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Akron Univ. School of Law

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Thursday, March 27, 2008

Socialized Medicine

The Washington Post's Jacob Hacker has an interesting piece on socialized medicine and how it might be time to retire the fear that the word generates.  He writes,

"Socialized medicine" is the bogeyman that just won't die. The epithet has been hurled at every national health plan since the New Deal -- even Medicare, which critics warned would strip Americans of their freedom.

And now it's back. Republicans from President Bush on down have invoked the specter of socialism in denouncing Democrats' attempts to expand publicly funded health insurance for children. Erstwhile GOP presidential contenders Rudy Giuliani and Mitt Romney lambasted the health plans of the leading Democratic candidates for mimicking "the socialist solution they have in Europe" (Giuliani) and trying to impose "a European-style socialized medicine plan" (Romney). The presumptive Republican nominee, Sen. John McCain, hasn't used the S-word yet, but after sewing up the nomination in early March, he criticized Democrats for intending "to return to the failed, big-government mandates of the '60s and '70s to address problems such as the lack of health-care insurance for some Americans."

Never mind that nobody is proposing to turn doctors into public employees and hospitals into government institutions -- the literal meaning of socialized medicine. The slogan gets its punch because it invokes a visceral public fear: that government involvement will drive up costs and drive down quality, wrecking the economy and damaging your health. Expanding government's role, the naysayers insist, will destroy what McCain calls "the world's best medical care."

But the critics have it backward. The best American medical care is indeed extremely good, but much of our system falls short -- especially when you consider how costly it is, how heavy a burden it places on employers and families, and how many it excludes. And far from being a threat, getting the government more involved in health care would actually reduce costs, improve quality and bolster the U.S. economy -- which helps explain why public insurance is the secret weapon in both of the leading Democratic candidates' plans. If socialized medicine means doing what our public-insurance programs and other nations' health systems do to control costs, expand coverage and improve the quality of care, it's high time for a little socialization.

To see the advantages of public insurance, just look at the program that once prompted the fiercest charges of socialized medicine, Medicare. Since the introduction of cost controls in the 1980s, Medicare's expenditures have grown at a substantially slower rate than spending on private insurance, according to a recent analysis by the health-care experts Cristina Boccuti and Marilyn Moon. And despite Medicare's comparative frugality, the program's beneficiaries express greater happiness with their coverage than do privately insured patients in surveys of consumer satisfaction. . . .

Indeed, by some measures, U.S. health care looks downright lousy. A six-country study by researchers at the Commonwealth Fund, a health-care think tank with a generally liberal bent, concludes that the United States "scores particularly poorly on its ability to promote healthy lives, and on the provision of care that is safe and coordinated." Meanwhile, a recent analysis of 19 rich nations by Ellen Nolte and C. Martin McKee of the London School of Hygiene and Tropical Medicine found that the United States has the highest rate of "amenable mortality" before age 75 (the odd term of art for deaths that could have been prevented with timely care) -- and that we're falling farther behind. . . .

It's time, in other words, to embrace a government role in health care, rather than run from it. . . .  That's wise, because the only proven way to provide good affordable care to all Americans over the long run is to expand public insurance.

Don't take my word for it. The Lewin Group, a well-respected health-care consulting firm, recently estimated the potential impact of a health plan I've developed with the support of the Economic Policy Institute. The proposal -- which resembles the plans of the leading Democrats, whom I've advised -- requires employers either to cover their workers or to contribute to the cost of their workers' coverage. Workers whose employers make the contribution will be enrolled in a public plan modeled after Medicare. Like those covered by Medicare, they will have the option of purchasing regulated private insurance instead. According to the estimates, this proposal would cover all but a tiny sliver of the non-elderly population -- about half through the new federal system and half through employers. Yet it would actually reduce national health spending, cost the federal government an eminently reasonable $50 billion a year (about what the Medicare drug benefit costs) and save states and employers big money.

How is it possible to cover everyone without driving up costs? The one-word answer is "government" -- specifically, government's ability to lower service prices, streamline administration and get a better deal on drugs, thus reducing medical inflation over time. And these are only the direct savings. Reducing the burden of health care on employers will allow them to compete more effectively (and on a level playing field) with foreign producers. Just as important, making coverage affordable for everyone will allow people to change jobs or start their own businesses without the fear of catastrophic costs or the hassle, expense and inadequacy of individually purchased coverage.

Maybe socialized medicine doesn't sound so bad after all.

Thanks to Erza Klein for the cite.

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