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{{short description|Government-run health care system}}
{{about|the term
{{use American English|date=February 2014}}
'''Socialized medicine''' is a term used in the United States to describe and discuss systems of [[universal health care]]—medical and hospital care for all by means of government regulation of [[health care]] and subsidies derived from [[taxation]].<ref>The American Heritage Medical Dictionary, Houghton Mifflin Harcourt Publishing Company</ref> Because of historically negative associations with [[socialism]] in American culture, the term is usually used [[pejorative]]ly in American political discourse.<ref name="autogenerated2">Paul Burleigh Horton, Gerald R. Leslie, [https://books.google.com/books?id=vu7XcDy2x4cC
==Background==
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[[Jonathan Oberlander]], a professor of health policy at the [[University of North Carolina]], maintains that the term is merely a political pejorative that has been defined to mean different levels of government involvement in health care, depending on what the speaker was arguing against at the time.<ref name="NPR">[https://www.npr.org/templates/story/story.php?storyId=16962482 Socialized Medicine Belittled on Campaign Trail] {{webarchive|url=https://web.archive.org/web/20170707232709/http://www.npr.org/templates/story/story.php?storyId=16962482 |date=2017-07-07 }} from NPR.</ref>
The term is often used by conservatives in the U.S. to imply that the privately run health care system would become controlled by the government, thereby associating it with [[socialism]], which has negative connotations to some people in American political culture.<ref name="MFriedman">{{Cite web|url=http://www.hillsdale.edu/hctools/imprimis_archive/2006/07/2006_07_Imprimis.pdf |title=Free to Choose: A Conversation with Milton Friedman |access-date=2008-04-14 |url-status=dead |archive-url=https://web.archive.org/web/20080530160511/http://www.hillsdale.edu/hctools/imprimis_archive/2006/07/2006_07_Imprimis.pdf |archive-date=May 30, 2008 }}</ref> As such, its usage is controversial,<ref name="autogenerated6" /><ref name="autogenerated3" /><ref name="autogenerated1" /><ref name="NPR" /> and at odds with the views of conservatives in other countries prepared to defend socialized medicine such as [[Margaret Thatcher]].<ref>{{cite web |url=http://opinion.publicfinance.co.uk/2009/08/the-end-is-nye/ |title=
==History of term==
When the term "socialized medicine" first appeared in the United States in the early 20th century, it bore no negative connotations. Otto P. Geier, chairman of the Preventive Medicine Section of the [[American Medical Association]], was quoted in ''The New York Times'' in 1917 as praising socialized medicine as a way to "discover disease in its incipiency
Government involvement in health care was ardently opposed by the AMA, which distributed posters to doctors with slogans such as "Socialized medicine ... will undermine the democratic form of government."<ref>Olivier Garceau, "Organized Medicine Enforces its 'Party Line'", Public Opinion Quarterly, September 1940, p. 416.</ref> According to T.R. Reid (''The Healing of America'', 2009):
The AMA conducted a nationwide campaign called [[Operation Coffee Cup]] during the late 1950s and early 1960s in opposition to the Democrats' plans to extend [[Social Security (United States)|Social Security]] to include health insurance for the elderly, later known as [[Medicare (United States)|Medicare]]. As part of the plan, doctors' wives would organize coffee meetings in an attempt to convince acquaintances to write letters to Congress opposing the program.<ref name=OCC>{{cite news| url=https://www.nytimes.com/2005/01/16/magazine/16SOCIAL.html| title=A Question of Numbers| newspaper=[[The New York Times]]| author=Roger Lowenstein| date=2009-07-27| url-status=live| archive-url=https://web.archive.org/web/20140331144728/http://www.nytimes.com/2005/01/16/magazine/16SOCIAL.html| archive-date=2014-03-31}}</ref> In 1961, [[Ronald Reagan]] recorded a disc entitled ''[[Ronald Reagan Speaks Out Against Socialized Medicine]]'' warning its audience the "dangers" that socialized medicine could bring. The recording was widely played at Operation Coffee Cup meetings.<ref name=OCC/> Other pressure groups began to extend the definition from state managed health care to any form of state finance in health care.{{Citation needed|date=September 2009}} President [[Dwight Eisenhower]] opposed plans to expand government role in healthcare during his time in [[Eisenhower administration|office]].<ref name="Slate history lesson"/>
In more recent times, the term was brought up again by [[Republican Party (United States)|Republicans]] in the [[2008 United States presidential election|2008 U.S. presidential election]].<ref>{{Cite news |author=Meckler, Laura |date=January 25, 2008 |title=Tempering health-care goals; Democrats' proposals build on current system, reject single-payer |work=[[The Wall Street Journal]] |page=A5 |url=https://www.wsj.com/articles/SB120123158058516047 |quote="Say something too kind about single-payer and there's a Republican around the corner ready to brand you a socialist"..."Say something too harsh and you will alienate many on the left wing of the party." |url-status=live |archive-url=https://web.archive.org/web/20160309000001/http://www.wsj.com/articles/SB120123158058516047 |archive-date=March 9, 2016 }}</ref> In July 2007, one month after the release of [[Michael Moore]]'s film ''[[Sicko]]'', [[Rudy Giuliani]], the front-runner for the [[Republican Party (United States) presidential candidates, 2008|2008 Republican presidential nomination]], attacked the health care plans of [[Democratic Party (United States) presidential candidates, 2008|Democratic presidential candidates]] as socialized medicine that was European and [[socialism|socialist]],<ref>{{Cite news |author=Steinhauser, Paul |date=July 31, 2007 |title=Giuliani attacks Democratic health plans as
Health care professionals have tended to avoid the term because of its pejorative nature, but if they use it, they do not include publicly funded private medical schemes such as [[Medicaid]].<ref name="isbn0-7656-1478-2"/><ref>{{cite web |url=http://www.medterms.com/script/main/art.asp?articlekey=25520 |title=
The term is widely used by the American media and pressure groups. Some have even stretched use of the term to cover any regulation of health care, publicly financed or not.<ref>{{Cite web | url = http://www.cato.org/pub_display.php?pub_id=8686 | title = Socialized Medicine is Already Here | url-status = live | archive-url = https://web.archive.org/web/20071217204310/https://www.cato.org/pub_display.php?pub_id=8686 | archive-date = 2007-12-17 }}</ref> The term is often used to criticize publicly provided health care outside the US, but rarely to describe similar health care programs there, such as the [[United States Department of Veterans Affairs|Veterans Administration]] clinics and hospitals, military health care,<ref>{{Cite web | author=Timothy Noah | title=The Triumph of Socialized Medicine | work=Slate | date=March 8, 2005 | url=http://www.slate.com/id/2114554/ | url-status=live | archive-url=https://web.archive.org/web/20060614160232/http://www.slate.com/id/2114554/ | archive-date=June 14, 2006 }}</ref> or the single payer programs such as [[Medicaid]] and [[Medicare (United States)|Medicare]]. Many conservatives use the term to evoke negative sentiment toward health care reform that would involve increasing government involvement in the US health care system.
Medical staff, academics and most professionals in the field and international bodies such as the [[World Health Organization]] tend to avoid use of the term.{{Citation needed|date=February 2008}} Outside the US, the terms most commonly used are [[universal health care]] or [[public health care]].{{Citation needed|date=February 2008}} According to health economist [[Uwe Reinhardt]], "strictly speaking, the term
In more recent times, the term has gained a more positive reappraisal. Documentary movie maker [[Michael Moore]] in his documentary ''[[Sicko]]'' pointed out that Americans do not talk about public libraries or the police or the fire department as being "socialized" and do not have negative opinions of these. Media personalities such as [[Oprah Winfrey]] have also weighed in behind the concept of public involvement in healthcare.<ref>{{cite web |url=http://www.alternet.org/blogs/video/63935/michael_moore_and_oprah_ask_audience:_why_should_us_health_care_be_for_profit/?comments=view&cID=741898&pID=741639 |title=
==History in United States==
{{See also|Health care in the United States|Health care reform in the United States|Health insurance in the United States}}
The [[Veterans Health Administration]], the [[Military Health System]],<ref name="Boffey NYT">Phillip Boffey, [https://www.nytimes.com/2007/09/28/opinion/28fri4.html
[[Medicare (United States)|Medicare]] and [[Medicaid]] are forms of [[publicly funded health care]], which fits the looser definition of socialized medicine.{{Citation needed|date=January 2009}} Part B coverage (Medical) requires a monthly premium of $96.40 (and possibly higher) and the first $135 of costs per year also fall to the senior, not the government.<ref>http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=2100 Medicare rates</ref>
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A poll released in February 2008, conducted by the [[Harvard School of Public Health]] and [[Harris Insights & Analytics|Harris Interactive]], indicated that Americans are currently divided in their opinions of socialized medicine, and this split correlates strongly with their political party affiliation.<ref name="Harvard School of Public Health">{{cite press release |title=Poll Finds Americans Split by Political Party Over Whether Socialized Medicine Better or Worse Than Current System |publisher=Harvard School of Public Health |date=2007-02-14 |url=http://www.hsph.harvard.edu/news/press-releases/2008-releases/poll-americans-split-by-political-party-over-socialized-medicine.html |access-date=2008-02-27 |url-status=live |archive-url=https://web.archive.org/web/20080217230522/http://www.hsph.harvard.edu/news/press-releases/2008-releases/poll-americans-split-by-political-party-over-socialized-medicine.html |archive-date=2008-02-17 }}</ref>
Two thirds of those polled said they understood the term "socialized medicine" very well or somewhat well.<ref name="Harvard School of Public Health" /> When offered descriptions of what such a system could mean, strong majorities believed that it means "the government makes sure everyone has health insurance" (79%) and "the government pays most of the cost of health care" (73%). One third (32%) felt that socialized medicine is a system in which "the government tells doctors what to do
According to Robert J. Blendon, professor of health policy and political analysis at the Harvard School of Public Health, "The phrase 'socialized medicine' really resonates as a pejorative with Republicans. However, that so many Democrats believe that socialized medicine would be an improvement is an indication of their dissatisfaction with our current system." Physicians' opinions have become more favorable toward "socialized medicine
A 2008 survey of doctors, published in ''[[Annals of Internal Medicine]]'', shows that physicians support universal health care and national health insurance by almost 2 to 1.<ref>[https://www.reuters.com/article/healthNews/idUSN3143203520080331?
==Political controversies in the United States==
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Opponents also claim that the absence of a market mechanism may slow innovation in treatment and research.<ref>{{Cite web|title=Medicare for All Means Innovation for None {{!}} RealClearPolicy|url=https://www.realclearpolicy.com/articles/2019/04/08/medicare_for_all_means_innovation_for_none_111151.html|access-date=2021-07-05|website=www.realclearpolicy.com}}</ref>
===Cost of care===
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Other studies have found no consistent and systematic relationship between the type of financing of health care and cost containment; the efficiency of operation of the health care system itself appears to depend much more on how providers are paid and how the delivery of care is organized than on the method used to raise these funds.<ref>{{cite journal |author-link1=Sherry Glied |first=Sherry A. |last=Glied |title=Health Care Financing, Efficiency, and Equity |date=March 2008 |journal=NBER Working Paper No. 13881 |doi=10.3386/w13881 |doi-access=free }}</ref>
Some supporters argue that government involvement in health care would reduce costs not just because of the exercise of monopsony power, e.g. in drug purchasing,<ref>{{cite web|url=http://www.pnhp.org/facts/singlepayer_faq.php#drug_prices|title=Single Payer FAQ – Physicians for a National Health Program|website=pnhp.org|access-date=27 April 2018|url-status=live|archive-url=https://web.archive.org/web/20091026121131/http://www.pnhp.org/facts/singlepayer_faq.php#drug_prices|archive-date=26 October 2009}}</ref> but also because it eliminates profit margins and administrative overhead associated with private insurance, and because it can make use of [[economies of scale]] in administration. In certain circumstances, a volume purchaser may be able to guarantee sufficient volume to reduce overall prices while providing greater profitability to the seller, such as in so-called "[[Advance market commitments|purchase commitment]]" programs.<ref>{{cite journal |last1=Löfgren |first1=Hans |title=Purchase commitments: Big business bias or solution to the
[[Milton Friedman]] has argued that government has weak incentives to reduce costs because "nobody spends somebody
[[Paul Krugman]] and [[Robin Wells (economist)|Robin Wells]] argue that all of the evidence indicates that public insurance of the kind available in several European countries achieves equal or better results at much lower cost, a conclusion that also applies within the United States. In terms of actual administrative costs, Medicare spent less than 2% of its resources on administration, while private insurance companies spent more than 13%.<ref>Paul Krugman and Robin Wells, [http://www.nybooks.com/articles/18802 "The Health Care Crisis and What to Do About It"] {{webarchive|url=https://web.archive.org/web/20070627092738/http://www.nybooks.com/articles/18802 |date=2007-06-27 }}, The New York Review of Books, Volume 53, Number 5, March 23, 2006</ref> The [[Cato Institute]] argues that the 2% Medicare cost figure ignores all costs shifted to doctors and hospitals, and alleges that Medicare is not very efficient at all when those costs are incorporated.<ref>{{Cite web | author=John Goodman | title=Five Myths of Socialized Medicine | work=[[Cato Institute]] | date=Winter 2005 | url=http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf | url-status=live | archive-url=https://web.archive.org/web/20061230100531/https://www.cato.org/pubs/catosletter/catosletterv3n1.pdf | archive-date=2006-12-30 }}</ref> Some studies have found that the U.S. wastes more on bureaucracy (compared to the Canadian level), and that this excess administrative cost would be sufficient to provide health care to the uninsured population in the U.S.<ref>Summary of New England Journal of Medicine Study, [http://www.medicalnewstoday.com/articles/8800.php USA wastes more on health care bureaucracy than it would cost to provide health care to all of the uninsured] {{webarchive|url=https://web.archive.org/web/20080223201811/http://www.medicalnewstoday.com/articles/8800.php |date=2008-02-23 }}, Medical News Today, 28 May 2004.</ref>
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===Taxation===
Opponents claim that socialized medicine would require higher taxes but international comparisons do not support this; the ratio of public to private spending on health is lower in the U.S. than that of Canada, Australia, New Zealand, Japan, or any EU country, yet the per capita tax funding of health in those countries is already lower than that of the United States.<ref>{{cite web |url=http://hdr.undp.org/en/media/HDR_20072008_EN_Indicator_tables.pdf |title=
Taxation is not necessarily an unpopular form of funding for health care. In England, a survey for the [[British Medical Association]] of the general public showed overwhelming support for the tax funding of health care. Nine out of ten people agreed or strongly agreed with a statement that the NHS should be funded from taxation with care being free at the point of use.<ref>{{cite web |url=http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFnhssystreform2007/$FILE/48751Surveynhsreform.pdf |title=Archived copy |access-date=2017-03-31 |url-status=dead |archive-url=https://web.archive.org/web/20080227150902/http://www.bma.org.uk/ap.nsf/AttachmentsByTitle/PDFnhssystreform2007/%24FILE/48751Surveynhsreform.pdf |archive-date=2008-02-27 }} Survey of the general
An [[opinion piece]] in ''The Wall Street Journal'' by two conservative Republicans argues that government sponsored health care will legitimatize support for government services generally, and make an activist government acceptable. "Once a large number of citizens get their health care from the state, it dramatically alters their attachment to government. Every time a tax cut is proposed, the guardians of the new medical-welfare state will argue that tax cuts would come at the expense of health care -- an argument that would resonate with middle-class families entirely dependent on the government for access to doctors and hospitals."<ref>[https://www.wsj.com/articles/SB123207075026188601 Beware of the Big-Government Tipping Point] {{webarchive|url=https://web.archive.org/web/20180120205305/https://www.wsj.com/articles/SB123207075026188601 |date=2018-01-20 }}, [[Peter Wehner]] and Paul Ryan, The Wall Street Journal, January 16, 2009</ref>
===Innovation===
Some in the U.S. argue that if government were to use its size to bargain down health care prices, this would undermine American leadership in medical innovation.<ref>Tyler Cowen, [https://www.nytimes.com/2006/10/05/business/05scene.html
Others point out that the American health care system spends more on state-of-the-art treatment for people who have good insurance, and spending is reduced on those lacking it<ref>Paul Krugman, Robin Wells, [http://www.nybooks.com/articles/18802 "The Health Care Crisis and What to Do About It"] {{webarchive|url=https://web.archive.org/web/20070627092738/http://www.nybooks.com/articles/18802 |date=2007-06-27 }}</ref> and question the costs and benefits of some medical innovations, noting, for example, that "rising spending on new medical technologies designed to address heart disease has not meant that more patients have survived
===Access===
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Part of the current debate about [[health care in the United States]] revolves around whether the [[Affordable Care Act]] as part of [[health care reform in the United States|health care reform]] will result in a more systematic and logical allocation of health care. Opponents tend to believe that the law will eventually result in a government takeover of health care and ultimately to socialized medicine and rationing based not on being able to afford the care you want but on whether a third party other than the patient and the doctor decides whether the procedure or the cost is justifiable. Supporters of reform point out that health care rationing already exists in the United States through insurance companies issuing denial for reimbursement on the grounds that the insurance company believes the procedure is [[Medical research|experimental]] or will not assist even though the doctor has recommended it.<ref>[http://www.kmbc.com/r/6882159/detail.html Man Dies After Insurance Co. Refuses To Cover Treatment] {{webarchive|url=https://web.archive.org/web/20120119100834/http://www.kmbc.com/r/6882159/detail.html |date=2012-01-19 }} ABC station KBMC report on case featured by Michael Moore in Sicko!</ref> A public insurance plan was not included in the Affordable Care Act but some argue that it would have added to health care access choices,<ref name=patel/><ref name=scott/> and others argue that the central issue is whether health care is rationed sensibly.<ref name=McArdle/><ref name="leonhardt">{{cite news|first=David|last=Leonhardt|author-link=David Leonhardt|title=Health Care Rationing Rhetoric Overlooks Reality|url=https://www.nytimes.com/2009/06/17/business/economy/17leonhardt.html|newspaper=The New York Times|date=June 17, 2009|access-date=September 7, 2009|url-status=live|archive-url=https://web.archive.org/web/20110706001751/http://www.nytimes.com/2009/06/17/business/economy/17leonhardt.html|archive-date=July 6, 2011}}</ref>
Opponents of reform invoke the term socialized medicine because they say it will lead to health care rationing by denial of coverage, denial of access, and use of waiting lists, but often do so without acknowledging coverage denial, lack of access and waiting lists exist in the U.S. health care system currently<ref>"95,000+ U.S. patients are currently waiting for an organ transplant; nearly 4,000 new patients are added to the waiting list each month. Every day, 17 people die while waiting for a transplant of a vital organ, such as a heart, liver, kidney, pancreas, lung or bone marrow. Because of the lack of available donors in this country, 3,916 kidney patients, 1,570 liver patients, 356 heart patients and 245 lung patients died in 2006 while waiting for life-saving organ transplants:National Kidney Foundation http://www.kidney.org/news/newsroom/fs_new/25factsorgdon&trans.cfm {{webarchive|url=https://web.archive.org/web/20090711030138/http://www.kidney.org/news/newsroom/fs_new/25factsorgdon%26trans.cfm |date=2009-07-11 }}</ref> or that waiting lists in the U.S. are sometimes longer than the waiting lists in countries with socialized medicine.<ref>"Right now more than 8,000 people in the UK need an organ transplant that could save or improve their life. But each year around 400 people die while waiting for a transplant". National Kidney Federation. {{cite web |url=http://www.kidney.org.uk/donor.html |title=
There is a frequent misunderstanding to think that waiting happens in places like the United Kingdom and Canada but does not happen in the United States. For instance it is not uncommon even for emergency cases in some U.S. hospitals to be boarded on beds in hallways for 48 hours or more due to lack of inpatient beds<ref>{{Cite web | last =
</ref> and people in the U.S. rationed out by being unable to afford their care are simply never counted and may never receive the care they need, a factor that is often overlooked. Statistics about waiting times in national systems are an honest approach to the issue of those waiting for access to care. Everyone waiting for care is reflected in the data, which, in the UK for example, are used to inform debate, decision-making and research within the government and the wider community.<ref>{{cite web|url=http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=1091|title=What does the Department of Health do? - Health Questions - NHS Direct<!-- Bot generated title -->|website=nhsdirect.nhs.uk|access-date=27 April 2018|url-status=live|archive-url=https://web.archive.org/web/20071031075726/http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=1091|archive-date=31 October 2007}}</ref><ref>{{cite web|url=http://www.hc-sc.gc.ca/hcs-sss/indicat/index_e.html|title=Health Indicators – Canada.ca|first=Health|last=Canada|website=www.hc-sc.gc.ca|date=19 December 2006 |access-date=27 April 2018|url-status=live|archive-url=https://web.archive.org/web/20080513015835/http://www.hc-sc.gc.ca/hcs-sss/indicat/index_e.html|archive-date=13 May 2008}}</ref><ref>{{cite web |url=http://www.18weeks.nhs.uk/endwaiting/documents/EWCL_patient_LON_280907.pdf |title=Archived copy |access-date=2009-09-14 |url-status=live |archive-url=https://web.archive.org/web/20091012102149/http://www.18weeks.nhs.uk/endwaiting/documents/EWCL_patient_LON_280907.pdf |archive-date=2009-10-12 }} Setting new standards for your care: 2007 NHS patient leaflet on the 18 week maximum wait time promise for Dec 2008.</ref> Some people in the U.S. are rationed out of care by unaffordable care or denial of access by [[Health maintenance organization|HMOs]] and insurers or simply because they cannot afford co-pays or deductibles even if they have insurance.<ref>{{Cite news | url=https://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html
Opponents of the current reform care proposals fear that U.S. comparative effective research (a plan introduced in the stimulus bill) will be used to curtail spending and ration treatments, which is one function of the [[National Institute for Health and Care Excellence]] (NICE), arguing that rationing by market pricing rather by government is the best way for care to be rationed. However, when defining any group scheme, the same rules must apply to everyone in the scheme so some coverage rules had to be established. Britain has a national budget for public funded health care, and recognizes there has to be a logical trade off between spending on expensive treatments for some against, for example, caring for sick children.<ref>{{cite
The debate in the U.S. over rationing has enraged some in the UK and statements made by politicians such as [[Sarah Palin]] and [[Chuck Grassley]] resulted in a mass Internet protest on websites such as Twitter and Facebook under the banner title "welovetheNHS" with positive stories of NHS experiences to counter the negative ones being expressed by these politicians and others and by certain media outlets such as ''Investor's Business Daily'' and Fox News.<ref>https://www.mirror.co.uk/news/top-stories/2009/08/14/welove-thenhs-115875-21595748/The{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }} Mirror (UK newspaper) on public reaction and rage in UK to Palin, Grassley, IBD, and Fox (Hanan) interviews intended to denigrate the NHS</ref> In the UK, it is private health insurers that ration care (in the sense of not covering the most common services such as access to a primary care physician or excluding pre-existing conditions) rather than the NHS. Free access to a general practitioner is a core right in the NHS, but private insurers in the UK will not pay for payments to a private primary care physician.<ref name="ABI"/> Private insurers exclude many of the most common services as well as many of the most expensive treatments, whereas the vast majority of these are not excluded from the NHS but are obtainable at no cost to the patient. According to the [[Association of British Insurers]] (ABI), a typical policy will exclude the following: going to a general practitioner; going to [[Emergency department|accident and emergency]]; drug abuse; HIV/AIDS; normal pregnancy; gender reassignment; mobility aids, such as wheelchairs; organ transplant; injuries arising from dangerous hobbies (often called hazardous pursuits); pre-existing conditions; dental services; outpatient drugs and dressings; deliberately self-inflicted injuries; infertility; cosmetic treatment; experimental or unproven treatment or drugs; and war risks. Chronic illnesses, such as [[diabetes]] and [[Chronic kidney disease|end stage renal disease]] requiring [[Kidney dialysis|dialysis]] are also excluded from coverage.<ref name="ABI">{{Cite web|url=http://www.abi.org.uk/Information/Consumers/Health_and_Protection/496.pdf|title=Are you buying private medical insurance? Take a look at this guide before you decide (Association of British Insurers, 2008)|publisher=[[Association of British Insurers]]|year=2008|access-date=September 5, 2009|url-status=live|archive-url=https://web.archive.org/web/20100215035140/http://www.abi.org.uk/Information/Consumers/Health_and_Protection/496.pdf|archive-date=February 15, 2010}}</ref> Insurers do not cover these because they feel they do not need to since the NHS already provides coverage and to provide the choice of a private provider would make the insurance prohibitively expensive.<ref name="ABI"/> Thus in the UK there is cost shifting from the private sector to the public sector, which again is the ''opposite'' of the allegation of cost shifting in the U.S. from public providers such as Medicare and Medicaid to the private sector.{{Citation needed|date=September 2009}}
Palin had alleged that America will create rationing "[[death panels]]" to decide whether old people could live or die, again widely taken to be a reference to NICE. U.S. Senator Chuck Grassley alleged that he was told that Senator [[Edward Kennedy]] would have been refused the brain tumor treatment he was receiving in the United States had he instead lived a country with government run health care. This, he alleged, would have been due to rationing because of Kennedy's age (77 years) and the high cost of treatment.<ref>Audio of Senator Grassly repeating allegation Sen Kennedy would not receive care in the UK on grounds of his age. {{cite web |url=https://www.youtube.com/watch?v=QZK8ffUpL60 |title=
Some argue that countries with national health care may use waiting lists as a form of rationing compared to countries that ration by price, such as the United States, according to several commentators and healthcare experts.<ref name=patel/><ref name=scoring/><ref name=JPE/> ''The Washington Post'' columnist [[Ezra Klein]] compared 27% of Canadians reportedly waiting four months or more for [[elective surgery]] with 26% of Americans reporting that they did not fulfill a [[Medical prescription|prescription]] due to cost (compared to only 6% of Canadians).<ref name=ezra>{{cite news|url=http://voices.washingtonpost.com/ezra-klein/2009/06/a_rational_look_at_rationing.html|title=A Rational Look At Rationing|newspaper=[[The Washington Post]]|access-date=September 7, 2009|date=June 17, 2009|author=Ezra Klein|author-link=Ezra Klein}}</ref><ref>{{Cite news |first=David |last=Gratzer |title=Canada's ObamaCare Precedent |url=https://www.wsj.com/articles/SB124451570546396929 |work=[[OpinionJournal.com]] |publisher=The Wall Street Journal |date=June 9, 2009 |access-date=September 1, 2009 |url-status=live |archive-url=https://web.archive.org/web/20150322085442/http://www.wsj.com/articles/SB124451570546396929 |archive-date=March 22, 2015 }}</ref> Britain's former age-based policy that once prevented the use of [[kidney dialysis]] as treatment for older patients with renal problems, even to those who can privately afford the costs, has been cited as another example.<ref name=patel>{{Cite book|url=https://books.google.com/books?id=XX_-rB07oP0C&q=Health+Care+Rationing&pg=PA360|title=Health Care Politics and Policy in America|author1=Kant Patel|author2=Mark E. Rushefsky|publisher=3rd Ed. M.E. Sharpe|year=2006|isbn=978-0-7656-1479-7|pages=360–361|url-status=live|archive-url=https://web.archive.org/web/20180427175646/https://books.google.com/books?id=XX_-rB07oP0C&pg=PA360&dq=Health+Care+Rationing#v=onepage&q=Health%20Care%20Rationing|archive-date=2018-04-27}}</ref> A 1999 study in the ''Journal of Public Economics'' analyzed the British National Health Service and found that its waiting times function as an effective market disincentive, with a low [[Price elasticity of demand|elasticity of demand]] with respect to time.<ref name=JPE>{{Cite journal| first1 = S. | title = Rationing by waiting lists: an empirical investigation | journal = Journal of Public Economics | volume = 71| last1 = Martin | pages = 141–164 | year = 1999 | doi = 10.1016/S0047-2727(98)00067-X}}</ref>
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Supporters of private price rationing over waiting time rationing, such as ''[[The Atlantic]]'' columnist [[Megan McArdle]], argue time rationing leaves patients worse off since their time (measured as an [[opportunity cost]]) is worth much more than the price they would pay.<ref name=McArdle>[http://business.theatlantic.com/2009/08/rationing_by_any_other_name.php "Rationing By Any Other Name"] {{webarchive|url=https://web.archive.org/web/20090903182419/http://business.theatlantic.com/2009/08/rationing_by_any_other_name.php |date=2009-09-03 }}. By [[Megan McArdle]]. ''[[The Atlantic]]''. Published August 10, 2009.</ref> Opponents also state categorizing patients based on factors such as social value to the community or age will not work in a heterogeneous society without a common ethical consensus such as the U.S.<ref name=patel/> [[Doug Bandow]] of the [[CATO Institute]] wrote that government decision making would "override the differences in preferences and circumstances" for individuals and that it is a matter of personal liberty to be able to buy as much or as little care as one wants.<ref>{{Cite web|author=Doug Bandow|title=Uwe Reinhardt on Health Care Rationing|publisher=[[CATO Institute]]|url=http://www.cato-at-liberty.org/2009/07/06/uwe-reinhardt-on-health-care-rationing/|access-date=September 7, 2009|author-link=Doug Bandow|url-status=live|archive-url=https://web.archive.org/web/20090906173825/http://www.cato-at-liberty.org/2009/07/06/uwe-reinhardt-on-health-care-rationing/|archive-date=September 6, 2009}}</ref> Neither argument recognizes the fact that in most countries with socialized medicine, a parallel system of private health care allows people to pay extra to reduce their waiting time. The exception is that some provinces in Canada disallow the right to bypass queuing unless the matter is one in which the rights of the person under the constitution.
A 1999 article in the ''[[British Medical Journal]]'', stated "there is much merit in using waiting lists as a rationing mechanism for elective health care if the waiting lists are managed efficiently and fairly
Some argue that waiting lists result in great pain and suffering, but again evidence for this is unclear. In a recent survey of patients admitted to hospital in the UK from a waiting list or by planned appointment, only 10% reported they felt they should have been admitted sooner than they were. 72% reported the admission was as timely as they felt necessary.<ref>{{cite web |url=http://www.healthcarecommission.org.uk/_db/_documents/Full_2007_results_with_historical_comparisons_-_tables.doc |title=Archived copy |access-date=2008-10-17 |url-status=live |archive-url=https://web.archive.org/web/20081029031549/http://www.healthcarecommission.org.uk/_db/_documents/Full_2007_results_with_historical_comparisons_-_tables.doc |archive-date=2008-10-29 }} Healthcare Commission: 'Survey of adult inpatients in the NHS 2007'</ref> Medical facilities in the U.S. do not report waiting times in national statistics as is done in other countries and it is a myth to believe there is no waiting for care in the U.S. Some argue that wait times in the U.S. could actually be as long as or longer than in other countries with universal health care.<ref>{{cite web |url=http://www.businessweek.com/magazine/content/07_28/b4042072.htm |title=
There is considerable argument about whether any of the health bills currently before congress will introduce rationing. [[Howard Dean]] for example contested in an interview that they do not. However, ''[[Politico]]'' has pointed out that all health systems contain elements of rationing (such as coverage rules) and the public health care plan will therefore implicitly involve some element of rationing.<ref name=scott/><ref name=dean>{{Cite web|url=http://www.politifact.com/truth-o-meter/statements/2009/aug/25/howard-dean/rationing-health-care-reform/|title=There's rationing in health care now, and there still would be under reform bill|publisher=[[PolitiFact]]|access-date=September 7, 2009|url-status=live|archive-url=https://web.archive.org/web/20090830200720/http://www.politifact.com/truth-o-meter/statements/2009/aug/25/howard-dean/rationing-health-care-reform/|archive-date=August 30, 2009}}</ref>
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The veracity and significance of the claims of targeting interfering with clinical priorities are often hard to judge. For example, some UK ambulance crews have complained that hospitals would deliberately leave patients with ambulance crews to prevent an accident and emergency department (A&E, or emergency room) target-time for treatment from starting to run. The Department of Health vehemently denied the claim, because the A&E time begins when the ambulance arrives at the hospital and not after the handover. It defended the A&E target by pointing out that the percentage of people waiting four hours or more in A&E had dropped from just under 25% in 2004 to less than 2% in 2008.<ref>
[http://news.bbc.co.uk/1/hi/uk/7249514.stm BBC News:Anger at
[https://www.theguardian.com/society/2008/feb/17/health.nhs1 copy of original Observer story from Guardian website] {{webarchive|url=https://web.archive.org/web/20160718130903/https://www.theguardian.com/society/2008/feb/17/health.nhs1 |date=2016-07-18 }}
</ref> However, in the context of the total number of emergency ambulance attendances by the [[London Ambulance Service]] each year (approximately 865,000),<ref>
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[[Category:Publicly funded health care]]
[[Category:Right to health]]
==Links==
* [https://books.google.com/books?id=PKA5AAAAMAAJ&dq=Percentage+of+population+covered+under+national+health+programs+,+selected+countries+,+1955+and+1970&pg=PA43 Percentage of population covered under national health programs , selected countries , 1955 and 1970]
* [https://books.google.com/books?id=HMa8ZP5SRUEC&q=national+health+systems+of+the+world+roemer Contains information on health coverage in various countries in the 1980s]
* [https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Unmet_health_care_needs_statistics&oldid=587170#Unmet_needs_for_health_care Contains information on healthcare access in various European countries]
* [https://read.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe-2018_health_glance_eur-2018-en#page1 Contains information on healthcare coverage in various European countries]
* [https://books.google.com/books?id=nVsWAAAAIAAJ&dq=National+health+insurance+resource+book+1974+France&pg=PA357 Includes information about he healthcare systems of various countries in the 1970s]
* [https://books.google.com/books?id=B_35R-1p_eUC&dq=Countries+with+social+security+programs+in+operation,+January+1,+1955,+by+type+of+program+and+date+of+legislation&pg=RA4-PA21 Countries with social security programs in operation, January 1, 1955, by type of program and date of legislation]
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