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{{about|the term "socialized medicine" as it is used in U.S. politics|national health care systems generally|Universal health care}}
{{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&q=socialized+medicine&pgis=1#+of+so ''The Sociology of Social Problems''], 1965, p.59 (cited as an example of a standard propaganda device).</ref><ref name="isbn0-7656-1478-2">{{Cite book|author1=Rushefsky, Mark E. |author2=Patel, Kant |title=Health Care Politics And Policy in America |url=https://archive.org/details/healthcarepoliti0000pate |url-access=registration |publisher=M.E. Sharpe |location=Armonk, N.Y.|year= 2006|page=[https://archive.org/details/healthcarepoliti0000pate/page/47 47] |isbn=978-0-7656-1478-0 | quote=....socialized medicine, a pejorative term used to help polarize debate}}</ref><ref name="autogenerated6">Dorothy Porter, [https://books.google.com/books?id=_ZtIAaLlII0C&pg=PA252 Health, Civilization, and the State], Routledge, p. 252: "...what the Americans liked to call "socialized medicine"..."</ref><ref name="autogenerated3">Paul Wasserman, Don Hausrath, [https://books.google.com/books?id=N3Y_Tg4TWLYC&pg=RA2-PA60 Weasel Words: The Dictionary of American Doublespeak], p. 60: "One of the terms to denigrate and attack any system under which complete medical aid would be provided to every citizen through public funding."</ref><ref name="autogenerated1">Edward Conrad Smith, New Dictionary of American Politics, p. 350: "A somewhat loose term applied to..."</ref> The term was first widely used in the United States by advocates of the [[American Medical Association]] in opposition to President [[Harry S. Truman]]'s 1947 health care initiative.<ref>W. Michael Byrd, Linda A. Clayton (2002) ''An American Health Dilemma: Race, medicine, and health care in the United States, 1900–2000'' pp. 238 ff.</ref><ref name="T.R. Reid, 2009">T.R. Reid, (2009) ''The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care''</ref><ref name="abcnews.go.com">{{cite web|last=Reid|first=T.R.|date=2010-11-04|title=The Healing of America (excerpt)|website=[[ABC News (United States)|ABC News]] |url=https://abcnews.go.com/m/screen?id=8383452&pid=248|url-status=dead|archive-url=https://web.archive.org/web/20101105023515/https://abcnews.go.com/m/screen?id=8383452&pid=248|archive-date=2010-11-05|access-date=2009-09-05}}</ref> It was later used in opposition to [[Medicare (United States)|Medicare]]. The [[Affordable Care Act]] has been described in terms of socialized medicine, but the act's objective is rather socialized insurance, not government ownership of hospitals and other facilities as is common in other nations.
 
==Background==
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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", help end "venereal diseases, alcoholism, tuberculosis", and "make a fundamental contribution to social welfare".<ref>{{cite news|url=https://timesmachine.nytimes.com/timesmachine/1917/07/01/96251567.pdf |title=World at War is Facing a Shortage of Doctors|access-date=2009-04-02 |date=1917-07-01 |newspaper=[[The New York Times]] }}</ref> However, by the 1930s, the term socialized medicine was routinely used negatively by [[American conservatism|conservative]] opponents of [[publicly funded health care]] who wished to imply it represented socialism, and by extension, communism.<ref name="Slate history lesson">{{cite magazine |url=http://www.slate.com/id/2175477 |title=Who's Afraid of Socialized Medicine? Two dangerous words that kill health-care reform |access-date=2008-02-27 |last=Greenberg |first=David |date=2007-10-08 |magazine=[[Slate Magazine|Slate]] |url-status=live |archive-url=https://web.archive.org/web/20080224140651/http://www.slate.com/id/2175477 |archive-date=2008-02-24 }}</ref> Universal health care and [[national health insurance]] were first proposed by U.S. President [[Theodore Roosevelt]].<ref>[http://www.healthinsurance.info/issues-and-advocacy/National-Health-Care.HTM National Health Care] {{webarchive|url=https://web.archive.org/web/20080513023853/http://www.healthinsurance.info/issues-and-advocacy/National-Health-Care.HTM |date=2008-05-13 }}, HealthInsurance.info</ref><ref>Chris Farrell, [http://www.businessweek.com/bwdaily/dnflash/jan2006/nf20060123_1965_db013.htm It's Time to Cure Health Care] {{webarchive|url=https://web.archive.org/web/20080330230653/http://www.businessweek.com/bwdaily/dnflash/jan2006/nf20060123_1965_db013.htm |date=2008-03-30 }}, BusinessWeek</ref><ref name="Progressive Platform of 1912">{{cite web|url=http://www.teachingamericanhistory.org/library/index.asp?document=607|title=Progressive Party Platform of 1912 – Teaching American History|website=www.teachingamericanhistory.org|access-date=27 April 2018|url-status=live|archive-url=https://web.archive.org/web/20130409010531/http://teachingamericanhistory.org/library/index.asp?document=607|archive-date=9 April 2013}}</ref> President [[Franklin D. Roosevelt]] later championed it, as did [[Harry S. Truman]] as part of his [[Fair Deal]]<ref>[http://www.trumanlibrary.org/anniversaries/healthprogram.htm President Truman Addresses Congress on Proposed Health Program, Washington, D.C.] {{webarchive|url=https://web.archive.org/web/20120308120819/http://www.trumanlibrary.org/anniversaries/healthprogram.htm |date=2012-03-08 }}, Harry S. Truman Library and Museum</ref> and many others. Truman announced before describing his proposal that: "This is not socialized medicine".<ref name="Slate history lesson"/>
 
Government involvement in health care was ardently opposed by the AMA, which distributed posters to doctors with slogans such as "Socialized medicine&nbsp;... 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): {{blockquote|The term ["socialized medicine"] was popularized by a public relations firm [<nowiki/>[[Whitaker and Baxter]]{{Failed verification|date=September 2020}}] working for the American Medical Association in 1947 to disparage President Truman's proposal for a national health care system. It was a label, at the dawn of the [[Cold War|cold war]], meant to suggest that anybody advocating universal access to health care must be a communist. And the phrase has retained its political power for six decades.<ref name="T.R. Reid, 2009"/><ref name="abcnews.go.com"/>}}
 
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 "socialist" |publisher=[[CNN]].com |url=http://www.cnn.com/2007/POLITICS/07/31/giuliani.democrats/index.html |quote=The American way is not single-payer, government-controlled anything. That's a European way of doing something; that's frankly a socialist way of doing something. That's why when you hear Democrats in particular talk about single-mandated health care, universal health care, what they're talking about is socialized medicine. |url-status=live |archive-url=https://web.archive.org/web/20071011213503/http://www.cnn.com/2007/POLITICS/07/31/giuliani.democrats/index.html |archive-date=October 11, 2007 }}</ref><ref>{{cite news|author=Ramer, Holly (Associated Press) |date=July 31, 2007 |title=Giuliani offers health plan |newspaper=[[USA Today|USAToday.com]] |url=https://www.usatoday.com/news/topstories/2007-07-31-3646301646_x.htm|quote=We've got to solve our health care problem with American principles, not the principles of socialism.}}</ref>{{Citation needed|date=October 2009}} Giuliani claimed that he had a better chance of surviving [[prostate cancer]] in the US than he would have had in [[England]]<ref>{{cite news |author=Haberman, Shir |date=August 1, 2007 |title=Giuliani touts health plan |newspaper=[[The Portsmouth Herald|SeacoastOnline.com]] |url=http://www.seacoastonline.com/apps/pbcs.dll/article?AID=/20070801/NEWS/708010376/-1/TOWN0302 |url-status=live |archive-url=https://web.archive.org/web/20110606150954/http://www.seacoastonline.com/apps/pbcs.dll/article?AID=%2F20070801%2FNEWS%2F708010376%2F-1%2FTOWN0302 |archive-date=June 6, 2011 }}</ref> and went on to repeat the claim in campaign speeches for three months<ref>{{cite news |author=Mayko, Michael P. |date=July 31, 2007 |title=Giuliani prescribes health care reform |newspaper=[[Connecticut Post|ConnPost.com]] |url=http://www.newsmodo.com/display.jsp?id=400161 |access-date=July 17, 2009 |archive-date=April 21, 2021 |archive-url=https://web.archive.org/web/20210421104046/https://www.newsmodo.com/display.jsp?id=400161 |url-status=dead }}</ref><ref>{{Cite news|author=March, William |date=September 18, 2007 |title=Giuliani breezes through state; He attends Tampa fundraising event |work=[[The Tampa Tribune]] |page=5 (Metro) |url=http://www2.tbo.com/content/2007/sep/17/giuliani-breezes-through-state/news-breaking|archive-url=https://web.archive.org/web/20071121094743/http://www2.tbo.com/content/2007/sep/17/giuliani-breezes-through-state/?news-breaking%3C/p|archive-date=2007-11-21|access-date=2023-01-25}}{{cbignore}}</ref><ref>{{Cite news |author=Hutchinson, Bill |date=September 18, 2007 |title=Giuliani fans greet "the Mayor" in Tampa |work=[[Sarasota Herald-Tribune]] |page=BCE1 |url=http://www.heraldtribune.com/article/20070918/NEWS/709180411?Title=Giuliani-fans-greet-the-Mayor-at-Tampa-cafe |url-status=live |archive-url=https://web.archive.org/web/20110605100520/http://www.heraldtribune.com/article/20070918/NEWS/709180411?Title=Giuliani-fans-greet-the-Mayor-at-Tampa-cafe |archive-date=June 5, 2011 }}</ref><ref>{{cite news |date=September 19, 2007 |title=Giuliani's warning over UK's NHS |work=[[BBC News Online]] |url=http://news.bbc.co.uk/2/hi/uk_news/politics/7003286.stm |url-status=live |archive-url=https://web.archive.org/web/20140302212254/http://news.bbc.co.uk/2/hi/uk_news/politics/7003286.stm |archive-date=March 2, 2014 }}</ref><ref>{{cite news|date=September 19, 2007 |title=Giuliani pays homage to Thatcher on UK visit |newspaper=[[The Times|TimesOnline.co.uk]] |url=http://www.timesonline.co.uk/tol/news/world/us_and_americas/article2491657.ece | location=London}}</ref><ref>{{cite news |author=Cook, Emily |date=September 20, 2007 |title=Giuliani in blast at the NHS |newspaper=[[Daily Mirror|Mirror.co.uk]] |url=https://www.mirror.co.uk/news/top-stories/2007/09/20/giuliani-in-nhs-blast-115875-19817725 |url-status=live |archive-url=https://web.archive.org/web/20110605233940/http://www.mirror.co.uk/news/top-stories/2007/09/20/giuliani-in-nhs-blast-115875-19817725/ |archive-date=June 5, 2011 }}</ref> before making them in a radio advertisement.<ref>{{Cite news |author1=Cillizza, Chris |author2=Murray, Shailagh |date=October 28, 2007 |title=Giuliani's bid to woo New Hampshire independents centers on health care |newspaper=[[The Washington Post]] |page=A02 |url=https://www.washingtonpost.com/wp-dyn/content/article/2007/10/27/AR2007102701241.html |url-status=live |archive-url=https://web.archive.org/web/20161122081341/http://www.washingtonpost.com/wp-dyn/content/article/2007/10/27/AR2007102701241.html |archive-date=November 22, 2016 }}</ref> After the radio ad began running, the use of the statistic was widely criticized by [[FactCheck]].org,<ref>{{Cite web |author1=Robertson, Lori |author2=Henig, Jess |date=October 30, 2007 |title=A bogus cancer statistic |publisher=[[FactCheck]].org |url=http://www.factcheck.org/elections-2008/a_bogus_cancer_statistic.html |url-status=live |archive-url=https://web.archive.org/web/20080120022621/http://www.factcheck.org/elections-2008/a_bogus_cancer_statistic.html |archive-date=January 20, 2008 }}</ref> [[PolitiFact.com]],<ref>{{cite news |author1=Greene, Lisa |author2=August, Lissa |date=October 31, 2007 |title=A cancer ad gone wrong for Rudy |work=[[PolitiFact.com]] |url=http://politifact.com/truth-o-meter/article/2007/oct/31/cancer-ad-gone-wrong-rudy |url-status=live |archive-url=https://web.archive.org/web/20090804093707/http://politifact.com/truth-o-meter/article/2007/oct/31/cancer-ad-gone-wrong-rudy/ |archive-date=August 4, 2009 }}</ref> by ''[[The Washington Post]]'',<ref>{{Cite news |author=Dobbs, Michael |date=October 30, 2007 |title=Rudy wrong on cancer survival chances |work=The Fact Checker |publisher=[[The Washington Post|WashingtonPost.com]] |url=http://blog.washingtonpost.com/fact-checker/2007/10/rudy_miscalculates_cancer_surv.html |url-status=live |archive-url=https://web.archive.org/web/20110818152631/http://blog.washingtonpost.com/fact-checker/2007/10/rudy_miscalculates_cancer_surv.html |archive-date=August 18, 2011 }}</ref> and others who consulted leading cancer experts and found that Giuliani's cancer survival statistics to be false, misleading or "flat wrong", the numbers having been reported to have been obtained from an opinion article by Giuliani health care advisor [[David Gratzer]], a Canadian [[psychiatrist]] in the [[Manhattan Institute]]'s ''[[City Journal (New York)|City Journal]]'' where Gratzer was a senior fellow.<ref name="lieberman">{{cite magazine |author=Lieberman, Trudy |date=November 21, 2007 |title=Rudy's unhealthy stats; Some good reporting holds Giuliani's phony cancer numbers at bay |magazine=[[Columbia Journalism Review]] |url=https://www.cjr.org/campaign_desk/rudys_unhealthy_stats.php?page=all |url-status=live |archive-url=https://web.archive.org/web/20090804014428/https://www.cjr.org/campaign_desk/rudys_unhealthy_stats.php?page=all |archive-date=August 4, 2009 }}</ref> ''[[The Times]]'' reported that the British [[Secretary of State for Health|Health Secretary]] pleaded with Giuliani to stop using the NHS as a political football in American presidential politics. The article reported that not only the figures were five years out of date and wrong but also that US health experts disputed both the accuracy of Giuliani's figures and questioned whether it was fair to make a direct comparison.<ref>{{Cite news |author=Baldwin, Tom |date=November 1, 2007 |title=Rudy Giuliani uses the NHS as 'political football to give Hillary Clinton a kicking |work=[[The Times]] |page=2 |quote=Doctors in the two countries have different philosophies for treating the disease with the US putting more emphasis on early diagnosis and surgery. An analysis of mortality rates suggests that about 25 out of 100,000 men are dying from prostate cancer each year in both Britain and the US. |url=http://www.timesonline.co.uk/tol/news/world/us_and_americas/article2781602.ece |location=London |url-status=live |archive-url=https://web.archive.org/web/20080516053000/http://www.timesonline.co.uk/tol/news/world/us_and_americas/article2781602.ece |archive-date=May 16, 2008 }}</ref> The ''[[St. Petersburg Times]]'' said that Giuliani's tactic of "injecting a little fear" exploited cancer, which was "apparently not beneath a survivor with presidential aspirations".<ref>{{Cite news |author=editorial |date=November 3, 2007 |title=Giuliani's dose of fear |work=[[St. Petersburg Times]] |page=14A |url=http://www.sptimes.com/2007/11/03/Opinion/Giuliani_s_dose_of_fe.shtml |url-status=live |archive-url=https://web.archive.org/web/20080226195228/http://www.sptimes.com/2007/11/03/Opinion/Giuliani_s_dose_of_fe.shtml |archive-date=February 26, 2008 }}</ref> Giuliani's repetition of the error even after it had been pointed out to him earned him more criticism and was awarded four "Pinocchios" by the ''Washington Post'' for recidivism.<ref>{{Cite news |author=Dobbs, Michael |date=November 7, 2007 |title=Four Pinocchios for recidivist Rudy |work=The Fact Checker |publisher=[[The Washington Post|WashingtonPost.com]] |url=http://blog.washingtonpost.com/fact-checker/2007/11/four_pinocchios_for_rudy_the_r.html |url-status=live |archive-url=https://web.archive.org/web/20110925192527/http://blog.washingtonpost.com/fact-checker/2007/11/four_pinocchios_for_rudy_the_r.html |archive-date=September 25, 2011 }}</ref><ref>{{Cite web |author1=Robertson, Lori |author2=Henig, Jess |date=November 8, 2007 |title=Bogus cancer stats, again |publisher=[[FactCheck]].org |url=http://www.factcheck.org/bogus_cancer_stats_again.html |url-status=live |archive-url=https://web.archive.org/web/20080101083039/http://www.factcheck.org/bogus_cancer_stats_again.html |archive-date=January 1, 2008 }}</ref>
 
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=Single-payer health care - Medical Dictionary definitions of popular medical terms |access-date=2007-12-22 |url-status=live |archive-url=https://web.archive.org/web/20050215083438/http://www.medterms.com/script/main/art.asp?articlekey=25520 |archive-date=2005-02-15 }} Webster's New World Medical Dictionary, "Single-payer health care is distinct and different from socialized medicine in which doctors and hospitals work for and draw salaries from the government."</ref><ref>{{cite web |url=http://www.pnhp.org/news/2006/june/kevin_drum_and_uwe_r.php |title=Kevin Drum and Uwe Reinhardt on social insurance {{pipe}} Physicians for a National Health Program |access-date=2007-12-22 |url-status=live |archive-url=https://web.archive.org/web/20071011044949/http://www.pnhp.org/news/2006/june/kevin_drum_and_uwe_r.php |archive-date=2007-10-11 }} Uwe Reinhardt, quoted in ''The Washington Monthly'': "'Socialism' is an arrangement under which the means of production are owned by the state. Government-run health insurance is not "socialism," and only an ignoramus would call it that. Rather, government-run health insurance is a form of "social insurance," that can be coupled with privately owned for-profit or not-for-profit health care delivery systems."</ref> Opponents of state involvement in health care tend to use the looser definition.<ref name="Winston-Salem Journal">[http://www.journalnow.com/servlet/Satellite?pagename=WSJ/MGArticle/WSJ_ColumnistArticle&c=MGArticle&cid=1173353854523 "Dirty Words"]{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }}, ''Winston-Salem Journal'', December 14, 2007, "Jonathan Oberlander, a professor of health policy at UNC Chapel Hill, explained that the term itself has no meaning. There is no definition of socialized medicine. It originated with an American Medical Association campaign against government-provided health care a century ago and has been used recently to describe even private-sector initiatives such as HMOs." See also [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 }}, National Public Radio, Morning Edition, December 6, 2007: "The term socialized medicine, technically, to most health policy analysts, actually doesn't mean anything at all," says Jonathan Oberlander, a professor of health policy at the University of North Carolina."</ref>
 
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.
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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>
 
Both sides have also looked to more philosophical arguments, debating whether people have a fundamental [[Rights|right]] to have health care provided to them by their government.{{Citation needed|date=September 2009}}
 
===Cost of care===
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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=ArchivedHuman copyDevelopment Report 2007/8 |date=January 2008 |access-date=2008-03-11 |url-status=live |archive-url=https://web.archive.org/web/20080226204118/http://hdr.undp.org/en/media/hdr_20072008_en_indicator_tables.pdf |archive-date=2008-02-26 }} UN Human Development Report 2007/2008 Table 6 Page 247</ref>
 
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 public's views on NHS system reform – in England: BMA June 2007</ref>
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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 news |url=https://www.nytimes.com/2008/12/03/health/03nice.html |title=British Balance Benefit vs. Cost of Latest Drugs |website=[[The New York Times]] |date=3 December 2008 |access-date=2017-02-18 |url-status=live |archive-url=https://web.archive.org/web/20130515102140/http://www.nytimes.com/2008/12/03/health/03nice.html?_r=3&hp=&pagewanted=all |archive-date=2013-05-15 |last1=Harris |first1=Gardiner }} Quote "Britain's National Health Service provides 95 percent of the nation's care from an annual budget, so paying for costly treatments means less money for, say, sick children." from NY Times article Dec 2, 2008</ref> NICE is therefore applying the same market pricing principles to make the hard job of deciding between funding some treatments and not funding others on behalf of everyone in the insured pool. This rationing does not preclude choice of obtaining insurance coverage for excluded treatment as insured persons do having the choice to take out supplemental health insurance for drugs and treatments that the NHS does not cover (at least one private insurer offers such a plan) or from meeting treatment costs out-of-pocket.
 
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=YouTube |website=[[YouTube]] |access-date=2016-11-28 |url-status=live |archive-url=https://web.archive.org/web/20160414063816/https://www.youtube.com/watch?v=QZK8ffUpL60 |archive-date=2016-04-14 }}</ref> The UK Department of Health said that Grassley's claims were "just wrong" and reiterated health service in Britain provides health care on the basis of clinical need regardless of age or ability to pay. The chairman of the British Medical Association, Hamish Meldrum, said he was dismayed by the "jaw-droppingly untruthful attacks" made by American critics. The chief executive of the National Institute for Health and Clinical Excellence (NICE), told ''The Guardian'' newspaper that "it is neither true, nor is it anything you could extrapolate from anything we've ever recommended" that Kennedy would be denied treatment by the NHS.<ref name="foreignpolicy.com">{{cite web |url=https://foreignpolicy.com/articles/2009/08/18/the_most_outrageous_us_lies_about_global_healthcare?page=0,0 |title=The Most Outrageous U.S. Lies About Global Healthcare {{pipe}} Foreign Policy |access-date=2017-03-11 |url-status=live |archive-url=https://web.archive.org/web/20130728041712/http://www.foreignpolicy.com/articles/2009/08/18/the_most_outrageous_us_lies_about_global_healthcare?page=0,0 |archive-date=2013-07-28 }}</ref> The business journal ''Investor's Business Daily'' claimed mathematician and astrophysicist [[Stephen Hawking]], who had ALS and spoke with the aid of an American-accented voice synthesizer, would not have survived if he had been treated in the British National Health Service. Hawking was British and was treated throughout his life (67 years) by the NHS and issued a statement to the effect he owed his life to the quality of care he has received from the NHS.<ref name="foreignpolicy.com"/><ref>{{Cite news | url=http://news.bbc.co.uk/2/hi/americas/8198084.stm | work=BBC News | title=Bloggers debate British healthcare | date=August 12, 2009 | access-date=May 23, 2010 | url-status=live | archive-url=https://web.archive.org/web/20100814233453/http://news.bbc.co.uk/2/hi/americas/8198084.stm | archive-date=August 14, 2010 }}</ref><ref>{{cite web |url=http://www.spectator.co.uk/alexmassie/5255761/stephen-hawking-has-not-yet-been-murdered-by-the-nhs.thtml |title=The Spectator |access-date=2009-09-07 |url-status=live |archive-url=https://web.archive.org/web/20090814202439/http://www.spectator.co.uk/alexmassie/5255761/stephen-hawking-has-not-yet-been-murdered-by-the-nhs.thtml |archive-date=2009-08-14 }}</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".<ref name=scoring>[http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1114887 Points for pain: waiting list priority scoring systems] by Rhiannon Tudor Edwards. ''[[British Medical Journal]]''. 1999 February 13; 318 (7181): 412–414. Accessed September 1, 2009.</ref> [[Arthur Kellermann|Dr. Arthur Kellermann]], associate dean for health policy at [[Emory University]], stated rationing by ability to pay rather than by anticipated medical benefits in the U.S. makes its system more unproductive, with poor people avoiding preventive care and eventually using expensive emergency treatment.<ref name=scott>{{Cite news|title=Doctors Say Health Care Rationing Already Exists|url=https://www.npr.org/templates/story/story.php?storyId=106168331|access-date=September 7, 2009|publisher=[[National Public Radio]]: [[All Things Considered]]|date=July 1, 2009|first=Scott|last=Horsley|url-status=live|archive-url=https://web.archive.org/web/20090904033216/http://www.npr.org/templates/story/story.php?storyId=106168331|archive-date=September 4, 2009}}</ref> [[Ethicist]] [[Daniel Callahan]] has written that U.S. culture overly emphasizes individual autonomy rather than [[communitarian]] morals and that stops beneficial rationing by social value, which benefits everyone.<ref name=patel/>
 
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=The Doctor Will See You-In Three Months |access-date=2008-10-30 |url-status=livedead |archive-url=https://web.archive.org/web/20081007064527/http://www.businessweek.com/magazine/content/07_28/b4042072.htm |archive-date=2008-10-07 }} ''Business Week'': The doctor will see you in 3 months</ref>
 
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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==Links==
 
* [https://wwwbooks.google.co.ukcom/books/edition/Social_Security_Bulletin/PKA5AAAAMAAJ?hlid=en&gbpv=1PKA5AAAAMAAJ&dq=Percentage+of+population+covered+under+national+health+programs+,+selected+countries+,+1955+and+1970&pg=PA43&printsec=frontcover Percentage of population covered under national health programs , selected countries , 1955 and 1970]
 
* [https://wwwbooks.google.co.ukcom/books/edition/National_Health_Systems_of_the_World/HMa8ZP5SRUEC?hlid=enHMa8ZP5SRUEC&gbpv=1&dqq=national+health+systems+of+the+world+roemer&printsec=frontcover 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]
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* [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://www.google.co.uk/books/edition/Social_Security_Bulletin/B_35R-1p_eUC?hl=en&gbpv=1&dq=Countries+with+social+security+programs+in+operation,+January+1,+1955,+by+type+of+program+and+date+of+legislation&pg=RA4-PA21&printsec=frontcover Countries with social security programs in operation, January 1, 1955, by type of program and date of legislation]
 
* [https://wwwbooks.google.co.ukcom/books/edition/Social_Security_Bulletin/?id=B_35R-1p_eUC?hl=en&gbpv=1&dq=Countries+with+social+security+programs+in+operation,+January+1,+1955,+by+type+of+program+and+date+of+legislation&pg=RA4-PA21&printsec=frontcover Countries with social security programs in operation, January 1, 1955, by type of program and date of legislation]