Would National Health Insurance
Be "Socialized Medicine"?

Stephen Barrett, M.D.
Peter S. Vig, D.D.S., Ph.D., J.D.

Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. Doctors in the U.S. Veterans Administration and our Armed Services are paid this way. The health systems in Great Britain and Spain are other examples. But Canada, Australia, Japan, and most European countries that offer universal health care would be more accurately described as socialized health insurance, not socialized medicine. These governments pay for care that is delivered in the private (mostly not-for-profit) sector, which is similar to how Medicare works in this country. Doctors are in private practice and are paid on a fee-for-service basis from government funds. The government does not own or manage medical practices or hospitals.

The term "socialized medicine" is often used to conjure up images of government bureaucratic interference in medical care. However, in countries with national health insurance, doctors and patients often have more clinical freedom than now exists in the United States. Moreover, socialization does not mean that private options cannot exist. In Britain, everyone in country must pay the relevant tax and is eligible for care under the National Health Service (NHS). However, there is also a parallel private health system. Patients can elect to get private care for any item of treatment they choose. Those who want to self-refer to a specialist, wait less have some elective procedure, or stay in a hospital that they believe would be more comfortable can do so. Private care can be financed out-of-pocket or through private insurance, which is not paid by the government and is managed by large insurance companies such as the British United Provident Association (BUPA). To prevent favoritism within the NHS, doctors are not permitted to co-mingle NHS and private patients and must maintain separate offices and hospital privileges for their private patients. (In other words, all patients seen in an NHS office must be NHS patients.)


Dr. Vig, a retired orthodonist who had a lengthy career in academic dentistry and subsequently practiced law, is an expert on clinical research design, quality standards, and health care delivery systems.

This article was posted on August 16, 2009.

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