Implementing Socialized Healthcare in the United States

Subject: Administration and Regulation
Pages: 11
Words: 2881
Reading time:
11 min
Study level: College

Socialized Health Care is one of the terms used to describe publicly0-funded healthcare facilities. Critics admit that US healthcare will benefit if the state introduces a socialized healthcare system for all citizens. The main problems that affected Americans are poor healthcare services for low social classes and racial minorities, immigrants, and single mothers with children. Americans should choose a socialized healthcare system as a basis upon which individuals and their families can build toward their economic and healthcare security.

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Socialized healthcare proposes wide opportunities for all citizens and proposes wider access to healthcare (Boase 12). Many authors cite the Canadian healthcare system as the best example for the US to improve its healthcare service and introduce socialized healthcare.

Universal access is the chief rationale for the Canadian system: Instead of some Americans receiving miserable treatment or none at all while others enjoy the best in the world, all would be taken care of. The rub is that universal access also means equal access–that all Americans will meet somewhere in the medical middle, sharing the same waiting room, the same doctor, the same equipment, the same quality of care” (Watzman 43).

The modern healthcare system may be important, but as the subject of inquiry, many people regard it as dry and dull. Although most people want modern healthcare to be there for them when they reach retirement age, few people want to know the details of how these programs operate. Despite the existence of a grand political debate on the subject of Social Security and Medicare, few of the participants want to take the time to gather facts about the program for fear of stumbling over its complexity (Fogoros et al 43).

The US needs socialized healthcare in order to ensure equal access of all citizens to medical services in spite of their age or occupation. As the baby boom generation ages and as the economy fluctuates, these choices will come to have a prominent place on America’s public agenda. Indeed, people have already started to argue about poor medical services, often with only the vaguest idea of how the program operates (Fogoros et al 44). Beyond these societal concerns, the details of program operation have very personal implications that make it imperative for all American citizens to know what they can expect from current Social Security and Medicare. It does not help either public discourse or private decisions that misunderstandings about these programs abound. Medicare, a program of health insurance for people on Social Security, could serve as an example. Because the contents of Medicare are murky to so many people, a spell of illness often leads to a mystifying trail of bills and financial statements for which many people are unprepared. Nor are the limits of Medicare and how it differs from Medicaid clearly understood. Often as the painful decision is made to enter a nursing home, elders and their families are not aware until it is too late that Medicare does not provide significant long-term care protection. Prudence demands prior knowledge of how the program works (Boase 16).

The retirement of the baby boom generation presents particular problems. Some experts suggest that the system as structured cannot support the expense of paying retirement and health care benefits to the baby boomers (Fogoros et al 45). Others express confidence in the ability of Medicare to solve future problems as they arise, based in large part on their history of meeting past crises. Indeed, the current controversies surrounding the financing of the programs involve a surplus in revenues, not a shortfall. At the same time, the problems in Medicare are more immediate and pressing. Most people agree that changes will be needed in this program within the next few years. For some, these changes invite the creation of national health insurance; for others, these changes are viewed as a political opportunity to cut back on the program.

Socialized medicine would allow the society to supplement the pensions with ordinary funds that come primarily from income taxes and government borrowing. Congress has, for the most part, resisted this suggestion, fearing that the use of general revenues would be hard to control and would lead to benefit increases that would be difficult to sustain. Even so, many indirect infusions of general revenues are made into the program, including the revenue produced from treating a portion of healthcare benefits as taxable income. This approach, however, has the benefit of keeping taxes low, avoiding the difficult problem of how to preserve the supposed surpluses in the program. This approach has the disadvantage of leaving the future to take care of itself, arguably bequeathing large burdens to future generations (Boase 18).

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Questions about benefit levels and tax rates imply a third persistent issue or theme to which healthcare professionals attach the label “fairness.” Even if politicians can agree on which benefits the program should provide and on how to finance them, that still does not mean that everyone pays his or her fair share and receives a fair amount. Instead, the state needs to fashion a relationship between an individual’s contributions and an individual’s anticipated benefits that will sustain the program financially and politically. What should be the terms of this relationship? Some people believe that benefits should directly reflect contributions (Fogoros et al 43). They tend to favor private investment opportunities, such as Individual Retirement Accounts, over expansions of Social Security. Others consider it unfair that Social Security and Medicare benefits go to the rich (Halvorson 82). They view the relatively low living standards of many aged and disabled persons as manifestations of the program’s lack of fairness. Yet others consider it unfair that lower-income beneficiaries receive proportionately larger benefits. Still, others see problems with the fact that housewives receive no credit for the work they perform or the fact that some generations bear greater tax burdens than others.

Critics admit that the US needs a healthcare system to rise above politics, yet they realize that goal is difficult to achieve. Winning and losing constitute the very essence of politics and guarantee that the modern healthcare system would like to function for many decades (Kooijman 336). The trick of the effective public policy lies in blending scientific, impartial program administration and the imperatives of political management (Halvorson 81). Within broad boundaries, critics and healthcare professionals want the right people to get benefits, and the state wants to keep its political options open, so that citizens, get to choose healthcare programs (Boase 33). Today, Social Security and Medicare are inherently political scares many people, fearful that shifts in public opinion and the nation’s politics might trigger undesirable policy changes. A group of liberal defenders has argued that politics, as practiced in this country, leads some conservatives to characterize Social Security as a program in crisis, mainly as a strategy to undermine the program. In contrast to a modern system, socialized medicine guarantees access to all citizens to medical services.

As the pollsters, Anna Greenberg, David Walker, Stanley Greenberg, and James Carville commented: “A key selling point to a universal system is not simply covering the 47 million uninsured Americans… but also that a universal system means health care can never be taken away from average families” (O’Sullivan 21

The modern healthcare system in the US is ineffective because most of the programs provide money to a particular problem (sickness) or condition (old age) arise. Hence, one can speak of social insurance as a contingency payment against the financial or medical risks associated with the realities of modern life. At the same time, social insurance programs operate as social benefit systems in which the government transfers money from one group, the working able-bodied, for example, to another, such as the retired (Halvorson 81). Social insurance, in other words, has some of the features of a public assistance program. It is neither exactly like private insurance, which operates on the principle that a person is getting either a monetary return or a service in direct proportion to his investment or fee, or welfare, which operates on the notion that the government should tax those with income or property to support the poor (Boase 36).

Following Dunn (2006), Taylor (1999), Boase (1996) a real need exists for socialized medicine, even though social insurance programs, by their very nature, attract political opposition. These authors simply posit that a certain amount of security does not fatally undermine liberty and individual initiative and may augment them. Hybrids of the social insurance type face opposition from right-wing purists who favor private control over the economy and want the government of the people’s backs.

The result is that mature social insurance programs have greater tendencies toward financial instability, in part because of anticipated outflows of revenues, but also because their short-term financing is increasingly dependent on the economy. Socialized medicine will help to escape this problem for a long time because of growth in the number of people working and increases in wage rates, combined with relatively prudent expansions in the benefit levels and careful monitoring of the programs’ financing (Halvorson 84). The economic emergency puts a premium on short-range payments to people who are already old and unemployed. With the emphasis on short-range payments, little support emerges for social insurance, which depends on contributions from a labor force that is badly depleted by the depression. These social forces reduce the immediate pressures for benefit expansion in the social insurance programs (Dunn 273).

Program defenders must argue for the programs on grounds as successful mixtures of public responsibility and private initiative, or in effect, as the best that citizens can get out of a system in which proponents of public and private approaches to Social Security continually tug at one another (Halvorson 87). Whether good or bad, social insurance, with its contrary characteristics, is difficult to explain. Here is where social commentators have most failed their public by not making an effort to describe the program in terms that all citizens can understand. If one realizes the program’s hybrid nature, its practices become easier to comprehend. Following Watzman (1991):

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Even by south-of-the-border standards, that’s good service. But it gets better. In all those operations, through vaccines and infections and a dozen bouts of flu, the Dunns have never seen a hospital bill. The only money they ever hand over for health care is what goes to the government in taxes–and, believe it or not, it’s less than what it costs to supply the average American with health care: (43).

If everyone gets benefits underpaying taxes to the state, then it is inevitable that some people who do not need the benefits will nonetheless receive them. It does not mean, however, that benefits are simply entitlements, which are poorly targeted to persons in greatest need, as some on both the right and the left argue. Giving something to everyone may be the best way to underwrite the political stability of the system and assure that the poor get something; it may also be seen as wasteful. The political system must somehow decide this matter by striking a balance between contributions and benefits (Dunn 273).

Opponents state that socialized medicine is discriminating proposing different benefits and opportunities for different social and racial groups. For instance, if African Americans live shorter lives than white Americans, then, arguably, Social Security is discriminating (Halvorson 82). Most people would concede that the matter is more complicated than that. If blacks are poorer than whites or more likely to receive disability benefits–as they are–then the program also rewards African Americans more than white Americans. Here again, complicated judgments need to be made. Debate requires that all people be informed. It potentially undermines public discourse about the future of Social Security and Medicare, allowing myths and half-truths to substitute for fact and reasoned discussion. It tends to polarize debate between those who argue that the modern healthcare system is inequitable and unsustainable and proponents who are often positioned to defend all aspects of these programs–thereby allowing flaws to remain uncorrected (Taylor 133). Following the example of the Canadian system,

One reason we’ll be able to afford Mamie’s insurance under a Canadian-style plan is that such a system would put an end to several perversions and inefficiencies in the U.S. medical market. Critics of the Canadian approach may rail about creeping socialism, but right now, American medicine turns the laws of supply and demand on their head” (Watzman 43).

If the US adopts socialized medicine, its healthcare will work more effectively toward the participation of the elderly and the disabled in the labor force, rather than encouraging their withdrawal from work and from other social activities. Rehabilitation has therefore become a continuing public concern. Some people, including one of the present authors, have questioned public policies that, on the one hand, protect the civil rights of disabled people and guard against discrimination in the workplace, and, on the other, make a withdrawal from the labor force an express condition of public aid. In this regard, the definition of disability as the “inability to engage in substantial gainful activity” has come into question (Halvorson 85). Other people have raised questions about the double standards in public policy.

Mothers of young children on welfare are encouraged, even required, to go to work; mothers of young children on socialized medicine are encouraged to remain out of the labor force. Without a doubt, socialized medicine, often working in concert with private pension incentives, has facilitated the trend toward early retirement among many who are able to work. There are many other early retirees whose health and labor market circumstances greatly restrict the ability to find work. Whether the early retirement of able persons meshes well with changing demographic and labor force conditions constitutes an important policy issue (Taylor 133). Some, concerned about possible shortages of entry-level workers in the next twenty years, believe Social Security and Medicare should do more to encourage later retirement. Noting substantial increases in life expectancies, they also suggest that the age of eligibility for socialized medicine benefits should be raised. Some critics (Halvorson 82) warn of the potential that the legitimate needs of partially disabled or otherwise marginally employable older workers will be overlooked as retirement ages move upward. Thus, how to encourage later retirement of some without penalizing those who are not in a position to work remains an important policy dilemma (Dunn 273).

Socialized healthcare in the US will go to anyone who falls into a particular category, such as the injured, the unemployed, or the elderly, regardless of the person’s resources. Congress and state legislators typically fund social insurance programs from earmarked taxes rather than from general revenues. Whereas welfare seeks to ameliorate the effects of poverty, social insurance works to prevent poverty and to lessen economic insecurity across all income classes. Interestingly, while many people think of welfare programs as receiving the lion’s share of government expenditures, public assistance spending by local, state, and federal governments represents less than one-third of the spending on social insurance programs–about $120 billion in 1988 compared to $432 billion (Halvorson 42). Despite the existence of other public and private transfers, people have also chosen to make a substantial investment in social insurance. Half of everything that federal, state, and local governments spend on social welfare, including education, housing, welfare, veterans programs, health, social insurance, and other human services, goes toward social insurance expenditures that amount to 9 percent of the gross national product. The major healthcare programs will cover nearly all workers and their families. Each month tens of millions of Americans will benefit from these programs (Jost 21)

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Socialized healthcare may resemble private insurance, but it is fundamentally different. The driving principle of socialized healthcare is a concern for adequacy–that benefits meet the basic needs of persons these programs are designed to protect. The emphasis on social adequacy is consistent with societal goals directed at providing for the general welfare, protecting the dignity of individuals, and maintaining the stability of families and society (Jost 22). Another difference is that: people choose to buy private insurance; they are often forced to pay taxes for social insurance. Because of this feature, social insurance programs are not hindered by what economists call “market failure” even though these programs are structured to accept all, that is, to include persons who for such reasons as illness or advanced age would not be considered suitable for many private insurance plans. Private insurance depends on a search for profit. But, as noted, a concern for adequacy–that benefits meet people’s basic needs–drives social insurance (Jost 27; Dunn 273).

In sum, socialized healthcare in the US will benefit both the government and the society proposing wider access to medical services for all citizens. The effectiveness of socialized medicine is linked to the principle of individual equity and equal access. If socialized medicine went all the way, its beneficiaries could rely upon it exclusively and not need to make other arrangements for their old age. The advantage of socialized healthcare in this regard lies in the way that it helps to solve social problems; the disadvantage stems from a lack of limits that a market might otherwise set, through the political process, care financing, and the linkage of benefit payments to payroll and other forms of taxation serve as a check.

Works Cited

Boase, J.P. Health Care Reform or Health Care Rationing? A Comparative Study. Canadian-American Public Policy, 26 (1996), 1-48.

Dunn, S.P., Prolegomena to a Post Keynesian Health Economics. Review of Social Economy, 64 (2006); 273.

Fogoros, R.N., Shomon, M.J. Chiaramonte, D. Fixing American Healthcare: Wonkonians, Gekkonians, and the Grand Unification Theory of Healthcare. Publish or Perish DBS, 2007.

Halvorson, G.C. Health Care Reform Now!: A Prescription for Change. Jossey-Bass; 1 edition, 2007.

Jost, T.S. Health Care at Risk: A Critique of the Consumer-Driven Movement. Duke University Press; 1 edition, 2007.

Kooijman, J. Soon or Later On: Franklin D. Roosevelt and National Health Insurance, 1933-1945. Presidential Studies Quarterly, 29 (1999); 336.

Taylor, E.H. ERISA Preemption: Will the Elimination of the ERISA Preemption Clause Help or Harm America’s Ability to Death with Its Pending Health Care Crisis? Journal of Law and Health, 14 (1999); 133.

Watzman, N. Socialized Medicine Now – without the Wait. Washington Monthly, 23 (October 1991); p. 43.

O’Sullivan, J. Risky Operation: Socialized Medicine Comes at a Cost. National Review, 59 (August 27, 2007), p. 21.