such a plan doesn’t do any medicine. The only thing it does is give people an opportunity to buy insurance from a public agency. Charges from the right that this is “socialized medicine” are just attempts to use “scary” labels to prevent efforts to bring insurance companies under control. The worst you can say about them is that they provide a “socialized” insurance option, but not that they provide “socialized medicine.” It’s time everyone recognized the distinction between the two. Most of the health care systems in the world that work better than ours are “socialized insurance systems,” not “socialized medicine systems.”
Now, why would one want to have “socialized insurance”? Simply because the market system in the insurance industry is broken. It works to ration health care, to deny the insured services based on technicalities, and it is monopolistic so that competition doesn’t work to reduce prices and control costs. In other words, there is no market in the classical sense of a supply and demand system. There is only a group of very large companies that administer prices and extract profits from consumers. A “socialized insurance” system can stop the profit extraction and administer prices in such a way as to bring health care costs under control. Provided that the system is adequately funded, it can greatly reduce the rationing that exists in the system now, and would serve people better, as we can already see from the way systems like this have worked in other nations. In short, “socialized insurance” is a fix for a broken insurance market that for reasons made clear by Paul Krugman, can never be fixed.
Second, the distinction between “socialized insurance” and “socialized medicine,” applies just as well to single payer plans, the systems that Republicans have been attacking as “socialized medicine” since the days of Franklin Roosevelt and Harry Truman. Single payer systems are not “socialized medicine.” To call them that is to lie about them. They involve no Government medicine, only Government funding of health care services. The are “socialized insurance,” not “socialized medicine.” So, in closing, let me quote the GOPs favorite current oracle. “How ’bout ya quit making things up.”
1 response so far ↓
1 Henk Hadders // Jul 30, 2009 at 6:48 am
Joe,
I liked your advice to Obama to visit Canada and France; those are certainly places to learn something about healthcare. However I don’t think that there exists a general or global consensus about the question how healthcare can best be delivered. Medical technology has no boundaries, but the organization of healthcare has. The comparison of healthcare systems is far from easy due to differences in cultural, social and political structures, the lack of sufficient reliable and detailed information and the lack of uniformity in professions as well. Nevertheless despite the differences in systems, reforms in healthcare have the same convergence goal, namely to increase macro- and micro efficiency with as precondition a basis of equal and fair access of care for all citizens. And mostly added are the importance of prevention and the quality of care. This convergence goal creates tensions all over. Tensions which basically can be reduced to differences between countries regarding the distinction in collective versus individual responsibility with as their pendants the merits of state regulation versus regulations by the market.
Personally I think that Americans and Europeans can’t be wrong all the time regarding healthcare; so there must be something good in both systems. Personally I think we are in an evolutionary process in which a new kind of healthcare and medicine is emerging, which transcends and includes both systems. We need more inclusive thinking and acting. Europe needs more market elements in their systems (encapsulated competition) and the US needs more state regulations (which is also true for their financial sector). I think healthcare and medicine will eventually move from modern to postmodern to integral, or using the colors of Beck and Cowan in their Spiral Dynamics theory it has to move from orange to green (and from there even further to yellow). The modern rational scientific US healthcare sector is orange, while in Europe we are struggling to become green and more social pluralistic. Obama should look for a postmodern healthcare and medicine in the US.
R.B. Saltman (European Journal of Public Health Volume 4, 1994, no 4, page. 287-293) once developed a conceptual framework to plot reform measures. Against the background of its goals, reforms in healthcare can be described in terms of their influence on three, dynamic interdependent basic components of each healthcare system. The first is the financing of healthcare by taxation, social insurance, private insurance or own payments based on own risks or contributions. The second component is the delivery of care which has many varieties, which can be partly summarized with the difference between “public” and “private” and “for profit” and “non for profit”. The third element are the allocation mechanisms.
The role of market elements might be successful in the delivery or ‘production’ side and the allocation mechanisms. But as Saltman noticed “Thus far, no one has succeeded in structuring a competition-based market on the finance side of their system for their entire population while still maintaining a commitment to universal access to equal services. The only convincing evidence to suggest that a satisfactory “universal” finance-side market is possible exists in the realm of economic theory rather than real-world practice”
I fully agree with the things you said in your post. This whole US operation is about financing healthcare and dealing with budgetary problems. It is not about state run medical practices. I find the term “socialized medicine” rather silly. At first glance one might think that McCarthy is back in the US, chasing communist doctors. Here the term “medicine” is used for the primary process in healthcare, which is simply a situation where two people meet and one is helping the other. It is not about “the doctor knows best” nor about “the patient is King”; it is about a dialogue where the patient defines the problems and goals and the professional selects the right treatment (this isn’t socialism, this is professionalism). One of the cornerstones in the organization of Dutch healthcare are private (non profit) organizations performing a public task. We have to be very cautious to keep the delivery of healthcare in private hands.
For me an issue really missing in all these discussions is: “green healthcare” and “green medicine”. Modern healthcare and medicine are not sustainable and not inclusive; it needs to shift its focus not only on creating health for patients, but also for doctors, communities and the environment. The US has some leading organizations in the world advocating for sustainable healthcare, like Teleosis, Practice Greenhealth, Healthcare without Harm, Physicians for Social Responsibility etcetc. But these also are not heard, as the financial sector just continues to threaten our financial and economic health. Business as usual… again.
We really need to develop to a next level of moral intelligence (from “I”, and “We” to “All of Us” or from egocentric and ethnocentric to a worldcentric point of view). And now is the time.
Henk