I guess this speaks volumes about me, since I’d never thought of a distinction. According to a definition, socialised medicine is ‘the provision of medical and hospital care for all by means of public funds.’ Sounds like single-payer to me.
I think the poster is saying that single-payer is a scheme where public finds are used to pay for medical services, and that socialised medicine is a scheme where the government actually provides the services. That is, single-payer isn’t ‘socialised medicine’ because the providers are (largely/effectively) private entities.
Is there actually a distinction? Or is the poster splitting hairs?
Apart from providing a way for contractors to skim a little overhead from the transactions they provide in that definition of single payer, there doesn’t seem to be any practical difference in outcome. Should one not prefer the profit model of the present U.S. arrangement, as so many do.
However the latter is somewhat overcomplicated for simple tastes, and I would prefer the socialized model over all. It also makes Health just another service, like the Army or the Coast Guard, which seems preferable to a carnival of competitions.
That’s a rather arbitrary definition or distinction, but the whole question is basically meaningless. “Socialized” or “socialism” and variants thereof generally mean whatever the speaker wants them to mean. The term “socialized medicine” really exists at all only as an attempt by defenders of private insurance systems to cast aspersions on those promoting universal health care, since “socialism” has come to have such negative connotations in America. It’s essentially Orwellian thought control through manipulation of language.
I think the only meaningful point is that single-payer describes a general structure for funding health care and there is a continuum of different degrees of government intervention, or “socialization”, if you will. Within the funding model, the government can act as a single payer, the government can authorize and regulate one or many payers that all adhere to common rates and benefits, the funding can come entirely from general taxes, or entirely from insurance premiums, or a combination of the two. Also, if there is an element of direct payment of premiums or co-pays, there is the question of subsidies for lower income earners. Within the provider model, the government can employ doctors and health care workers or it can leave it to the private sector, or, again, some combination of the two. And the structure of the market is yet another dimension; single-payer might be the only available system for providing medically necessary health care, or consumers might have the choice of opting for private risk-based insurance for whatever benefits they think it provides.
I would consider all of these to be single payer, the major criterion being that it’s universal and covers everyone for medically necessary procedures at a common community-rated cost, so everyone has the same costs and benefits regardless of payer or provider. But there are a vast number of ways to mix and match the above options. Which one is “socialized medicine”? I don’t care, and I don’t think it’s even a meaningful question.
I would disagree, wolfpup. It’s not a distinction without a difference. It was this distinction that made Medicare viable in Saskatchewan.
One of the major objections from the doctors during the doctors’ strike was that they didn’t want to be government employees, which is how the National Health Service worked in the U.K. at that time. One of the compromises that settled the strike was that the doctors would bill the provincial medical commission for their services, but still run their own clinics as they saw fit.
That concession by the government was essential to settling the strike and letting Medicare be implemented.
And it’s not just Orwellian. The classic definition of socialism is that the government controls the means of production. A system where the government owns all the hospitals and employs everyone in the medical system, including the doctors, does fit that classic definition of socialism.
What you’re saying is that becoming government employees was one of the doctors’ major sticking points during the establishment of Medicare in Saskatchewan. This is true, but it was far from the only one. This is just one element, albeit a big one, in the continuum of socialization, if one wants to use that word. For example, another big issue the doctors had is that, even if they continued to be in private practice, as the single payer the government would regulate their fees and thus control their income. Does this not also fit the definition of “socialism” you just gave? Indeed, Saskatchewan doctors, aided by hysteria from American insurers and the AMA, were predicting that because of this alone doctors would flock from Saskatchewan in droves and the province would be left without a medical system.
Of course that never happened, but the free marketers and libertarians would argue that such a measure is pure socialism. That’s just another element in the continuum. Or how about disallowing new private for-profit hospitals, as Ontario and other provinces did? Is that government control of the means of production and thus socialism?
My point is that it’s a continuum scale and there’s no magic line in the sand that defines when one should apply that silly “socialist” label to a medical system. Granted, government ownership of the public medical provider network is a big factor, and I don’t disagree with you on that, but as I noted, there are many other ways that universal health care systems regulate and control the health care system for the public good, as well they should.
I think it’s worth pointing out that the Saskatchewan arguments seem to mirror those in the UK as the NHS was being set up. Except that in the UK the hospitals, which like so much of the economy, had been skimped and run down under the financial pressures of the war, were only too glad to be nationalised, especially once their senior specialist doctors had been offered a generous deal for nine-elevenths of their time and a guarantee they could have the rest for private practice or any other external interests they wanted to pursue: and the junior doctors had a standardised set of salaried training posts to climb up. On the other hand, the GPs/family doctors were much tougher in their resistance, even though the system was to be based on their remaining self-employed contractors with the NHS and with the status of gatekeepers to the hospitals and other specialist services, and the right to take on private patients if they wanted. But eventually they did come round and sign up to the contract offered. As the minister of the time said “We stuffed their mouths with gold”. More recently they’ve been given a much bigger function in controlling the local NHS budgets for commissioning hospital and other specialist services. Nor surprisingly, the GPs in particular can be the system’s most vocal defenders.
The NHS is the dominant player and the default service for the bulk of us, but there is still a private market for about 10%, so it’s not fully “socialised”; I suspect that’s about the rough proportions of doctors for and against the system (provided it’s funded to their satisfaction, of course).
One of the most commonly repeated fear-mongering stories that opponents of single-payer medical coverage have repeated and riffed on, is the idea that with single payer, comes single payer control of actual medical procedures and choices. I.e., the threat of “Death Panels,” and the assertion that what medical help you receive, will be determined by politicians like your congressmen, rather than by you and your medical provider.
The same people who like to scream about Death Panels, all somehow manage to miss the fact that all private insurance based systems do exactly that already.
I would assert then, that there is very much a difference between socializing medical COVERAGE, which is what is finally now being proposed, and socializing MEDICAL CARE ITSELF, which we are currently suffering under, and which is one of the big reasons for the bloat in American medical care costs. Ironically, medical care has been “socialized” directly by the private practice administrators, entirely for the sake of PROFIT. Not by the government or by the American people.
The primary defect I personally associate with a doctrinaire approach to socialism, such as we saw in places like the Soviet Union, is that that approach emphasizes nominal political adherence, and ignores functional results. I would of course, oppose that.
Well, that’s true for the middle class. However, under the status quo the truly rich can just pay out of pocket for whatever the insurance companies don’t decide to cover.
I suspect that’s not the case in the UK for things the NHS doesn’t decide to cover, and that they’d have to travel for out-of-system exotic care… though I admit my knowledge of the UK may be incomplete. I do recall that private hospitals with overnight stays are (were?) illegal in Canada.
Not exactly. Take for instance this world-class hernia center located in a converted mansion in an upscale Toronto neighborhood. It’s private and for-profit.
The actual situation with private hospitals is somewhat nuanced. Each province has its own rules, and I’m only familiar with the ones in Ontario, where private for-profit hospitals cannot be established but existing ones, like in my example, were grandfathered. The Canada Health Act places restrictions on what all provinces may do, but only on the condition of receiving health care transfer payments; otherwise they can do what they like. The basic restriction is that any such facility, when treating eligible covered residents, must accept as full payment the standard single-payer fee schedule. It should also be noted that hospitals, while mostly non-profit and not private businesses, are not government owned or operated, but rather, operated by independent boards of trustees.
I lived in Calgary for a while and was there when a proposal for private hospitals was voted down… and that was in what I understood to be the relatively conservative part of Canada. I hadn’t thought about grandfathering.
True, but Health care, bearing in mind the primitive medical knowledge and implements of the time, was quite good in both the USSR and Cuba from the '60s to the '80s.
Most other things were not optimal.
Not really, apart from BUPA insurance schemes, Harley Street still flourishes, as it always has for the upper classes since the 19th century.
[ There was a well-known doctor of the 1950s/60s, named Richard Gordon, who wrote popular medical comedies, which included how much more NHS hospital doctors could make back then by briefly subbing in Harley Street. ]
And going abroad for exotic treatment, as say for Dental work to Hungary, is as when Americans do it, to save money more than to pay for extra expense.
Actually in the U.S. an example would be the Veterans Administration health care system. For some strange reason you don’t see traditional conservatives calling this socialized medicine and trying to shut it down.
Also in Aus. And, as a matter of interest, they didn’t all come around: they had no choice. Some of those UK GP’s who were young enough and flexible enough migrated to Aus.
Also, like many places, our “single payer” isn’t entirely single: so there is some
private payer – public provider
as well as the other three mentioned above,
(private-private, public-private, public-public)
Of whom, looking him up on Wiki, I see he died a month ago aged 95.
Real name, Gordon Stanley Ostlere. Which I as thought came from Ostler/Hostler, a man who looked after the horses at an inn, although before the words referred to the hostel-keeper himself.
Films had people like James Robertson Justice ( rather a strong leftie ), Dirk Bogarde and Leslie Phillips, who is still alive at 93.
And… looking up other actors of that period, I see Terry-Thomas died in poverty reduced by bills of £40,000 a year to unsuccessfully treat his Parkinson’s Disease.
Since he would have not paid for his NHS healthcare, this implies private healthcare, Harley Street or other, is not cheap.