Distinguishing Between Socialized Health Insurance & Socialized Medicine

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120px-GrassrootsLeadershipAny  equitable grassroots or consumer driven healthcare changes in the USA will be more successful if healthcare professionals and consumers have a deeper understanding of the problems and solutions we face.  It is easy for me to get lost in the lingo and politics of various healthcare strategies. Even as a nurse with over 25 years of service, I find things can be incredibly confusing.  I know what we have now is not working and I have little faith in the Affordable Care Act.  With a commitment to increasing understanding, here are slightly edited answers to related questions about socialized insurance vs socialized medicine from the Physician’s for National Health Program FAQ webpage along with a comment and question for PNHP.

What is single payer or socialized health insurance?

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

What is ‘socialized medicine’?

Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. Doctors in the Veterans Administration and the Armed Services are paid this way. The health systems in Great Britain and Spain are other examples. But in most European countries, Canada, Australia and Japan they have

socialized health insurance, not socialized medicine. The government pays for care that is delivered in the private (mostly not-for-profit) sector. This is similar to how Medicare works in this country. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage medical practices or hospitals.

The term socialized medicine is often used to conjure up images of government bureaucratic interference in medical care. That does not describe what happens in countries with national health insurance where doctors and patients often have more clinical freedom than in the U.S., where bureaucrats attempt to direct care.

I can see the value of eliminating wastes and bureaucracy with socialized health insurance.  I also find it very exciting to think about eliminating financial gains and conflicting agendas in for-profit health insurance.  I do, however, worry about physicians having too much power in such a system and wonder how leadership from other health care professions, patient advocates and other stakeholders would be included in a more collaborative approach.  For instance, in the answer to another question in the FAQ, I find the absence of any mention of Nurse Practitioners and Physician Assistants to address cost-effective primary care to be disturbing.  I wonder how PHNP might answer this concern and have emailed them to see.

What does PNHP have to say about the primary care workforce shortage?

Countries with strong health care systems have at least half of their physicians in generalist primary care practice 50 percent in Canada, 70 percent in the United Kingdom (Starfield, B, Is primary care essential? Lancet 344: 1129, 1994)

In 2008, less than 8 percent of U. S. seniors chose family medicine, a 50 percent decline since 1997; only 199 U. S, seniors matched into primary car


e internal medicine, 248 into IM/Peds, and 53 into primary Peds. The percentage of international medical graduates (IMG’s) in our 3 primary care specialties is now 73 percent for IM, 68 percent for Peds, and 55 percent for Fam. Med. (Pugno, P , et al Fam Med 40 (8): 563, 2008) I don’t believe that we have more than about 30 percent of our physicians in primary care. Only 20 percent of internal medicine graduates become general internists, and most pediatric graduates go into sub-specialties. (Bodenheimer, T. Primary care—Will it survive? N Engl J Med 355 (9):861, 2006).

Primary care has been declining in this country for many years, as a result of multiple factors, including more attractive lifestyles and reimbursement on the non-primary care fields;student perceptions of the demands, rewards, and prestige of generalist practice; and uncertainty of the health care environment. The American College of Physicians in 2007 declared that: “Our primary care infrastructure is at grave risk of collapse”.

Single-payer national health insurance will provide an opportunity to restructure the U.S. physician workforce, strenghten and rebuild primary care. We should have at least 50 percent of our physicians in primary care fields. Useful approaches include reimbursement reform, loan forgiveness programs for graduating medical students entering primary care residencies, increased funding for graduate medical education (GME) teaching programs in primary care, and reallocation of GME training slots by specialty.  —Answer contributed by Dr. John Geyman, PNHP Past President

What thoughts, concerns, and/questions do you have? 

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