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The term socialized medicine refers to a publicly administered national health care system, also referred to as a "universal health care system." Versions of socialized medicine systems can range from programs in which the government runs hospitals and health organizations to programs in which there is a single-payer national universal health care plan.

Supporters of universal health care emphasize that single-payer systems save money when compared to multipayer systems in which health care is funded by private and public contributions. Germany and France use the latter. Denmark, Sweden, and Canada are some of the countries that employ single-payer financing of health care.

Health care systems can also be classified according to whether they provide universal coverage, provide portable and comprehensive benefits, have geographically accessible care, offer affordable coverage, are financially efficient, and provide reasonable levels of choice for consumers.

In the United States, the populist view associates these programs with communist-run countries, but most industrialized countries have some form of socialized medicine. The matter is important to the United States now more than ever, due to the high percentage of Americans without health insurance (44.8 million in 2007). The cost of health care and insurance premiums has risen dramatically in recent years, resulting in a high number of employers dropping health insurance benefits for their employees. The rising costs of health care insurance result from higher costs of prescriptions, doctors' fees, and hospitalization and administrative expenses.

The United States is the only industrialized country without a system of socialized medicine. The only health care programs subsidized by the U.S. government are Medicaid and Medicare, instituted in 1965. Medicare covers Americans over age 65 and some permanently disabled persons, while Medicaid covers a small portion of persons who are poor and aged, blind, disabled, pregnant, or the parent of a dependent child. These two programs are the closest to a socialized health care system plan within the United States.

Great Britain provides its citizens with a National Health Service (NHS), through which the government directly pays all health care costs for all citizens. Implemented in 1948, it was subsequently used as a socialized medicine model by other industrialized countries. Under national terms and conditions of service, doctors, nurses, and other specialists work as salaried employees at hospitals or health care facilities. Funding for the publicly owned hospital and community services comes from central taxation. Before the implementation of NHS, more than half of Great Britain's population--mainly women, children, and the elderly--had no health coverage.

To keep costs down, the NHS has relied on national and regional planning and shifted services to the private sector, severely undermining the fundamental bases of universal health care in Great Britain. The government shifted some costs and risks to patients and discouraged central taxation as the funding base of the NHS. Even with the erosion of the NHS in the past decades, compared to the United States, access to care is much greater and costs of care are far less.

Canada offers universal coverage through a National Health Insurance (NHI) program run by the government as a single payer. Canadian hospitals receive both an annual operating budget and a capital expenditure budget from the government. Hospital doctors are salaried; other doctors who own their practices submit their bills directly to the health insurance system, using a fee schedule negotiated annually between the provincial governments and medical associations.

Canada has one of the world's most successful health care systems. Canadians have greater access to care than U.S. citizens, and Canadian doctors report higher levels of satisfaction than do U.S. doctors. Harvard Medical School researchers reported in 2006 that not only are Canadians healthier than Americans, but that the latter have more unmet health needs due to greater difficulty in getting care, despite the United States spending nearly twice as much per capita for health care. U.S. residents had higher rates of nearly every serious chronic disease, including arthritis, chronic lung disease, and diabetes. Canadians were 19 percent less likely to have an unmet health need, partly due to the fact that twice as many Americans went without a needed medicine due to its cost (9.9 percent versus 5.1 percent). Also, Canadians were 7 percent more likely to have a regular doctor.

Health care in Germany is organized through an entrepreneurial system, with primary health care provided by private practitioners paid on a fee-for-service basis by insurance companies. The system relies on social insurance groups: cities, occupations, or industries that provide insurance for their residents or members. These groups are known as "sickness funds." Premiums are based on community ratings (group rate premiums) and are paid jointly by employers and their workers. On the other hand, insurance companies in the United States use actuarial risk rating, which means that they insure low-risk individuals and/or high-risk individuals only if they pay high premiums. Germany has been more successful than any other industrialized nation in limiting increases in health care spending. Nevertheless, costs continue to rise and affect patient services. One problem is that Germany's complex insurance system results in higher administrative costs compared to the Canadian and British health care systems.

In the United States, the most recent heated discussions about health care occurred in the early 1990s, when President William Clinton proposed the Health Care Security Act (HCSA). Because the HCSA proposal represented a liberal approach to health care reform, conservatives attacked it and the public expressed concern about its costs and implementation through the federal bureaucracy. As a result, the bill never made it to the floor of Congress.

It now seems more likely that reforms to the U.S. health care system will occur at the state level. For example, the Massachusetts legislature passed a new state health insurance law in 2006. This plan offers combined subsidized and low-cost insurance plans, expands Medicaid coverage, offers incentives for businesses to cover workers, and requires some form of coverage for everyone. The bill offered mechanisms for all citizens to have access to health care, mandating coverage for all by July 1, 2007.

Private businesses with more than 10 workers must provide insurance or incur a penalty per employee per year. People able to purchase private insurance must do so on their own; if they do not, they pay a fine when they file their state income taxes. The state government subsidizes private insurance plans, thereby allowing more of the working poor to buy insurance. Also, the law increases the number of children who are eligible for free coverage. Meanwhile, the federal government continued to provide Massachusetts with its annual Medicaid money for the first 2 years under the new law. Experts predict that the Massachusetts universal health care plan could serve as a model for the rest of the United States to achieve an equal system of health insurance coverage, thus approximating the systems of socialized medicines that other industrialized countries offer to their citizens.

Bibliography:

1) Belluck, Pam. 2006. "Massachusetts Sets Health Plan for Nearly All." New York Times, April 4.

2) Center for Economic and Social Rights. 2004. "The Right to Health in the United States of America: What Does It Mean?" October 29.

3) Kaiser Network. 2006. "Massachusetts Legislature Approves Bill That Would Require Individuals to Have Health Insurance, Levy Assessment on Employers That Do Not Provide Coverage," April 5.

4) Lasser, Karen E., David U. Himmelstein, and Steffie Woolhandler. 2006. "Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey." American Journal of Public Health 96(July):1300-1307.

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