One Cheer for Socialized Medicine
Royal Gwent Hospital (NHS Photo)
Ezra Klein writes about what “socialized medicine” would really look like:
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 the technology. I have literally never heard a proposal for converting America to a socialized system of medicine. And I know a lot of liberals.
Not that I think we should make this a near-term legislative priority, but I actually think there’s a very strong case on the merits for a limited form of socialized medicine. Which is to say that I think it would be smart for the government to directly provide a certain class of relatively cheap, not-very-interesting preventive services. You would have clinics in neighborhoods where medical personnel (mostly nurse-practitioners and dental hygenists, I would think) directly employed by the government could provide things like vaccinations, regular tooth cleaning, prostate exams, etc. Obviously, you would want actual medical doctors and public health researchers to determine what the appropriate list of services is rather than a blogger. But the general aim would be to identify a list of preventive health services where it’s not desirable for people to be economizing and then we’d bring the services to the people directly as a public service. And the upshot would be a kind of National Health Service but not one that, UK-style, aspires to comprehensively meet all medical needs. Instead, it would have a limited mission to provide basic preventive care.
Now needless to say, we’re not going to build a system like that. But we can try to make sure that health reform strengthens the position of community health centers that do some of this kind of stuff.
31 Responses to “One Cheer for Socialized Medicine”
Register
RSSLogin
Topic Cloud
ArchivesBlog RollAbout Matt YglesiasContact Me
Donate
June 9th, 2009 at 4:50 pm
Socialized medicine could help with alcoholism prevention. For example, it’s clear from looking at Sotomayor’s face that she’s a long-term, heavy drinker.
June 9th, 2009 at 5:05 pm
Right. Graduating summa from Princeton and becoming a federal judge in one’s 30s is typically consistent with “long-term, heavy” drinking.
June 9th, 2009 at 5:20 pm
I can only say that Ezra must not listen to the voices on his side of the aisle very well. If he’s never heard anyone promote socialized medicine, he’s not qualified to be a pundit on any topic, much less politics – he’s not attentive enough.
June 9th, 2009 at 5:26 pm
I can only say that Ezra must not listen to the voices on his side of the aisle very well. If he’s never heard anyone promote socialized medicine
You’ll be providing supporting links to those people who’ve called for a government takeover of all hospitals, physicians and ancillary workers in the US, right?
June 9th, 2009 at 5:26 pm
Jasper, the first poster is a troll using the name of someone else (few professors attach a link to their university department when writing dumb rants on Internet). He should be banned already.
June 9th, 2009 at 5:30 pm
Although to be fair, single payer could accurately be described as socialized health insurance (as opposed to socialized health care).
And I see no harm in admitting this, since the GOP has done the work of diluting the term “socialism” to the point that nobody really cares.
June 9th, 2009 at 5:34 pm
Single Payer is effectively socialized medicine because the payer ends up setting the rules under which they’ll pay – which implicitly sets up what kind of care will and won’t be allowed. If you can’t figure out which Democrats have called for that, then you aren’t paying attention either. And if you decide to somehow call that something other than socialized medicine, well – you’re just playing dumb definition games in order to avoid having to justify what you’re calling for.
Which is fairly common in politics across the spectrum…
June 9th, 2009 at 5:38 pm
And if you decide to somehow call that something other than socialized medicine, well – you’re just playing dumb definition games in order to avoid having to justify what you’re calling for.
Shorter James Robertson: “I googled for five minutes, realised I’d completely pwn3d myself, and then had to bullshit in order to save face.”
Lame.
June 9th, 2009 at 5:47 pm
I beg to differ: while these are exactly the kinds of things that government should be paying for, they’re probably not the kinds of things that would be provided as well by a socialized system as a privitized one. Take flu shots: you, the government, could simply buy clinics in every neighborhood and offer free flu shots for all. But how much better, instead, to pay the market a fixed (maybe variable depending upon location) bounty for each shot given, then let profit-making entreprenures figure out how to do it? Lower capital costs that way, not to mention that you can capture efficiencies by lowering next year’s price and the market will come up with solutions that you never dreamed of. Private parties are much much better at getting people to do/buy things than the government — while the government buying more of underdemanded things is great, the right model for a lot of this is single payer, not socialized medicine.
June 9th, 2009 at 5:49 pm
Actually, in my rural county we don’t have a clinic unless “the government” (that’s us) builds one. So we’ve passed a property levy, affiliated with a hospital about 20 miles away, and are building ourselves a clinic.
In the southern half of the county, about 35 miles away, is the county hospital, also built by the public.
If you can’t form yourselves into a government and tax yourselves to build facilities, the “health care” in rural America varies from pitiable to nonexistent. When you get out in the woods you can forget all that b-s about “going to the Emergency room”. There aren’t any.
Yes, I know the idea of taxing ourselves to govern ourselves will come as a real shock to some, but when “free enterprise” totally fails, that’s what you do.
June 9th, 2009 at 6:01 pm
One of the problems with existing public clinics is that they’re usually run on a sliding scale based upon income. That makes some sense, given that the un- and under-insured occupy a relatively wide income range in the US, but it also perpetuates the uncertainty about cost that keeps the un- and under-insured from seeing someone in the first place.
The $20 flu shot (Dennis’s example) is the easiest scenario for private providers: fixed cost, single service, no follow-up usually necessary. Prostate exams or pap smears don’t fit that model.
June 9th, 2009 at 6:01 pm
Shorter James Robertson: “I googled for five minutes, realised I’d completely pwn3d myself, and then had to bullshit in order to save face.”
One thing I’ve noticed about James is how his arguments and posts are all about “winning” some perceived point he wants to hammer, and he will purposely and obstinately ignore facts or simply make them up to double down on his points when he is confronted with counterevidence. It’s not about facts and analysis, it’s about placating his ego and reinforcing his worldview, which he considers under threat from MattY’s relatively innocuous posts on health care and transit.
June 9th, 2009 at 6:07 pm
Why not instead of the government building clinics for preventative medicine using nurse practitioners and dental hygienists, remove the barriers for private enterprise to provide these clinics. I can’t go to a hygienist to get my teeth cleaned, I have to go to the dentist who employs a hygienist to clean my teeth and the dentist checks their work.
You, Matthew, do a good job with licensing requirements being a barrier to lowering costs in other areas such as barbers. Apply the same logic to medicine. We don’t need to see a doctor (M.D.) for much of our health care, but the licensing board requires it backed up by law. Remove these requirements and you will see more low cost clinics.
June 9th, 2009 at 6:10 pm
Re: Single Payer is effectively socialized medicine because the payer ends up setting the rules under which they’ll pay – which implicitly sets up what kind of care will and won’t be allowed.
So we must have a socialized defense industry, since the government is the only customer for this industry’s products and services, and as such sets the rules and determines what it will pay.
June 9th, 2009 at 6:28 pm
I’d like to see at least an expanded opportunity to utilize the existing socialized medicine facilities that the VA has created. Why couldn’t we allow private citizens to buy in to the VA system, which in some cases appears to be underutilized when we don’t have a war going on (which seems to be always nowadays)? I can remember wandering around a huge, deserted VA hospital (pre-Desert Storm) that was kept fully staffed and open just in case we needed it, which proved to be a good idea. Still, this seems to be a system that works, if sometimes imperfectly with regard to veterans’ care. Similarly, why can’t we just buy in to Medicare, another system that appears to be pretty efficient? I don’t understand why we have to reinvent these wheels.
June 9th, 2009 at 6:49 pm
DTM (#6) wrote: “…the GOP has done the work of diluting the term “socialism” to the point that nobody really cares.”
Oh, they’ve gone further than that. Over the last few months,
as the the Republicans have been calling everything Obama does “socialism”, the public’s opinion of socialism has become more favorable.
June 9th, 2009 at 6:51 pm
So we must have a socialized defense industry, since the government is the only customer for this industry’s products and services, and as such sets the rules and determines what it will pay.
Wow is that stupid.
June 9th, 2009 at 8:11 pm
According to several independent studies the VHA is the NUMBER ONE rated health care institution in the country.
Even if you question the idea or results of independent studies, you would have to concede that the VHA must at least be a top ten candidate, which would put it ahead of thousands of other private health care institutions.
I was in one today, in the long term wing of a beautiful, old VA facility that sits on lovely public ground. I decided to research the VA based on a positive assessment in an earlier Yglesias post. I could not have been more impressed.
My dad has been a long term health care patient for some time. For various reasons, he has been in several different private facilities. They all sucked.
As soon as the paperwork goes through I am moving my Dad to the VA hospital. I will always regret I did not look into this sooner.
June 9th, 2009 at 8:50 pm
When I was a kid, the only medical treatment I received was from public community health centers and military clinics, with the exception of a locally performed surgery at the county hospital. I never had any complaints about the treatment I received, except for the smell of the waiting rooms and the lame old issues of High-Lights as the only reading materials.
June 9th, 2009 at 9:11 pm
I love all these proposals for health care reform. I would be happier with any of them, happy with any one that MY would bless, ecstatic with any one that Ezra Klein would sprinkle holy water on.
One tiny little problem: have you tried to find a primary care physician recently? Say in the last 10 years? Particularly if you are over 30 and your medical needs are no longer limited to strep throat tests and knee surgery? Guess what? There is already, here and now, at this instant, and massive shortage of adult primary care doctors. And adult primary care nurses too for that matter. There just ain’t no one going into primary care these past 20 years, and those in primary care are either retiring or leaving for salaried jobs.
So if we get this great health care system, who is going to provide the primary care?
Cranky
June 9th, 2009 at 9:21 pm
I grew up in the military (my father was in the Air Force) so the medical system was socialized/govt run/whatever. Seemed to work fine for me, except perhaps in my early teen years, when we lived in Japan and the doctors and nurses may have been preoccupied with keeping the older kids and young men wounded in Vietnam alive and somewhat whole.
June 9th, 2009 at 10:16 pm
Advertise Socialized Medicine with pictures of slutty, half-dressed nurses and watch the guys at National Review crumble like cupcakes.
June 9th, 2009 at 10:22 pm
I love the irony of James fucking Robertson whining that someone else is unqualified to opine on the issues of the day. Hey James, how did that war on Iraq you were so hot on turn out?
Does it ever occur to you that getting the single most important issue of the past decade so wildly wrong that it resulted in the senseless deaths of hundreds of thousands of innocents might, just maybe, make you too stupid to opine on anything else for, I don’t know, let’s say the rest of your useless life?
June 9th, 2009 at 10:32 pm
Wow is that stupid.
Indeed, and it was the exact same logic James offered. So there you go.
June 9th, 2009 at 11:51 pm
Doesn’t France do this by providing what amounts to a floor on medical services–guaranteeing everyone a basic level of care then allowing people to buy whatever services they want on top of it? Doesn’t France have, overall, the best health care system in the world?
June 10th, 2009 at 12:14 am
France offers far more than a floor: the Sécu reimburses a large proportion (60-70% of the “tarif” for most services, 80% for hospital care) and most people get insurance from a mutuelle to reimburse the rest, and provide additional services on top, like access to private rooms or better optical/dental. At about EUR100 a month for a gold-plated mutuelle, which is about as much as a high-deductible catastrophic insurance policy in the US. If you want to see a specialist who charges above the standard rate, you’re free to do so, you’ll only get reimbursed for the “tarif” and it’s up to your mutuelle or your pocket to cover the rest. Of course, it doesn’t cost six figures in tuition to become a doctor in France.
To flesh out my earlier point: a clinic that provides screening — a prostate check, a pap smear, etc. — still raises the question of “now what?” for the un- and underinsured. You have a cough, they take a chest X-ray, there’s a shadow on your lung, and you still face the choice between going untreated or incurring bankruptcy-inducing bills.
Another point: the state (or, more accurately, “the states”) are heavily involved in mental health services, because there’s a public interest to keep the severely mentally ill from harming themselves or others. That’s not something private enterprise wants to go near– unless it’s the no-liability administrative side, which they tend to fuck up anyway. Since the severely mentally ill don’t have a great lobbying machine, they tend to get screwed over in budget squeezes: the tax break for Apple offered up in Raleigh right now works out at substantially more than what’s being cut from the mental health budget.
June 10th, 2009 at 12:39 am
I’d like to point out from my own experience in using public health insurance that there is quite a bit of it already in this country and national reform would not require working from the ground up.
DC has a fully comprehensive system known as Alliance that provides a bridge between medicare and private health insurance. There is often a wait, not all medication is covered, but you can get dental services and almost all basic medical ailments taken care of at several government-run clinics. It’s kind of dc’s “best kept secret” — free and available to anyone earning below 200% of the poverty line.
I find these clinics to be far humbler than a private practice, but staffed with very hard working professionals.
In fact, there are a large number of state and local governments that have similar programs– i know New York and San Fransisco have them, as does the state of Maryland. I can’t attest to these programs’ efficacy, but I can’t imagine they can’t be built into a national network. Maybe their relatively poor websites are all that’s keeping them out of public view.
June 10th, 2009 at 9:48 am
There’s also a strong case for government ownership of MRI and CT scanners, hemodialysis machines, DaVinci surgical robots and other $100,000+ pieces of durable medical equipment. Then patients could get an MRI for the marginal cost of providing it, which is closer to a couple hundred bucks for labor than a couple thousand bucks for labor plus debt service on the machine.
June 10th, 2009 at 2:30 pm
Here are some of the problems with President Obama’s zillion dollar health care plan . It will raise the deficit, raise taxes in an already bad economy (which history shows is not good), and reduce the quality of health care. Moreover, what if this kazillion dollar government mandated boondoggle passes, and physicians and other health care professionals vote ‘no’—with their careers? That’s what has happened in other Nations that have government run health care. That is why many of them are changing course and going towards a private system. Duh.
For example, know of a physician who has been a medical specialist for 16 years, after ten years of training. The 22 physicians in his practice employ 80 people. Only strict attention to costs keeps them afloat. They see 5000—yes, that’s ‘thousand’—patient per year with cancer and blood disorders. Another 10% drop in reimbursements, and most of the MDs over 58 (they have
will quit; the rest will likely seek alternate careers or practices, or simply go half time. Guess what happens than? You guessed it you get your universal health care but no one is there to provide health care for anyone.
So: go ahead. Put Medicare clerks and Canadian health care fans in charge. Maybe they’ll have some good ideas on how to treat your advanced, but curable colon cancer or lymphoma. But probably not. The American public will get the the shaft and they are not going to like it at all. Don’t say you weren’t warned. Any politician, Democrat or Republican, who votes for this moronic mess will pay the price at the ballot box.
June 10th, 2009 at 2:40 pm
Don’t you get it. President Obama wants the government to make life and death decisions on who gets what health care if any. If Obama gets his way, some faceless bureaucrat sitting in his ivory tower in DC will be telling your doctor what if any treatment you will get based on your “worth” to society. Your elderly mom and dad will be frozen out of critical health care and told to just die already.
The trillions of dollars that Obama is proposing to pay for his government run health care plan will come out of everyone’s pockets, rich and poor, since the so called “rich” are getting poorer and do not have enough money to pay for the zillion dollar program Obama is proposing. Defict’s will skyrocket and everyone will be the poorer. So if you think you will be getting “free” health care you are a fool. If President Obama gets his way the biggest winners will be Government bureaucrats and union workers. Everyone else will lose.
June 11th, 2009 at 3:50 am
I smell that unique American situation known as “arrogant stupidity” in your post. Guess what, the Canadian system, which is the single-payer model that most single-payer advocates look towards, allows you to pick whatever doctor you want that provides the service! None of this bullshit you see with most health insurance plans in the US, which have lovely things like “in-network” and “out-network” distinctions. But I guess you don’t mind having some faceless bureaucrat from Blue Cross Blue Shield from deciding whether or not you get reduced to poverty, bankruptcy, and even homelessness, do you? Especially since, unlike in Canada, they have an incentive to try to get rid of you in any way possible.
Let me guess, you haven’t actually read anything about what’s being proposed for the US, have you, other than what you’ve been peeling off of Republitard blogs?
If premiums go down at the same rate (or faster) than taxes to pay for the system go up, then who gives a shit? Money is fungible, after all.
More stupidity from you. Unions already tend to have the best health care plans for anyone who isn’t rich, so I fail to see what they have to gain from going to universal health care.
Bullshit. Canada already offers a comparable system in terms of outcomes with significantly lower per capita spending, and systems like that of France, which has higher per capita spending than Canada but lower than that of the US (as well as having a government plan that covers most of the cost of care), have better outcomes for almost all types of care.
I notice, in this Yglesias post and the next one on health care, you have yet to actually provide examples.
Only if they have better alternatives. The rest of the world that has better health outcomes than the US seems to do fine without the exceptionally high rates of doctor compensation that the US has.
Gladly. I’ll take the Canadian system any day – at least then I don’t have to think, “Damn, my leg is hurting – but if I go to the doctor and it turns out to be nothing, then I’ll end up paying $500 in deductible costs”.