Last week The Washington Post ran a good opinion piece by Ezekiel J. Emanuel, Director of the Clinical Bioethics Department at NIH (and brother of Congressman Rahm Emanuel) on the insidiousness of labeling any and all positions on health care apart from free market fundamentalism as being “socialized” medicine, doomed to failure.
Emanuel notes that “ ‘socialized medicine’ is when the doctors are state employees; when the hospitals, drugstores, home health agencies and other facilities are owned and controlled by the government…” As Emanuel rightly points out, none of the universal coverage proposals being debated in the U.S. today “can be characterized as socialized medicine. None calls for government ownership or control over U.S. hospitals, drugstores or home health agencies, or for making doctors employees of the federal or state governments.”
This is right on the money—maybe even more so than Emanuel intends. Opponents of “socialized” medicine are wrong three times over: not only do most reformers not want socialized medicine, but even European health care systems (often used as examples of socialized medicine) do not meet the criteria outlined above. Further, publicly-run health care carries with it some significant benefits that are evident right here in the U.S.
To dispel the myth of monolithic government-run European health care, look no further than Germany, where most of the population (88%) receives health care through “sickness funds"–non-profit, third-party pools of money devoted to health services. Sickness funds are built on the principle of “subsidized self-governance”: they receive public funding, but the funds must be financially self-sufficient (i.e. be able to govern themselves) and also allow a high degree of freedom on the part of patients and doctors (the former can choose their doctors and hospitals, and the latter have much flexibility in treatments).
Since the mid 1990s, there has been open-enrollment in sickness funds,
meaning anyone can pick any fund they want, with the intent being to
increase competition between the funds. Unable to make it in the new
marketplace, the number of sickness funds has plummeted, from over
1,000 in 1993 to about 250 today. Does this sound like socialism to you?
Other countries are similarly nuanced in their approach to health
care. When critics of health care reform refer to European health care
systems as “socialized” medicine, they seek to disrupt a potentially
productive dialogue about reform options.
In the meantime, if you really want to talk about a system that is
truly “socialized,” you’ll find it right here in the U.S in the
veterans’ health-care system, which is wholly owned and operated by the
federal government–much to the delight of its patients.
As Emanuel puts it, “veterans love the [VA] system and vigorously
oppose any suggestions of dismantling it and integrating them into
civilian health care. By many measures, this bastion of socialized
medicine may constitute the highest-quality and most efficient part of
American health care.”
The conversation-stopping phrase of “socialized medicine” distorts the
potential success of publicly-run health services like the VA. But it’s not just veterans that benefit from a public health services: across the nation, public hospitals provide the
essential care that other types of hospitals don’t—often for the
neediest patients.
A 2005 Health Affairs study (subscription required) showed that
(surprise, surprise), “for-profits are most likely to offer relatively
profitable medical services; government hospitals are most likely to
offer relatively unprofitable services; nonprofits often fall in the
middle.” Profitable services included (among others) sports medicine,
orthopedic surgeries, and fitness centers. Unprofitable services
include any and all services related to AIDS and alcohol, burn centers,
trauma centers, and emergency rooms—all fundamental, must-have stuff.
As the study shows, there is growing division of labor across hospitals
that contours to the public/non-profit/private spectrum, with the more
public institutions responsible for crises and the more private ones
taking on ‘sure bets,’ i.e. more predictable (and thus financially
reliable) services.
Worse still, it’s not just economically risky services that are in
question, but also risky patients. Also in 2005, the SUNY Downstate
Medical Center released a report which concluded that across the nation
“public hospitals appear to care for more seriously ill patients.” The
study concluded this fact because “public hospitals continued to have a
longer average length of stay overall and for Medicaid patients in both
cities and suburbs, compared to for-profit and non-profit hospitals,
which suggests that they are caring for relatively sicker, and thus
more costly patients.”
Public hospitals are doing the heavy-lifting of medical care—and not
just in terms of health. According to the SUNY study, “Medicaid
patients continue to make up a much larger percentage of total
admissions (31.1% in 2002) for public hospitals, compared with
for-profit (19.8%) and non-profit (18%) hospitals…” Public hospitals
are taking on the sick and the poor.
For those—most of us, I think—who see hospitals as being the
fundamental keystone of the safety net (rather than purveyors of the
newest bells and whistles of modern medicine), public hospitals are not harbingers of socialism but rather the true workhorses of our health
system.
Unfortunately, the SUNY report also noted that public hospitals are on
the decline: “more public hospitals were lost between 1996 and 2002
(16% in cities and 27% in suburbs) than for-profit (11% in cities and
11% in suburbs) and non-profit hospitals (11% in cities and 2% in
suburbs).” That means that more institutions likely to provide
essential care to the sickest Americans are being lost to communities.
The more we hear about socialized medicine, the easier it is to lose
sight of the fact that public hospitals are taking care of those who
need care the most, even as their numbers dwindle. Invoking the specter
of socialism makes rallying for these struggling, and much-needed,
institutions a more difficult proposition—after all, socialism is among the most potent bogey-men in American political culture.
But if
we abandon our commitment to public hospitals—or to rethinking the
growing role of for-profit and private hospitals in medical
services—the most vulnerable among us will pay the price.
THANKS MAGGIE!
Rudy Giuliani especially is guilty of jingoism when he CONSTANTLY uses the term “socialized medicine”.
I’m so sick of it!
He is beginning to sound more like the late Sen. Joseph McCarthy than a credible contemporary 21st century politician who dares to run for president of our broken nation.
His handlers ought to muzzle him soon on that worn out inaccurate (as you Maggie point out in your good blogpost above) jingoistic phrase “socialized medicine”
Enough already Rudy!
Dr. Rick Lippin
Southampton, Pa
I agree with the last comment: Hurrah to author Mahar! It’s too bad that so many conservative campaigns whip up the bogeyman of socialism.
As Mahar essentially says, it’s not necessary to be a socialist to support the pro-private insurance insurance programs most Democrats are proposing for national health care.
But to change the subject to a different conservative campaign: Have you heard about stalking against whistleblowers, liberals and the left? David Lawson, private investigator, infiltrated STALKing groups for 12 years and proves they exist to mimic life’s little hardships. This is low-level warfare against liberals. If you think you get more than your share of life’s catastrophes, this might not be an accident. Please see http://www.raven1.net to read more about STALKing!
“veterans love the [VA] system and vigorously oppose any suggestions of dismantling it …”
Of course they love it … its free! You and I foot the bill.
“… highest-quality and most efficient part of American health care.”??
How could we know? They have no competition. Put them on equal footing with the nearest private service and lets see what would happen.
Oh My God! The famed “VA Health Care System.”
The VA is the most godforsaken POS ever created by Man.
I’m a US veteran who long ago saw the lie for what it was. You would like an appointment to see a doctor? How about August 3, 2045? The gall bladder might need to be removed? Well, your VA hospital doesn’t do that anymore, could you drive from Orlando to Los Angeles for the surgery?
Don’t believe me? Just read the past 12 issues of the American Legion magazine /www.legion.org/ or Veterans of Foreign Wars magazine /www.vfw.org/.
Month after month after month after depressing month of documented FACTS of injured combat veterans being “put on hold” for YEARS waiting for treatment.
Last and certainly not least….Walter Reed Army Hospital.
If you think this is the pinnacle of health care, we are all DOOOOOOMED!
BobMan and Stephen,
Take a look at some of Maggie’s previous work on the VA (for example, at http://www.thehealthcareblog.com/the_health_care_blog/2006/06/tech_the_va_and.html ) for some info on how it matches up to the private sector.
Also keep in mind that the point of my post here isn’t really that the VA is so great, but rather that “socialized medicine” is a disingenuous term–in part because it ignores the fact that public hospitals serve an essential function in our society. The way I see it, those who would vilify any and all public health care need to account for the fact that public health care helps the neediest Americans before breaking out the rhetoric. Thanks for your thoughts.
Based on their belief that all people are equal and should enjoy equal social, political, and economic rights and opportunities, the Democratic Party leadership has assumed that people ought to have provided for them by the federal government free access to health care. Niko Karvounis supports this campaign and would like to strike the phrase “socialized medicine” from the discussion because it casts too bright a light on the transposing of those words “rights” and “opportunities” into “privilege” and “entitlement.” It’s not going to work Niko. Mrs. Clinton’s plan (where all of this will end up) looks, walks, and quacks, like socialized medicine by any standard source definition you care to use. So, I invite you to cast off your attempt at disguising your intentions as things they are not and discuss the plane and simple merits of socialism vs. capitalism in the context of the future health care marketplace. And please, spare us the alarmist rhetoric. Everything human is in disorder. Change, better put as “the need for change,” is a constant.
Sir:
Nearly everyone agrees that U.S. health care is FUBAR. Nearly everyone is trying to fix the problems.
To those who attempt to minimize the financial and accountability issues involved with public hospitals, consider this —
http://www.signonsandiego.com/news/health/20061106-1935-cnshospital.html
The public knows what is going on. No amount of Clintonian triangulation can cover-up a King-Harbor, which received an enormous amount of public resources.
Niko,
Don’t take my word for it, the Happy Hospitalist has a blog on the wonderful VA system. He quotes a 100% disabled service-connected veteran about his experience with the VA.
http://thehappyhospitalist.blogspot.com/2008/01/va-medicine-from-one-patients.html
That old soldier is truly a needy and deserving citizen, having earned his due the hard way. Our “compassionate” public health system just pisses on him like a dog.
What’s worse is he is just one of millions.
The truth about public (government owned) hospitals is that they are cesspools where the poor and stupid go to die. Just keep them out of sight.
I’ll pile on to Russ’ comment and add Grady hospital in Atlanta, GA. It, too, is a government owned money-suck that couldn’t put a band-aid on a 5 year old. It is bankrupt, the utilities are in court trying to get permission to cut service, suppliers are in court demanding payment, and payroll checks bounced in November and December! The locals are trying to keep the doors open. How? Sell the place to the private sector. : – ) Just go to ajc.com and search on “Grady”.
BTW, when will you and Maggie drop the “progessive” BS and proudly call yourselves what you are, namely: Communists?
I am a nurse and I have worked in med/surg for several years now. I have a friend who goes to the VA for treatment and the hospital I work at. I have also talked to many VA patients who are sick at my hospital who have been my patients. They have one thing in common to say about the VA: Don’t bother with it because it is a system that does not care about you. They have nothing but bad things to say about the VA healthcare system here in Ohio.
I really enjoy reading this blog. I have put together a website on health reform that touches on many of the issues on this site. I would love for any or all of you to visit and both enjoy its content and let me know what you think.
The ads for all visits go to charity to fight Ulcerative Colitis too!
http://www.satvathealthcare.com
Best,
Amir
Thanks in advance.
Nice post