Ezra Klein on socialized medicine
The words "socialized medicine" and"single-payer health care" getthrown around with such gleeful abandon that they've both become a bitunmoored from their actual meanings. In the American health-caredebate, they tend to refer to "whatever the Democrats are proposing."But that's not what they mean.
Socialized medicine is a system in which the government owns the means of providing medicine. Britain is an example of socialized system, as, in America, is the Veterans Health Administration.In a socialized system, the government employs the doctors and nurses,builds and owns the hospitals, and bargains for and purchases thetechnology. I have literally never heard a proposal for converting America to a socialized system of medicine. And I know a lot of liberals.
Single-payer health care is not socialized medicine. It's a system in which one institution purchasesall, or in reality, most, of the care. But the payer does not own thedoctors or the hospitals or the nurses or the MRI scanners. Medicareis an example of a mostly single-payer system, as is France. Both ofthese systems have private insurers to choose from, but the governmentis the dominant purchaser. (As an aside here, unlike in socializedmedicine, "single-payer health care" has nothing in particular to dowith the government. The state might be the single payer. But if Aetnamanaged to wrest 100 percent of the health insurance market, then itwould be the single payer. The term refers to market share, not federalcontrol.)
Socialized medicine is far outside any discussion we're having.Single-payer medicine has a genuine constituency but is also avanishingly unlikely outcome. But the promiscuous use of the terms hascreated a rather confused population. "Socialized medicine" is thething we don't have. In some case, it's the thing we don't like. Thegraph atop this post comes from a poll conducted by the Harvard School of Public Health. They found that Americans actually preferred socialized medicine to our system. Or take this question, about our current system:
You're reading that right. About 30 percent of Americans think HMOsare socialized medicine. Which implies a couple things. First, the term"socialized medicine" has been diluted beyond all meaning. Second, it'sno longer considered a terrifying outcome. And third, nothing that'sthis amorphous — and actually preferred by a plurality of thepopulation — is likely to prove a terribly effective attack againsthealth reform. Socialized medicine has become such a stand-in for "notthis system of medicine" that it's begun to look good in comparison.
Meanwhile, what we're actually going to get is not socializedmedicine or single-payer health care. It's a hybrid system. Privateinsurers, hopefully competing with a public option. Private doctors andprivate hospitals. Government regulation and subsidies. It's going tobe complicated and messy and inefficient and hopeful and the product ofa strange mix of corporate preferences and public compassion and latentpopulism. It will, in other words, be a uniquely American system, andhard to describe with a single epithet.