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Mercury droplets posing as pills [Photo: Bertrand Berube]

Wordplay Racket
America’s Killer Prejudice

Socialized medicine.

Say the words and you might as well be conjuring up the Ebola virus. Or terrorism. Or Dick Cheney. The words kill whatever chance there may be of having an intelligent conversation about health-care reform—the most relevant issue concerning most of us directly. The words are lethal, not because they’re true, but because they exploit a prejudice that seems perfectly acceptable to those who buy into it: That when government pays for something, it’s somehow un-American. In that case, we shouldn’t have public schools. They’re socialized education. We shouldn’t have public universities. They’re socialized higher-ed. We shouldn’t have Social Security. It’s socialized retirement. For that matter, we shouldn’t have a military. It’s socialized defense.

If it sounds absurd, that’s because it is. So is the argument that anything based on a government-funded, single-payer system like those bedrock institutions mentioned above is inalienably evil, even as it is, strictly speaking, socialism. And, of course, the very people who might rail at “socialized medicine” are happy to send their children to public schools, cash their Social Security checks and—lucky them—take advantage of Medicare, one of the best single-payer, socialist health-care systems around. But here was Rudy Giuliani, who’s Medicare-eligible, doing his bit of railing against government-run universal health care the other day in Rochester, N.Y.: “We’ve got to do it the American way. The American way is not single-payer, government-controlled anything. That’s a European way of doing something; that’s frankly a socialist way of doing something.” Rudy is obviously not too familiar with the American way.

Or with the racket that passes for America’s health-care system—the worst of the industrialized world, judging from its costs, access and quality. At $5,267 (based on 2004 data), Americans spend on health care by far more, per capita, than any other country. ( Canada is next at $2,931.) Despite that, between Canada, France and Britain—the three countries whose “socialized” medicine system we’re most often compared to—we have the lowest life expectancy, the highest infant-mortality rate and the fewest hospital beds per 1,000 people. We have the fewest nurses except in France, but France has more doctors.

Best care in the world? Think again. Opponents of a single-payer system quickly say that in other countries you have to wait umpteen months to get this or that elective procedure done, as if waiting times don’t exist here. Yet the 1.1 billion visits for care in 2004 added up to a combined 36 million days of waiting time for Americans, according to the National Center for Health Statistics, and that’s just in the waiting halls of doctors’ offices and emergency rooms—not the week- and month-long waits to see specialists. That’s if you’re lucky enough to have coverage. Once you do get to see a care-giver, good luck. Last March, The New England Journal of Medicine exploded the myth of quality care with a study that showed that half the time, patients don’t receive the care they need. They’re mis-diagnosed, mistreated (literally) and mis-referred. Then they’re billed enough to induce fresh coronaries.

In Giuliani-world, which is really the world most of us are stuck with at the moment, it’s not OK for the government to pay health-care providers directly with taxpayer money. But it’s OK for government to subsidize insurers who then pay health-care providers, taking their cut to fatten up some of American business’ most obscene profit margins. Why the middle man? Because the truth about Republican philosophy has as much to do with letting business roam free of any constraints as ensuring direct and lucrative business access to the nation’s biggest cash cow—taxpayers—while preaching the fiction that the private sector does it better. That’s the fattest myth of all.

Consider. In 2004, we spent $1.89 trillion on health care (that’s 16 percent of the economy), of which $1 trillion, or 53 percent, was from the private sector. And $659 billion of that was insurance premiums, which have risen 181 percent since 1990—with what to show for it but a more unequal, sicker system? The private sector share of spending in Canada, France and Britain is 30 percent, 24 percent and 17 percent, in that order, yet their costs are lower and their care quality higher.

In health care, the private sector isn’t the solution. It’s the problem. Call it “socialized medicine” if you like. Bring it on, too. The alternative, profitable though it is to a few happy shareholders, is killing the rest of us.

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