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system A, a public program through which the

Health found that a majority of responders--

government taxes and spends your money on

and fully 60 percent of those who claim to

its health care priorities, and health care system

know what the phrase means--consider

B, a completely "private" system in which the

Medicare to be socialized medicine. Even larg-

government forces you to spend your money

er majorities took the journalist's side on

on identical priorities. In a paper for the left-

whether Clinton supports socialized medicine

wing Center for American Progress, University

(69 percent of those who claim to know the

of Texas public affairs professor Jeanne Lam-

term's meaning) and whether universal cover-

age equals socialized medicine (79 percent).12

brew and colleagues write that the concept of

socialized medicine "has been embraced,

That's not necessarily bad news for support-

demonized, and misunderstood since the early

ers of socialized--er, universal coverage. Seven-

20th century in the United States." Neverthe-

ty percent of Democrats think socialized medi-

less, they acknowledge that a (nominally) pri-

cine would improve American health care,

vate sector is no barrier to socialized medicine:

whereas 70 percent of Republicans say the op-

"the government role in socialized medicine

posite. Independents are evenly split. Neverthe-

systems [can include] public financing of pri-

less, supporters of universal coverage are scram-

vate insurance and providers."15

bling to inoculate themselves against the charge

To say that

that they are pushing "socialized medicine,"

Clinton, Dorn, and Holahan suggest that

socialized

principally by attempting to narrow the term's

health care systems cannot be fairly described

definition.

as socialized if they provide adequate access to

medicine only

care. In her exchange with the journalist,

exists when there

Clinton responded, "Medicare is a system that

Defining Socialism Down

are waiting lists is

we fund through our paychecks. And yes, the

government pays the bills. But no government

to argue that

bureaucrat tells you what doctor you have to

At the above-mentioned forum, Urban

socialized

go to or what hospital you have to go to."16

Institute president and former Congressional

Budget Office director Robert Reischauer

Dorn and Holahan write that "strict limits on

medicine would

claimed, "Classic socialism involves govern-

consumer choice, rationing, delays, and poor

disappear if the

ment or collective ownership of the means and

quality [are] all concerns traditionally associat-

government

distribution of production. . . . Truly socialized

ed with socialized medicine. These concerns,

medicine doesn't exist anywhere in the

however, do not apply to the . . . plans advanced

wrote bigger

world."13 He's right. But were we to define

by leading Democratic candidates. . . . "17

checks.

everything so narrowly, we would find that

Again, this notion does not sit well. Barriers

capitalism doesn't exist anywhere in the world,

to access occur when the government limits

either. Neither does democracy.

spending below what is required to meet

Others, such as Dorn and Holahan, suggest

patients' demand for medical care. To say that

that medicine can't be considered socialized if

socialized medicine only exists when there are

a country retains a large role for the private sec-

access problems (e.g., waiting lists) is to make

tor. They write, "Strictly speaking, socialized

the rather curious argument that socialized

medicine involves government financing and

medicine would disappear if the government

direct provision of health care services, as with

wrote bigger checks.

the traditional British system." The Obama

The boldest attempt to narrow the definition

plan and other major Democratic plans cannot

of socialized medicine comes from University of

be considered socialized medicine because

North Carolina­Chapel Hill health policy pro-

"none would overturn the dominant role of

fessor Jonathan Oberlander. In a 2007 interview

private insurance and private providers in

with National Public Radio, Oberlander wryly

America's health care system."14

noted that the American Medical Association

has used the term to describe most anything

But that's not quite right, either. There is lit-

they do not like, including free-market innova-

tle functional difference between health care

3