When President Harry Truman brought forward a proposal for national health insurance in 1945, he emphasized that this was only a financing mechanism, and that the delivery of health care would remain in the private sector's marketplace of hospitals, other facilities, physicians and other health professionals. As he said at the time:
Socialized medicine means that all doctors are employees of the Government. The American people want no such system. No such system is here proposed. (1)
But Dr. Morris Fishbein, then the president of the American Medical Association, quickly countered with this extreme reactionary overstatement:
[This] is the first step toward the regimentation of utilities, of industry, of finance, and eventually of labor itself. This is the kind of regimentation that led to totalitarianism in Germany and the downfall of that nation . . . no one will ever convince the physicians of America that the . . . bill is not socialized medicine. (2)
Since then, conservatives have repeatedly condemned any mention of national health insurance (NHI) as socialized medicine, as an intentional and uniformed way to block debate over the issue.
This myth is generally based on misunderstanding of what socialized medicine means. England is a good example of socialized medicine, with the government owning hospitals and other facilities and employing physicians and other health professionals. Despite some of its critics on this side of the border, Canada does not have socialized medicine, since its public, single-payer financing system is coupled with a private delivery system.
Our own Veterans Administration (VA) has already qualified for many years as an example of socialized medicine, with ownership by the government of facilities and employer of health professionals. There is no way that we would want to eliminate it on this basis, despite the attempts of many conservatives to privatize it. Privatization would bring less efficiency, higher costs, restricted services, and new overhead costs and profits, not improved health care for veterans.
In his 2011 book, The "S" Word: A Short History of an American Tradition . . . Socialism, John Nichols, Washington correspondent for The Nation magazine, brings this important insight:
This country, which was founded on a radical interpretation of enlightenment ideals, which advanced toward the realization of those ideals with an even more radical assault on the southern aristocracy, which was made more humane and responsible by the progressive reforms, the New and Fair Deals and the wars on poverty and inequality of the first three quarters of the twentieth century, is now tinkering around the edges of the challenges posed by the twenty-first century. Our dumbed-down debate is narrower, more constrained, and more meaningless than at any time in our history. One need not embrace socialism ideologically or practically to recognize that public-policy discussions ought to entertain a full range of ideas -- from right to left, not from far right to center right.
Historically, America welcomed that range of ideas, and benefited by the discourse. (3)
Since it was first introduced by presidential candidate Theodore Roosevelt in 1912, opponents of NHI have defeated it through recurrent bitter debates featured by demagoguery and disinformation. NHI was never on the table in the last go-around over health care reform that brought us the Affordable Care Act (ACA) in 2010, when powerful economic and political interests of the corporate medical industrial complex prevailed. As a result, what we now have is a government subsidized private insurance industry that largely calls the shots, loss of free choice of physician and hospital through narrow networks, no significant containment of prices or costs of health care, growing unaffordability of care for much of the population, consolidation of hospitals and other facilities with more market share and less competition, almost two-thirds of U. S. physicians employed by others (especially expanding hospital systems), increasing dissatisfaction and burnout of physicians dealing with the growing bureaucracy of some 1,300 private insurers, and corporate profiteering on the backs of patients, their families, and taxpayers.
NHI would bring us public financing tied to a private delivery system, not a government takeover as conservatives claim. So it is long overdue to ask these kinds of questions when opponents of NHI (Medicare for All) again trot out the claim that it is socialized medicine. Is it socialized medicine to:
- want health care to be available and affordable based on medical need, not ability to pay?
- believe that all Americans should have free choice of physician and hospital wherever they live?
- think that everyone should pay into the system based on a progressive tax system and ability to pay?
- replace the wasteful multi-payer, for profit financing system with a simplified, not-for-profit single-payer system that will cost 95 percent of Americans less than they already pay for health insurance and actual care?
- want the most efficient and least bureaucratic system possible?
- want a large risk pool -- our entire population -- that most effectively shares risk for whatever health care all of us will need?
- combat health care fraud by close oversight and stewardship of taxpayer dollars?
- expect that health care services that are provided have been found to be effective and cost-effective by the best available scientific evidence?
- accept health care as an essential human right, as most industrialized countries have long recognized, as well as the United Nations since 1948 and the World Health Organization in later years?
If NHI were to be decided upon through a democratic process, instead of through the political power and lobbying of corporate stakeholders in the status quo, we would have had it long ago. We have seen majority support for NHI based on public surveys for some 50 years. As one recent example, a national Gallup poll two months ago found that 58 percent of more than 1,500 adult U. S. respondents favored Bernie Sanders' federally-funded Medicare for All proposal; that number included 73 percent of Democrats/Leaners and 41 percent of Republicans/Leaners. A Kaiser poll in December, 2015, also found that 58 percent of Americans want NHI, compared to just 40 percent favoring the ACA. (4) Another recent Kaiser survey found that 54 percent of enrollees in the ACA's individual plans rate their coverage as "only fair" or "poor", while almost one-half are dissatisfied with their plans' annual deductibles. (5) As for physician support for NHI, a 2008 national survey of more than 2,200 U. S. physicians in all specialties found that 59 percent support NHI. (6)
The November elections give us an important opportunity to move toward real health care reform. Hillary Clinton once believed that the momentum for single-payer would sweep the country, as she said to a group at Lehman Brothers Health Corporation in 1994 before the Clinton Health Plan died in a congressional committee:
If there is not health care reform this year, and if, for whatever reason, the Congress doesn't pass health care reform . . . I believe that by the year 2000 we will have a single payer system. . . I don't even think it's a close call politically. I think that the momentum for a single payer system will sweep the country . . . it will be such a huge popular issue . . . that even if it's not successful the first time, it will eventually be.(7)
We need to hold her to her words since she tells us how much she knows about health care in this country. This will require her to move farther left than the current Democratic platform and endorse single-payer NHI as a part of her Party's platform. She talks support for universal access, which the ACA will never accomplish. Now is the time for her to walk the walk.
John Geyman, M.D. is the author of The Human Face of ObamaCare: Promises vs. Reality and What Comes Next and How Obamacare is Unsustainable: Why We Need a Single-Payer Solution For All Americans
1. Truman, HS. Special Message to the Congress Recommending a Comprehensive Health Program, November 19, 1945.
2. Fishbein, M. As quoted in "Fishbein assails new health plan, Truman's national program condemned as 'socialized medicine' at its worst." New York Times, November 19, 1945.
3. Nichols, J. The "S" Word: A Short History of an American Tradition . . . Socialism. London. Verso, 2011, p. 260.
4. Healthcare-NOW! Republican support for single-payer. May 16, 20126.
5. Hamel, L, Firth, J, Levitt, L et al. Survey of non-group health insurance enrollees, Wave 3. Kaiser Family Foundation, May 20, 2016.
6. Carroll, AE, Ackermann, RT. Support for national health insurance among U. S. physicians: five years later. Ann Intern Med 1481: 566-567, 2008.
7. Clinton, H. speaking to a group at Lehman Brothers Health Corporation, June 15, 1994, as reported by Health Care for All-WA Newsletter, Winter 2015, p. 9.