Socialized medicine is a theoretical term used to describe a political system where medical and hospital care is provided and guaranteed to an individual through means of government regulation. This term first was first used in political discourse by the American Medical Associations opposition to President Harry S. Truman’s 1947 health-care initiative, forewarning McCarthyism (Poen 1989, 251). A narrow definition of the term describes a system through which the state regulates healthcare, operates facilities, and employs healthcare professionals, a system where the state is responsible for end to end care for the individual. This can be used to describe such government systems as the British National Health Service and the United States Veterans Health Administration (Anderson 2001, 224). This limited definition, however, does not apply to single payer health insurance systems, where the state is responsible for regulating and financing healthcare but is not involved in its delivery, despite their frequent characterization as socialized medicine.
Of course, any conversation about healthcare must be precipitated by its financing and the efficiency of the system. Socialized medical systems are pejoratively designed to eliminate the insurance industry and marginalize profit, prioritizing the health of the individual. Yet, there is a parable that socialized systems are inefficient and do not provide quality care. A Johns Hopkins University Bloomberg School of Public Health report showed that the United Kingdom’s National Health Service (which can be considered socialized healthcare based on its narrow definition) experienced greater content with their services than under the free-market system in the United States (which cannot be considered socialized healthcare) (Blendon, Schoen, DesRoches et al. 2003, 14). This can be contextualized with total health care expenditures per capita, where the United States’ $9403 is more than double the United Kingdom’s $3935 per annum (World Bank 2015). Furthermore, two benchmark statistics to evaluate overall health of a population are life expectancy and infant mortality rates. The United States’ life expectancy for both genders is 79.3 years, with 6.1 infant mortalities/1000 births. For the UK, life expectancy is 81.2 years, with 4.2 infant mortalities /1000 births (World Bank 2015).
The United Kingdom’s National Health Service can be characterized as the world’s most sophisticated socialized medical system, but the first such system in the modern world was established in the Soviet Union in the 1920s. Popular culture currently typifies socialized healthcare through the Soviet style, drawing parallel to the communist country. Additionally, many current healthcare systems are modeled off of the Soviets. As such, the history of the Soviet socialized healthcare system can be used to understand the history, and structural issues, of socialized healthcare. The Soviet Union was the first state to constitutionally guarantee that every citizen was entitled to quality medical care at no cost at the time of service in 1918, with then commissure of health Nikolai Semashko introduced the system to Lenin through the introduction of the Ministry of Health Protection (Field 1999, 2). Under its conception, healthcare was a public service, guaranteed by the state and financed through the treasury. The Soviet Union became responsible for dispensing health care to its citizenry, training physicians, building medical institutions and financing the entire process. Healthcare became a department of government, and for the first 40 years of the USSR it was a consistently effective system. Yet, the Mid-1960’s brought political changes to the Soviet Union, where the central government prioritized military superiority over civilian priorities, which disproportionally drained the Soviet economy. The regression of health conditions was abysmal, with mortality rates skyrocketing (Field 1999, 5). The dwindling financial support particularly impacted medical provisions and equipment, and by 1987 only “35% of rural distract hospitals ha[d] hot running water” (Field 1999, 6). This exposed the flawed physician accruement and wage systems in the Soviet Union, where there was little incentive for a physician to work hard because their salaries were fixed. While the blueprint and purposes of the Soviet healthcare system were noble, and served great purpose, they faced structural issues that starved the system. After reforms in the 1990s, the current Russian healthcare model relies on financing from a variety of sources, including insurance funds (Field 1999, 9). While nostalgia for the guaranteed healthcare system of the Soviet Union remains within marginalized populations throughout modern Russia, their current system seems to be at least sustainable through the 2010s.
After the 1959 Cuban Revolution, Cuba became one modern country that still has a socialized healthcare system. Today, healthcare is entirely regulated by the government, with privatization outside of the public sector not being legal. It is typically of high quality, and is free for all Cubans (Cooper 2006, 820). Cuba is an interesting exception to the trend between economic productivity and population health, spending roughly $320 per person per annum on healthcare (16% of its GNP) yet still having exceptional quality of care (5.8 infant mortalities/1000 births, high investment in biotechnology and biopharmaceuticals) (Cooper 2006, 822). In relative terms, Cuba’s socialized healthcare system is outperforming its expectations.
Another country with a socialized healthcare system is Germany. Germany’s comprehensive social health insurance system is considered to be one of the best in the world, yet it is also the third most costly in the world (Castañeda 2011, 3). Recently, critics have warned of impending budget shortfalls and the need for systematic restricting to maintain the quality of care for its populations. Since 2005, several neo-liberal reforms have scaled back Germany’s healthcare system, exposing increasing segments of the population to marginalization. In fact, a common fear among Germans is a movement towards amerikanische Verhältnisse (American conditions), where uninsured Germans fall outside of the welfare net (Castañeda 2011, 5). Despite Germany’s commitment to universal health coverage to all individuals, including legal foreigners, insurance is not extended to undocumented migrants, forcing them to seek treatment at non-governmental organizations (NGOs).
In the United States, the socialized healthcare debate has recently been topical because of its connotations with the Affordable Care Act, but often misunderstandings of the term lead to its abuse and exploitation. Since the McCarthy era, socialized healthcare has been inexorably linked to communism, an American political taboo. Furthermore, as discussed previously, several parables about exorbitant costs of care and poor quality of care under socialized healthcare exist and taint its true intentions. Further, the issue of paying for a socialized healthcare through taxation raises doubts about the public will for the program. As current Speaker of the House of Representatives Paul Ryan wrote in a 2009 opinion piece, “Once a large number of citizens get their health care from the state, it dramatically alters their attachment to government” (Wehner, Ryan 2009). Additionally, there are beliefs that socialized healthcare stifles innovation, leads to insufficient and pitiable access to care, and causes rationing of services. Because of this, the term has been hijacked by conservatives in the US to imply that socialism will become rampant in American society if even a step towards socialized healthcare is taken.
Yet, the United States does have several popular socialized healthcare programs, such as the Veterans Health Administration, Military Health Administration, the Indian Health Service, and the prison healthcare system which all provide universal healthcare coverage to specific populations. In this way, American socialized healthcare relates to the politics of health, specifically the concept of therapeutic citizenship, or a biomedical form of government that classifies citizens and variably provides healthcare based on those conditions. Universal healthcare coverage is only awarded to select populations who have all experienced historical trauma. Providing this coverage is not considered a structural privilege in the United States, but rather a remedy and reparation for past trauma. In a broader sense, however, socialized healthcare relates to the politics of health through the role of the institution in controlling the body. Through regulation, the state determines what appropriate treatments are, how they are to be administered, and how much an individual is entitled to. Additionally, the state controls access to this care, with patients often in little control over when their appointment is scheduled (sometimes the wait can be weeks, even months). The state determines what is considered an emergency case, and how best to prioritize that individual. Furthermore, the state determines what their definition of ‘normal’ is, and how medical intervention should be used to treat patients until they reach that normal (or it is no longer cost effective to attempt to do so).
Anderson, Gerard, and Peter Hussey. 2001. Comparing Health System Performance in OECD Countries. Health Affairs 20 (3): 219–232.
Blendon, Robert J., Cathy Schoen, Catherine DesRoches, et al. 2003. “Common Concerns amid Diverse Systems: Health Care Experiences in Five Countries”. Health Affairs 22 (3): 106– 121.
Castañeda, Heide. 2011. “Medical Humanitarianism and Physicians’ Organized Efforts to
Provide Aid to Unauthorized Migrants in Germany.” Human Organization 70:1-10.
Cooper, Richard S. 2006. “Health in Cuba.” International Journal of Epidemiology 35 (4): 817- 824.
Field, Mark G. 1999. “Reflections on a Painful Transition: From Socialized to Insurance Medicine in Russia”. Croatian Medical Journal Vol 40. (2): 1-11.
Poen, Mone M., “National Health Insurance”. The Harry S. Truman Encyclpedia (Richard S. Kirkendall ed. G.K. Hall& Co, 1989:251.
Woolhandeler, Steffie, and David Himmelstein. 1991. The Deteriorating Administrative Efficiency of the U.S. Health Care System. New England Journal of Medicine 324: 1253– 1258.
Wehner, Pater, Ryan, Paul. “Beware of the Big-Government Tipping Point; Socialized health care fundamentally changes the relationship between citizens and state” Wall Street Journal. January 16, 2009
The World Bank. 2015. World Health Organization Global Health Expenditure database: Health Expenditure per capita (US$). http://data.worldbank.org/indicator/SH.XPD.PCAP? end=2014 &locations=MM&start=1995&view=chart&year_low_des
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