During the 2020 campaign, many Democratic presidential candidates will be eager to describe their healthcare proposals as “Medicare for all.” But it would be perfectly fair to characterize such a vision with another term: socialized healthcare.
The term “Medicare for all” is best seen as a marketing slogan, because liberals understand it’s a more popular way of branding their ambitions. According to a survey from the Kaiser Family Foundation, 62 percent had a “very” or “somewhat” positive reaction to the term “Medicare for all.” In contrast, the clunky, wonky term “single payer health insurance system” elicited a positive reaction from just 48 percent of respondents. “Socialized medicine,” meanwhile, was viewed positively by just 44 percent.
During the Obamacare debate, when the term “socialized medicine” got thrown around, Democrats had a fair rejoinder: The new program preserved employer sponsored coverage as well as private health insurance. But they have less of a leg to stand on when it comes to “Medicare for all.”
Though “Medicare for all” is a vague marketing term that could mean different things, it’s helpful to look at one leading proposal released by Sen. Bernie Sanders, because it was co-sponsored by likely Democratic presidential candidates Sens. Elizabeth Warren, Kirsten Gillibrand, Cory Booker, and Kamala Harris.
Under the proposal, within four years, all Americans would be enrolled in a government-run healthcare plan. They could not enroll in any private plan that offered any of the same benefits as the government plan, effectively doing away with private coverage beyond a possible small market for supplemental insurance.
All of this would fit pretty comfortably within the Oxford English Dictionary’s definition of “socialized,” which is: “Made socialist; established or developed according to the principles of socialism; spec. (of an industry, company, etc.) financed with public funds, brought under public control.”
Clearly, the system that Sanders and other presumed 2020 contenders have signed on to would be financed with public funds and heavily controlled by the government.
The argument does not end there, however. The OED itself goes on to define “socialized medicine” specifically as, “a system of medical care that is financed and administered by the state.” But what constitutes being “administered”?
The liberal economist Uwe Reinhardt took a relatively narrow view of the term “socialized medicine” in a 2009 reflection on this subject, describing it only as a system “in which the government owns and operates both the financing of health care and its delivery.” In other words, under this definition, it isn’t enough for the government to be financing healthcare, it must also be running the hospitals and employing the doctors.
Even taking into account this definition, one would be on indisputably safe ground describing “Medicare for all” as a “socialized health insurance system.” There is no dispute that the government would be both financing and administering insurance.
As far as using the more general term “socialized healthcare system,” it’s worth noting that Reinhardt’s attempt at a precise definition runs into its own problems as few, if any, systems would fit perfectly. The system in the United Kingdom, for instance, which nobody would dispute is socialized, allows room for private clinics even as the government operates most hospitals.
The term “socialized healthcare,” thus, is best viewed as a continuum. The Sanders “Medicare for all” plan may not go as far as the U.K., but it’s well within the spectrum of “socialized.” Under the proposal, government would be paying the hospitals and doctors, dictating payment rates, deciding who can participate, fixing drug prices, and determining what goods and services get covered by the insurance plan that would be the primary coverage for everybody. Even if the government won’t technically own hospitals or employ doctors, in effect all providers would be at the mercy of the state. Indeed, the whole argument for why “Medicare for all” can contain costs is that by making government the sole financier, it will be able to exert bargaining power to lower prices and establish best practices.
On top of all of this, it seems selective to insist on a very narrow and precise definition of “socialized healthcare” while loosely employing the term “Medicare for all.” The Sanders plan, for instance, does not simply enroll everybody in existing Medicare. It creates a new program and migrates everybody to it, including current Medicare enrollees. If he can call that “Medicare for all,” then opponents can call it “socialized healthcare.”
