2-16-05, 1:13 pm

Medicare, while the most significant public health care breakthrough in U.S. history, is still quite limited compared to the program that Truman advocated in the 1948 campaign, which would have covered the whole population. Systems of socialized medicine, like fee for service medicine and our own present mix of fee for service and private insurance coverage systems, are as good as the level of economic development within a society and the political forces which guide the development of the system make them.

There are, for example, poor countries with formal systems of socialized medicine where services are very few and far between for the general population. There are also examples of bureaucratic foulups in rich countries with socialized medicine which have had disastrous consequences for individuals. Of course, there are many poor countries where medical care is reserved only for those who can pay for it and among rich countries, there is the U.S. with over 40 million people without any coverage and many millions more without major medical and other basic coverage.

However, there are generalizations which we can make concerning all other developed or rich countries, all of whom have systems of socialized medicine of various kinds (and all are not the same by any means). Life expectancies are higher than in the U.S., infant mortality is much lower, and the cost of the systems as measured in percentage of GDP is much lower (prescription drugs for example average about 50% of the cost in the U.S.). In every society where socialized medicine has been established, it has been the most difficult thing for conservative forces to get rid of--the social policy that people have most consistently defended. Regressive out of pocket expenses for health care (super regressive in that the people who are in the lower income brackets in the labor force have the worst coverage and have to pay the most out of pocket for health care or go without) are insignificant in the rest of the developed world and, of course, are an important cause of personal bankruptcy in the U.S. Even in Great Britain, where Margaret Thatcher was at least as extreme an anti-social welfare ideologue as Ronald Reagan or the present-day advisors to George W. Bush, she was able only to weaken the system, not 'privatize' it.

The analogy with social security is important, I think. Americans have supported Social Security in spite of elite attempts to undermine or eliminate the system since the 1930s because they have experienced its successes and understand its value. Thus, they can’t be so easily fooled about its failures, which conservatives have found out the hard way over the generations. The Bush administration will hopefully find out again.

People in the rest of the developed world, who by the way have traditionally looked at the American medical system in horror, even some of those who come to the U.S. to get procedures that their systems won’t give them or, because of budgetary restraints delay in giving them, can't be so easily fooled about the benefits of privatized medical care. Americans who associated socialized medicine with cold war enemies in the past and with the poor and the elderly today (Medicare/Medicaid) rather than with themselves have unfortunately been fooled over and over again--the last time in 1993-1994 when the insurance companies and their allies buried the Clinton administration’s attempt to establish a very modest system guaranteeing some universal coverage.

As a postscript, I might mention that a few years ago I was on a radio program for an international panel discussing Canadian, British, and U.S. health care. A British doctor, working in California, who was among the most conservative people on the panel in his overall views and his sympathies for the high tech and research aspects of the American health care system, surprised everyone, when he said that the one thing he liked about the British system was that it was far less bureaucratic for patients and doctors than the American one – the exact opposite of what most people have been taught to believe!



--Norman Markowtiz is a contributing editor of Political Affairs.

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