This title is a somewhat tongue-in-cheek (while still accurate) way to describe the views of the Democratic candidates on health care as presented at the New Leadership on Health Care 2008 Presidential Forum. Whenever Democratic health care proposals are raised, conservatives start screaming “socialized medicine” but none of the Democratic proposals fit this by any reasonable definition of the term. Many conservatives reflexively refer to any Democratic proposal as socialism, even when their proposals are more consistent with the free market than the corporate welfare policies of the GOP. If we stick to more conventional definitions of socialism, it would suggest having government own and control the health care industry as is seen in some European countries. All Democratic candidates oppose such plans.
Democrats do advocate government involvement in health care, but this is not a radical change from the status quo. A tremendous number of Americans currently receive health care through Medicare, Medicaid, veterans programs, and other government programs. Increased government involvement is even welcomed by many businesses which are struggling to afford coverage for their employees and find that such expenses place them at a competitive disadvantage internationally. Under the current system 44.8 million are left uninsured, and another 30 to 50 million are underinsured creating a need for some action.
Dennis Kucinich advocates the plan which most greatly increases government involvement in health care. He opposes socialized medicine in supporting continuation of the current system of privately delivered health care, while eliminating the private health insurance industry by advocating a single payer Medicare for all plan. Such plans create confusion among those who don’t understand the difference between Medicare and true socialized medicine.
I currently run a private medical practice and submit claims to both Medicare and private insurance plans. Under Kucinich’s plan I would still operate a private practice, but would save a considerable amount of money by only having to deal with one plan. While conservatives cry “socialized medicine” to give the impression of lack of choice, Medicare typically places less inane restrictions on individual’s health care choices than many of the other plans I deal with. Medicare wastes less on employees whose function it is to decide whether to approve the consultations or tests recommended by physicians. Medicare is also more reliable in paying the bills than many insurance plans which are basically schemes to take in premiums but avoid paying out benefits.
After Dennis Kucinich the other candidates keep much more of the private insurance system while trying to do more to make coverage affordable. The devil here is in the details. Barack Obama promises to provide details of his plan in the future but had little to say today. The Edwards plan could evolve into single payer as it offers a government plan similar to Medicare as one alternative. Hillary Clinton has never seemed to understand that her plan was rejected not simply due to the Harry and Louise ads but because it was far too regimented to be tolerated by most Americans. She also placed far too much emphasis on the HMO model, one of Richard Nixon’s ideas which should be discarded as a failure. Rather than showing that she understands the problems with her plan, Clinton believes the answer is to sell the plan better.
Bill Richardson remains the candidate who might have the most experience and ideas but is also the most unexciting, including on health care. This is not necessarily bad as a simple pragmatic solution might be preferable to those which are more exciting. Richardson’s plan is reminiscent of John Kerry’s 2004 plan in allowing individuals the option of buying into the plan which insures government employees, including Senators. He offers tax credits to enable more people to afford coverage. His plan to expand Medicare to cover those between the ages of 55 and 65, while coming far short of Medicare for all, would still offer tremendous benefits. The older people get the more likely it is that they are unable to obtain affordable insurance, especially if they have any medical problems. Richardson also advocates allowing those in the VA system to obtain care from any hospital, which should please conservatives opposed to government-provided health care.
MyDD has provided summaries of the positions presented by the candidates. The summaries are worth reading, but the discussion has little more to offer as it primarily displays the irrational exuberance for John Edwards which is common in the blogosphere and ignores the less exciting proposals from Bill Richardson which have gained more attention in the media. As a large percentage of Americans who do have coverage prefer to remain with their current coverage, plans such as those offered by Richardson do offer the advantage that they are most likely to be accepted politically.
Update: A site which is properly named (although not for the reasons intended by the blogger) Health Care BS is linking to this post claiming that the “reality based community” is out of touch with reality. The post links to another post on the same site here which gives a totally inaccurate view of Medicare. David Catron make claims such as that “in their effort to dictate every nuance of an incredibly complex system, our masters in Washington have created a labyrinthine nightmare of conflicting priorities and incentives.” The post claims that Medicare is socialized medicine, controlling the health care delivery system.
I deal with Medicare and many private plans every day and see how they operate first hand, as opposed to deciding how Medicare works based upon political philosophy. While I have other qualms about single payer plans, at present Medicare is one of the least restrictive and bureaucratic plans I deal with. For the most part I can practice medicine without having to worry about a set of bizarre rules. When there is a problem there is a fair appeals mechanism, which is rarely seen with private insurance. Medicare makes it faults, but at least their primary goal is to pay for medical care, as opposed to many insurance plans which play all sorts of games to avoid paying to increaes their profits. Before writing about who is out of touch with reality, Catron might want to actually experience the reality of practicing medicine or at last pay attention to those of us who do.
Update II: Much more in the comments following a response from David Catron.