If you have paid any attention to politics in the past few years, you have almost certainly heard at least one politician refer to our “broken healthcare system.” As healthcare expenditures have skyrocketed in the last decade and show no signs of slowing, our institutions have struggled to adapt. According to the Centers for Medicare and Medicaid Services, healthcare spending currently makes up 17.9 percent of our GDP. As that proportion increases, the topic of healthcare is becoming more and more prevalent in our national political discourse. You may have even heard healthcare mentioned as recently as the second Cruz-O’Rourke debate. Most reasonable people agree that something needs to be done to reign in the out-of-control expenditures in our healthcare system, but what should that something be? Unsurprisingly, each of the main political parties has adopted their own vision for addressing the pressing health concerns that affect all Americans. Although not by any means mutually exclusive, these two perspectives tend to be divergent in their policies and methods.
In general, Republicans tend to support a more privatized view of medicine and the healthcare system while Democrats support a more public, government-centered model. The philosophical reasoning behind these two perspectives is complicated, but is essentially as follows: Republicans believe receiving treatment is an earned privilege and that healthcare, like other industries, ought to be largely regulated by the dynamics of the marketplace. But this perspective has some major flaws. For one, healthcare is extremely complicated and non-transparent. Its nuances are extremely difficult for the common consumer to comprehend — even in rare instances when complete information is available — which make it next to impossible to make fully-informed healthcare decisions. Additionally, the customers in a healthcare marketplace, unlike in other industries, have their lives depending on their ability to purchase products. Healthcare companies have customers who can’t refuse to buy their products, no matter how high the price may rise. Thus, citizens of a country whose system relies extensively on privatized healthcare will often be forced to fend for themselves in an exceedingly complicated environment riddled with profiteering.
On the other hand, Democrats are much more inclined to believe that healthcare is a human right. They believe that if our government really is a government of the people, by the people, and for the people, then our government has the responsibility and the power to look after the welfare of its citizens. This is what it does for national defense and even fire brigades; now add healthcare.
A democratic government that is elected by citizens and derives its funding from citizens in the form of taxes is necessarily responsive to the needs of those citizens. For example, the government has a direct financial interest in ensuring you get proper medical care because if you do not, you are not able to work, pay taxes, or contribute positively to the collective society. No one would argue that public health isn’t a public concern, so why should the government not be intimately involved like it is with other public concerns like national defense, disaster relief, and fire brigades? Human rights and public concerns fall more so under the domain of government than private entities. So the philosophical reasoning for government involvement in healthcare, one of the core tenets of socialized medicine, has its roots in a deep tradition going all the way back to the foundation of democratic society.
The Democratic perspective has often been criticized by conservatives and opponents of government intervention in healthcare as “socialized medicine.” But what exactly does this mean? And is this really bad for the American people?
Socialized medicine is defined as a system of health care in which the state owns and operates medical facilities while employing medical professionals, meaning it also pays for all health care services. You can see this system abroad in the United Kingdom, Finland, and Spain. One of the best examples of socialized medicine in practice in our country is the Veterans Health Administration, commonly referred to as the VA (from the U.S. Department of Veterans Affairs). At the VA, the government owns the hospitals, employs the doctors and support staff, and ensures that our veterans get the medical care they deserve.
Yet this definition of socialized medicine does not measure up to the one most people imagine. In particular, conservatives often view any single-payer systems or increased government involvement in healthcare as “socialized medicine,” and any attempts at providing more universal treatment or coverage for people can expect to be labeled as such. Programs like these stifle competition in the healthcare marketplace, increase regulations on healthcare entities, and lower reimbursement rates (the money received for treating patients) for doctors and other healthcare providers. Yet these results aren’t necessarily bad, and they also help a tremendous amount of people.
The United States already has programs that can be considered forms of socialized medicine: Medicare, which covers senior citizens, and Medicaid, which covers poor Americans. These are examples of attempts to provide more universal health coverage and were extremely controversial at the times of conception in part due to fear of “socialized medicine.” The Affordable Care Act, colloquially known as ObamaCare, was also deemed “socialized medicine” but it secured coverage for pre-existing conditions, created quality standards for health insurance, and led to millions of Americans gaining access to health insurance. Government programs, especially Medicare, are popular specifically because they do help so many people. An article in the journal of the American Society of Aging stated, “Since 1996, roughly seven in ten Americans have expressed a favorable view of the program.” The government intervenes to provide care to those who mostly would not be able to afford it otherwise in the private marketplace. These programs were built on the same principles that proponents of socialized medicine profess.
With healthcare costs rising out of control, people are increasingly unable to afford the care they need. The American people are no strangers to GoFundMe pages started to pay for cancer treatment or exorbitant bills for emergency room intervention. Government programs like Medicare and Medicaid were specifically designed to help people who couldn’t afford treatment. Now, many average-income Americans are falling under this category but do not meet the requirements to enter into these programs (age, total income, etc).
This is where Medicare for All fits in. Proponents of this policy advocate for an expansion of the requirements of the current Medicare system to create universally accessible healthcare for the general population. This has been widely criticized as “socialized medicine” by Republicans like Ted Cruz because it represents an expansion of the role of government in healthcare even if it does not technically meet the definition provided earlier. The term itself is nothing short of a scare tactic. It is meant to conjure up images of long lines of people waiting for basic items in the Soviet Union, images of all-out socialism, of absolute elimination of private entities, and of communism itself. Because of America’s particular history (Red Scare, anyone?), this rhetoric is remarkably effective at scaring people into disavowing any government intervention in healthcare. Far from being sinister, efforts like Medicare for All simply seek to expand upon an already-popular idea to increase healthcare access and provide a small bit of relief from a broken healthcare system that has relied extensively on private entities for public welfare.
You may be thinking that even if government involvement in medicine and socialized medicine make sense philosophically and politically, these ideas probably can’t be practical due to the enormous expense they would entail. Well, not necessarily. Though the government would have to pay for the healthcare costs of more people, it might also save money in the process. Take for example that, by law, hospitals must treat any person in the event of an emergency regardless of their ability to pay. A poor person who is treated for a major issue will receive expensive treatment and be unable to pay for it, so the fee inevitably falls to the American taxpayers.
However, what if the government had provided this poor person the resources to go get care initially before the condition worsened? Then the treatment would be faster and cheaper than the treatment for a major issue that develops later. Thus, the person not only receives a better health outcome, but the government and American taxpayers save by not having to pay for the outrageous costs of a major medical intervention. This source of savings can be underestimated in government cost estimates because the Congressional Budget Office can only look at the effects of a policy 10 years into the future. This scenario does not even just apply to the poor, but to an enormous number of middle-class Americans who worry about how to pay medical bills and postpone treatment and prescription refills due to cost concerns.
Let’s also not forget that public government programs like Medicare and Medicaid reduce the rates paid to doctors, pharmaceutical companies, and hospitals, so they also reduce the cost that patients and taxpayers have to pay for treatment. Assuming the government reduces the costs of drugs and administration, the Mercatus Centre, a think-tank, estimates that healthcare spending could decrease by roughly two trillion dollars. Additionally, if people are better able to get the care they need, they will be healthier and therefore more able to work and pay taxes, helping feed the cycle and system. In summary, spend some in the short-term, save a lot in the long-term. Applied on a large scale, this sort of “socialized medicine” is practical because it can provide better health outcomes and reduce national healthcare expenditures in the long-term.
It is never politically easy to advocate for increased spending, especially among conservative circles. However, investment in an appreciating asset is something that should appeal to even the most hardened Republican. The American people are an appreciating asset, and investment in healthcare is one of the most important investments we can make for our people. We should all be so lucky as to have representatives who see past fear-mongering toward a long-term vision for fixing this broken healthcare system.