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Print“Apparently the critical test for socialized medicine isn't whether government pays the bill, but who proposes the plan.”
Presidential hopeful Rudy Giuliani in a radio ad talked about his fight against prostate cancer several years ago. He said that his chance of surviving in the United States had been 82 percent, but that in England, “under socialized medicine,” he would have stood only a 44 percent chance.
While critics in England and the United States were quick to find fault with these statistics, Giuliani exploited one of the most reliable bogeymen of American politics: the specter of government-run healthcare. In fact, socialized medicine is an epithet that has been used to attack everything from Lyndon Johnson’s Medicare and Medicaid legislation to Hillary Clinton’s health reform plan.
As medical historian Ronald L. Numbers showed in his classic study, Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912-1920, the country wasn’t always afraid of socialized medicine. Indeed, before World War I the American Medical Association liked the idea of mandated coverage because it would improve public health and provide doctors with a larger pool of paying patients. In those days, “socialized” wasn’t a bad word; it implied a general benefit to all of society.
The meaning changed dramatically during the 1930s, especially after the election of Franklin D. Roosevelt, whose policies were increasingly attacked as communist or socialist. To help create a plan for universal coverage, Roosevelt brought in Henry Sigerist, a distinguished Johns Hopkins physician. Sigerist had spent years studying ancient and modern medical cultures and believed that medicine undergoes an evolutionary process in which the ultimate state of development is socialized medicine.
As medicine and society grow in complexity, Sigerist argued that healthcare, like primary education, could not be left to individual judgment. Like many American intellectuals in the mid-1930s, Sigerist was attracted to the Soviet ‘experiment. He traveled several times to Russia and, after a thorough analysis of its health system, in 1937 published Socialized Medicine in the Soviet Union. He appeared in January 1939 on the cover of Time. The magazine reported, "no man's arguments are read by either side of the socialized medicine controversy with greater respect.”
But his moment of glory was brief. After the 1939 Nazi-Soviet pact, Sigerist's left-wing politics fell out of favor and his plans for universal health coverage were eclipsed by the War. In April 1944, shortly after Sigerist met to advise U.S. Senators Wagner, Murray, and Dingell, about their bill proposing a national system of health insurance, he got a letter from the Civil Service Commission saying that his Communist ideas rendered him ineligible for government service.
By the time Harry Truman tried to introduce national health insurance, the Cold War cast a dark shadow over anything associated with socialism. Despite Truman’s protest that “this is not socialized medicine,” his GOP opponents branded his scheme “the most socialistic measure this Congress has ever had before it.” It wasn’t until 1965 when, over the American Medical Association’s warnings that government-financed medicine augured “a dangerous experiment” that would produce “mountains of red tape,” President Johnson signed Medicare and Medicaid into law. Socialized medicine seemed to have lost its terror. Even during the 1993-94 Clinton healthcare reform battles, the term was seldom used. Alternatively, phrases like “government-run” and “government takeover of the health system” were commonly employed to condemn “Hillarycare.”
Since polling today shows that Medicare is extremely popular, no presidential candidate is suggesting that government roll back medicine for seniors. In fact, a Republican Congress and President recently adopted the largest expansion of Medicare since inception: a new prescription drug benefit that the White House estimates could cost $1.2 trillion over the next decade. Government’s role in health care is inexorably growing. Apparently the critical test for socialized medicine isn’t whether government pays the bill, but who proposes the plan.
David Gollaher is publisher of The Journal of Life Sciences and CEO of the California Healthcare Institute.
