health spending.22 According to Holahan, "all
tions like health maintenance organizations.
Oberlander therefore concludes that the term
but 5 percent of the U.S. population that is
"socialized medicine" has no meaning at all.18
insured receive government assistance" of one
form or another.23 In the Harris/Harvard poll,
We've seen this sort of tactic before. In a
1993 journal article titled "Defining Deviancy
the public acknowledged the importance of
Down," the late senator Daniel Patrick Moyn-
who controls the money: 73 percent said that
ihan (D-NY) argued that when deviant behav-
socialized medicine exists when "the govern-
ment pays most of the cost of health care."24
ior grows beyond the amount that society can
"afford to recognize," society will cope by nar-
Yet controlling the money that purchases
rowing its definition of deviancy.19 Similarly,
medical services is only one among many ways
that government controls America's medical
supporters of universal coverage are trying to
resources:
convince the public that policies generally con-
sidered socialist really aren't.
· Medical personnel. Federal and state
governments rarely employ physicians.
What Is Socialized Medicine?
But state-level clinician licensing laws
do control the number of physicians,
who can hire them, where medical pro-
Contrary to Oberlander's claim--and the
fessionals can practice, and what tasks
physician lobby's naked opportunism--a rea-
they may perform.25 Those laws and the
sonable definition is possible. Socialized medi-
Medicare and Medicaid programs large-
cine exists to the extent that government controls
medical resources and socializes the costs. We might
ly determine how and how much physi-
even award countries an extra red rose--the
cians and other clinicians will be paid.
· Medical products. Government doesn't
official symbol of the Socialist Internation-
al20--if they socialize the costs according to the
manufacture medical products, but it sets
prices for most of them through the
Marxist principle of "from each according to
Medicare and Medicaid programs. The
his ability."
federal Food and Drug Administration
Notice that under this definition, it is irrel-
controls whether, how, and to whom med-
evant whether we describe medical resources
ical products may be marketed and sold.
(e.g., hospitals, employees) as "public" or "pri-
· Physical capital. Most U.S. hospitals are
vate." What matters--what determines real as
opposed to nominal ownership--is who con-
privately owned. Through "certificate-of-
trols the resources. The particular decisions
need" laws, however, state governments
that government makes about those resources
frequently control who can open a hospi-
are likewise irrelevant. It matters not whether
tal or invest in new equipment. Federal
the government is stingy about medical
tax policy greatly influences hospitals'
spending (as in Canada's Medicare system, the
corporate form (profit vs. nonprofit).
The greatest trick
· Health insurance. Most Americans
British National Health Service, or the U.S.
Medicaid program) or obscenely lavish (as in
have private health insurance. Yet state
that supporters
the U.S. Medicare program). What matters is
and federal governments control what
of socialized
who decides.
kind of health insurance we may pur-
medicine ever
By that definition, America's health sector
chase, how much we will purchase,
is already well more than half socialized.
where we may purchase it, and often the
played was to
Government purchases 46 percent of all med-
premiums we will pay.
convince the
ical care.21 In a tip of the hat to Karl Marx, gov-
The list goes on. Oberlander himself argues
ernment finances that spending largely with
American people
that few Americans understand the extent to
tax rates that rise with one's earnings.
we don't already
which government already controls their
Oberlander and others posit that government
health care.26 To paraphrase Keyser Soze, the
have it.
ultimately controls about 60 percent of U.S.
4