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The American Heritage Dictionary (4th ed., 2001) defines socialized medicine as “a system for providing medical and hospital care for all at a nominal cost by means of government regulation.” This leaves room for considerable craftsmanship in the construction of socialist systems. Indeed existing socialized medical systems in, for example, Great Britain, Cuba, Finland, and Switzerland conform to this definition, but are far from monolithic.
Because every aspect of a socialized health care industry is controlled and provided by the government—most doctors, nurses, medics, and administrators are government employees—the system, such as the National Health Service (NHS) in Britain, determines where, when, and how services are provided. Of course citizens may seek care outside the system, in the private sector.
Socialized medical systems are designed to eliminate the insurance industry and marginalize profit while providing health care for all. According to many recent studies, socialized systems outperform free-market profit-driven systems in terms of availability, quality, and cost of care. In addition a report from the Johns Hopkins University Bloomberg School of Public Health stated that the United Kingdom’s socialized medical system outperforms the U.S. system in patient-reported perceptions (Blendon, Schoen, DesRoches, et al. 2003). In other words, the people with direct experiences report greater satisfaction with their health services under a socialized system than they do in a free-market system. These results must be considered along with the fact that the U.S. per capita health care expenditures ($4,887) are nearly triple those in the United Kingdom ($1,992). In the year 2000 the United States spent 44 percent more on health care than Switzerland, the nation with the next highest per capita health care costs. Nevertheless, Americans had fewer physician visits, and hospital stays were shorter compared with those in most other industrialized nations. The study suggests that the difference in spending is caused mostly by higher prices for health care goods and services in the United States.
The British system is probably the most instructive example for Americans to evaluate because of the similarities in economy and government structure between the two nations. According to the NHS Web site, the system “was set up on the 5th July 1948 to provide healthcare for all citizens, based on need, not the ability to pay” (National Health Service 2007). Originally conceived as a response to the massive casualties of World War II (1939–1945), the system survives and continues to evolve in the early twenty-first century. The NHS is funded by taxpayers and managed by the Department of Health, which sets overall policy on health issues. Individual patients are assigned a primary care center (with doctors, dentists, optician, pharmacist, and a walk-in center) managed by a primary care trust (PCT). The NHS explains its system of referrals this way: “If a health problem cannot be sorted out through primary care, or there is an emergency, the next stop is hospital. If you need hospital treatment, a general practitioner will normally arrange it for you” (National Health Service 2007).
The PCTs are responsible for planning secondary care. They look at the health needs of the local community and develop plans to set priorities locally. They then decide which secondary care services to commission to meet people’s needs and work closely with the providers of the secondary care services to agree about delivering those services.
The NHS may be the world’s most sophisticated socialized medical system, but the modern world’s first such system was established by the former Soviet Union in the 1920s. Whereas the NHS demonstrates that socialized medicine can exist within a capitalist economy, the failures of Soviet medicine demonstrated how corruption within a society can distort any system. China, Cuba, Sweden, and most of Scandinavia have successful and completely socialized health care systems.
Life expectancy and infant mortality rates are two of the best indicators of overall health. Average life expectancy in Great Britain was 77.4 years in 1998; in comparison, life expectancy for the U.S. population reached 76.9 years in 2000. Infant mortality in Finland is below 4 percent; in the United States it is 7 percent. Health services are available to all in Finland, regardless of their financial situations.
Single-payer systems such as Medicare are not socialized medicine. In socialized systems the government owns, operates, and provides every aspect of the health care services. Although it is true that in a single-payer system the government collects and disperses the capital for services rendered, its decision-making responsibilities end there. Even without socialized medicine’s additional powers to limit corporate profits, studies by the U.S. General Accounting Office and the Congressional Budget Office show that single-payer universal health care would save $100 to $200 billion dollars per year while covering every currently uninsured American and increasing health care benefits to those already insured (U.S. Government Accounting Office 1991; Congressional Budget Office 1993).
Outside of the United States, health care in the twenty-first century is increasingly seen as a basic human right that deserves to be protected and provided at an affordable fee to all citizens of civilized societies. This idea—that medical procedures and health care in general should not be subject to or motivated by market forces— is one that, in the late twentieth century, evolved back into favor only after repeated experiments with the capitalization of health care led to systematic and catastrophic failures, resulting in grotesque profits on the supply side contrasted with the suffering of millions of disenfranchised patients on the demand side of the equation. Socialized medicine is an egalitarian system that addresses these iniquities.
- Anderson, Gerard, and Peter Hussey. Comparing Health System Performance in OECD Countries. Health Affairs 20 (3): 219–232.
- Blendon, Robert , Cathy Schoen, Catherine DesRoches, et al. 2003. Common Concerns amid Diverse Systems: Health Care Experiences in Five Countries. Health Affairs 22 (3): 106–121.
- Congressional Budget O 1993. Single-Payer and All-Payer Insurance Systems Using Medicare’s Payment Rates. Washington, DC: Author.
- U. S. Government Accounting Office. Canadian Health Insurance: Lessons for the United States. Document GAO/HRD-91-90. Washington, DC: Author.
- Woolhandeler, Steffie, and David H 1991. The Deteriorating Administrative Efficiency of the U.S. Health Care System. New England Journal of Medicine 324: 1253–1258.
- World Health O 2000. The World Health Report 2000: Health Systems Improving Performance. Geneva: Author.
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