Saturday, February 16, 2008

Socialized Medicine

Matt Yglesias has the poll, Ezra Klein digs into it deeper. Short story: the term "socialized medicine" doesn't turn people off like it used to. In fact, a plurality of Americans say they'd prefer socialized medicine to the current system.

Now, the immediate impact of this is indirect: what Democrats are proposing is not, in fact, socialized medicine, so all this polling does is indicate that the favored GOP talking point (can two words be a talking point?) against universal health care may not turn out to be as effective as they'd hope.

Yglesias, however, says that Dems should use this poll as cover to push for some attributes of actual socialized medicine. Without getting into the merits of that, I'm skeptical that these numbers will hold if folks actually began to proactively adopt the label "socialized medicine." It's like impeachment: even if it polls well now, two months of the media being aghast at how radical the Democrats have become and things will start to slip quick. I hate to say play it safe, it safe, and be thankful that conservatives will have a harder time shutting down universal health care than they're expecting.

1 comment:

PG said...

Do you know of a good survey on American physicians' attitude toward single-payer?

I figured it must be getting popular with them a few years ago when my father, a fervent economic conservative who immigrated to the U.S. for the chance to make money as a doctor, said that he would welcome having *all* of his patients on Medicare. His rationale is that he wastes so much time and frustration trying to chase down private insurers to get them to pay up, and dealing with the battles with the insurers and the insured, that he would prefer just to get paid at the lower Medicare rates and know the check is in the mail. He could thereby run a much more cost-efficient business.

On the other hand, my dad is an independent physician (i.e. not an HMO employee) who already has a large number of Medicare patients because he has a geriatric specialty. Doctors in other positions may feel differently.

Furthermore, it's important to distinguish between single-payer (basically universal Medicare, which if not traditional fee-for-service still involves a lot of private sector because the government farms beneficiaries out to HMOs; much of the problems with adding the pharmaceutical benefit to Medicare arose from the Bush Administration's insistence that beneficiaries go into HMOs) and socialized medicine, which usually signifies that physicians will become employees of the state. I think folks like my dad can go for the former but would be more ideologically adverse to the latter. There's a certain amount of freedom in being an independent practitioner that is lost when one becomes an employee. For example, my parents are currently on a 10 day trip to India. My dad's responsibility as a practitioner is to ensure that his partners in the practice or other doctors in town cover his patients. In contrast, if he becomes a state employee, a bureaucrat has to approve his request for time off.

Much as tort reform has gained a lot of power from physicians' bitching about the cost of malpractice insurance -- in Texas, a constitutional amendment to cap damages passed with support in a traditionally Democratic area like South Texas because the physicians there engaged in a one day "strike" to make clear what would happen if malpractice rates were too high for them to afford practicing in the area -- I think reform of how providers are paid would be galvanized if physicians were as passionate about single-payer as they are about their malpractice costs.

(Personally I think doctors should be insured through the same state commission that licenses them, so that there's an incentive to take away the license of a doctor who is incurring expensive malpractice suits because he's a genuinely crap doctor. As it is, you can literally be a cokehead and keep your license as a physician, at least in Texas.)