Socialized Medicine

This might be a bit late to help my daughter’s research, but today’s article is on Health Insurance; a review and a discussion about the arguments often given against “socialized medicine.”

First, a little background to establish credibility. I have worked in the health insurance industry, and, as a tendency I often show, that resulted in my extensive study of how most other countries on Earth handle this universal issue. Also, I have lived under the National Health of Great Britain for almost 5 years of my life, during the time period when it was at its worst; when strikes and shrinking budgets badly damaged care.

From a review of the news, I can tell that there is a fundamental misunderstanding of medical care and insurance in this country. As a recent example, a friend lost her job, and asked me where to go online to signup for Obamacare. I asked her her primary news outlet, and then explained to her the reality. I once saw a photo of a man holding a sign that said “Keep Your Damn Government Hands Off My Medicare” and I really had to laugh.

First, a very simplified discussion of health insurance. In a nutshell, insurance companies negotiate with medical providers (doctors, hospitals, etc.) for a set of provided medical services and establish what they will pay for those services. This can be on an annual or multi-year arrangement. Customers and or their employers pay premiums to the insurance company to gain access to those medical providers at the prices negotiated. The customers may or may not have additional fees (“co-pays”) for care or prescriptions. Not all medical providers will agree to the terms, and they are termed “out of network providers.” Also, the insurance company will not pay for every type of medical care, and there can be “out of pocket expenses.” Sometimes, there are caps on how much medical care you can receive in a single year, or a limit on how much out of pocket expenses an individual or family pays in a year.

Most of the best plans today include basic care “for free” and a three tier prescription cost list.

At its most basic, a capitalist economy produces goods and services with the expectation of making a profit. In a socialist economy, goods and services can also be produced for a profit, but may also be provided for the common good. Most economies on earth today are a mix of these two ideas, to one degree or another.

Now, the original meaning of “Socialized medicine” was one in which the government operated the medical facilities and employed the medical providers as government employees. In the United States, The Veterans’ Administration, the medical departments of the various Military Services and the Indian Health Service are examples of these. For this article, I shall call this Type A.

(Yes, if you have ever served as, or been treated by, a military medic or corpsman, you have participated in socialized medicine.)

In very recent years, the term has been extended to any publicly funded health system, in which the government pays the fees to non-government health providers. In the United States, Medicare, Tricare, Medicaid, and TennCare are examples of these types of programs. This shall be called Type B.

A socialized medical system was first proposed in the United States by Republican President Theodore Roosevelt, based on the successes of the then German Empire. The arguments at that time were a reduction in the outbreak of plagues, rapid advancement in medical knowledge, and an improved quality of life for all citizens. Its was opposed on the ideas of high implementation costs and loss of income by doctors.

President Franklin Roosevelt also tried and failed during the New Deal, and President Truman tried during his Fair Deal. This would have been the time where socialized medicine would have been easiest to implement. The United States had just emerged from the Second World War. Almost the entire population had participated in the war effort, and had grown used to large government projects and edicts. Millions had served in the military and government jobs. It would have been an easier and more widely accepted transition. However, the American Medical Association, once again fearing the loss of doctor income, launched a campaign to stop it. Their main argument at the time played on the fears of the population of the Red Scare, labeling socialized medicine as “commie” and “undermining democracy”. (Of course, that means that the 16 million Americans who served during the war as soldiers did so under a commie health care system. The Reds are everywhere! Insert Evil Laughter here).

And there the argument has remained for almost 70 years. It is Commie and Undermines Democracy. Those are the root reasons for opposition to socialized healthcare, with some additional points used to add weight. These points are the next part of this discussion.

One of the most common arguments is Cost of Implementation. This is one of the oldest arguments, and can actually be applied to end any and all projects of any kind. However, it is an up front cost, and measured against the decades of costs of not doing it, it is an argument that fails upon review. As a non-medical example, the USS John F Kennedy CV-67 was built as a conventional aircraft carrier instead of nuclear like others at the time. The excuse was that it would save on upfront costs. Unfortunately, the vessel consumed its entire initial cost every two years in fuel alone, which means 20 times higher over its service life. A really bad idea.

The next is Cost of Care. This is usually stated without real evidence, because there is not any. Examination of the data shows that costs in the United States are higher than in compatible nations due to high salaries (to compensate for high education costs), a complex payment system, fee for service instead of fee for care, and diversified systems leading to more administration costs. If you have ever had to learn the medical coding for a variety of insurance companies, you can sympathize with this last part.

The next is Quality of Care. Again, this is usually stated without much supporting data, usually with an “everything is better in America” bias. The World Health Organization maintains information of health care around the world, and finds the United States better than most, and worse than about two dozen countries. The growing industry of medical tourism, in which people travel to other countries for treatment, seems to go against this. As another example, Israel sends its “second tier” medical students to the United States to learn, since they were not good enough to gain entry to Israeli universities.

Access to Care is also used. However, since the main objective of socialized medicine is universal access to health care, saying that it somehow limits access to care is foolish. I recently participated in a free medical clinic for those who did not have access to healthcare in Columbia, TN. People came form hundreds of miles to get care.

Rationing of Care. This argument has been popular since it was brought up in the 2008 presidential election. The fear of “death panels” was used to garner votes and support. Also, a handful of publicized cases of Canadians getting service in the United States are pointed to. The mention of long lists of patients waiting for surgery in other countries is a popular adage. As stated above, ALL insurance companies already limit what care you can and cannot receive, so panels are not new. Just spend a year going to out of network doctors and getting uncovered care and tell me how that works out for you. Most Canadians who receive care in the United States were already here on a visit, or they come for care that they did not wish to have included in their official medical files, such as abortions, mental health treatment, or substance abuse treatment. With the ever growing number of Americans going overseas for treatment, perhaps this argument should not be used. As for the lists, most socialized countries maintain national lists of everyone needing a particular type of surgery. It is a ratio of skilled doctors and needed resources versus those in need that cause the length. There is nowhere in the United States where you can find the exact number of people needing a particular surgery, since such records are not kept. There are waiting lists here, but they are incomplete. The single largest limiting factor in US health treatment is out of pocket expense, and many people do not seek medical treatment simply because they cannot afford it.

Higher taxes to pay for costs are also used, but again the evidence is not there. When compared to total taxes and overall health care costs, the expense in socialized countries is either compatible or lower.

Certain groups of Americans love to bash the British National Health Service. This is usually an Argument from Ignorance, since they have never experienced it. The NHS emerged from a war-torn Britain, devastated by decades of rationing and war. The Empire was disappearing fast, and British soldiers fought another twenty years in a futile attempt to hold on to colonies who hated them. In July 1945, the British public overwhelmingly voted out Winston Churchill and his Conservative government in one of the largest electoral changes in history. The war was over, and people wanted to have a new quality of life.

It is very true that socialism saved Western Europe from communism. If the powers that be had tried to stick to the Old Ways, all of Europe would have gladly voted in communist governments. (Only a rigged election in 1948 kept it out of Italy.) People wanted a new emphasis on them as something other than work units. National Health was a first step along that road. If you wish to see the early days of the NHS, I suggest to you the TV series “Call the Midwife.” It is a very accurate representation of the challenges and successes it faced.

My grandmother did have to once sleep on paper sheets in a hospital in the 1970s because all of the cleaning staff were on strike. But at the same time, no one in England has ever gone bankrupt due to medical costs either under NHS. I once had to get an allergy shot with a reused needle (cleaned in iodine), but they have more resources now. And people no longer have teeth like Austin Powers, since dental is at least partially covered by government expense, and some by co-pay.

Most industrialized nations have some form of socialized healthcare, often with additional private doctors and hospitals available to those who wish to pay. Germany has over 200 insurance companies, so a loss of income to them is no excuse. Doctors in other countries do often have lower salaries, but this is usually balanced against free or low cost education. Tiered medical expenses or free care prevent families from choosing between losing everything or a cherished family member. They do have their challenges, but so does everyone.

If you think about it as a closed system, you share a Type B relationship with your own insurance company; they pay your medical providers but don’t usually employ them.

Our health care in the United States is already a mix of private and public medical systems. It is ironic how many of those who oppose “socialized medicine” are themselves living on some type of government supported health insurance or have it heavily subsidized by their employers. You do not have to accept Medicare; you can find private insurance who will cover you, but with an expectation of higher cost for less coverage. If you are wealthy enough, you can even forgo insurance all together. This happened with Rush Limbaugh during his famous “doctor shopping” incident, when he convinced 4 doctors that they were his “only” physician, and then chose a number of different pharmacies that did not link their computer medical records together in an attempt to obtain thousands of pain killers illegally. Generally speaking, if you can afford insurance, you should get it to save costs.

Health care debate in this country has a long road ahead, with the advocates of Care and the advocates of Cost in opposition. It is impossible to see where it leads. I hope that this post will spur you on to further research of your own.

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