Universal Health Care vs Socialized Medicine

During my visit to the States a few weeks ago, the eye doctor who performed my eye exam said he believes the health care reform bill recently passed in the States will make American medical care like the UK’s National Health Service (NHS).

The eye doctor failed to distinguish between universal coverage for health care and socialized medicine. The two are not synonymous.

It’s an easy mistake when you don’t live with one or both. I do, and it’s an important distinction. If you are in the States and have been told health care reform there is setting up socialized medicine, that is incorrect, and you should question the rest of what you have been told by the same source.

The UK’s NHS combines universal coverage and socialized medicine.

Thanks to a friend in Geneva who has severe systemic lupus, I’ve gotten a good look at how the Swiss deliver health care. The Swiss have universal coverage, but not socialized medicine. Health care reform in the USA is setting up a Swiss-style system. Health care in Switzerland is the best in the world—my friend most likely wouldn’t still be alive if she lived anywhere else—so I can’t imagine a better model for changing the system in the States.

What’s the difference? Immense.

Everyone who lives in the UK is entitled to turn to the NHS for health care. Every worker pays into the system. People who pay into the system beyond a specific low threshold are entitled to a little more (such as higher payments from the government if they are disabled) than people who don’t pay enough into the system. The USA has long had a similar threshold in regard to Social Security and payments for disabled people.

In the UK system, patients have limited choice about getting their medical care. If a doctor or hospital delivers poor care, patients cannot simply go elsewhere. When something goes wrong, accountability is much weaker than in the States. The NHS, by its own admission, has become swollen with administrators, has quality control problems, and requires a budget the government is struggling to maintain.

Everyone who lives in Switzerland is required to carry health insurance, and the insurance companies are not allowed to cherry-pick only the healthiest people to be their customers. People who are too poor to buy their own health insurance get help from the government to obtain it.

In the Swiss system, people have ample choice about getting their medical care. Doctors and hospitals have an incentive to deliver medical care well so patients will want to go to them. Insurers want to provide good coverage so people will buy their policies, and their influence moderates increases in health care costs.

Personally, I am glad to see health care reform in the States, and delighted that it is along the lines of the Swiss model. It would be nice to have the option of living in the USA again, someday, if I want to return. Without health care reform, living there isn’t an option.

The Swiss model for universal health care coverage works. It provides excellent care, ample patient choice, and does it without requiring an unsustainably high proportion of GDP. That’s the direction the USA’s health care reform has chosen. But don’t call it socialized medicine in either Switzerland or the States. It isn’t. If you want socialized medicine, join me in the UK.