art by Jill McDonnell, Sarah Burns, and Dheeraj K. Jalluri
The Red [Health] Scare: Is It Time for Socialized Medicine in America?
by Jill McDonnell
In 1920, there was one word every American loved to hate: socialism. Almost 100 years later, the words “socialized medicine” still conjure images of Che Guevara and Joseph Stalin ripping apart an American flag. The United States was built on the idea of individualism and limited government, but that same rugged Americanism has us trapped in a political frenzy when it comes to health care.
Socialized medicine is a system in which the government owns the health care facilities, employs health care workers and pays all of the health care costs. The U.S. is the only developed Western nation without a government-run system. Instead, we have a market-driven, private health care system in which individuals are responsible for obtaining their own insurance. The only public assistance programs available are Medicare (for the elderly and disabled), Medicaid (for those with low income) and CHIP (for children and pregnant women).
Many developed countries have slightly different versions of “socialized” health care systems. For example, the government pays for health care in Canada, but Canadian hospitals and doctors remain private. In the United Kingdom, however, hospitals and doctors are owned by the government. Despite structural differences between countries, socialized systems prioritize the human side of medicine, while the U.S. health care system tends to prioritize the business side of medical care.
Similarities in American and British cultures allow for a good comparison of the two health care systems and their inherent differences. The U.K.’s National Health Service (NHS) is the first and longest running nationalized health care system in the world. Under the care of the NHS, individuals enjoy free services from general practitioners and specialists as well as access to free or low cost prescription drugs. According to the World Health Organization, the average life expectancy in the U.K. is 81 years, compared to 79 years in the U.S. Government-run health systems can be beneficial for all people, but are especially beneficial to marginalized populations.
Despite the U.K.’s socialized health care system, there are still regions and ethnicities with lower than average life expectancies due to environmental and socioeconomic factors. For instance, towns in northern England tend to face more economic difficulties than towns in the south, and overall public health reflects these regional differences. Similar health deficits exist in the U.S. as well in areas such as the Deep South, rural towns and inner city neighborhoods. The key difference between the two countries is that the marginalized in the U.K. have greater access to health care.
Philip Kao, PhD, an anthropology professor at the University of Pittsburgh, points out that “marginalized” may mean different things in different countries. For example, gypsies as well as Scottish citizens are marginalized U.K. populations that the U.S. lacks. Nevertheless, Michael Moore still notes in his documentary “Sicko” that the poorest people in the U.K. have a higher life expectancy than the richest people in our country.
The U.S.’s largely private health care system has created a problem: no one, including those on Medicare and Medicaid, has market power to lower health care related prices through negotiation. In the U.K., the government buys each drug or medical device from one company, causing each corporation to compete for the government contract. Valarie Blake, JD, an associate professor of law from West Virginia University who focuses on health care law, says that drug pricing is the biggest issue for marginalized populations in the U.S. because of a lack of negotiation. Drugs that target vulnerable populations, such as Sovaldi for Hepatitis C, are even more susceptible to market dangers. Turing Pharmaceuticals, for instance, caused public outrage after increasing the cost of their antiparasitic medication from $13.50 to over $750 per tablet in September 2015.
According to Blake, the poor are better cared for under socialized systems. In the U.K., eligibility for health care has nothing to do with income—everyone has the same access to health services. If they wish, the rich in the U.K. may still buy an additional private plan to get more specialized care and avoid waitlists.
In the U.S., however, health care access is dependent on a person’s income. Even with Medicaid, those near the poverty line have nowhere near the access to care as do people with a similar socioeconomic status in socialized systems. This is because Medicaid is controlled by each state individually. While states provide some of the funding for Medicaid, additional federal subsidies only apply to those states that have agreed to expand the program. This creates a phenomenon known as the Medicaid gap, in which the poor in one state may receive much lower quality health care than the poor in another state, depending on the choices of their individual state governments. For instance, southern states with larger populations of minorities have bigger health care disparities, as these states often do not expand Medicaid due to regional political ideologies.
The U.S. system also presents significant problems for unemployed Americans. While employers do pay for part of their employees’ health care coverage, when a person loses their job, they also lose all of their benefits within a variable amount of time. This situation is unique to the U.S. Since employers in socialized health care systems do not pay for any part of their employees’ health care to begin with, this problem does not arise and unemployed populations are protected.
Those with low incomes are not the only ones who suffer under the U.S. health care system. Legal immigrants do not qualify for Medicare or Medicaid until they have been in the country for five years. According to Blake, these individuals can buy private insurance but can rarely afford it. On the other hand, illegal immigrants do not receive any health care coverage whatsoever, even though they might comply with tax requirements. They are unlikely to have an employer providing coverage and are not allowed to buy their own insurance from Affordable Care Act (ACA) health exchanges. This is in contrast to the U.K., where the current policy allows legal immigrants to use the NHS once they have paid an Immigration Health Surcharge.
On the other hand, everyone in the U.S. is guaranteed emergency medical care, regardless of immigration status or level of health care coverage. After treatment, individuals must find a way to pay or else the premiums of every insured person will increase in order to make up for the unpaid bill. In comparison, U.K. doctors may deny care to illegal immigrants at the bedside.
Elderly individuals may also be negatively affected by the American health care system. In the U.S., people over the age of 65 years are eligible for Medicare, which provides much-needed health care but can also be extremely expensive. Though the elderly make up only 5 percent of the population, they account for 50 percent of U.S. health care costs. Without any cost control measures from the government, drug companies and hospital systems exploit the increase in average life expectancy and the subsequent surge in chronic medical conditions. Additionally, when a person switches into the Medicare system, they will likely have to switch to a new doctor who accepts Medicare payments.
In contrast, U.K. citizens have better access to health care after retiring since they can continue to see their previous doctor who is already familiar with their medical history. There have been news headlines that U.K. doctors ration care and products to the elderly, but Blake says this is not true. Just as in the U.S., U.K. doctors will consider whether or not certain treatments are medically necessary, but they will not deny care to the elderly based solely on age. Decision-making about which elderly patients should receive critical treatments, or “death panels” as Sarah Palin coined the term, was one of the biggest misconceptions when pushing the ACA through legislation. Many elderly constituents voted against President Obama in both of his presidential runs because of death panel propaganda, and many Americans still believe that the government will try to rush the death of an older person to save money on medical supplies.
Women have additional health care concerns that are handled differently in various countries. The U.K. has progressive policies in place on abortion and reproductive care, starkly contrasted by those in the U.S., especially in terms of fertility treatments. U.S. women can expect to pay thousands of dollars for fertility treatments, with no guarantee that they will work. On the other hand, the U.K. health care system will pay for women to undergo these treatments with payment to egg donors being prohibited. All in all, women in the U.K. may have easier access to fertility treatments than do U.S. women, but they could also have less access to donor eggs.
In addition, abortion is legal up to 24 weeks in the U.K., but may be allowed after this time frame if there is a substantial risk to the mother or baby. In the U.S., Roe v. Wade legalized abortion in 1973, but states have tried to individually pass their own restrictions on a term limit or on the entire procedure.
Beyond increased access to quality health care, one significant advantage of implementing a socialized health care system in the U.S. is civil rights protection of any federal money used. If the U.S. government puts more money into the health care system, there is more opportunity for discrimination lawsuits. As a result, vulnerable populations, such as the poor and the elderly, can be protected.
Though a socialized health care system can bring with it a range of benefits, there are also many widely held negative beliefs. These include absurdly high taxes and long wait times, both of which Blake and Kao fiercely challenge.
“I have never seen evidence that socialized medicine is more expensive,” said Blake. “It doesn’t necessarily cost more, but you need to put the money up front.”
The U.K. and even the Veterans Affairs medical system in the U.S. are currently experiencing financial problems because not enough money was originally invested to get the systems rolling. However, more tax money is currently going towards health care than if the U.S. had a socialized system. In 2013, the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care, which is almost double the 8.8 percent that the U.K. spends each year.
Blake also notes that waitlists are equally a problem with Medicaid, Medicare and private insurers. Not all doctors accept Medicaid and Medicare, so those that do have longer waitlists. With private plans, insurance companies must pre-approve most treatments, a process that may delay care by weeks or months. Kao explains that if a patient in the U.K. wants a third or fourth opinion or would like to visit a doctor with highly specialized skills, there may be a slight wait. In most general cases, patients call the NHS with their medical concern and are assigned a hospital or office to report to based on their specific problem, being seen right away and usually treated within a day.
As evidenced, a socialized system such as in the U.K. sees more health care access, lower costs and fewer disparities for marginalized populations. The U.S. has a long and complex history of lackluster health care reform, with existing political ideologies making it extremely difficult to pass any major health care legislation. There may be a long road ahead before we see universal health care coverage, as the current U.S. system encourages high costs, ambitious companies and discrimination against marginalized populations. The only way to provide quality care for everyone may be to finally confront one of America’s biggest fears: socialism.