COMMENTARY

What Socialized Medicine Is and Isn't

Hello and welcome. I'm Dr George Lundberg and this is At Large at Medscape.

My first recollection of the term "socialized medicine" was as a college freshman in Chicago. President Harry Truman, having noted the dreadful health of large numbers of American men who were rejected for military service in World War II, stated his belief that every American had a "right to adequate medical care."[1] He tried to establish national healthcare along the lines that the British did immediately after that war.

In response, our American Medical Association (AMA) launched a spirited attack against the bill, characterizing it as "socialized medicine," thereby linking socialism to pre-McCarthy-era fears of Communism in the public mind. The AMA called Truman White House staffers "followers of the Moscow party line."[2]

Some of my fellow 1948 pre-meds reacted with scorn and picked up the AMA's derogatory label. Many docs never stopped. Truman's bill was killed and here we are today, still fighting about it.

By accepted definition, socialized medicine is a healthcare system in which the government owns and operates healthcare facilities, employs healthcare professionals, and also pays for healthcare services. Examples include the British National Health Service and national health systems in countries such as Finland and Spain. There are escape valves for those few who wish to pay for private care.

In the United States, the Veterans Health Administration (VHA) is a true example of "socialized medicine." We, among many others, have described a giant gap between the practices—even the culture—of the VHA over the past 50 years and what might be envisioned as "ideal" by many American physicians. Thus, it is not surprising that the hundreds of thousands of American physicians who received much of their training in Veterans Affairs (VA) hospitals are so dead-set against any American national healthcare system.

"Universal healthcare," such as has long existed in almost the entire civilized world (except the United States), is not necessarily socialized medicine. Instead, each of the various developed countries has its own way to provide basic care to all of its people, control cost escalation, ensure quality and safety, and appropriately compensate the workers. And they do all of that more effectively and more efficiently than the United States, with proven better outcomes at much lower costs.

Countries with such universal healthcare include Australia, Austria, Canada, Ireland, The Netherlands, France, Germany, Denmark, Switzerland, Taiwan, Singapore, and Japan. There are many others—even Moldova and Portugal.

They are not smarter than we are. They do not work harder than we do. They are not richer nations than ours. They don't have more or better education than we do. They don't have better equipment and supplies than we do.

Their health systems are simply framed by a different set of values. The primary purpose of their healthcare system approach is to provide decent medical care for all of their inhabitants. In contrast, our current American healthcare system is organized to transfer money from the many to the few. As W. Edward Deming described, "every system is perfectly designed to get the results it gets." How true.

Open your eyes, all you unhappy workers and customers of the US healthcare system. Be not afraid to change. The world is full of good models for medical care systems that are not socialized medicine. And they are not the VA.

That's my opinion. I'm Dr George Lundberg, at large for Medscape.

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