The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.
The text below is the Summary of the complete document. Read the full report in PDF format.
Abstract
With health reform at the forefront of the national campaign, some charge that proposals to restructure our health care system represent dangerous steps moving the country towards government-run health care and socialized medicine. Similar rhetoric was heard last fall when President Bush vetoed legislation reauthorizing the State Children's Health Insurance Program (SCHIP). We find this rhetoric inapplicable to both the SCHIP bill and proposals from most presidential candidates. The core issues in health reform involve, not the size of government, but proposals' effect on the number of uninsured, access to quality care, cost growth, and consumers' health care choices.
Summary
Amid a spirited campaign where health reform will be
a leading issue, some have charged that proposals to
restructure the nation's health care system represent
dangerous steps that would move the United States
toward a government-run health care system and socialized
medicine. Similar rhetoric was heard last fall when
President Bush vetoed reauthorization legislation for the
State Children's Health Insurance Program (SCHIP) that
passed the House and Senate with bipartisan support.
This paper examines that rhetoric and, in short, finds no
evidence to support it.
Strictly speaking, socialized medicine involves government
financing and direct provision of health care services,
as with the traditional British system. Neither SCHIP
reauthorization nor proposals from the major Democratic
presidential candidates fit this description. While these
policies would provide additional public resources to
help the uninsured pay for coverage and would increase
the pooling of risks in insurance markets, none would
overturn the dominant role of private insurance and
private providers in America's health care system. However,
some single-payer proposals (like former candidate Dennis
Kucinich's plan) would limit the ability of individuals to
obtain, and providers to render, care outside the public
system—potentially giving the federal government
sufficient power to constitute the functional equivalent
of socialized medicine.
Some suggest that almost any expanded role for
government in health care inevitably leads to strict limits
on consumer choice, rationing, delays, and poor quality—all concerns traditionally associated with socialized
medicine. These concerns, however, do not apply to the
2007 SCHIP proposals or to plans advanced by leading
Democratic candidates, which would offer workers more
choices among competing, private health plans than they
currently receive from their employers.
Market-oriented approaches proposed by President Bush
and some current and former Republican presidential
candidates would expand coverage by granting tax
subsidies that people could use to buy insurance in the
individual market. But if tax subsidies are inadequate at low
levels of income and there is little or no improvement in
the nongroup market's pooling of risk, many low-income
households and people with health problems will face
difficulties obtaining essential care—exactly the problems
of poor access and quality that supposedly characterize
public-sector coverage.
No reform proposal under serious consideration would
result in either a purely government-run system or a free
market that offers entirely unregulated and unsubsidized
health care. All serious proposals are on a continuum
between these extremes. For example, market-oriented
plans retain significant public-sector responsibilities for
Medicaid, Medicare, medical research, product safety, etc.
Similarly, proposals to replace the current tax deductibility
of employer coverage with refundable tax credits would
redistribute a substantial amount of income from higherto
lower-income households—one of the major ways the
government affects Americans' lives.
The core issue in health reform is not specifically the role
of government, but what policies yield the best possible
consequences for the American public. Such results include
the number of people with health coverage, individuals'
access to quality care, curbing cost growth, and consumers'
ability to make choices about their health care and health
coverage. Inaccurate rhetoric about socialized medicine
and government-run health care is a distraction from these
much more fundamental concerns.
(End of excerpt. The entire report is available in PDF format.)
Usage, posting and reprint of materials on the UI web site:
Most publications may be downloaded free of charge from the web site in PDF format. This information may be used and copies made for research, academic, policy or other non-commercial purposes. Proper attribution is required. Copyright of the written materials contained within the Urban Institute website is owned or controlled by the Urban Institute. Posting UI research papers on other websites is permitted subject to prior approval from the Urban Institute—contact paffairs@ui.urban.org.
If you are unable to access or print the PDF document please contact us or call the Publications Office at (202) 261-5687.
Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.
