Talk:Socialized medicine/Archive 3

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Question to right-wing American editors

When you use the term "socialized medicine", do you feel it is a pejorative or do you think it is an accurate description? If yes do you think the sentence in the lead "The term is often used in the U.S. as a pejorative..." has a left-wing bias? --Doopdoop (talk) 19:08, 28 February 2008 (UTC)

What, only right-wing American editors are allowed to respond to your question? What kind of consensus building is that? And, I'm sorry, but personal opinions of usage by Wikipedia editors, even in the multiple, constitute original research. --Sfmammamia (talk) 23:30, 28 February 2008 (UTC)

Sorry. Rephrasing the question- A question to ALL American editors - "When right-wing authors use the term "socialized medicine", do they think it is a pejorative or do these authors think it is an accurate description? If yes do you agree that the sentence in the lead "The term is often used in the U.S. as a pejorative..." has a left-wing bias? " --Doopdoop (talk) 00:37, 1 March 2008 (UTC)

How can the reader know what the author thinks? One can only second guess what the author is thinking! --Tom (talk) 08:31, 2 March 2008 (UTC)

lead sentence

The first sentence in the lead rewrite inserted by Kborer, which I have reverted twice, characterizes socialized medicine as "any health care system that embodies the fundamental principle of socialism, namely reduced individual liberty in favor of increased centralized control." I find this characterization of socialism highly biased and not in keeping with the definition contained in the Wikipedia article on socialism, in which the primary goal is defined in the lead as "a socio-economic system in which property and the distribution of wealth are subject to control by the community." We should not be redefining socialism on this page. --Sfmammamia (talk) 21:15, 2 March 2008 (UTC)

You may not have noticed this, so I'll just politely point out that I put a reference in the article for the definition of socialism that I was using. Kborer (talk) 22:40, 2 March 2008 (UTC)

Kborer's lead sentence is hallucinatory. He fights over whether or not the term is pejorative, while attempting to introduce a definition that is several steps beyond POV and pejorative itself. Just keep reverting.--Gregalton (talk) 22:08, 2 March 2008 (UTC)

If you really think that there is a mistake then please point out what is factually incorrect. Encouraging people to revert rather than discuss is counter productive. Kborer (talk) 22:40, 2 March 2008 (UTC)

This is a non-mainstream definition using sources that are far less reliable than the ones used before. The definition of socialized medicine is not the same as that of socialism. And the use of an unusual definition of socialism is so biased it is absurd. Defining the "fundamental principle of socialism" as reduced liberty in favour of centralized control is in itself biased.

I am encouraging to revert here because you have undertaken edit warring with an inflammatory definition and no discussion. If you were even attempting to be NPOV, it may be worth discussing, but you have clearly decided to simply edit war.--Gregalton (talk) 06:50, 3 March 2008 (UTC)

In defense of my definition of socialism, here is a definition that is "main stream" "Britannica"..

You are right that socialized medicine and socialism are different. One is a health care system, one is an economic system.

There is nothing biased about defining the fundamental principle of socialism as decreased individual liberty in favor of increased centralized control. That is what the definitions say. You could rephrase it the way that Doopdoop did by replacing individual liberty with individual control, but they mean the same thing.

As far as edit warring, there are a number of editors who have been very liberal with their use wholesale reverts. I do not think that anyone has been abusing it lately, but I think there were a few cases earlier this year and last year where a certain editor was asked to make incremental changes so that they could be evaluated individually. When those changes were reverted all at once with no discussion, that was probably inappropriate.

Yes the definition is inflammatory, but it was not intended to be. I was merely trying to convey what socialized medicine is in a clear and succinct manner. So your conclusion is incorrect, and I hope you will consider discussing the changes. Kborer (talk) 23:39, 3 March 2008 (UTC)

Britannica uses the phrase "social control"; Wikipedia uses the phrase "community control". Either of these is acceptable -- "centralized control" -- is not. I believe it would be neutral and acceptable to define socialized medicine as a broad term that encompasses all systems that subject health care to "social control" or "community control" rather than individual control or the free market. Beyond that, saying that different words for something "mean the same thing" is where you get into trouble and very quickly show your bias. --Sfmammamia (talk) 00:39, 4 March 2008 (UTC)

When I say individual liberty and individual control mean the same thing, I mean that they literally mean the same thing, as the definition of liberty is the "condition of being free from restriction or control." I think "social control" is less clear than centralized control or government control or centralized government control. Also, "socialized control" has another "meaning". which might be confusing. Kborer (talk) 01:05, 4 March 2008 (UTC)

You may think that "social control" is less clear, but I disagree. So where does that leave us? "Social control" is a more neutral phrase, which is why Britannica uses it. Words have connotations, which is why they must be chosen with care. "Liberty" is another word that carries heavy connotations. Also, "social control" has the benefit of being credibly sourced. No one is recommending "socialized control". May I remind again you that the goal is consensus? --Sfmammamia (talk) 04:58, 4 March 2008 (UTC)

I meant to say above that social control has another meaning, which makes it a somewhat confusing euphemism. I do not see how the word liberty has any connotations other than it's definition. Kborer (talk) 00:43, 11 March 2008 (UTC)

Well, let's see, the first definition of liberty here is: "freedom from arbitrary or despotic government or control." Kborer, if you insist that two words are "the same" in meaning, why can you not accept the alternate term if someone else objects to your chosen word or phrase? That's the nature of the consensus process. --Sfmammamia (talk) 01:31, 11 March 2008 (UTC)

I don't mind interchanging government control and centralized control as they are very similar. I said before that social control is intended to be a synonym, but might be confusing, so I prefer not to use it. For my last merge, in place of individual liberty I tried "free market approach". If there is a better term, I don't mind changing it again. Kborer (talk) 01:35, 11 March 2008 (UTC)

There is no consensus that socialized medicine is necessarily "centralized control". Nor have you supplied a reliable source to support that claim. Even if you could supply a reliable source, it would only be one POV, and we would have to give others.

There is no consensus for any of the definitions. Centralized control and government control are synonymous. We have definitions that say that socialized medicine is a health care system controlled by the government. This is the same thing as saying that socialized medicine is a health care system that is centrally controlled. Kborer (talk) 00:43, 11 March 2008 (UTC)

Once again, you've misused the source and left out important parts: (Dorlands)"a system of medical care regulated and controlled by the government, in which the government assumes responsibility for providing for the health needs and hospital care of the entire population, at no direct cost or at a nominal fee to the individual, by means of subsidies obtained by taxation." This does not say that regulation and control are the defining feature, nor sufficient to call a system socialized. This definition includes the concepts of universality and government financing, as well as provision at little or no cost. These are not "optional" components under the Dorland's definition.--Gregalton (talk) 07:50, 11 March 2008 (UTC)

(It's not an objective, universally acknowledged fact that socialism is centralized control. Emma Goldman was an anarchist socialist who didn't believe in centralized control. Giving up some liberty isn't a unique characteristic of socialism, it's a characteristic of any form of social organization.)

The point is not that it is a characteristic. The point is that it is the dominant characteristic. If the government is involved a little bit, it is not considered socialized medicine. If the government deeply integrated, then it is socialized medicine. Kborer (talk) 00:43, 11 March 2008 (UTC)

Blogs are not reliable sources. Nor are partisan think tanks. The Encyclopedia Britainnica is a reliable source, but it doesn't say "centralized control." The definition cited merely says:

"system of social organization in which property and the distribution of income are subject to social control rather than individual determination or market forces."

Nothing about central control. So your own sources argue against using "centralized control."

Social control is a euphemism for centralized control in that context. That should be obvious from the actual definition of social control. This source, among most of the others, supports the notion of centralized control as the key aspect of socialized medicine. This makes sense because socialized medicine is just a health care system done in a manner consistent with socialism, and socialism is all about central control. Kborer (talk) 00:43, 11 March 2008 (UTC)

You can have systems that could reasonably be called socialized medicine without central control. For example, there are national systems which place much or most of the control on the province level.

A province is still a centralized location. That like saying that if the UN provided health care, but most of the control was given to the governments of individual countries, then it is not centralized control. It is still far removed from the individual. Kborer (talk) 00:43, 11 March 2008 (UTC)

Calling it central control is original research, or unsupported opinion, or both. Unless you can support it according to WP rules, it has to go. That's independent of whether it's a value judgment. Nbauman (talk) 06:19, 4 March 2008 (UTC)

It is not original research. For example, the very first reference on the page, (which is again being misapplied to an incorrect definition of socialized medicine) says "a system of medical care regulated and controlled by the government". If the government is controlling it, that is centralized by definition. Kborer (talk) 00:43, 11 March 2008 (UTC)

This version of the first sentence ("Socialized medicine is any health care system that embodies the principle of socialism,[1] [2] namely centralized community control") is not biased. Do you agree? What are the other issues that cause you to revert Kborer's version? --Doopdoop (talk) 22:48, 2 March 2008 (UTC)

The cites are from clearly critical websites and opinion pieces at that. The lead on an article should concentrate on defining and describing the subject, not demolishing it. By all means use these cites appropriately later in the article, but they shouldn't be leading it. --Escape Orbit ^(Talk) 00:29, 3 March 2008 (UTC)

How exactly does the opening sentence demolish socialized medicine? Kborer (talk) 03:28, 3 March 2008 (UTC)

Biased - imagine if it said "embodying the principle of socialism, enhancing the liberty of the individual in the face of control by capitalist medical monopolies?". This article is not about socialism. The sources used are not reliable (certainly not compared to those that were in the lead). I believe Escape Orbit meant that the lead sentence above is so biased that only those who favour reduced liberty and centralized control (presumably not many, the language is so biased) would continue to read on.

Can you honestly not see why others would see this as biased?--Gregalton (talk) 06:56, 3 March 2008 (UTC)

Merely stating who gets to make decisions in the system is not biased. Implying that one way or the other is better or worse is biased. The newer version does not make a value judgment.

If you have a problem with any particular reference, then please point it out. There are a number of them and all of the ones from the older version are included the new version.

If the topic is repulsive by its very nature, then there is nothing that can be done. If there is more accurate way to to describe it, then we should certainly move towards that. Kborer (talk) 00:05, 4 March 2008 (UTC)

If I could find an opinion piece from a left-wing website that described "Socialized medicine" as bees-knees, and the ultimate indication of a civilised society, would it be ok for me to change the definition in the lead sentence accordingly, using it as a cite? No, of course it wouldn't. The lead in any article should strive to be as neutral as possible, particularly on controversial subjects, leaving criticism or praise to suitably balanced sections further down. --Escape Orbit ^(Talk) 09:17, 3 March 2008 (UTC)

That is a value judgement, so it would not be NPOV. As I stated above, there is no value judgment in stating that socialism and socialized medicine are about centralized control. Kborer (talk) 00:05, 4 March 2008 (UTC)

I have reverted the recent changes which attempt push bias, POV, and guilt by association into the lead sentence. I have the clear sense that most editors here do not accept the changes that have been inserted by --Doopdoop and Kborer which have been previously reverted. My own reversion is not without precendent and needs no further explanation. --Tom (talk) 07:12, 4 March 2008 (UTC)

Some editors would prefer the version you reverted to, but unfortunately it is too flawed to be acceptable. It is misleading in both fact and in its misuse of references. It defines socialized medicine as a derogatory synonym for publicly funded health care, which is not true according to the very definitions that are used to support that claim! Kborer (talk) 02:19, 5 March 2008 (UTC)

Most of the above attempts to justify this version of the lead seem to be discussion of the meaning of socialism, liberty, central control, and has little to do with this topic. There is no reason to get into this in the opening sentence.

There is no discussion of the meaning of anything besides socialized medicine. Explaining that socialized medicine is medicine done in a socialized way, and then explaining what that means is not off topic in the least. Kborer (talk) 02:19, 5 March 2008 (UTC)

And I find the defence of "inflammatory, but not intentionally so" a bit of a stretch, particularly when this had been pointed out by editors.--Gregalton (talk) 07:20, 4 March 2008 (UTC)

If an editor writes something that is true, and it evokes strong emotions from other editors then it is inflammatory. That does not mean there is anything wrong with it. Kborer (talk) 02:19, 5 March 2008 (UTC)

The edit histories also allege that the (more or less) stable version is misreferenced and missourced. Please provide details.--Gregalton (talk) 09:52, 4 March 2008 (UTC)

The opening claim is that socialized medicine is 1) a term 2) synonymous with publicly funded health care 3) that is derogatory. However, of the first reference "supporting" it: says that it is 1) a system 2) that in addition to being publicly funded is controlled by the government 3) and does not say that it is pejorative. In fact, most of the definitions cited in the article make do not say that it is pejorative, and also say that it is a system. Kborer (talk) 02:19, 5 March 2008 (UTC)

I'm agreement with Tom. The redefinition of the term in the lead sentence is entirely reliant on a definitions from opinion pieces on biased websites. As I've said before, opening sections should always strive to be neutral. This clearly isn't and establishes a unbalanced tone from the offset. The references provided also don't quite say what the cites claims they say, and the combination of them sails very close to original synthesis, particularly the irrelevant introduction of a cite for a definition of socialism. --Escape Orbit ^(Talk) 11:00, 4 March 2008 (UTC)

You decry the references used by the newer version, yet the first reference used in the old version directly contradicts every aspect of the claimed definition. You say the new version is not neutral, yet the old definition completely ignores referenced definitions in favor of implying that "socialized medicine" is just some dirty term that is not even worth talking about.

In the new version, there is no synthesis of ideas. Socialism is centralized control. Socialized medicine is centralized control of medicine. Stating that socialized medicine is a health care system implemented in a socialized way is not anywhere close to a new idea. It is merely describing socialized medicine in the context of socialism in order to make it easier to understand. Kborer (talk) 02:19, 5 March 2008 (UTC)

Once again, there's no consensus on usage of the term "centralized control". --Sfmammamia (talk) 06:14, 5 March 2008 (UTC)

Once again, there is no consensus on any of the definitions. Kborer (talk) 03:44, 9 March 2008 (UTC)

In response to kborer on the sources: the sources provided cover both a) term and b) pejorative. You may have moved sources down in the article before and now:

1. Paul Wasserman, Don Hausrath, Weasel Words: The Dictionary of American Doublespeak, p. 60: "One of the terms to denigrate and attack any system under which complete medical aid would be provided to every citizen through public funding."
2. Edward Conrad Smith, New Dictionary of American Politics, p. 350: "A somewhat loose term applied to..."
3. "Dirty Words", Winston-Salem Journal, December 14, 2007, "Jonathan Oberlander, a professor of health policy at UNC Chapel Hill, explained that the term itself has no meaning. There is no definition of socialized medicine. It originated with an American Medical Association campaign against government-provided health care a century ago and has been used recently to describe even private-sector initiatives such as HMOs." See also Socialized Medicine Belittled on Campaign Trail, National Public Radio, Morning Edition, December 6, 2007: "The term socialized medicine, technically, to most health policy analysts, actually doesn't mean anything at all," says Jonathan Oberlander, a professor of health policy at the University of North Carolina."
4. [http://www.npr.org/templates/story/story.php?storyId=16962482 "In the debate over health care on the campaign trail, the term "socialized medicine" is getting thrown around more and more often. It is almost never a compliment. But the politically loaded phrase means different things to different people."

As noted before in this talk page, saying that it is "a system" when the definitions of what system it is contradict each other is the reason to use "it is a term used to describe."

This new version is, IMO, terrible, even after the compromise version. "Social control" is loaded and most of the definitions do not say anything like this. An example of the specific definition "A system of health care in which all health personnel and health facilities, including doctors and hospitals, work for the government and draw salaries from the government" has also been relegated to later in the article, and I see no reason to prefer the other definitions over this one.--Gregalton (talk) 07:43, 5 March 2008 (UTC)

The first reference is rather weak, as the author has a large incentive to use definitions of words that fit his agenda. Your second reference is clearly wrong, as definitions have been provided above. The first NPR reference says that it does not mean anything to health care analysts. That is fine, but it does not mean that the socialized medicine is meaningless to other people -- for example economists. The second NPR reference says that socialized medicine means different things to different people. That is obvious from the first NPR reference, and more relevant to the usage section than the definition.

There are no definitions in contradiction on what a health care system is. There are definitions that differ on implementation, but not on the fact that it is a health care system.

The broad definition was not given preference in the newer version. It merely said that some definitions go one way, and some go another. Kborer (talk) 03:44, 9 March 2008 (UTC)

You have alleged bias for one of the sources, claimed a dictionary is clearly wrong (when the point is that the term is "loose" because definitions used vary and contradict each other - the point of this). If you want an economist's version, we can go with Reinhardt, who is quoted as saying ""strictly speaking, the term 'socialized medicine' should be reserved for health systems in which the government operates the production of health care and provides its financing." The implication and the article make it clear that the term is not used strictly, contradicting the other uses of the term. Your revert to a much-earlier version has also removed the other corrections and issues fixed previously.--Gregalton (talk) 07:40, 9 March 2008 (UTC)

My 'clearly wrong' comment was aimed at the "Dirty Words" reference. As you can see from your very own quote, Reinhardt says that socialized medicine is a system. Kborer (talk) 14:50, 9 March 2008 (UTC)

You are selectively reading the Reinhardt quote: he says the term should be reserved for a particular type of system; it is clear from the context that the term is not used in this sense alone. And his reference to the 'term' supports the usage of 'term' in the opening: the term is used to mean different things (outside the usage for which he believes it should be reserved).--Gregalton (talk) 09:43, 10 March 2008 (UTC)

If you read this Reinhart reference, he defines socialism as a government ownership. Other people define socialism as centralized control. The question is not what socialized medicine is. Socialized medicine is a health care system implemented in a manner consistent with socialism. The disagreement here is what constitutes socialism. Furthermore, Reinhardt admits to having little experience with the United States. This hardly makes him a more reliable source than dictionaries and encyclopedias for this particular argument. Kborer (talk) 00:43, 11 March 2008 (UTC)

You should check on background before making comments like this. He does not say he has little experience in the US; he says he "grew up" in other countries. Since he's been at Princeton since 1968 and a member of the Institute of Medicine of the National Academy of Sciences since 1978, I think his experience is likely sufficient by any measure.--Gregalton (talk) 07:26, 11 March 2008 (UTC)

Kborer seems to misunderstand how socialized systems work. My health care in Finland or in the UK is no more subject to "social control" than I assume his/hers is in the U.S. under private health care. If I get ill I see my doctor and he passes an opinion on what the problem may be or may call for more tests before he decides. I think that is pretty much common practise everywhere. When the results come back we discuss what this means and what the alternatives are. We choose the option that suits me and treatment begins. I have no idea where he thinks the social control comes into play. I'd be interested to know though. --Tom (talk) 12:51, 5 March 2008 (UTC)

I have no knowledge of your specific health care system. I did not claim that Finland has socialized medicine. There is not enough information in your first hand account for me to draw any conclusion, and I do not see how it is relevant. Kborer (talk) 03:44, 9 March 2008 (UTC)

Look into how doctors are paid... --Doopdoop (talk) 18:21, 5 March 2008 (UTC)

So you ARE Kborer! --Tom (talk) 16:17, 6 March 2008 (UTC)

Why do you think so? --Doopdoop (talk) 20:44, 6 March 2008 (UTC)

It was said tongue firmly in cheek! But doctors are paid very well in the UK and I'm sure the pay levels are comparable. (GP's in the UK I believe earn on average about US$200,000 per annum (this is AFTER deduction of business expenses like staff, accommodation etc..) In the US doctors have to finance their own way through medical school (which surely must excludes many poor people from ever becoming doctors). In the UK most general university course fees are subsidized by the government (I think the student pays about 1/3 the cost and the government the other 2/3. On top of this, the NHS pays bursuries to assist all medical students with both their living expenses and their medical course costs which over and above the help which non-medical students receive. See http://www.nhsstudentgrants.co.uk/ Thus, in the UK, most students do not leave college with as high a mountain of debt round their necks as happens in many other countries. Finland actually goes one better. Students get all their living costs paid for by the government AND all their course fees, so they start work with no debt whatsoever. I think many US medical students would be in awe at that!

But I digress. I think Kborer can answer the issue of "social control" himself. --Tom (talk) 16:25, 9 March 2008 (UTC)

I am not sure why this is directed at me. I am opposed to including this notion of social control in the article. Kborer (talk) 00:43, 11 March 2008 (UTC)

Well you added socialism which Britannica regards as social control so you introduced the notion but yes it was not you but rather Sfmammamia that preferred the actual term social control. The point is that in the countries I know that have this system of medicine my general practitioner may get re-imbursed or salaried by the government, but both my GP and my surgeon (as and when I go under the knife) and all the nursing staff are in practice actually working for me, not the government. This notion that the government is somehow interferring or "socially controlling" the delivery of my health care is complete nonsense for most practical purposes. And I am sure the same happens in the US. The medical and nursing staff may get paid by the owner of the hospital but the hospital owners are in no meaningful way controlling your health care. Your care is delivered by dedicated professionals whose number one aim is your welfare. And that is the same in both systems. --Tom (talk) 12:36, 11 March 2008 (UTC)

Actually, Tom (while this is somewhat off-topic), in the US, with the ubiquity of managed care, there's some degree of "centralized control" exercised by insurance companies. They decide what procedures are worth the cost. --Sfmammamia (talk) 14:44, 11 March 2008 (UTC)

Medicare and Medicaid both make coverage determinations too. EastTN (talk) 16:04, 11 March 2008 (UTC)

It may be off topic for this section of TALK , but perhaps not for the article. It maybe its worth adding a section to the article to how "value for money" decisions are made in deomcratized health care in socialized systems and compare it with value for money decicions made by private insurance companies, managed care organizations, and at the other extreme, pay-as-you-go medicine. This is perhaps a distinctive feature of socialized systems that is worth exploring.--Tom (talk) 07:24, 12 March 2008 (UTC)

Broad and Narrow definitions... and now a third?

We originally had one broad and one narrow definition set. Broad being any kind of medicine which is publicly financed and narrow which is public financed and publicly delivered. We now seem to have added a third. It does so at the point where it says

"Others assert that government regulation and control, where the government takes responsibility for providing health care for the entire population (at no direct cost or a nominal fee) constitutes socialized medicine" for which it cites the Dorland defintion.

I am not convinced that this third definition is really necessary. The Dorland definition is really restating the obvious; spending public money requires controls and regulation to ensure fair play for taxpayers. To me the same type of controls and regulations must exist in private insurance which requires controls and regulation to ensure fair play between policy holders with the same policy. Or have I missed something?

I think we should remove this third definition because it adds nothing and just muddies the previously clear broad and narrow definitions which I think gave greater clarity.

Your collective thoughts please.--Tom (talk) 16:38, 6 March 2008 (UTC)

I don't disagree that this one is not a third definition, although I would prefer it be integrated rather than removed. The Dorland was being used as an example of a very broad definition ("control" if I remember correctly), whereas the actual text is much more complete; effectively, Dorland is a definition of publicly-funded universal health care. I corrected its usage because (in my view) it misrepresented the source. Hence what has now come out as a "third" definition is really just another point in the mushy grey scale between broad and narrow, and yet another example of inconsistent usage.--Gregalton (talk) 16:46, 6 March 2008 (UTC)

I didn't mean the link to the definition, but just whether "control" or "regulation" by government is not a defining factor as nearly all countries governments regulate health care to some extent. And even ignoring this, all systems where there are scarse resources are controlled and regulated. Private health insurance is controlled and regulated by private insurers and their bureacrats (Sicko gave lots of examples). Free market medicine is controlled by the invisible forces of supply and demand. "Control" and "Regulation" are simply not defining features. Government ownership of the delivery system is what marks out the narrow from the broad definitions.

And as for practicality, one might think that because the government owns the health delivery system, it is the government that is doing the regulation. But the reality is quite different. The government effectively sub-contracts this job to the medical profession which largely self-regulates it in the form of collective wisdom arising from the consensus of experts on what works and what does not and what is cost effective and what isn't.--Tom (talk) 18:55, 6 March 2008 (UTC)

I'll reserve judgment on those issues. My specific point was that the use of the source did not accurately reflect the source.--Gregalton (talk) 19:50, 6 March 2008 (UTC)

To clarify:

• Broad: Socialized medicine is where the government controls the health care industry.
• Narrow: Socialized medicine is where the government owns the health care industry.

The other definitions mentioned are wrong. For example "Broad being any kind of medicine which is publicly financed" is the definition for single payer health care. "government regulation and control, where the government takes responsibility for providing health care for the entire population" is just the broad definition. Kborer (talk) 14:58, 9 March 2008 (UTC)

I don't think that you can refer to industry. In the UK (narrow) the government does not control the medical care "industry" as you call it. But it does deliver and finance huge parts of it. And in Canada (broad) the government does not control the health care industry either, but again it finances a large part of it. Hence we come back to government finance being the core factor and ownnership of the delivery system the difference between the broad and narrow definitions. The use of the term "Single payer" just muddies the water because this term is as badly thought out as "socialized medicine". Your definition would define the UK's NHS as Single payer (which logically it is because funding for it is central), although most people in the U.S. would, I think, draw a distinction and say that Single Payer is not Socialized medicine (and vice versa). Therefore I think the existing distinction between broad and narrow is correct. I would object strongly if you tried to alter this in line with your suggestion.

Single payer just means one source of funds. Single payer health insurance means the government pays bills and that is it. In the UK, is the government just paying the bills and that is it? No, they make lots of other health care decisions too. But in Canada, are they just paying the bills? Many would argue that is the case. Now say hypothetically that Canada wrote a list of instructions that told doctors how to do their job. They would still have private practices, but the government would have taken control of the health care system. My approach to explaining this is giving a high level explanation of what socialized medicine is, then explaining the broad and narrow definitions in more detail. I am not trying to remove the distinction, just to explain that they are similar. Kborer (talk) 01:01, 11 March 2008 (UTC)

Incidentally Kborer , how do you think Health care in The Netherlands should be described? The government funds only 5% and owns neither the hospitals nor the health insurance companies. Is this socialized medicine? If so, why? If not, why not? --Tom (talk) 15:56, 9 March 2008 (UTC)

Actually Tom, according to the WHO, the health care system in the Netherlands was 62% government funded. Here's my attempt to analyze the discussion so far. I'm listing the definitions provided in neutral references, and categorizing them according to the broad and narrow definitions we are discussing.

Broad -- common feature of these definitions is government funding ("subsidies" being the most common term)

American Heritage

Columbia Encyclopedia

Dorland's

Random House Unabridged Dictionary

Merriam Webster's

Narrow -- government employs doctors and runs hospitals

MedTerms

After looking through these carefully, I feel that a third definition -- that government regulation alone constitutes socialized medicine -- would probably come from only a highly biased source (free market libertarians) and therefore would probably fall under WP:UNDUE. We have plenty of neutral reliable references to support these two definitions as well as the general statement that usage varies. And I agree with Gregalton that Kborer's version, which used the Dorland definition to support this statement -- " heavy government regulation constitutes socialized medicine" -- is a distortion of what that source actually says. --Sfmammamia (talk) 17:41, 9 March 2008 (UTC)

The source says that socialized medicine is a system controlled and regulated and financed by the government. How exactly is the claim that socialized medicine is a system funded and heavily regulated by the government a distortion? Kborer (talk) 01:01, 11 March 2008 (UTC)

Because the word "heavy or "heavily" is nowhere in the source, and introduces bias into the defintion. Who's to say what constitutes "heavily regulated"? --Sfmammamia (talk) 01:23, 11 March 2008 (UTC)

I do not mind changing the term heavily to something else. It is merely to illustrate that the government is not just lightly involved, or involved in a small way. Rather, that it actually exerts a relatively large amount of control. Kborer (talk) 01:31, 11 March 2008 (UTC)

Sorry, but there's no way to neutrally define the degree of government involvement or control that is required for a health care system to fit the broad definition of socialized medicine. Actually, as I think Tom has pointed out on numerous occasions quite eloquently, there's no way for universal health care to be achieved without government involvement, and whether you think that's "heavy" or "light" depends completely on your point of view. Can you cite any system that fits the broad definition of socialized medicine where the government has little control or light involvement? It seems we are going in circles in these discussions, as I scan the talk page, it appears these same topics and debates came up in December. --Sfmammamia (talk) 01:53, 11 March 2008 (UTC)

Sfmammamia: re 62% (Netherlands data and WHO). Is the 62% WHO figure from before or after the 1 Jan 2007 health care reform? The dutch government video claims the new system is only 5% funded by government.--Tom (talk) 14:08, 10 March 2008 (UTC)

The WHO figure is a few years old (I think 2004 or 2005, the last year of common data in the WHOSIS database). I'd be interested in seeing the video you mention -- is it available online somewhere? --Sfmammamia (talk) 14:16, 10 March 2008 (UTC)

Click on this link to see the 8 minute video explaining the health care system. But be aware of this; the video sound track is in both English and Dutch but an English subtitle track is visible if the T symbol is clicked in the video control.--Tom (talk) 09:35, 11 March 2008 (UTC)

Yes, we've been through this before. Apart from citing any so-called "socialized" health care system where the government has little control or light involvement, it would be useful to identify any non-socialized systems where the government has "little control or light involvement." Depending on how tightly one wants to define control and involvement, it is probably only failed states or the least developed countries that would qualify.--Gregalton (talk) 07:31, 11 March 2008 (UTC)

RfC --- Article identity

Editors cannot even agree on a purpose for this article, much less the presentation of content. Help is needed in determining an acceptable structure for this article. The primary issues in contention are:

• A) with multiple verifiable definitions, are any of them "mainstream" and are any of them insignificant enough to exclude;
• B) is "socialized medicine" only a POV term that should be discussed only insofar as the connotations of the phrase, or is "socialized medicine" a system of health care;
• C) if "socialized medicine" is indeed a POV term, then should the history of the system that it disparages be discussed anyways;
• D) is "socialized medicine" functionally distinct from Publicly-funded health care in any significant way; and,
• E) should the implementation section be included here or merged into another article.

In addition to input on the above topics, it would be helpful for editors to post their personal preference about the relative priority of the above issues. In order of importance, I would say the most important issue to be resolved is: B, then D, C, A, and finally E. BigK HeX (talk) 06:50, 20 February 2008 (UTC)

B, D, E, A, C. As a note, "disparages" in C is POV. Kborer (talk) 15:57, 22 February 2008 (UTC)

A, B, D, C, E. Not sure if this list of prioritization is particularly helpful, but you asked. I think the main focus needs to be the usage of the term - including the political connotations. This includes the various definitions. I think implementation is largely repeated elsewhere, but I recognize Tom's valid point that the issue will end up getting reinserted, so do not insist that implementation be addressed only in other articles.--Gregalton (talk) 08:32, 23 February 2008 (UTC)

A. Socialised medecine is a term that is used also outside the US, In France for example. It seems to me this is only the extreme of a Publicly-funded health care system, a system where health care are provided by the state as a public service. The English "National Health Service" looks very much like socialised medecine.
B. It is true the word socialism is everywhere more or less negatively connotated, so socialised medecine is also negative. A non negatively term would be rather "public medecine".
D. Yes, in publicly-funded system is a mix between a private system and a public system, a system where medecine is still private but some funding is public.
E. I think the article should be merged with "publicly-funded health care" into a new wiki page named "public health care systems", that would deal with all systems of health care that involves the state, whether these are systems of public funding or system of public medecine. In the critics about public systems, there would be a section about "socialised medecine", as an expression of hostility to public medecine.--Voui (talk) 21:38, 1 March 2008 (UTC)

You say it is used in France but you have not given us any example. The French use the word social derivations from social or derivations from it to mean "community" such as "médecine communitaire", community medicine. This does not have the same meaning as socialized medicine as it is used in the US. There is the phrase in French "la médecine socialisée" but it is a direct translation of the usage in the US and is used to report on issues in US medicine such as the current US elections and in reviews of the movie Sicko.It is not an example of usage. I see you have have only ever made 2 WP edits and that was to comment in this discussion. Faux-nez? —Preceding unsigned comment added by Hauskalainen (talk • contribs) 18:12, 4 March 2008 (UTC)

• Redirect to Publicly-funded health care. As per Partial Birth Abortion. Dlabtot (talk) 19:17, 16 March 2008 (UTC)

order of definitions and who uses them in lead

I have reverted an edit that attempted to switch the order in which the two definitions were presented in the lead, and to characterize who uses the term in those two ways. Here's my reasoning: as noted above, we have been able to find numerous neutral sources (dictionaries and other encyclopedias) that define the term in its broad sense. For that reason, I think the broad definition should come first, and should not be characterized as biased usage ("pressure groups and the political right"). The narrower term may be the more accurate one used by health economists and policymakers, but that assertion was unsourced in the edit, and citing one such individual (Reinhardt), no matter how well-respected, seems a little weak to me. Can we leave those fine points to the "Current usage" section? --Sfmammamia (talk) 14:09, 10 March 2008 (UTC)

There are other citations which can be moved up that support both the narrow and the pejorative. It is well-supported by sources.--Gregalton (talk) 07:54, 14 March 2008 (UTC)

No doubt, but that was not the nature of the edit as first presented. --Sfmammamia (talk) 14:23, 14 March 2008 (UTC)

I'm not sure about the edit in question. The usage, however (no comment on the specific terminology as above) is clear and documented. As for the citations provided, there was a period way back when during which citations were requested, subsequently provided, and then moved down into lower sections (for reasons that were never clear). Likewise, the "usage" section keeps getting moved down below "implementations". While there is certainly no consensus, there seem to be a number of editors that support keeping it higher up. And a broader point: if the definition is either broad or narrow, and hence applied to an inconsistent group of "implementations", it would seem to me odd to put implementations higher than usage. Best,--Gregalton (talk) 16:04, 14 March 2008 (UTC)

Here's the diff that started this discussion. The change implied two points: 1. that the broad definition is the one most commonly used by opponents of public health care -- in other words, the ones most likely to use the term pejoratively, and 2. that the narrow definition is the one most used by health economists and policymakers. While these points may be true, they need to be pretty strongly supported by references within the lead itself. I just didn't see that done in the edit in question. Is that doable? Also, at the risk of repeating myself, I agree that the usage section should precede implementations in the body of the article. --Sfmammamia (talk) 17:36, 14 March 2008 (UTC)

Fair enough, I believe I misunderstood your point.--Gregalton (talk) 19:19, 14 March 2008 (UTC)

What? A lack of clarity; on THIS talk page? Shocking! ;-) --Sfmammamia (talk) 22:08, 14 March 2008 (UTC)

The term is used often pejoratively...

The claim that socialized medicine is a pejorative term is made by left-wing sources and is POV. It should be moved from the lead to some other section and there it should be noted that it is a lef-wing claim. --Doopdoop (talk) 22:39, 14 March 2008 (UTC)

Doopdoop, I appreciate the attempt at discussion, but have you reviewed all 80 Google Books references? What about the book I just added as a ref? What evidence do you have for your assertion that all are left-wing sources? --Sfmammamia (talk) 22:47, 14 March 2008 (UTC)

Which book is written by the oponent of the Socialized medicine? --Doopdoop (talk) 22:50, 14 March 2008 (UTC)

As noted in the edit summary, a simple seach on Google Books for the phrase "socialized medicine and pejorative" yielded 80 references. The reference I added, by Mark Rushefsky and Kant Patel, shows no evidence of being a left-wing screed. It's a well-regarded book, in its third edition, that has earned positive reviews in the New England Journal of Medicine and other respected publications [1]. There are numerous other references supporting the statement that the term is used pejoratively. Unless you can demonstrate that ALL sources who state that the term is a pejorative are biased (or find a reliable source who so states your assertion), the weight of evidence is against your assertion. Remember, the standard is verifiability. The statement in the article has been more than adequately verified. --Sfmammamia (talk) 23:51, 14 March 2008 (UTC)

One standard is verifiability, and I am sure Kborer has many verifiable Rothbardian statements to put into lead. Another good standard is NPOV, and here we have in the lead a piece of left wing bias. Rushefsky and Patel are biased, for example they have criticised stem cell research funding policies of current government, and while I agree with their criticism, I know there are many who don't. --Doopdoop (talk) 22:59, 15 March 2008 (UTC)

Doopdoop, the wording you are insisting on reverting (at least four times in three days) is that the term is "often used as a pejorative". Not "always used" -- "often used". This is well supported, and so far you haven't supplied any evidence supporting your view that ALL sources who so characterize its usage are left-wing biased. To cut to the chase, there is no consensus for your constant revert of this statement, and I urge you to self-revert and work it out here on talk. --Sfmammamia (talk) 00:10, 16 March 2008 (UTC)

Just for additional backup: Paul Burleigh Horton, Gerald R. Leslie, The Sociology of Social Problems, 1965, page 59 (cited as an example of a standard propaganda device). Quite literally a textbook example (this has been referred to as one of the few sociology textbooks to be reprinted more than ten times over a period approaching fifty years) of "name-calling". Could this be considered, specific support of pejorative usage?--Gregalton (talk) 07:58, 15 March 2008 (UTC)

Thanks Gregalton. It's just the ticket... And its age is such that it has a considerable pedigree and not tied to recent debates. —Preceding unsigned comment added by Hauskalainen (talk • contribs) 02:58, 15 March 2008,

WP:UNDUE requires that article should fairly represent all significant viewpoints. If we add a view that term is "often used as a pejorative", we should also add a view that "some argue there is much in healthcare socializm everywere that mirrors the former Soviet experience" [2]. I would prefere moving these two viewpoints from the lead to appropriate sections below. --Doopdoop (talk) 14:53, 16 March 2008 (UTC)

Seems to me, your additional statement represents the SAME POV, not a different one. "Socialized medicine=bad." --Sfmammamia (talk) 17:50, 16 March 2008 (UTC)

If so, let's replace it. --Doopdoop (talk) 18:01, 16 March 2008 (UTC)

Why would we do that? The current statement is much broader, shorter, and more broadly sourced. I can only suggest that your addition be used as an example of the first sentence in the third paragraph of the lead: "The term is often used in the U.S. to evoke negative sentiment toward public control of the health care system by associating it with socialism, which has negative connotations in American political culture". The cite could be added as a source in the lead and expanded upon in the usage section. --Sfmammamia (talk) 18:36, 16 March 2008 (UTC)

Then I'll try to incorporate this [3] briefly in the lead. --Doopdoop (talk) 19:16, 16 March 2008 (UTC)

Disadvantages of socialism

I've modified Doopdoop's version that read: "The term is often used in the U.S. to evoke negative sentiment toward public control of the health care system by those who argue that disadvantages of socialism apply to socialized medicine, thus making an association with socialism, which has negative connotations in American political culture."

The citations here made no such point, so I've returned the original text but added the sentence: "Some argue that the disadvantages of socialism apply to socialized medicine." With a citation flag.

As noted in the edit line, the citations say no such thing, but presumably a citation from a reliable source can be found that does. (Or we could just add Giuliani's line and say it's "European". That should be clear enough :))--Gregalton (talk) 07:09, 18 March 2008 (UTC)

I originally reverted it because it seems to me, having read so much about this subject over the past year, that the connection between "socialized medicine" as a term of abuse in the U.S. has mostly used a different process and has not drawn to the connection to socialism (which was always rather weak given that the world's largest communist country China does not have universal socialized medicine whereas that many capitalist countries such as the UK and Spain do). It has usually been left to the reader or listener to conclude that he or she should belong on one particular side of the argument on the basis of the negative associations set up by the context in which it used. This is why there are so many identical blogs plastered over the web and articles planted in the press about this topic of socialized medicine with so many lies and unsubstantiated horror stories associated with them. Even the so called "Think Tanks" and "Policy Institutes" such Cato, The Centre for Policy Analysis, The Manhattan Institute and others revert to using distortions based on the misuse of statistics and citing shock-horror news stories from the tabloid press (and others) and regarding these as indicative of some norm. The point is not to argue the matter from rational analysis of the situation but to set up negative associations with the word through fear. See the article Culture of fear for more of this. The same technique has been used in recent times to make even the rather positive words "DEMOCRAT" and "LIBERAL" are made to be dirty words by the way that opinionated talk radio hosts spit the word out with disgust and to associate religiosity with being right wing (subtly leaving one to believe that being left wing is somehow Godless). Sure, there are those who explicitly argue the socialized medicine conection with socialism (as Giulliani did) but this is not the norm, and that point it is already covered in the article. And I would argue that the same negative association set-up is what editors here like Freedomwarrior and Kborer did when they were all the time using Wikilinks to highlight words to trigger negative feelings in the U.S. reader... words such as socialism, taxation, government, and even control, as if such words needed explanation. That too was POV pushing of a subtle nature. I wonder how Doopdoop would react if I added a contra argument to the header that countries adopt socialized medicine because of the advantages of socialism and left that unexplained? He would certainly think that was POV! The WP article should not revert to these techniques but give a neutral look at the topic and true facts supported by statistics from neutral and fact-checked sources.--Tom (talk) 08:05, 18 March 2008 (UTC)

Please take a look at a preceding section. If we want a NPOV lead, it should either contain no POVs (including pejorative claim), or it should have balancing POVs. For now I'll try to remove all POVs from the lead. --Doopdoop (talk) 22:58, 18 March 2008 (UTC)

You have not established that this is POV at all. There are numerous sources, which appear to be balanced. Saying it is POV does not make it so.--Gregalton (talk) 07:24, 19 March 2008 (UTC)

I agree wholeheartedly with Gregalton. This has not been established at all. You have to be blind to fail to see how the term socialized medicine is used and which groups use it and which groups do not to see that it is nearly always being used pejoratively. Given this reality the claim cannot be POV.--Tom (talk) 08:50, 19 March 2008 (UTC)

When I wrote "WP:UNDUE requires that article should fairly represent all significant viewpoints. If we add a view that term is "often used as a pejorative", we should also add a view that "some argue there is much in healthcare socializm everywere that mirrors the former Soviet experience" [6]. I would prefere moving these two viewpoints from the lead to appropriate sections below." Sfmammamia replied "Seems to me, your additional statement represents the SAME POV, not a different one.". So both are POVS. --Doopdoop (talk) 20:49, 19 March 2008 (UTC)

Neutral POV is not the same as NO POV -- it is fairly representing all significant viewpoints. My point was that the usage of the term as a pejorative is well-documented and represents a significant viewpoint, and that the quote you wished to add was more a demonstration of pejorative usage than a reflection of a different viewpoint. Please do not use my words to make a point opposite to the one I was making. --Sfmammamia (talk) 22:24, 19 March 2008 (UTC)

What's wrong with adding such a demonstration of a usage to the lead? --Doopdoop (talk) 22:37, 19 March 2008 (UTC)

I will make a bold edit to demonstrate how I think this could be handled neutrally, but allow me to express a lack of confidence that my approach will satisfy consensus. --Sfmammamia (talk) 23:34, 19 March 2008 (UTC)

Your edit has restored NPOV. Do you agree that this ("Some argue that the disadvantages of socialism apply to socialized medicine") is a fair summary of Rockwell article? Also, if you know a more mainstream source that can replace Rockwell please use it. --Doopdoop (talk) 23:51, 20 March 2008 (UTC)

Argue? The article makes claims but does not substantiate them with factual data (see next section in this discussion). I do not think that is argument. For example it claims that Free markets always allocate resources efficiently. But that case is actually hard to make in the case of health. MRI investment is often held up by socialized medicine's critics to be a prime example of efficient free market investment delivering in the U.S. compared to low investment in countries with centally planned systems. The truth is that free market providers in the U.S. have over invested in MRI technology. The over investment caused the cost of MRI scans in the U.S. to be much higher because the equipment and the trained staff to run them are not used efficiently. An article in Imaging Economics magazine stated that "the key to MRI financial viability is now volume, volume, volume. But how can MRI facility managers conjure up the additional patients to meet their costs?" The response to this was for the U.S. scanning industry to call for more referals from the medical profession to keep the surplus equipment in profitable use. See http://www.imagingeconomics.com/issues/articles/2001-05_03.asp. And it seems to have done so because the U.S. performs more of these expensive scans per capita than almost any other country apart from Japan. As a result there are probably more unnecessary scans being done in the U.S. and they are also on average more expensive than in other countries. A case of the tail wagging the dog if ever there was one.

The UK has much more central planning in health matters than, say the U.S. which, if the argument that free markets deliver more and more cheaply was true, should mean that health care in the U.S. would be both cheaper and more widely available in the U.S. than it is in the U.K. But clearly all the main statistics seem to show the reverse to be true. -Tom (talk) 10:06, 21 March 2008 (UTC)

Mises article

The Mises article is a good example of how policy institutes bend the truth and tell lie lies.

The title of this artice is Socialized Medicine in a Wealthy Country. I think we can take it from the discussions in the article that it is talking about the U.S. As the WP article makes clear, the examples of socialized medicine in the U.S. are systems such as the Military and Veterens health care services and that set up for native (indian) americans. But the Mises article chooses to ignore these examples completely.

Instead it begins by discussing what happpened in the Soviet Union and makes the claim that "A similar experience was repeated in every socialized state. Health declined." But it gives no evidence of this. The reader is just invited to believe the statement is factual.

Later we get another claim.

This (regulation and taxation on the assumption that health-care provision cannot be left to the market alone in former socialist countries) is despite the vast number of stories we hear about English and Canadian health care socialism, mostly having to do with a lack of innovation and a grim shortage of medical, surgical, and emergency services. In these countries, there is much that mirrors the former Soviet experience, except in one area: their governments are not as poor.

(My highlighting)

So here again is another statement, so blazingly obvious to the author that it does not need actual proof. A grim shortage of medical, surgical, and emgergency services? Lack of innovation? Much that mirrors the former Soviet experience? Where is the evidence for this claim? This is just a complete lie wrapped up and sold as as fact. Readers with no experience of the English or Canadian health care systems are likely to believe such nonsense because most will of course have no personal experience of it to be able to challenge it. And yes the right wing blogs in the US are very fond of quoting new stories from the UK and Canada but such stories are often with very little foundation and an example of an incident in one hospital say, just cannot lead one to make conclusions about a nation's health care system.

I despair at the ways the American public are lied to about this subject every day. And I despair that we have to include links to biased, non-fact checked articles in encyclopedia that is supposed to be well referenced. (And before anone reminds me, yes of course, I do realize that this reference was included as an example of guilt by association).--Tom (talk) 09:46, 20 March 2008 (UTC)

It would be very interesting to hear Kborer's reply to your comment. I think he might be a fan of Mises institute. --Doopdoop (talk) 23:46, 20 March 2008 (UTC)

Support and criticism sections

Both of these sections have been tagged for awhile, becauase they do not follow the preferred structure for a Wikipedia article. Namely, support and criticism should not be isolated in their own sections, they should integrated and organized topically. See Template:Criticism-section. I beleve this suggestion has been raised before, but I haven't seen any effort expended so far in this direction. Perhaps it would be worthwhile to discuss here a possible topical structure that could contain the pros and cons more neutrally. There are also numerous unreferenced statements in these sections -- they really should be tightened up and cited. In my opinion, this would vastly improve this article.

Alternatively, perhaps it's time to resurface another suggestion I have made before here and elsewhere. See this discussion. I have suggested starting an article specific to the debate in the U.S., for example, "Health care reform in the United States", so that the numerous debate sections that seem primarily focused on the debate in the U.S. but appear in several global articles: Universal health care,publicly-funded health care, Health care reform and here, could be consolidated in one place and removed from global articles, where their relevance is questionable. Thoughts about either or both of these suggestions? --Sfmammamia (talk) 20:42, 13 March 2008 (UTC)

I strongly support the first proposal about integrating the criticism section. However I think that arguments presented in the American debates are very important from the global perspective too. --Doopdoop (talk) 23:00, 13 March 2008 (UTC)

Doopdoop, can you please expand on your second point? Why is the US debate important from a global perspective? --Sfmammamia (talk) 23:26, 13 March 2008 (UTC)

Healthcare expenditures in the US make up a large part of global healthcare expenditures. A large part of medical research is performed in the US. Some conservative politicians in the UK use the arguments from socialized medicine debate when they propose various healthcare reforms (for example "patients' passport" plan, the scheme that allows patients to use half the cost of their NHS operation to be treated privately). Debate about the appropriate degree of centralized control of healthcare is also continuing in other countries. --Doopdoop (talk) 23:51, 13 March 2008 (UTC)

The US debate does not add anything to debate in the UK as far as I can tell. Of course, those who choose to pay for private medical care would love the government to help them with their costs on the grounds that they are saving the government money by being treated privately. But because this is a form of queue jumping, all governments (on the right and the left) have always resisted this. There is no widespread support for this idea and it certainly is not an idea coming from the U.S.--Tom (talk) 07:13, 14 March 2008 (UTC)

The idea has considerable suport among Conservative party activists, and the implementation would be a major step towards the US-style decentralization. There is a sharing of healthcare reform ideas between US and UK conservatives. --Doopdoop (talk) 21:23, 14 March 2008 (UTC)

Your evidence for this ("considerable support" and "sharing of hc reform ideas")? I have seen no evidence for this other than a few well funded "think tanks" or "policy groups" which look and sound very much like their American cousins (so much so that one suspects that one is an off-shoot of the other). There is scant information about who is behind them and especially who is financing them. They make a bit of noise but they do not hold the centre ground and have virtually no political influence as far as I can tell. They are certainly not mainstream conservatives.--Tom (talk) 10:55, 15 March 2008 (UTC)

Okay, based on this discussion so far, it sounds like there's perhaps less resistance to reorganizing the debate section in this article than there is to the (hugely ambitious) idea of forking it (from here and other places) into a US-specific article. I volunteer to compile a topic outline that I will post here before undertaking such a reorganization. I'm going to attempt to encourage discussion and comments BEFORE the section undergoes major refactoring, so perhaps we can avoid another slow-motion edit war on yet another section of this article. --Sfmammamia (talk) 22:23, 14 March 2008 (UTC)

I think social justice concerns, level of innovation, and cost vs. quality should be the top three topics. --Doopdoop (talk) 22:43, 14 March 2008 (UTC)

See below for my attempted outline. Suggested changes or additions are welcome. Looks like this could be done in three main sections, although further breakout may be possible. A: represents supporters of public systems, B: represents opponents.

Health care as a market A: benefits of eliminating profit motives, avoiding overproduction, administrative simplicity B: third-party payment incentivizes over-consumption (moral hazard argument), leads to wait times and other forms of rationing, market incentives lead to efficiency and innovation, governments never as efficient as private sector, regulation imposes extra costs

Access, equality A: benefits of preventive care versus delayed, expensive treatments; economic benefits of healthy populace; broad pooling eliminates adverse selection problems, human rights argument B: requiring health insurance limits personal freedom and choice, requires higher taxes, universal systems also limit access, adequate government funding is not sustainable as populations age

Outcomes Debate over what constitutes quality, how value for money decisions are made in private vs public systems, how difficult it is to measure system effectiveness, difficulty of drawing conclusions from international comparisons

I will leave this up for discussion a few days and perhaps tackle the actual edit this weekend. --Sfmammamia (talk) 14:45, 19 March 2008 (UTC)

I think the structure is good, although I remain concerned that this duplicates info in public health care, et al. But I'll think on this. One suggestion is that much of the topic areas could be covered broadly and piped to main article health economics (which also needs some work and should possibly be renamed health care economics). Thanks for the constructive suggestion.--Gregalton (talk) 15:15, 19 March 2008 (UTC)

Sfmammamia's proposal preserves grouping the arguments into the groups by POV and so does not really solve the Template:Criticism-section problem. --Doopdoop (talk) 22:45, 19 March 2008 (UTC)

I don't intend to label arguments as pros and cons, and other than that, I can't see anything in Template:Criticism-section that says you can't group arguments logically. The As and Bs in the outline above are just to make it easier to see what topics from the existing section go where. I think neutral presentation can be achieved by presenting the arguments in neutral language. Perhaps the best way to see if this is valid will be for me to undertake the edit and post it on a subpage of my userpage for anyone to look at ahead of making the overall edit. If you have other constructive structural suggestions, I'm open to them.--Sfmammamia (talk) 23:30, 19 March 2008 (UTC)

I think it should be determined which items from the long list of topics you gave are most important for the supporters and opponents of socialized medicine. Then for each topic prominent views from both sides should be presented. Neutral language is not required if two opposing viewpoints about a topic are presented one after another. In my opinion social justice concerns, level of innovation, cost and quality should be the top four topics (not necessary in that order) but of course I'm open to other suggestions.--Doopdoop (talk) 22:37, 22 March 2008 (UTC)

I broadly support the development of a text which is less focussed on the US debate and more focused on factual information rather than claims that are unsubstantiated or based on rather flimsy evidence (such as tabloid news articles, blogs). I agree that topics should be grouped together. I disagree entirely with the suggestion above that neutral language is not required and I suspect that sequencing is again going to be controversial because there will be those editors who wish to influence the debate and put their issues to the fore rather than the prime reasons why countries that have socialized medicine have chosen to adopt that model (which to my mind seems to be the logical set of issues to be discussed first). The success or otherwise of this and any unforseen negative consequences, if any, should follow on. This would make the article flow better and give it a more logical view to the reader.

I do think that we will have a problem when we come to the claims of the various pressure groups. I am thinking of claims such as the outrageous one made by one pressure group that under provision of hospital care led to the deaths of thousands in France during a heatwave. (The issue here was there was a heatwave in France and hospitals came under pressure. Many people did die in the heatwave, but lack of medical facilities was not the cause of the high number of deaths). We should avoid repeating such claims just because they are made, and I would argue that we should even avoid leading readers to such articles without warning them first that the claims made in those articles may not be substantiated, even if certain facts in them are (e.g. hospitals did come under pressure and many people did die). --Tom (talk) 09:42, 23 March 2008 (UTC)

Like Greg Alton I want this article to explain the history of the term and somehow not give it more legitimacy. The problem I have that there is no internationally accepted term for socialized medicine in the narrow sense (medical services run by government for an entire population). Public medicine it seems does not mean the same in the US as it does in the UK for example. There should be a place in WP where such systems are explained and their effectiveness´or otherwise is examined. So perhaps Socialized Medicine is as good as a place as any. Which in one sense is why I like Sfmammamia's suggestion about looking at topics. But maybe this could be done by country by topic? After all different countries adopt different ways of doing things and what works in one country may not work in another. The International comparison on expenditure and broad outcomes may have to sit in an international comparisons section. The only thing I would say though is that it should be restricted to socialized medicine in the narrow sense (government adminstered systems) otherwise it will just repeat all the arguments at Publicly-funded health care. There will be plenty of good source material and stats for the UK and I could see what is available in English for Finland. Someone could expand the U.S. section to say more about the Veterans and military health care systems and perhaps that for Native Americans. It should be possible also to get material in English for Israel and perhaps too for other Nordic countries such as Norway. In this way we can stay focussed on facts rather than claims from opininated sources which are often just claims not substantiated by the facts (like the French heatwave claims I mentioned earlier in this thread, or the claim that medicine is more expensive if run by the government because governments don't care and just pass on high costs on as higher taxes). —Preceding unsigned comment added by Hauskalainen (talk • contribs) 01:51, 26 March 2008

Header section (Again)

The lead paragraphs making up the header section should summarize the article as a whole. But we now seem to have 2 items therein which seem to go beyond this. I am proposing that we remove them and move them further down in the article. The two I am refering to are

Most industrialized countries, and many developing countries, operate some form of publicly-funded health care with universal coverage as the goal. According to some sources, the United States is the only wealthy, industrialized nation that does not provide universal health care

This seems to me to have nothing to do with the term "socialized medicine" per se. It could be deleted altogether.

and

Some argue that the disadvantages of socialism apply to socialized medicine. A 2008 poll indicates that Americans are sharply divided in their views on socialized medicine, with a large percentage of Democrats holding favorable views, while a large percentage of Republicans hold unfavorable views.

These are details rather than a summary of the article and therefore they belong lower down.

If no one objects I will move them.--Tom (talk) 22:14, 24 March 2008 (UTC)

I think all of the statements you highlighted as expendable in the lead are critical there for context, because they underscore why there's such a debate on this topic in the United States and how usage of the term "socialized medicine" fits into that debate. With a full third of the article devoted to the support and criticisms of systems that fall under the "socialized medicine" rubric, I think such statements help the reader understand in short form why it is such a contentious topic. I say keep them both. There's already a lengthier treatment of the poll results in the article, so the summary statement in the lead about the poll results is perfectly legitimate material. I thought we had achieved consensus on the sentence "Some argue that the disadvantages of socialism apply to socialized medicine." So I hope we don't reopen the debate on that one. --Sfmammamia (talk) 01:18, 25 March 2008 (UTC)

support / criticisms

I see that Doopdoop has merged support and criticms into one sub and has started a lead paragraph to this new section. If we are not careful, we are likely to end up repeating in the lead paragraph all the arguments in the subsequent lists. Although I have edited this new lead paragraph myself, I feel that we are on a slippery slope here. I would like to revert the article to a list of pros and cons and let the reader decide for him or herself what to think about each. I therefore propose that we revert to the situation prior to this change by Doopdoop. Comments please.--Tom (talk) 22:49, 24 March 2008 (UTC)

I started a discussion earlier on the talk page with suggestions about refactoring the entire support/criticisms section, because I believe the current section structure is not in keeping with Wikipedia's recommendations. Now I'm considering withdrawing the offer to refactor as I have proposed, as I'm getting the sense that it's unlikely to get support from either of the two editing factions on this article. At the risk of repeating myself, the section as written goes against Wikipedia's recommended style. See Wikipedia:Words_to_avoid#Article_structure and WP:CRIT. I've made my suggestion. If any more intrepid editor would like to undertake it, be my guest. If you'd like me to change my mind on this, you know where to reach me. --Sfmammamia (talk) 01:32, 25 March 2008 (UTC)

It is very important to follow guidelines from Wikipedia:Words_to_avoid#Article_structure and WP:CRIT. Current article structure encourages extremist viewpoints and there is no place for serious research findings, such as "Using data on expenditures and life expectancy by income quintile from the Canadian health care system, I find that universal, publicly-funded health insurance is modestly redistributive." and "Using data across the OECD, I find that almost all financing choices are compatible with efficiency in the delivery of health care, and that there has been no consistent and systematic relationship between financing and cost containment.", that were presented in [4]. --Doopdoop (talk) 14:08, 25 March 2008 (UTC)

I'm torn on this one. I repeat my overall opinion - as before - that since the term doesn't have much meaning, the bulk of support/criticisms end up being things that should be covered in other articles. So I'm leaning to getting rid of this entire section unless demonstrably specific to socialized medicine (same with implementations). I think a few other editors share that viewpoint, but I'm not trying to push it.

My comment for the time being is that support/criticisms should be explicit about whether the pro/con is specific to socialized medicine, or to universal health care, or to publicly-funded health care, or simply "government involvement." Most of the points made seem to refer to things that are not specific to socialized medicine (in the narrow sense) and most of the sources (at least support) never refer to socialized medicine at all. I don't think the article should attribute support for "socialized medicine" where the sources do not: if the source supports universal health care, that's what it supports.

In this view, and I'm being open, this article should be mostly restricted to use of the term. Finding an NPOV balance while retaining the uses of the term by the sources may simply be unworkable. But grateful views.--Gregalton (talk) 15:38, 25 March 2008 (UTC)

Most pro/cons are equally applicable to socialized medicine (in a wide sense), to universal health care, and to publicly-funded health care. I always wonder why there are so many different articles in WP about essentially the same topic. --Doopdoop (talk) 21:27, 25 March 2008 (UTC)

Agree that they can apply if the broadest definitions possible are used, but those terms are not pejoratives. To say that people support "socialized medicine" when they have said no such thing and may not agree with the terminology or association, and when the subject can be treated neutrally on the other pages makes the problem worse, not better.--Gregalton (talk) 08:29, 26 March 2008 (UTC)

2008 U.S. Presidential election

The section does NOT belong in the article. It is way too US-centric, suffers from recentism, and way too specific for the general article. Please incorporate the material to US-specific article(s). Renata (talk) 15:13, 25 March 2008 (UTC)

Per earlier discussion, to me and at least one other regular editor here, this example has value in demonstrating the politicized, pejorative usage of the term. Accordingly, I have moved the section to become a subtopic under current usage and have further pruned it. --Sfmammamia (talk) 21:42, 26 March 2008 (UTC)

Health Economics: Balancing Social, Moral, Ethical and Economic Dimensions

I think we owe some thanks to Gregalton. The reference he provided for market failure at http://www.oheschools.org/ohe.pdf is actually a very valuable find, and not just for the small piece on market failure. I just read the whole thing and it does manage to sum up many of the complex social, ethical, moral, financial and economic issues about health economics and delivery in layman's terms (suitable for the audience of teenage school kids at which it is aimed). And it is fairly neutral and unbiased in it presentation of the issues (at least as I read it). I'm wondering if we can make better use of that reference. Perhaps in the United Kingdom section? Or should it get more prominance? It is written in a way that not assume too much prior knowledge of the UK system and does explain some things quite well- The Teacher/Pupil discussion questions at the end of each section are somewhat geared to its UK audience. --Tom (talk) 09:29, 28 March 2008 (UTC)

auto-archive

I am going to be bold and set up an auto-archiver - this page is now so long...--Gregalton (talk) 07:53, 19 February 2008 (UTC)

Gregalton, may I suggest that we slow down the auto-archiver at this point? I think once every 60 to 90 days would be fast enough. Thanks for taking this on! --Sfmammamia (talk) 02:02, 29 February 2008 (UTC)

Will do. Note that I set it so frequent only because the page is so active - right now it is at 190k, 250k may be a point (I understand) where some browsers have issues. If you agree, I'll set it to 50days and see how it works.--Gregalton (talk) 06:06, 29 February 2008 (UTC)

I'm tweaking to 40days before archiving - page is getting long again due to activity. Messages here if there are complaints about this.--Gregalton (talk) 07:16, 4 March 2008 (UTC)

I'm tweaking again to 60days - not now as long as it had been getting. We shall see.--Gregalton (talk) 07:46, 12 April 2008 (UTC)

CLAIMS versus FACTS

I am worried that the support and criticism section is now mentioning claims and not staying focussed on facts. Anyone can claim anything and it may or may not be substantiated by incontravertible data. I think we should stay focussed on factual data. If a claim is made, the foundation for that claim should be examined. For example, the section says that proponents claim government involvement will increase quality and that opponents says it will reduce quality. What is the reader to make of all this? If are going to allow such claims and counter claims we must at least to try to understand the evidence for such claims and counterclaim.--Tom (talk) 00:20, 29 March 2008 (UTC)

WP:V and WP:ASF allows sourced facts about opinions. Also sometimes claims have factual basis, sometimes claims have a more theoretical justifications. Details about such claims (including factual and theoretical justifications) should be added in separate sections below (see the Costs section for an example). --Doopdoop (talk) 00:31, 29 March 2008 (UTC)

I think if an opinion is based on some facts or a well founded theory then that is OK. If an opinion is based on prejudice and not substantiated by factual data then it really has no place in WP unless it is very widely held. The article you added by Sherry A. Glied is full of assumptions that she does not even try to substantiate. Its based on several premises which may or may not be true. I therefore regard even that article as suspect as a source. --Tom (talk) 08:35, 2 April 2008 (UTC)

IMHO Sherry A. Glied paper is a good example of research that is based on facts and appropriate statistical techniques. --Doopdoop (talk) 20:43, 2 April 2008 (UTC)

I'd have liked to give you some examples but the paper has now become pay-per-view and I'll not waste my money paying to download it. . . . but an example was that it just assumed that free market maximised efficiency in the allocation of resources. The assumption was implicit throughout. But as we have seen in many examples in this and many other articles, this is an assumption that is not always true. From another perspective it also values people (or rather the wealth or insurance they have or may not have access to) as commodities. In practice, a low income mother with 4 children is likely to be every bit as valuable to her children and husband and perhaps to the rest of society as a similar mother with a higher income is to her loved ones. A free market health system does not recognize this very important value. --Tom (talk) 02:06, 3 April 2008 (UTC)

I really don't want to get into a wrestling match over this one, but I would point out that the vast majority of economic research is of necessity based on at least some theoretical and methodological assumptions. Those assumptions can, of course, be be challenged and perhaps even refuted. But Dr. Glied is hardly the first economist to publish research based on a particular set of economic assumptions. You might want to look at her CV. She's a well known, well-qualified economist. This particular work may be flawed - if so, let's find another source that explains why and how. But Dr. Glied's too serious an academic for us to reject her work out of hand. EastTN (talk) 14:39, 3 April 2008 (UTC)

I agree - this is too important a paper to throw into doubt based on criticism (but I haven't read it yet). That said, Tom, you're mixing up two different points (both standard in economics): 1) when there are significant market failures and externalities, maximum efficiency may not be achieved from simple free market (and of course, full free market in health care is probably only in failed states anyway); 2) efficiency does not tell you much about distributional equity (however one might wish to call it). The latter is a choice of the political system. (And there's a complex meta-argument about whether some degree of distributional equity has positive externalities on a societal level). (Okay, there's about thirty levels of complex meta-arguments)--Gregalton (talk) 15:10, 3 April 2008 (UTC)

Please note that Dr. Glied specifically analyzed various funding schemes in terms of distributional equity and has found that they have only limited impact - i.e. the subject of the paper is your second question. The first question (efficiency) was also analyzed in the same paper, and the paper found "Using data across the OECD, I find that almost all financing choices are compatible with efficiency in the delivery of health care". --Doopdoop (talk) 21:30, 3 April 2008 (UTC)

This is only partly on-topic: I am skimming the paper quickly, but I can find no reference to socialized medicine at all in Glied's paper.--Gregalton (talk) 14:09, 9 April 2008 (UTC)

I urge anyone interested to read the paper. It has been mostly misrepresented in the discussion above and in most of the press reporting on her article that I have seen - if anything she is advocating for MORE progressivity in health care provision, and she is certainly not advocating "free market" provision of health care - rather a mix of financing. The widely-reported conclusion about financing having not much effect on cost has neglected the conclusion that other aspects of market organisation can and do affect efficiency. "In terms of public financing, the results suggest that forms of revenue collection that tax both older adults and young people are more equitable, over the lifecycle, than those that tax younger people and cover older people. The greatest redistributive benefits of public health financing occur among middle-aged people who become seriously ill or disabled. Differential mortality and relatively equal health status among survivors make public financing of benefits to the elderly less redistributive. In terms of the mix of public and private financing, the potential for public health insurance to crowd out other forms of redistributive benefits, without generating significant redistribution themselves, suggests that a mixed financing system may be the optimal way to balance efficiency and equity in health care."

To sum up, the elderly are taxed less but receive much care (especially in the US), whereas it would be more progressive to provide more health insurance to the middle aged (young people need less health care, old people - due to survivor bias according to wealth - tend to be wealthier, and hence burden of lack of health insurance falls on the poor middle-aged). The widely-reported conclusion that Canada's health care system is "not very progressive" is a gross simplification - it is less progressive than it should be / could be, partly because it provides fairly high-end care to the elderly with little taxation, and the elderly represent those that were wealthy enough to live longer. (This ignores the question of the political system, which - since Medicare for the elderly in the US is strongly associated with Social Security - played a key role in how the system was structured. As Krugman and others have pointed out, the Medicare system for the elderly was a political trade-off - provide universality for some of the population to keep political support. Likewise universality in Canada and elsewhere.)

The conclusion on financing leaves out the part that "the efficiency of operation of the health care system itself appears to depend much more on how providers are paid and how the delivery of care is organized than on the method used to raise the funds." This does not necessarily contradict any part of "socialized medicine" or government involvement, either directly or through regulation. Her point is that the "technical efficiency depends on the systems used to pay providers." She also has a number of caveats to this point about financing: "There are many reasons that this happy outcome may not occur in the health care system and the market may bid prices up too high. Provider monopoly power or other related payment inefficiencies, however, do not affect the choice of financing system. Payment rates may also, in theory, be established independent of the form of financing, although this may be practically difficult to achieve. For example, by using regulation, systems with decentralized revenue collection can achieve the same monopsony payment rates that centralized payment systems can." In other words, government regulation may still be needed to achieve efficiency due to market failures.

She fairly succinctly and completely throws into question how private insurance may work in practice (even if theoretically possible to do efficiently): "In practice, the existence of employer-sponsored insurance, the preferential tax treatment of premiums, and the existence of substantial risk selection between plans may make it more difficult for private insurance systems to achieve efficiency in the delivery of services."

Finally, on costs, she also obliquely refers to the progressivity of "innovation": "These patterns suggest that focusing the marginal public health care dollar on skilled nursing days, access to general practitioners, and care associated with conditions that manifest in mid-life will have a more progressive effect than focusing additional tax dollars on elective surgical procedures or specialist care." In other words, using tax dollars for high-cost, "innovative" procedures that benefit the wealthy may be net regressive.

She is also fairly clear throughout that the progressivity of the financing system is part and parcel of the progressivity/equity of the tax system, which is worthy of further consideration.--Gregalton (talk) 15:32, 9 April 2008 (UTC)

Innovation section

Forgive me for asking, but what does the new innovation section tell us about socialized medicine? --Tom (talk) 08:26, 2 April 2008 (UTC)

The NY Times article is also rather inaccurate. MRI is attributed as a US innovation, but the application of NMR to MRI was as much a British discovery as an American one. I know this because my own teacher of physics in the 1970's was himself a student under a professor at Nottingham university (who I guess must have been Peter Mansfield) who washugely influential in this work and I can vivdly recall my teacher's excitement of himself being close to what seemed to be such a huge step forward. Mansfield shared the Nobel prize with an American for this work. The earlier Nobel prize for NMR discoveries were shared by a European and an American. Even more startling is that the CT scanner is also credited as an American innovation, but the first CT scanner was in fact developed in the UK by a British company! Come on!!! --Tom (talk) 08:56, 2 April 2008 (UTC)

It gets worse!! The article states that "in the last 10 years...12 Nobel Prizes in medicine have gone to American-born scientists working in the United States, 3 have gone to foreign-born scientists working in the United States, and just 7 have gone to researchers outside the country". Looking at Nobel Prize in Physiology or Medicine in the last 10 years shown (1998-2007) I see that the United States (Population 304 million) has 16 accreditations and the United Kingdom (population of 62 million) has 7 accreditations. In other words, even a cursory glance at some real facts reveals that a country (which happens to have socialized medicine) achieves about double the rate of Nobel prizes than one which mostly does not. Now I would not have the audacity to argue that the form of medicine delivery in the UK has any connection to this amazing achievement, but trying to use the socialized medicine article to argue that socialized medicine fails to deliver innovation and Nobel prizes is pulling my nose way beyond that which I can bear. I think this entire section is without merit.--Tom (talk) 09:26, 2 April 2008 (UTC)

The Innovation section adds nothing to this article, other than a reference to one opinion piece by one American academic. Notable perhaps, as a supporter of the current American system, but hardly meriting a section of its own in this article. The cited article doesn't make any mention "socialized medicine", yet is being used an argument against it by a Wikipedia editor, not the article itself. It is also very hard to present a balanced viewpoint of the argument, unless someone else can produce a notable cite for the other side. As Tom notes above, the argument has significant flaws, but unfortunately his figures would be considered original synthesis. So I'd say unless the whole argument can produce at least three more cites of greater relevance, at least one opposing, it should be removed. Or at the very least abridged and placed deep in the Criticisms section where it belongs. --Escape Orbit ^(Talk) 10:33, 2 April 2008 (UTC)

Krugman and Wells have already dealt with this. ""new medical technology" is the major factor in rising spending: we spend more on medicine because there's more that medicine can do. Third, in medical care, "technological advances have generally raised costs rather than lowered them": although new technology surely produces cost savings in medicine, as elsewhere, the additional spending that takes place as a result of the expansion of medical possibilities outweighs those savings." There's much more detail, but in simplistic terms, innovation doesn't lead to that many lives saved if people can't access it: "one study found that among Americans diagnosed with colorectal cancer, those without insurance were 70 percent more likely than those with insurance to die over the next three years." (Not that treatment of colorectal cancer is so very innovative). In terms of effectiveness in saving lives, hand-washing by doctors and nurses is one of the most cost-effective measures; unfortunately, the soap lobby is insufficiently incentivized. Another interesting study recently was that use of "innovative" (expensive) drugs in Canada tends to be far lower than in the US - not because of cost (drugs in use were studied), but because advertising severely restricted. (Note that as I recall, the health outcomes were no worse).

But as above, the Cowen quote does not appear to mention socialized medicine.--Gregalton (talk) 11:09, 2 April 2008 (UTC)

Mark Thoma (Dept of Econ, U. of Oregon) also has some good analysis: [5]. The best point I read on Cowen's piece being "changing the yardsticks": apparently the goal is no longer to improve health but to win research prizes. Perhaps an obvious choice for a university department, not so obvious for society as a whole. (No data provided on actual results of innovation, except for the same data showing ... high spending for poor results).--Gregalton (talk) 11:19, 2 April 2008 (UTC)

Thanks for the Krugman and Wells article. Interesting stuff. It mentions Taiwan and a move to Single payer there. Not something for this article but perhaps something that should be in Single-payer health care. I don't have the time to add it but perhaps User:Doopdoop does ;) (TFIC).

Based on the comments here, and a re-look at the source, I have deleted the section. As noted, there is little to no connection to socialized medicine made in the source, and its comparative claims appear to be inaccurate and unsubstantiated. The section was built, essentially, on one economist's opinion. --Sfmammamia (talk) 16:46, 2 April 2008 (UTC)

One other comment -- this paragraph has also been added to Health care reform in the United States, where it seems more relevant to me. --Sfmammamia (talk) 16:48, 2 April 2008 (UTC)

As Escape Orbit requested, I have added three more cites. --Doopdoop (talk) 20:56, 7 April 2008 (UTC)

As far as I can tell, none of these citations meet any of the points made by EscapeOrbit: they do not mention socialized medicine, and appear to be opinion pieces. Unless there's a compelling reason to keep this in this article (as opposed to some other article), I'll delete later.

Note that the sentence "The Cato Institute argues that socialized medicine would stifle lifesaving research and innovation" is blatant misrepresentation of the article cited (the Cato institute may argue this elsewhere, but this article does not). I'm deleting this immediately because of this.

As a final comment on this section, I'd note that the Cato article makes much of the use of "differing datasets" in the WHO report - while this same standard applied to the Cowen article would result in simple rejection as absurd simplification (NHI spending on research vs "All EU core countries" spending - are these even remotely comparable?).--Gregalton (talk) 06:25, 8 April 2008 (UTC)

I see that the innovation section has been reinstated. I fail to understand why. It does not once mention Socialized Medicine and does not even try to explain why its content is relevent to this article. A connection has not been established. Socialized medicine is about the delivery and financing of health care. Medical innovation is only tangentially connected to this. Also, the comparisons in the article and references are to "Europe" verses the "USA" which does not really map to "socialized medicine" versus "non socialized medicine" (if such a pure comparison could even be made because no country is purely one or the other). One might well be tempted to conclude that the reason so much money is invested in the US is merely that is where so much money is being spent (and where, it seems, there are few value-for money type controls in the US as for example is done in the UK by the National Institute for Clinical Excellence"). But that is pure speculation on my part.--Tom (talk) 09:06, 8 April 2008 (UTC)

As socialized medicine has many synonyms, it is sometimes refered to by other names in the sources, for example CATO piece that Gregalton deleted contrasts free-market medicine with "WHO's idea of government-provided universal health care", so the sentence that Gregalton deleted is a fair summary of what was written in the source, and I would like to restore it. Tom argues that medical innovation is only tangentially connected to socialized medicine, however Cowen opposes reforms that promote socialized medicine because they would stifle innovation. --Doopdoop (talk) 18:09, 8 April 2008 (UTC)

This (i.e. "socialized medicine has many synonyms") sounds like your own interpretation. Cowen merely contrasts Europe and the US and makes a broad reference to a European model without actually defining it (-hardly surprising because there is a wide variety of models across Europe, and if he had done so he would trip at the first hurdle). You seem to be doing an awful lot of interpolation to say that "Cowen opposes reforms that promote socialized medicine". That rather makes this your interpretation and therefore WP:OR. Cowen does not addresses socialized medicine at all. He is just argues that the US spends a lot more on medical research than Europe because the US spends more on health care, that there are different attitudes in the US than in Europe towards failure, and that European researchers work in the US because the salaries are higher there. Cutting that expenditure could hit research is the implication, but there is nothing about socialized medicine.

And as we said earlier, he seems to have got his facts wrong about the U.S. system leading to preminance in the 6 most important applied technologies of the last 25 years as well the reading and interpretation of data regarding pure research as measured by Nobel prizes. Britain seems relatively to have done as much even though it has a socialized system. It would be rather difficult to check the absolute numbers regarding expenditure and he seems to have just one source for that data. But I am not inclined to do any checking.

For this reason, and the reason that other editors seemed to agree with my earlier comments about relevance and factual correctness, I am going to delete this again.--Tom (talk) 06:25, 9 April 2008 (UTC)

The Kling summary also seems to gloss over (at least part of) the argument Kling makes in his book (not sure whether the Kling quote was properly used / linked to the book in one of the intermediate versions): "attributing our present cost crisis mainly to the practice of what he calls "premium medicine," which overuses expensive forms of technology that is of marginal or no proven benefit." See New England Journal of Medicine Review. Compare this to the argument that Kling makes as summarized in the article: "Arnold Kling says that America's role in medical innovation is crucial not just for Americans, but for the entire world". I can't compare the article content since not provided.

But at any rate, that whole section is still out of place in socialized medicine article and glad to see it gone (at least until EscapeOrbit's points can be met).--Gregalton (talk) 12:09, 9 April 2008 (UTC)

Please read the first paragraph of Cowen's article. It is refers to "advocates of national health insurance", and national health insurance schemes are covered by socialized medicine article, so innovation section should be restored. --Doopdoop (talk) 22:31, 9 April 2008 (UTC)

That rather depends on what you mean by National Health Insurance and also by Socialized Medicine. As we have seen, the meanings of these words can be very flexible. I don't think you can sit in the author's head and understand precisely what he or she did mean by that.--Tom (talk) 09:03, 12 April 2008 (UTC)

George Mason University - why so many sources connected to this one university??

How is it that George Mason University springs up eternal in matters related to socialized medicine? Several articles quoted in the WP article are from people connected to or working at this university. Even David Gratzer, writer and critic of socialized medicine and especially Canada's health care system (and infamous for being the source of Rudy Giulliani's doubtful statistics on prostate care under socialized medicine) was awarded a prize by this university. The predominance of sources from this one university seems decidely odd. Is there something going on here? Is this also WP:Undue?--Tom (talk) 08:50, 14 April 2008 (UTC)

I have read quite many GMU sources and accordingly I tend to use them, however when Kborer returns he will be able to supply additional references from Mises Institute and other sources, so there is no WP:Undue problem. --Doopdoop (talk) 19:19, 14 April 2008 (UTC)

Ha Ha Ha Ha. But this has nothing to do with you poviding these references... the connection is there from all angles. Why does this particular institution, supposedly an academic institute, manage to generate so many connections to this topic? They never seem to be neutrally written and are always antagonistic towards government and health care. Most universities take a scrupulously academic and detached view of topics they examine, but this one sems different. There is always a story with a moral based on a certain econo-political philosophy.--Tom (talk) 22:21, 14 April 2008 (UTC)

Have you heard of Chicago school from the so called University of Chicago ? --Doopdoop (talk) 17:24, 15 April 2008 (UTC)

George Mason is a legitimate academic institution. I'm not familiar with their faculty, but it wouldn't be surprising if GMU does have a number of faculty members who share similar views - that's pretty common in any academic organization. It's also not particularly sinister - people work together, learn from each other, and attract others with similar academic points of view. I don't have any special interest in defending George Mason, but "ad alma mater" attacks aren't any more useful than ad hominem attacks - ultimately, they are just distractions that can all too easily breed ill will. The health policy literature is full of work from academics all over the world - if we want a different point of view, let's just bring in more sources. EastTN (talk) 19:35, 15 April 2008 (UTC)

George Mason University, as a whole, may be a legitimate academic institution, but its economics dept is completely suspect. The Mercatus Center, a RW and corporate-sponsored think tank, is run by members of the GMU economics faculty. It's from this paid-for think that Doopdoop gets much of his "material". J.R. Hercules (talk) 00:20, 24 April 2008 (UTC)

Interesting argument. Are you willing to describe as "suspect" any any college or university department whose faculty are associated with the the Roosevelt Institution, the Center for Progressive Reform, the Center for American Progress, the Institute for Policy Studies or the Center for Economic and Policy Research? We're very close to saying "no, I'm not gonna listen to anything they say because they're just a pack of conservatives/leftists/right-wing nuts/wild-eyed radicals/(insert your favorite red-meat demons) who're in bed with corporate money/superannuated 60's radicals/the religious right/Godless anti-American atheists/(insert another, broader set of your personal demons)." It's fine to disagree with DoopDoop (or anyone else, for that matter). It's fine to think that he's throwing anything he can in to try and support his understanding of the world. But we're going too far when we start making blanket judgments about entire academic departments at large, well recognized public universities. (And if we go down that road, understand that others are going to make exactly the same kind of judgments about our favorite institutions based on their own world views - and we aren't always going to like the result.) EastTN (talk) 15:15, 24 April 2008 (UTC)

I mostly agree with EastTN. I actually read Cowen's blog from time to time - he's interesting on micro-economics/behaviour etc. I think looking at that blog would give some idea of what is going on: GWU has a fair number of "libertarian"-identified economics profs who are pretty good at getting info out on the internet and in the news. Period. I don't think there's that much more there: people looking on the internet for these points of view will likely find GWU-related links.

Apart from Kling (who I don't think is formally associated with the school), I don't think their analysis of healthcare adds much. And Kling wrote an interesting book noting costs are high because of fancy, mostly useless technology (I'm massively simplifying), followed by a bunch of anecdotes in various opinion pieces noting this person, that person and then their dogs were saved by technology blah blah blah. What about the people who weren't treated at lower cost? That's not analysis.

At any rate, I don't think this is very fruitful - counter opinion pieces with better sources. Cowen makes broad claims (written well), others do much more in-depth research (which then gets mis-quoted by Cowen and others in the press and even WP).--Gregalton (talk) 15:27, 24 April 2008 (UTC)

Oh, and thanks for the info on Mercator or whatever it's called.--Gregalton (talk) 15:32, 24 April 2008 (UTC)

Another connection to GMU and anti-socialized medicine articles. I Googled the term today and up popped this article http://www.townhall.com/Columnists/WalterEWilliams/2007/02/14/do_we_want_socialized_medicine by one Walter E. Williams who serves on the faculty of GMU as John M. Olin Distinguished Professor of Economics. There is definitely something fishy about the economics department of this university. The quoting of lurid newspaper articles (some more than 5 years old!) as support for a general argument against socialized medicine does not really smack of academic rigour IMHO.--Tom (talk) 15:39, 6 May 2008 (UTC)

proposed merge to Universal health care

I have proposed that this article be merged to Universal health care. To avoid fragmenting discussion, please leave comments at Talk:Universal health care#Proposed merge. Thanks. ⟳ausa کui ^× 02:36, 6 May 2008 (UTC)

NY Times reference on "slow" medical care (for aged)

This could equally go in any number of articles here to support the assertion (like Kling's point) that more money spent, procedures, expensive innovation and the like may do very little indeed to improve the quality of care (or even life expectancy): For the Elderly, Being Heard About Life's End. I'm sure many who have experienced the emergency care procedures applied to the elderly can see how the "default response" of many medical systems is often to provide care where it may not be needed or helpful (I have, and can support).--Gregalton (talk) 15:42, 6 May 2008 (UTC)

increased bureaucracy ? From where???

The article currently states that "Some opponents claim that increased bureaucracy costs more money" implying I presume that government delivered health care is more bureaucratic.

What increased bureacracy is there? Insurance companies do not add value to the health management process. They are a source of costs not benefits. They are the source of a lot of bureacracy in insurance based systems. England and Finland do not have this layer of bureaucracy (except in their small private health sectors). The public sector system has none of this bureaucracy and I do not see that it is replaced with another layer elsewhere. The doctor makes the final decision, not the doctor AND an insurance clerk. There are no claims forms filled out in the NHS. There ís no client billing. No insurance billing. No concept of the individual patient being a cost centre. All in all there would seem to me to be a LOT LESS bureacracy in socialized systems. If we repeat the claims of certain people, they should be identified and their claims should at least be backed by some credible research so that it can be verified. Otherwise this is just a lot of hot air.--Tom (talk) 16:11, 17 April 2008 (UTC)

One source is Milton Friedman's Free to Choose: "Dr. Gammon was led by his survey to promulgate what he calls a theory of bureaucratic displacement: the more bureaucratic an organization, the greater the extent to which useless work tends to displace useful work -- an interesting extension of one of Parkinson's laws. He illustrates the theory with hospital service in Britain from 1965-1973. In that eight year period hospital staffs increased in number by 28%, administrative and clerical help by 51%. But output, as measured by the number of hospital beds occupied daily, actually went down by 11%. And not, as Dr. Gammon hastened to point out , because of any lack of patients to occupy the beds. At all times there was a waiting list of patients to occupy the bed. At all times there was a waiting list for hospital beds of around 600,000 people. Many must wait for years to have an operation that the health service regards as optional or postponable." -- P.144 --Doopdoop (talk) 20:55, 17 April 2008 (UTC)

Uwe Reinhardt has criticised Milton Friedman's point here as being ridiculously simplistic: (paraphrasing) "does Milton Friedman believe that the output of a health care system is measured by beds?" "Health" is clearly not the number of beds (occupied or not). In any system, there will be empty beds, even when there is a waiting list, because they are in the wrong place, the wrong specialties, simple "friction" between one patient coming in and another out, etc. The lack of comparison to before/after (or any other system) makes this study no better than an anecdote, and a very dated one at that.

Given that one of the biggest cost/health improvements in the last thirty-forty or so years has been the recognition that patients *not* in hospital often do as well or better (at far lower cost) than those in hospital, so Friedman's comments are hopelessly dated.

Compare this to Krugman, Wells and others who have documented how much the administrative costs of the U.S. private insurance systems are - precisely because the insurers spend considerable amounts *not* treating people, *declining* treatment, and determining in advance who should have insurance or not. The administrative costs of the 'socialised/universal' parts of the U.S. medical system are by far the lowest compared to every other part of the U.S. healthcare system.--Gregalton (talk) 06:03, 18 April 2008 (UTC)

Well of course, the comparison that health output can be measured by the sheer number of hospital beds is of course ridiculous. But there is almost certainly a simple explanation for the observation that hospital beds declined in number after health was effectively nationalized. In the immediate post war years in the UK there was extremely poor housing (both due to pre-war poverty as well as the aftermath of German bombing) and tuberculosis (TB) was a huge problem. I recall that there were large numbers of sanatoria holding people in isolation for TB and other illnesses. Also there were large numbers of mental institutions. In the later post war years, following improvements in medicine, social housing and the treatment of mental illness, many of these institutions began to close. It is hardly surprising therefore that there was a drop in hospital beds over this period, but this is equated with health improvements not a drop in health care productivity! Milton Freidman was surely losing his mind in his latter years! --Tom (talk) 17:30, 18 April 2008 (UTC)

This is what Patricia M. Danzon actually says about this....

"In addition to forgone benefits, government health care systems have hidden costs. Any insurance system, public or private, must raise revenues, pay providers, control moral hazard, and bear some nondiversifiable risk. In a private insurance market such as in the United States, the costs of performing these functions can be measured by insurance overhead costs of premium collection, claims administration, and return on capital. Public monopoly insurers must also perform these functions, but their costs tend to be hidden and do not appear in health expenditure accounts. Tax financing entails deadweight costs that have been estimated at over seventeen cents per dollar raised—far higher than the 1 percent of premiums required by private insurers to collect premiums."

And where does she get this information? Seemingly from a paper by one Patricia M. Danzon comparing health care administration costs in Canada and the US. I have not read that paper in detail, but the comparison is about between government insurance in Canada and pluralistic private insurance in the U.S. It is a comparison between one country's Single-payer health insurance system and another country's pluralistic private insurance system. It is not about government administered health care (socialized medicine). I would also add, that a comparison between two specific countries' costs does not allow us to extend the analysis to all countries with one system and all countries with another, and certainly not about costs in countries such as England or Finland. Administration and managment costs in the NHS have historically been about 5-6 per cent of the total costs (see http://www.publications.parliament.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60123w02.htm). This compares to the Danzig estimate of 7.6 per cent in the U.S. health insurance industry alone!. On top of this must come management and administration costs in U.S. hospitals and other medical practices. Which seems to me to indicate that the U.S. must have a much higher precentage of bureaucratic costs than does the UK.--Tom (talk) 18:18, 18 April 2008 (UTC)

I've modified the wording of the argument to: "Some opponents argue that government bureaucracy is less efficient than private bureaucracy" and added a fact tag. I believe this wording more closely reflects the anti-government argument, but it still needs to be supported by a cite. Mind you, I don't think the argument is all that supportable by actual comparative data, but this is, in fact, the claim they make. --Sfmammamia (talk) 18:39, 18 April 2008 (UTC)

Milton Friedman's argument (excerpt is above) is reflected in the previous version. --Doopdoop (talk) 21:10, 18 April 2008 (UTC)

Ms. Danzon leaves out the information asymmetry costs that must be dealt with by an insurance company (unless there is a randomization or universality feature): see Krugman & Wells, [6].

The quote from Friedman above does not seem to clearly attribute increased bureaucracy as a necessary feature of government-run systems. That appears to be an assumption that (from the quote above) does not necessarily follow.--Gregalton (talk) 10:11, 19 April 2008 (UTC)

A more recent source of date than Friedman on administrative costs: New England Journal of Medicine study. This finds that administrative costs in U.S. are 31% of total healthcare spending, 17% in Canada. So much for bureaucracy.--Gregalton (talk) 12:33, 19 April 2008 (UTC)

I personally believe (based on my reading of NEJM, BMJ, Paul Krugman, etc.) that government-run or managed systems like Canada and the UK, and the government-run sector of the U.S. health care system, have lower administrative costs than the private sector of the U.S. health care system. (Although I'm open to new evidence.)

Nonetheless, I think that a WP entry should give the best arguments for the lower administrative costs of government, and also for the lower administrative costs of the private sector. In WP style, we can't just decide which side is right and delete the wrong side. I'd certainly like to see the evidence for and against Danzon's argument.

Many people argue, for example, that if George W. Bush were running the government health care system, the private market would be more efficient. Nbauman (talk) 23:08, 19 April 2008 (UTC)

I agree that (if we are going to continue having a section on 'socialized medicine' where none of the sources refer to socialized medicine at all) the arguments should be presented. They should be presented with some balance, however, and with at least some recognition of how much they correspond to reality in numbers.

At the moment, it does not read that way. There's the usual blah-blah-blah about govt bureaucracy, with all the actual facts relegated to a point lower down. Another thing that is incredibly unbalanced in all these sources is the bland and frankly idiotic assumption that bureacracy is purely a government issue, as opposed to large organisations (including private). It is widely recognised in economics/industrial organisation theory that there are trade-offs between economies of scale, "market-like" and other incentives, and organisational complexity and costs, and that these issues apply to the private sector as well, but these complex issues get reduced by the ideologues to "govt = bureaucracy."

This needs to be seriously re-edited to get some balance: if the vast majority of academic literature says administrative costs are lower in govt-run systems, the article should reflect that with some prominence.--Gregalton (talk) 10:36, 20 April 2008 (UTC)

Anyway the total cost levels are more important, and specific types of costs should be discussed in the article only after discussing total healthcare costs. I haven't seen any good studies about healthcare administrative costs, there is just a propaganda - one side shouts "Medicare has just 2% administrative costs", another side replies "these costs are just shifted from purely admninistrative workers to doctors and good administration has also benefits, not only costs. And monopolistic government systems suffer from Parkinson's law. Toyota has higher administrative costs than Yugo etc. etc. etc.". Have you seen any serious scientific studies about healthcare administrative costs (book review by Krugman doesn't count)?

And I just don't think that many sources have the bland and frankly idiotic assumption that bureacracy is purely a government issue, they just have an assumption that bureaucracy in private organizations is a little bit less idiotic and a little bit more efficient than the government bureaucracy. --Doopdoop (talk) 20:47, 24 April 2008 (UTC)

The claims about specific types of costs (bureaucracy) were put front and centre by you.

And I don't agree with your characterisation of propaganda re Medicare costs: Krugman cites "Health Care", the other cite is from NEJM. Krugman and Wells state they've reviewed the available evidence, which is quite unanimous.

Compare this to the Cato opinion piece "Five Myths" ('a quarterly message on liberty') which is difficult to distinguish from propaganda - not a single citation on this claim nor any throughout, as well as some blatantly absurd points. Comparing waiting times for the elderly in Canada and the US - precisely the sub-group with full government healthcare - and claiming this debunks government provided medicine is pretty rich.

As for bureaucracy of govt-provided medicine, I assume that the example he leads with (the hospital providing staff to sign people up) is one of the costs "pushed" to doctors - a cost that would simply not exist under universal, govt-provided health care of almost any type; at any rate, it's just a claim, not a reliable study or source. (Anecdotally, some doctors of my acquaintance in the US far prefer Medicare patients for admin reasons - Medicare pays, promptly, whereas claims from private insurance get dragged out, returned, delayed, etc - these are also costs "pushed" to doctors).

I will check, but I believe his claim about Canadian hospitals "loving" US patients (and queue-jumping for cash, etc) is simply false. And of course, no US figures on those "waiting" for procedures.--Gregalton (talk) 06:26, 25 April 2008 (UTC)

The original quote from Friedman about wateful bureaucracy lies in the bureaucracy created by third party approvals in systems where expenditures on health need to be approved, whether by an insurance company or the government. The context is nothing at all to do with socialized medicine. In pure forms of socialized medicine such as in the UK or Finland there are no third party approvals, so this level of bureaucracy just cannot apply in those circumstances. Friedman does go on to quote someone called Max Gammon who is particularly critical of what he sees as a creeping structural bureacracy in the NHS with nurses becoming more focussed on administration rather than patient care. Now, I had never heard of Max Gammon before and a search using his name on the BBC website produced no result whatsoever. The man may have these views but clearly he is not a significant figure in UK health care. The arguments are not unfamiliar but they are not widely held. It is a minority view and therefore should not be treated as if it represented some wider truth. It simply doesn't.

There is plenty of evidence that administration costs in government run health care systems are lower as Nbauman has described. And as Gregalton describes, there are assumption leaps in the text that are not justifiable.

The edit as it currently stands implies that government health care is more bureaucratic and more expensive which is simply untrue and not supported by factual data gleaned from the references provided. I am therefore deleting the text that says "opponents argue that increased bureaucracy costs more money".--Tom (talk) 02:32, 26 May 2008 (UTC)

Edit does not imply government healthcare is more bureaucratic. It just implies that opponents argue that it is. --Doopdoop (talk) 21:12, 27 May 2008 (UTC)

Doopdoop has reverted this disputed phrase 10 times over the last seven weeks, despite objections here by several different editors and reverts by more than a single editor. I have asked him on his talk page to work more constructively toward consensus here. Over this same period, I have proposed a couple different approaches to making this point in a more accurate, neutral way. I restate them here:

Some opponents argue that the government bureaucracy created in socialized systems is less efficient than private bureaucracy, thereby increasing costs...

Some opponents argue that the government bureaucracy created in socialized systems is less efficient than private providers in a free market, thereby increasing costs...

I continue to oppose DoopDoop's version of this phrase as an inaccurate oversimplification of the argument in the source. I request that we stop the revert war on this phrase and work constructively here toward consensus language. If you agree with me, may I request that you make suggestions here, and add your thoughts to DoopDoop's talk page regarding his editing behavior? --Sfmammamia (talk) 00:19, 5 June 2008 (UTC)

I have inserted your second version as a basis for minor improvements in future. --Doopdoop (talk) 20:07, 5 June 2008 (UTC)

Support and Criticisms section revamp

This section was at one time split simply between arguments for and against with references to data supporting or contradicting these claims. New sctions have now been added at the front of this section which now make the whole thing look a mess. I think it would be helpful to get back to laying out the arguments for and against in a more concise and logical way. I will give some thought as to how this could be done, but if anyone else has any ideas please join in. The important thing I think is to take the arguments that are used For and against and look to see how they are justified. That may mean getting away from just listing "arguments for" and "argumemts against" as different people will see them differently. For example "higher taxes" (a perceived negative) could also mean "no health insurance costs for business" (a perceived positive). It may mean splitting up the section as ISSUES and subdividing it into areas such as COST, CHOICE, RATIONING, EFFICIENCY, OUTCOMES, INNOVATION etc.. I personally would live to expose the widely distributed false statements made by some (e.g. that socialized medicine in France killed thousands of elderly by allowing doctors to be on vacation during a heatwave, and that British hospitals are so short of cash that they turn over the bedsheets between patients rather than washing them). Such arguments are widely held in the US and yet bear no relationship to the truth.--Tom (talk) 10:40, 4 May 2008 (UTC)

The point's well taken that whether something is an "advantage," "feature," "characteristic," or "disadvantage" can depend on the point of view of the observer. It could also be very useful to discuss the fundamental trade-offs that face anyone seriously interested in reforming a health care system (e.g., cost versus quality versus access, who pays, etc.), if we could do that without original research or synthesis. If practical, it could provide a very nice framework for most of the key arguments (e.g., "opponents in the US stress the importance of lower taxes and individual autonomy over universal access and uniform benefits"). I'm less excited by the idea of trying to decide which arguments are "justified" or not - many countries have decided that no direct health insurance costs for businesses justifies higher taxes. As of yet, the US hasn't (or, more properly, hasn't to the same extent - there is a payroll tax that's used to support Medicare, and general revenues support Medicaid). These are political decisions, not technical ones. We can, and should, address particular facts that are used to support the various arguments pro and con, but the kind of factoids you mentioned aren't really where the debate lies. Other more important questions, such as which kind of financing system results in the most innovation, are virtually impossible to answer empirically (I'm old enough to remember when there was an active debate over whether the old Soviet system was more economically efficient than the capitalist systems in Europe and the US - that debate wasn't settled until long after the Soviet Union was in obvious collapse, when it was too late to matter to anyone other than Fidel Castro). EastTN (talk) 15:32, 5 May 2008 (UTC)

Framing the discussion in terms of the debate in the United States could be misleading. This is not an article about the health care debate in the United States. Maybe those arguments you talk about are appropriate for a U.S. specific article, e.g. Health care in the United States or Health care reform (which seems to be about the U.S. in spite of the name). This article is about socialized medicine which has a long track record in many countries. It would be better to see how the structure of medicine delivery and finance in those countries affects outcomes/choice/quality/equity and so on. It should focus on the broad range of arguments used in those countries. Focusing in solely on the U.S. and espcially using mostly U.S. based sources would be unbalanced. Much of the information about socialized medicine in other countries that I have read which has been published in the U.S. in the context of the U.S. debate has very little relationship to reality and just seems reflect the bias of the writer or publisher. I'm still interested to hear the opinions of other editors before this revamp gets under way. I certainly don't think we should make changes before this has been fully discussed on these pages. I still need to find the time to layout my own suggestions--Tom (talk) 08:25, 6 May 2008 (UTC)

I have no desire to hijack the article and turn it into one on the US health care debate - that's what we created the Health care reform in the United States article for. But finding the right focus for this one seems tough to me. The article is, at least based on the title and lead at the top, ostensibly discussing the definition and usage of a term that's primarily used in the US. Granted, the focus of this article shouldn't be completely centered on the US, but just as there are better places to talk about US health care politics, there are other articles that may be better suited for discussing how various forms of "socialized medicine" work in other countries (e.g., Publicly-funded health care, Single-payer health care, National health insurance and Universal health care). Honestly, I think we'd be better off discussing what the nations you mention do in those articles, discussing the US debate in US-centric articles, and making this more of a political-science (or perhaps political rhetoric) article dealing with the way the term "socialized medicine" is used in political debate - but it doesn't look like that's going to happen. My thought was that to build on your suggestion of identifying key issues by identifying the trade-offs between them. I don't think the arguments pro and con are going to go away (both sides seem to anxious to make their case to just let it go), and I don't think we can simply declare that "con" arguments from the US are off limits. But, if we can identify the critical policy trade-offs involved, then we have a framework to discuss the arguments in a way that isn't US-centric. In retrospect, it was perhaps unfortunate that I chose a US argument as my illustration, but the value of a good conceptual framework is that it makes things easy to balance. "Opponents in the US stress the importance of lower taxes and individual autonomy over universal access and uniform benefits" can be balanced with "European and other proponents of a National Health Service type approach to universal coverage believe that considerations of social equity outweigh any loss of autonomy, and that the efficiency and public health benefits of universal coverage with a standardized benefit package more than justify the higher taxes required." Some things would likely be a wash - "both sides claim . . . studies have shown mixed results, with . . . " I honestly think that sort of approach would make it much easier for readers to think through the issues and to really understand where each side is coming from. EastTN (talk) 16:03, 6 May 2008 (UTC)

I proposed such a structure on this page back in March (see above), and while there were some supportive comments, it was also clear to me that even arriving at a topic list that would secure consensus was going to be more effort than I was willing to put into it. The back-and-forth that occurred on the innovation section alone was an example. I still support the general approach. --Sfmammamia (talk) 18:17, 6 May 2008 (UTC)

I just went back and looked at your prior suggestion - and the resulting discussion. Heck if I know how we develop a consensus. It would be nice, though, and I'd be willing to help with the editing if we could make it work. EastTN (talk) 18:36, 6 May 2008 (UTC)

You know, there is a whole academic literature on the question of how to evaluate the pros and cons of a health care system. Here's a recent book review from the New England Journal of Medicine:

NEJM, 20 Mar 2008, 358(12):1310, Book reviews: Just health: Meeting health needs fairly, by Norman Daniels. Reviewed by Samuel Y. Sessions. Theory of just health. "Fundamental question" of social justice for health: "What do we owe each other to promote and protect health in a population and to assist people when they are ill or disabled?" 3 focal questions: (1) Inequality is only fair if it results from talent and effort, not lack of opportunity, and health is required for fair opportunity. (2) Health inequalities are unjust if they result from "socially controllable factors." This includes education, income and wealth distribution, and workpalce organization. (3) Resources are limited. Since values differ, it is unlikely that agreement can be reached on allocation, so fair procedures should be used to decide.

One of the jobs that an academic advisor can do is to warn students when they're undertaking a research task that is so difficult as to be impossible. This could be one of those tasks. Maybe you can find somebody who has already done the job, and provided us with a framework in which to develop the debate. Or maybe the point-by-point comparison won't work. Maybe the best we can do is give some of the major arguments for "socialized medicine," and the main arguments against, in separate sections, section by section.

There are 2 obvious ways to organize it: (1) By topic or issues, such as cost, choice, outcomes, etc. (and deciding what those topics should be is a difficult job in itself) (2) By advocates, such as the Cato Institute (they're the ones who started the whole debate), the British advocates of socialized medicine of whom there are many in the British Medical Journal, etc. There may be another way to organize it. But you have to pick one organizing schema or another; you can't mix them all together. Nbauman (talk) 03:15, 7 May 2008 (UTC)

You're right, there are lots of ways to approach it - and the article is going to be a real mess until we pick one and go with it. The schemes I've found most helpful have been the ones that identify trade-offs (e.g., comprehensiveness of coverage versus cost). There are a couple of reasons for this. They don't, in and of themselves, presuppose that any one position is better than another. They tend to frame things as policy continua, rather than starkly binary, black/white, either/or choices, which leads to a more nuanced and realistic discussion - and by talking about continua you can cover a variety of approaches in a single discussion. They also seem to lead to discussions of underlying values (e.g., " . . . place more emphasis on . . . while see . . . as more important . . .").

We could, as you suggest, use one section to describe the case advocates present in support of "socialized medicine" and another to describe the case opponents present against it. It's tricky, though, because we'd have to decide whether we were presenting the "typical" case, an "exhaustive" case, or the "best" case for both sides - and we'd have to decide exactly what the cases were for and against. Right now the definition of "socialized medicine" seems pretty vague to me - it could encompass a variety of systems with some pretty important policy differences between them. That does seem to be the default way we're headed, though. If so, maybe we just need to get happy with it and make it work.

I don't think we want to organize it by advocate - there are too many potential entities on each side, and we'd likely end up with a lot of duplicative text. Does it really help to parse out the differences between Cato, Heritage, and AEI on the one side, and the British advocates versus the Canadian advocates versus the Kaiser Family Foundation on the other? Maybe it does, but if so, we probably need to rename and refocus the article.

Organizing by topics works for me, but I do think it's most useful if we don't just talk about cost in one section, what's covered in another, and who's covered in another, but highlight the connections between the various design issues. I really don't know what the best approach is, but I do believe there are real and important policy differences that are getting lost in the current wikipedia articles on health care and health care reform. It would be nice for the undergrad reading the articles to come away with an appreciation for why each side takes the position it does. EastTN (talk) 14:37, 7 May 2008 (UTC)

The main issue I think we will come up against is source material and balance. Most of the negative arguments against socialized medicine come from the US where certain interest groups seem hell bent on opposing its widespread adoption in that country, and others seem to be overcoming "the bogeyman" image of socialized medicine and have begun to argue for it. The arguments from the opponents would have more credence if those arguments were used in countries with socialized medicne and if there was popular pressure from within those countries calling for its abolition. The stark fact is that there is none. I am not aware of any significant group in the UK advocating the wholesale abandonment of tax funded health care that is free at the point of use. In fact over 90 percent of the UK population agreed with the statement that healthcare should be funded by taxation and free at the point of use. I know of no campaign in Finland either where I live now. Finns are one of the most satisfied national groups in Europe when it come to rating their hospital care. Therefore we also have the contra problem - you do not see much material from countries such as the UK or Finland praising their health care system and advocating it over other systems because nobody in their right mind would ever try to put the system back the way it was before the system was socialized. Therefore most of the material we have does seem to come from the US, which is heavily biased (on both sides perhaps). We had a long argument as I recall about rationing with some editors arguing that the free market does not ration health care but socialized systems do. It is nonsense like that makes me despair. --Tom (talk) 18:32, 7 May 2008 (UTC)

I'm not sure it's so surprising that the bulk of the arguments against this approach come from the one major industrialized nation that hasn't adopted it and in which it's under active political debate. It seems reasonable that most of the empirical evidence on how nationalized systems work would come from nations that have them; most of the empirical evidence on how free market systems work would come from countries that have them; and most of the current arguments for and against either approach would come countries where there's an active political debate. That's why my preferred approach would be to talk about publicly funded systems and universal coverage in the appropriate articles, with facts on how they work but no "point/counterpoint" debate about whether they're a good idea or not, cover the US debate in articles dedicated to it, and make this article a political science one on how the term "socialized medicine" is used rhetorically in US politics. If Finns are happy with their system, it doesn't seem likely that the debate's going to be terribly relevant to them. If they wanted to know what people in the US are saying to each other about health care, they could look to the US-specific articles. That would seem the appropriate place to put what US analysts on both sides have to say about the Finnish system in the course of the US debate. As long as there's no active debate in Finland, there doesn't seem to be any need to clutter up an article on the Finnish system with arguments either pro or con. That's why I'd really rather pull these arguments out of the "international" articles. If anything, all I'd put in those articles would be a fairly benign set of advantages and disadvantages. EastTN (talk) 20:33, 7 May 2008 (UTC)

You miss the point. If there were issues about quality, cost, innovation, access, that people in countries like the UK, Finland and Spain thought that a free market solution could solve, there would be people (and particularly political parties) arguing for that to happen. But I don't see any (certainly not in UK or Finland - I don't know about Spain). Privatization of parts of the NHS went ahead did happen in the early 1990s (hospital cleaning and catering in some places) but the results were lower costs (welcomed) AND poorer staff salaries/benefits and lower quality (not welcomed). The Blair reforms in the last 15 years or so have also created a mixed outcome. Some medical services and hospital construction projects have been outsourced, but many in the NHS argue that the NHS could have achieved the same or better if the funding had been placed in public rather than private hands. So the arguments in the US may be genuinely felt, but they don't seem to reflect reality as it relates to socialized medicine where it is practiced. I think that is highly siginficant. --Tom (talk) 16:14, 10 May 2008 (UTC)

Tom, I think your point support EastTN's position. If there's little debate about so-called socialized medicine in the countries that have it, then most of the support/criticism section in this article should be moved to an article strictly about such debate in the US. I think Health care reform in the United States is a perfect candidate. --Sfmammamia (talk) 17:45, 10 May 2008 (UTC)

But having this article pointing to examples from Cato and the like without challenging those claims here would be unbalanced. WP readers in the US need to get a more balanced view of socialized systems. The stuff put out by CATO, CPA, the Manhattan Institute and the like is totally distorted. I have not been editing here for the past year or more just to have all the balance that I have added swept away into another article. That would be unbalanced. --Tom (talk) 20:17, 10 May 2008 (UTC)

Tom, I agree that this article should not point to examples from Cato and the like without challenge, but I disagree that this is what is being proposed. Moving the US-centric support and criticisms to a US article would not leave the remaining article open to that kind of imbalance. As has been argued in the past, if this article points out that the term itself is pejorative, it appropriately addresses the perceptual imbalance you seem so concerned about. This article should then point to other articles, such as Universal health care and publicly funded health care and the articles on specific countries' implementations, such as National Health Service (England) for implementation details. --Sfmammamia (talk) 21:36, 12 May 2008 (UTC)

I don't think anyone said that the arguments put forward by Cato et al. shouldn't be challenged. That certainly wasn't my intent. The question I want to raise is where they should be challenged. Almost all of the criticisms currently being made of the various forms of national health insurance, single-payer health care or "socialized medicine" are being made in the context of the US political debate. But the way things have developed in wikipedia, the debate has spilled across a half dozen or more articles, many of which would seem to have little if anything to do with either the US health care system or US politics. The result has been a lot of confusing, duplicative text mucking up articles that would otherwise be much more understandable, approachable and useful to the typical reader.

If we pull both the criticisms of and arguments for "socialized medicine" out of the international articles and put them in a US-specific article, we can deal with them in one place. It would also seem appropriate to me, for instance, to note in the article on the British National Health Service that there is little opposition to the system within Britain. Then, if we have a source for someone making the argument you described above, that this demonstrates that socialized medicine works well because otherwise there'd be political opposition in countries that use that system, we would put it in the US-specific article as an argument "for."

The end result would be better for both US and non-US readers. A British reader, for instance, could go to articles on the NHS and national health insurance and read about how his system works, without having to wade through a bunch of arguments from the US that he doesn't care about. A US reader could go to an article on the US health care debate and read about what both sides say - he could also go to the article on the NHS and read about how that system works without having to wade through the US debate again. If the British reader wants to know what's going on in the US, he can go to the US-specific article as well, and it will be clear to him that all of the arguments flying back and forth (both "pro" and "con") are happening in the context of that specific political debate. Neither one of them should be mislead or confused, or feel that his system is being shortchanged. It might not be the best of all possible solutions, but what we have now is truly a mess. EastTN (talk) 21:53, 12 May 2008 (UTC)

Wikipedia is a global encyclopedia, so if an American debate is significant from a global perspective (and I believe it is), it should remain in all relevant articles. --Doopdoop (talk) 19:12, 13 May 2008 (UTC)

By reference or in summary form, sure, but if we mean including a full discussion then this approach applied more generally would make any encyclopedia unmanageable - every article would have to include a full discussion of every relevant related topic. For example, a similar case could be made for the relevance of the central limit theorem to any article dealing with statistics, the epsilon-delta definition of a limit to any calculus-related article, or atomic theory to any article dealing with chemistry. We don't want to go overboard and chop things up too much (and I do believe we may have some unnecessary articles in the health care area), but there's value in breaking things into separate but linked articles that allow readers to take things in digestible pieces while still moving around and finding what they need. EastTN (talk) 19:43, 13 May 2008 (UTC)

US-specific articles should have more detailed support/criticism sections than the global articles (for example views of famous politicians could be mentioned there but not in the global article). --Doopdoop (talk) 19:51, 13 May 2008 (UTC)

Doopdoop edits of May 27

This question is directed at editor Doopdoop but is being published here for others to see. You have reinstated certain texts which have been disputed on this page and which have been previously removed from the article for reasons already explained in some detail on this talk page. You have done this without making any proper attempt to explain your actions. This seems to be non-constructive editing. Please explain why you feel these edits are needed so that the community of editors can better understand you and to determine whether they agree with your desire to include these texts in the article. I am particularly keen to understand the relevance to the article which is socialized medicine (i.e. publicly financed medicine which may or may not be delivered by government agencies, according to your preferred definition).--Tom (talk) 22:48, 28 May 2008 (UTC)

Which diff are you interested in? --Doopdoop (talk) 20:05, 29 May 2008 (UTC)

I am sure you can read the comments here and use WP to identify differences. I am asking you to justify reinstating texts that have been removed for reasons already given. Assume that I mean all of it.--Tom (talk) 08:39, 30 May 2008 (UTC)

At least indicate the time zone you meant (May 27 in Buenos Aires is very different from May 27 in Sydney). --Doopdoop (talk) 19:01, 30 May 2008 (UTC)

I refer to the three edits you made to this article on this date (in US time)... according to my time zone you did not make any edits ti this article on the day either side so there can be no misunderstanding.--Tom (talk) 13:56, 4 June 2008 (UTC)

I'll try to present better explanations in edit summaries and in appropriate sections of talk page. --Doopdoop (talk) 19:59, 5 June 2008 (UTC)

Deletion of BNP Quote

DoopDoop has deleted several times now the long standing quote from the minority right wing party, the British National Party about its support for the core principles of the NHS and its criticisms of free market health care. The stated reason for the deletion is "undue weight" --- i.e. that this is a minority view not held by others. I beg to differ. The party itself may be a minority party, but the line it takes on health care is very mainstream. People in the UK do give high support for the principles of the NHS (as witnessed by survey data on attitudes to the NHS and mirrored in the views of all the political parties). Even the ultra right wing BNP. This is the reason for including the BNP quote. If even a minority right wing party supports so called "socialized medicine" and rejects notions of private sector efficiency, holding up its view of the failure of health care in the U.S. as a case in point, the popularity of "socialized medicine" in the UK is firm indeed. It is not a minority view lending undue weight. I want the quote added back. It seems to have been deleted because it does not reflect the view of the deleting editor. Or am I just too cynical?--Tom (talk) 23:27, 11 April 2008 (UTC)

DoopDoop is right. The party is a minority and it is undue weight. Extrapolation from their viewpoint to saying something about greater public opinion is your (or some other editor's) extrapolation. You're probably making a very good point, but it's not cited as such. --Escape Orbit ^(Talk) 23:33, 11 April 2008 (UTC)

The point is that medicine in the UK is most definitely not a LEFT/RIGHT issue as it seems to be in the U.S. Even far right parties (and most people in the UK would regard the BNP as far right) have a distain for free market when it comes to health care. How can one explain that issue without referal to the BNP's own sayings on the matter? I disagree that reporting this gives undue weight. It is just a short explanation in the section on the UK to give readers an understanding of how socialized medicine is viewed there. It is quite different from the view common in the U.S. and therefore needs to be understood. --Tom (talk) 09:13, 12 April 2008 (UTC)

The point is made there now in a short sentence, which should be enough given that this is a relatively marginal party.--Gregalton (talk) 09:19, 12 April 2008 (UTC)

Most people would in the UK would regard the BNP as far right; however, this could be a good example of how traditional notions of "left" and "right" can break down, especially at the extremes of the political spectrum. The BNP supports capital punishment, removal of non-whites from Britain, and other policies that are generally seen as right/extreme right wing. But it also (last time I read any of their literature - there is no mention of it on the BNP wikipedia page, and I don't want to dignify them by adding to the hits on their own website) supports various policies such as economic protectionism, provision of social housing, the NHS, etc, that are usually seen as left wing. (Or would be, if they were provided to everyone; they are not too keen on immigrants having access to the last two items). Wardog (talk) 18:20, 3 June 2008 (UTC)

I still remain puzzled at this. How is that the views of one economist (and I am referring to the recently added stuff from Tyler Cowen, who is not even a health economist), and just representing his own views, can be aired in the section on innovation (even though his arguments are demonstrably riddled with inaccuracies and were clearly not peer reviewed), whilst the views of a national political party (which was ranked 8th by popular vote out the 50 or so parties that took part in the 2005 British election) are considered to be undue weight?--Tom (talk) 06:03, 14 April 2008 (UTC)

No one has replied to this. Does that make me right? I am inclined to get rid of the Tyler Cowen stuff. It looks like original research (by Tyler Cowen) presented as somehow being unchallenged or unchallengable, which is clearly not the case. Or at least balance it with some real facts (but that would just make the article even longer and it's already getting way too long).

you have misunderstood WP:OR policy. please read it again. --Doopdoop (talk) 19:53, 12 June 2008 (UTC)

Cost of care section

I have deleted (twice now) the section that says

"Consumers want unfettered access to medical services; they also prefer to pay through insurance or tax rather than out of pocket. These two needs create problems for cost-efficiency" and a refererence to a commercial web site selling a book by the author of the claim.

I have deleted this for several reasons.

The first is that the claim (that users want unfettered access) may sound reasonable, but it is unsubstantiated and in any case, even if it was true, it does not say anything about socialized medicine versus alternative delivery forms.

The second is that the claim that the article said that "These two needs (unfettered access and insurance) create problems for cost-efficiency" which may be a claim made in the book, but it is not explained. What are the problems for cost-efficiency? And pray tell, what is the relevance to socialized medicine?

I see that Doopdoop has added the sections back claiming they are relevant, but there is no supporting explanation. --Tom (talk) 22:49, 15 May 2008 (UTC)

These sentences are a good background for the whole cost of socialized medicine debate, taking form a reliable source (a book the reform of healthcare). --Doopdoop (talk) 22:48, 17 May 2008 (UTC)

Please try harder.

What does "Users want unfettered access to health care" tell us about socialized medicine?

The book also claimed that "people prefer to pay through insurance". But in the UK, people prefer to pay for health care through taxation (which is why I added tax to that sentence). Opinion surveys and the actions of political parties prove this. So the book, which you say is good background, was wrong to make such a sweeping suggestion as it clearly does not apply in the UK which has a largely socialized system financed by taxation in line with peoples' wishes. Many democracies finance health care through an income related contribution. What reference does the author give for the claim that payment via insurance is prefered? It isn't in Canada, Britain, France, Finland, Denmark, Sweden, Spain and many many other countries.

And finally it talks about these two "needs" being a problem for cost-efficiency. But the article does not explain what they are. What are these problems and in particular how do these problems relate to socialized medicine?

I trust you will be able to answer the above questions in a way that will satisify most readers. Otherwise it is just using WP for promoting a book. If the views expressed in the book are contraversial then the article should reflect that.

My own take on the Cost of Care section and Socialized medicine is simply this. All health care has to be paid for and the issue is simply whether the wealthy should have better access to health care than the poor. In countries that have socialized medicine (for which I mean the loose definition of a fully publicly funded health care) there is a deliberate attempt to provide a level access to everyone regardless of means (to each according to his/her needs) and an attempt to meet the cost from taxation (from each according to his/her means), which is of course a basic socialist tennet. But it also aligns with the philosophies of most of the world's religions, so it is an age old idea based on ancient philosophies. --Tom (talk) 16:35, 18 May 2008 (UTC) & updated --Tom (talk) 13:24, 19 May 2008 (UTC)

Some of this disagreement isn't necessary - the book was written in the context of the current US system, which is why it talks about insurance rather than taxation. That's the economic choice most Americans currently face (insurance versus direct out-of-pocket payment), so it's the one discussed in this particular book. The broader principle is an important one, though, and it's consistent with what we see in a variety of everyday financial decisions. Most consumers prefer third-party reimbursement (whether that be through an insurance program, or a tax-supported government program) to direct out-of-pocket spending. It's less visible, and the psychology is different - even if we know better, it doesn't feel like we're paying. We see this effect a lot in retirement programs - people who would not put money in savings or investment for retirement, will participate in an employer-sponsored retirement plan that's funded through payroll deduction (especially if it's tax-advantaged). The contributions never show up in take-home pay, and once the election to participate is made, you don't have to continually make the choice to save the money rather than spend it. It also makes spending more predictable, and thus easier to budget for. As a result, people will opt for insurance or tax-based programs even when they increase the total cost due to administrative overhead and other system inefficiencies.

This is relevant to any form of third-party reimbursement for health care. The same psychology that creates the preference for third party reimbursement affects consumer behavior when seeking health care. Because there is little or no direct out-of-pocket cost at the time care is received, people are more likely to seek care. This effect is recognized by both proponents and opponents of third-party reimbursement, and is used in arguments in support of both sides. Proponents argue that high out-of-pocket costs cause people to forgo care that they need, in order to avoid the cost. Opponents argue that if out-of-pocket costs are brought too low, people will seek unnecessary and wasteful care. There are no easy answers, because in the US at least good research can be found on the one hand to demonstrate that some people do indeed forgo care that they need because it's too expensive, and on the other hand to demonstrate that a great deal of unnecessary, wasteful and in some cases counter-productive care is provided to people who don't have to pay for it directly (and that most Americans have no idea what the real cost of their health care or health insurance is, because they never see the full bill). Then we start dancing on the head of a pin trying to decide exactly how much health care is "just right." (The effect is well-recognized enough that reflecting the impact of additional benefits on utilization is written into the regulations governing the actuarial bids that private insurers submit to CMS to participate in the Medicare Part D program - the additional "induced utilization" for an enhanced Part D plan has to be separately identified and included in the supplemental premium paid by the enrollee, so the government doesn't end up footing the bill for it.)

Bottom line, most of us don't want to be faced with a large, unexpected bill if we need to take a sick child to the doctor - we'd rather have an insurance or social program (or rich uncle) to take care of it for us. We really, really don't want to be faced with a catastrophic bill if our spouse is diagnosed with a terminal illness. But once we know someone else is picking up the check, it's going to start affecting our behavior at least marginally. That preference, and the resulting effects on patterns of care usage, should be understood by anyone seeking to design or manage a health care system, whether the system be public or private. It's also the basis for many of the arguments about what type of system is most effective, and which methods of controlling health care utilization are most appropriate. EastTN (talk) 14:09, 19 May 2008 (UTC)

That explains a little about what the book is saying, but I still am not sure what the text in the article is trying to say about socialized medicine. The premise of the section of the book as you explained seems to be that if health care is free then demand will rise and hence spending will rise (especially if it is re-imbursed spending and the user is free to choose his own treatments). Well of course that does not happen in socialized systems such as the UK or Finland where health care is mostly free of charge to the user. This is because they are essentially not re-imbursing systems. They entrust doctors to judge what is both good for the patient and cost effective; in effect to allocate precious public resources between patients. This is so-called "gatekeeper function" prevents wasteful spending and encourages only cost effective spending because they have to work within a spending cap for ALL patients. Furthermore performing unnecessary medicine does not bring in more salary for doctors (or income for their employers) because because they already have an assured salary as public employees. And it certainly does not encourage so called "defensive medicine" (i.e that done merely to avoid potential malpractise lawsuits which could wreck a doctor's livelihood). I would think therefore that this book should regard socialized solutions as being an effective solution to this problem of overspend risk. Do you know if it does?

I still think DoopDoop should explain the relevence of the text to socialized medicine. We need to have this buttoned down. Otherwise the text belongs in another article such as Health care reform.--Tom (talk) 16:41, 20 May 2008 (UTC)

First of all, I tend to agree that the current text doesn't do a good job of explaining how this all relates. But if we're going to try and cover the arguments for and against "socialized medicine" in this article (which I really do think would be better handled in an article such as Health care reform or Health care reform in the United States), then the discussion is relevant.

You make an important point when you note that socialized systems use health care providers to perform a gatekeeping function. (As an aside, that concept isn't unknown in the US - many HMOs were organized around the use of "gatekeeper" primary care physicians who authorized any use of specialists or hospital services. The tight control of access to care through these gatekeepers was one of the primary complaints against HMOs back in the 1980's & 1990's, and most health plans in the US no longer use them.) US opponents of a socialized system argue that if you make health care "mostly free of charge to the user" then, all other things being equal, patient demand for services will go up. Of course, in any real system "all other things" won't be equal - there will have to be some method for controlling spending levels. (As another aside, US proponents of reform have often been disingenuous about this point, by denying that there would be any form of "rationing" in a national system. In my opinion, that's not helped their case.) Several methods have been suggested in the US debate: formal "gatekeeping" systems with uniform national treatment guidelines and utilization targets; "global budget" systems where system-wide spending targets are set and then used to set budgets for hospitals, physician practices, and labs which would ultimate determine how much was spent on care each year; a variety of suggested programs for promoting more cost-effective care, etc.

The crux of the US debate comes down to this: if we have to have some mechanism for controlling overall health spending (and I think that all serious analysts would say that we do), then what works best? Making care essentially free and using administrative systems to control utilization, or making patients pay part of the cost of care and using market mechanisms to control spending? For whatever reason, many Americans have a visceral dislike for administrative barriers to care. As I mentioned above, that's not just true when considering government systems; it's also one of the biggest complaints about health insurance companies. People, including myself, really don't like requirements that they get pre-authorization for a procedure, or a referral from a primary care "gatekeeper" before going to a specialist, etc. On the other hand, we don't much care for having to pay a lot for care. More than that, without appropriate subsidies or other targeted programs for low-income individuals, market-based mechanism can create inequities for people who cannot afford to participate in the market. (As another aside, one underlying problem of the US system that's not well recognized are the "categorical" eligibility requirements for Medicaid. Being poor isn't enough to qualify - you also have to be a child, parent of an eligible child, disabled or elderly. Non-disabled, non-elderly singles and childless couples are out of luck, even if they have absolutely zero income. Two-thirds of the uninsured have family incomes below 150% of the federal poverty level. In other words, if Medicaid covered everyone below 150% FPL, it would cut the uninsured problem in the country by more than half.)

I don't have a lot of personal effort invested in this particular article, so I really don't feel like I have a dog in this fight. But if the article is going to talk about the arguments for and against socialized health care systems, I do think it's important to talk about how such a system controls spending, and the debate over whether administrative mechanisms are a better approach than market-based mechanisms for allocating health care resources and controlling overall spending levels. EastTN (talk) 18:37, 20 May 2008 (UTC)

I deleted this again and it has been added back. The Kling argument is about third party payment systems where the payer (be it a private insurance company or the government acting as an insurer) pays another party... i.e. a hospital or medical practitioner or other health service provider. The health care provider has no incentive to spend the money wisely because costs will (usually) be re-imbursed. In pure socialized systems such as in the UK, where the government is both health care provider AND controls the budget for health care for everyone, this problem is considerably reduced because if money is spent unwisely on person A there is less to spend on person B. In other words in pure socialized systems there are only two parties... just the patient and the health care provider (which holds the financial pot for EVERYONE's healthcare). This issue is perhaps more pertinent to single-payer health insurance bút not really to socialized medicine. This is why I am so adamant that the text "Consumers want unfettered access to medical services; they also prefer to pay through insurance or tax rather than out of pocket. These two needs create problems for cost-efficiency" is misplaced. The argument (which leads from the the text) applies less to purely socialized systems than it does to say free market private insurance based health care systems. --Tom (talk) 19:34, 3 June 2008 (UTC)

Kling's argument also applies to fully socialized systems in democratic countries (exception is dictatorships where government is completely unresponsive to the wishes of consumers to have unfettered access to healthcare). --Doopdoop (talk) 20:17, 4 June 2008 (UTC)

It cannot apply in the UK or Finland (which are pure forms of socialized medicine because they are both government run and financed) because health care costs are NOT spent by one group and reimbursed by another. The Kling argument was the separation of spender and payer creates no incentives for the spender to be as economical as if it were, for a example, a person spending his/her own money. That applies as much to private medical insurers as it does to public insurers like Medicare. Because of this it cannot be an argument that tells us anything about socialized medicine. The argument does not hold in countries such as Finland or the UK because the health care provider also holds the financial pot. Therefore I fail to see how you can say "also applies to fully socialized systems.." - please explain your logic in extending Kling's argument of third party reimbursement as if it were something unique and/or only applicable to socialized medicine. It just isn't.

It applies to the UK because costs that are spent on any individual are reimbursed by all other people. Voluntary nonsocialized insurance might reduce this problem due to competition. --Doopdoop (talk) 20:02, 5 June 2008 (UTC)

You are not following the argument at all and have just created another one! The issue is about Kling's argument which is the segregation of payers and spenders in a re-imbursement model. But in the UK and Finland, payers and spenders are the same (public budgets for health care are held by the agencies providing health service). Your argument (that costs that are spent on any individual are reimbursed by all other people) applies to all insurance reimbursement systems, private or public and completely sidesteps the argument that Kling makes. Socialized systems (by the strict definition) are not reimbursement systems at all. So Kling's argument has nothing to tell us about strict definition socialized systems, and if we take the loose definition, what applies to public re-imbursement programs could equaly apply to private one. The second point you raise (the allegation that public bureacracies are more expensive than private ones because of a lack of competition) is a completely different issue and therefore a diversion. Let's stick to what Kling actually says.--Tom (talk) 15:38, 7 June 2008 (UTC)

You have misunderstood Kling. Pleas read this [7]. It is obvious that in the UK and Finland "consumers enjoy the peace of mind of having their medical services paid for by a third party". --Doopdoop (talk) 21:31, 8 June 2008 (UTC)

Absolutely not. It confirms what I say. Its about reimbursement systems and spenders (health providers) who don't worry about cost. In socialized systems, there is a careful balance act to ensure that spend delivers both good health care and value for money. It is in fact the opposite of what you are arguing.

You chose to focus on "consumers enjoy the peace of mind of having their medical services paid for by a third party"... well private health insurers pay an insurance premium and may receive more or less value in health care services than they paid in. It is exactly the same with socialized medicine except we are talking about taxes and not insurance premiums. The main dilemma Kling refers to is where there is "unrestricted access, where consumers and doctors can choose medical procedures without bureaucratic interference or government budget limits". That seems to apply to some private health care systems that Kling describes but it does not apply to socialized systems where there is always a balance drawn between spend and benefit. Hence I intend to delete your edit. Kling was NOT talking about socialized medicine!--Tom (talk) 13:28, 9 June 2008 (UTC)

Absolutely not. "Kling's trilemma" applies to all socialized systems. Kling is talking about tension among three conflicting needs, in your comment above you are forgetting one of the factors - the budget limits in socialized systems. --Doopdoop (talk) 18:15, 10 June 2008 (UTC)

I added back the reference to re-imbursement systems because that was the context in which Kling was discussing problems of cost efficiency. I also agree that budgets are what constrain cost growth in socialized systems so I added that in too. I hope that resolves this particular spat.--Tom (talk) 08:20, 12 June 2008 (UTC)

In reference to the last reply from Doopdoop, I would say that you are trying to shift the argument. We are not in dispute about the Kling's trilemma. You added the Kling reference when I wanted an explanation of the cost efficiency dilemma. Kling's argument is indeed about conflicts in the re-imbursement system (which is applicable to free market insurance as well as public insurance such as Medicare for example). --Tom (talk) 09:10, 12 June 2008 (UTC)

You have not explained why Kling's trillema does not apply to the UK. --Doopdoop (talk) 19:57, 12 June 2008 (UTC)

Get it into your head that I am not in dispute with you about the reality of the so called "trilemma". In socialized systems the budget caps costs and doctors deliver attempt to maximise delivery by efficiently allocating the resources they have. They can do this because they are both fund holder and fund spender. Fundamentally that does not happen in insurance based reimbursement systems and as EastTN has pointed out, reimbursement systems was the context of Kling's book. Centrally planned systems are a different concept entirely. The Milton Freedman article also criticises systems based on third party payment for the lack of control incentives in third party reimbursement systems. At least in the countries with socialized medicine we know exactly what we as voters and taxpayers will pay for our healthcare and when we will pay for it. We pay as we earn and not when we need to use it. And broadly we know the quality of care we will receive, which is very good (and not as is often painted by those lurid press reports and think tank articles that you are fond of quoting). --Tom (talk) 20:38, 12 June 2008 (UTC)

Some supporters/opponents argue.....

The article is littered with phrases such as this. I find the style tedious and not really appropriate for an encylopedia article. I think we should get rid of such phrases and focus on the underlying data. The readers can decide for themselves whether this is positive or negative.

Wikipedia should not allow criticism sections where any nutcase can be quoted. Nobody could take Wikipedia seriously. Therefore we should allow only creditable (and ideally peer reviwed or professionally connected) sources for factual data.

Comments please.--Tom (talk) 10:12, 12 June 2008 (UTC)

The Cato Institute is not just any nutcase; they're a nutcase that's taken seriously by some politicians and policy makers not only in the U.S. but even in relatively rational European countries like the U.K. and Holland. There is a raging debate in those countries about whether the free market is appropriate to health care, and the people who are trying to understand those debates have a real need to know the arguments for the free market, and the problems with those arguments -- both sides of the debate.

Therefore we quote nutcases who meet the definition of WP:RS. People take WP seriously because it gives both sides of the argument, not because it only gives the side that someone decides is right. WP:RS are definitely not limited to peer-reviewed sources (though in my opinion peer-reviewed sources almost always trump other sources). You quote the nutcases, you quote the peer-reviewed sources, and you've done everything you can do for your reader.

Did you ever read John Stuart Mill's On Liberty? Nbauman (talk) 21:59, 16 June 2008 (UTC)

I'd like to strongly second Nbauman's comments, and note that sometimes my "nutcase" can be your respected non-profit (and vice versa). Many people think there may be merit in a free-market approach to health care. We can't understand why, or help a reader understand why, unless we look at what the people they're listening to have to say. EastTN (talk) 13:55, 17 June 2008 (UTC)

I was thinking as much of the trade union offical who believed that patients were being queued in ambulances because of government targets in emergency room waiting ... though as far as I could see there was no actual proof, just an accusation. I do have a bee in my bonnet about the accuracy of some of Cato's output. That's why we should examine the data that supports the claims. We can mention them of course, but just because someone says something is true, does not automatically mean that it is true. I read something the other day from Cato which compared costs and outcomes in the UK NHS compared to an HMO in the U.S. (Kaiser Permanente in California) which basically said the HMO was not very much more expensive and was more effective. When I checked Cato's source, the source data had INCREASED the NHS costs by a factor of 1.5 (i.e. a 50 per cent increase for medical "purchasing parity adjustment"... because costs in the US for health care inputs (drugs, salaries etc.) were reckoned to be 1.5 times higher in the U.S. than in the UK!!! (Er... you don't need to have a degree in economics to see how that one is twisted!) And they also excluded the non-profit HMO's profit (work that one out!!) from the KP costs. Well they are not a cost to the HMO but they are to the end user of course!!! If these aren't cooking the numbers I'd like to know what is! Cato did not cook the numbers but the fact their source did so should be exposed. I'm not against quoting Cato, but if we do we should understand their data.

(My reference to nutcases and criticism sections was heavily borrowed from another editor commenting on a criticism section in another article. I though it also applied nicely here too. The editor, who remains nameless for the time being, is in the same camp as Kborer/Freedomwarrior/Doopdoop when it comes to the topic of socialized medicine and I thought he or she might make another appearance soon).--Tom (talk) 15:58, 18 June 2008 (UTC)

Actually, you do have to have a degree in economics to see how that one is twisted. Paul Krugman, for example, is one of the people who can figure this stuff out.

The BMJ has had debates on the economics of the U.K. vs. U.S. system, with authors such as David Himmelstein arguing in behalf of government health care. They commissioned an article from the Adam Smith Society, but their peer reviewers rejected it because of its poor scholarly quality, so they got a different free-market nutjob.

They were comparing Kaiser Permanente to the NHS, because Kaiser is one of the more successful non-profits in the U.S. The comparison very quickly got very complicated, because among other things the NHS and American private insurance companies insure different services, for example the NHS covers dental care while Kaiser usually doesn't. They also had to factor in the value of capital investments, which is always difficult. What's the value of a 50-year-old hospital?

I couldn't follow all of it, and I couldn't always tell who was right. I don't think you can either. That's moot, because it's not Wikipedia's job to decide who is right and wrong, and only publish what is right. On the contrary, Wikipedia's stated job is to publish all notable views from what are, according to Wikipedia's specific definition, reliable sources, and Cato certainly meets that definition. We leave the job of deciding who is right and wrong to our readers. That's what free speech is, and Wikipedia is strongly committed to free speech. Nbauman (talk) 16:59, 18 June 2008 (UTC)

There's also nothing wrong with including published criticism of Cato's claims, so long as it, too, comes from reliable sources. --Sfmammamia (talk) 17:28, 18 June 2008 (UTC)

We not only can include published criticism of Cato's claims when it's reliably sourced, we should. But with respect to the specific example raised ("I was thinking as much of the trade union offical who believed that patients were being queued in ambulances because of government targets in emergency room waiting . . .") there seems to be a much simpler solution - we just need to characterize the source more carefully (e.g., "In arguing that XXX, a Cato Institute paper quotes a leader of the YYY union as saying ZZZ . . ."). That's a good rule on both sides - there was a "study" of medical underwriting a number of years ago that got a great deal of play, coming from a prominent US think tank that supported a national health care system. When you read the thing, it turned out that they made up a dozen "hypothetical" individuals with different health conditions, sent them to some underwriters, and drew the conclusion that most people wouldn't qualify for individual health insurance - without making any attempt to match their hypothetical people to the general US population, people in the individual health insurance market, people who were uninsured at the time, or anything else (much less look at a sample of people who'd actually tried to buy insurance). At bottom, they basically said "we're thinking of a small group of people like . . . like. . . like this! And guess what? None of them are healthy enough to buy insurance!" EastTN (talk) 18:23, 18 June 2008 (UTC)

I agree with much of what has been said in the last 3 comments, but you really do not need a degree in economics to know that lower levels of salaries paid to medical staff and the lower costs of drugs negotiated with the pharmaceutical companies are two areas where there are real differences in costs which contribute to the lower real cost of health care to people in the UK compared to the U.S. Its nonsense to make a "price-parity" adjustment that balances for this and then say that the costs are not very different!

As for EastTN's comments about the inclusion of quotes, I think it would depend on the reality. If institute X claims something is true on the claims of person Y, but there is no other evidence to substantiate person Y's claims, then person Y's claims should be regarded as suspect (and would not meet reliability criteria), which implicitly makes Institute X's claims just as suspect. (If there really was evidence of hospitals keeping patients in ambulances instead of admiting them to the hospital, I'd be okay about that reference being in the article. But that story lacks credibility. If it really was true then there would be a public outcry and heads would roll. As far as I can see, no one has taken this story seriously because it is, sadly, like many other newspaper stories, probably without foundation. The British public do not trust British newspapers when it comes to information about the NHS, and for good reason. Newspapers are frequently critical of the NHS but the news one reads from them has to be regarded with a great deal of scepticism. (See the poll responses to questions 33 and 34 at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4118109.pdf). But that drip drip drip of constant negative background noise from newspapers still has a mild influence and probably explains why people's overall perception of the NHS is lower than their own ratings of it as patients, and why people think their local services are better than the service obtained elsewhere in the country (see the graphs on page 18 and page 10). I think it was Cato that reported that a UK cancer patient had his operation cancelled 18 times (or some such silly number), but what they failed to report was that the cancelation letters were due to a fault with a new bookings system.... it was not an endemic failure in the health care system as they tried to portray it. The newspaper in the UK pportrayed this as a scandalous story, but buried at the bottom of the article was the true reason. "Faulty computer system cancels operation 18 times" is not as interesting a headline as "NHS Cancer patient has operation cancelled 18 times". Both are true as headlines go, but one is more honest than the other. It is this kind of false reporting by groups such as Cato that should be exposed. --Tom (talk) 11:10, 20 June 2008 (UTC)

If you'd read these debates in the peer-reviewed journals, as I have, you'd see that the Cato Institute and the people they cite always has evidence to back up their claims, and there is always evidence to challenge their claims. If you drill down to the sources and numbers, they just get exponentially more voluminous and complicated. The problem is to figure out who's telling the truth, or which part is true and which isn't. I don't trust myself to figure that out, and I don't trust you either. That's why in Wikipedia we can't let editors just go around deciding who's telling the truth and who's lying, and deleting whatever they don't like based on their own WP:POV. Nbauman (talk) 13:59, 20 June 2008 (UTC)

And we can really find ourselves heading down a rat hole when we start dismissing the press as being systematically biased. In the US, no one trusts the press either. People on the liberal left are absolutely convinced that the newspapers are in the pocket of big businesses that want to push a conservative, business friendly agenda (they use the term "corporate media"). People on the conservative right are absolutely convinced that the newspapers are run by liberals who grew up in the 1960s and entered into journalism as a way to change the world and advance their progressive causes (they use the term "main stream liberal press"). They can't both be right, but there you have it. Sometimes conspiracy theories are easier to believe than the possibility that we may not always be right, or that the evidence is mixed, or that the authors we read are just people doing the best they can with what they know and their own life experiences and instincts. EastTN (talk) 14:10, 20 June 2008 (UTC)

Innovation section

Cowen, in his article connects the American health care system to American involvement in medical innovations and Nobel achievements and makes many statements which, as we saw on these pages earlier, are in fact not true. British achievements are just as, if not more notable. So the referenced article is riddled with inaccuracy.

User:Doopdoop has been using Cowen's other core argument which seems to be the following

1. the U.S. spends more money on health care than other countries

2. the extra money going into health care encourages research

3. other countries benefit from that research but don't pay for it

4. if government cuts the spend on health care by forcing down costs, medical research will be at risk

5. medical research has been cost effective

The first point is well known. The second point may well be true but we are left with it as an implicit assumption. The third point is a somewhat debatable (because when products are sold, the price will recoup some of the original investment - all businesses are in it for profit). The fourth point contains an implicit assumption just like 2. The fifth point may or may not be true. He quotes cardiovascular disease research but that is just one example. I do not see that he has proven a case for saying that all the money that has been spent on medical research has brough rewards that exceed the cost. But let's even forgive Cowen for a moment for failing to justify all his points.

The question I have is this. 'What is the connection to socialized medicine? It is very tenuous. Cowen makes only the following statement: "The American government could use its size, or use the law, to bargain down health care prices, as many European governments have done."

So Cowen claims that European governments have used their size and/or the law the bargain down health care prices. But how? He does not say. Its a very sweeping statement but does not try to justify that claim in any way whatsoever.

Most European governments do not run hospitals or negotiate health care prices directly with producers, though they do finance health care from taxation. These have lower spends than the U.S. Why? We are not told. Those like the UK, Finland and Spain that have socialized medicine and employ practioners directly spend even less overall on health than similar European countries. But as we have seen, this could just be because socialized systems have less bureaucracy. Or because they have no investors to pay dividends to. Or because they allocate resources more cost effectively, or because medical practioners in socialized systems do not have to be paid a salary which compensates them for the cost of their medical training (which could be free to the student) or for litigious malpractice suits (which are discouraged or compensated for in other ways). There are a myriad reasons why spend in socialized systems could be lower. Yes, there are government agencies that negotiate pharmaceuticals pricing centrally with the producers, but many people would argue that this is just a balance against the monopoly power of patent protected producers. The producers will not sell their drugs to anyone at a price that did not yield a profit which compensated them for their sunken investments in research. If they did, the drug companies would soon be out of business, and overall there is little sign of that.

This entire paragraph is based on a non-peer reviewed article by an economist (amd not even a health economist) who makes glaring factual errors (like the Nobel arguments), and basis arguments on some very shaky assumptions.

Unless a viable connection is made between private financing and effective medical innovation and its converse (public finance and ineffective medical innovation) I think this entire section should be deleted. Britons may been more successful in obtaining Nobel prizes for medicine than their American cousins (taking into account population), but I would not have the gall to say that this is due to the system of medical practice in operation (which Cowen seems happy to do). --Tom (talk) 09:30, 16 June 2008 (UTC)

NHS 60th Anniversary - lessons in tranformation from private health care to a socialized model

For those interested in how socialized medicine was achieved in Britain there is a new series of radio programs examining the history of the NHS, which has started on BBC Radio 4. The first of 3 programs contains many interesting interviews with doctors around at the time of the transformation from one system to the other and how power in the medical industry shifted (mostly in favour of the doctors who were largely left to run the NHS because the politicians new that they held all the cards), and how many doctors that had been opposed to the introduction of the NHS actually came around to seeing it as not only a good thing, but an absolutely necessary one. There are some interesting arguments that back up what is said in this article (for example that doctors know that health care is not like other market based product to which economic rules apply because it has a negative utility of consumption), and there are some arguments in there which are not heard in the article at present (that tackling delivery of health care is just part of a wider picture of improving the nation's health - such issues as housing conditions, industrial diseases, and other in-population risks. Then it was poor housing and industrial diseases;today I guess it would be problems of affluence as well as deprivation. The first program can be heard at http://www.bbc.co.uk/radio/aod/networks/radio4/aod.shtml?radio4/nhsat60. --Tom (talk) 13:25, 30 June 2008 (UTC)

government regulations impose extra costs in free market health care that distort the price mechanism

The article currently says "Some have argued that government regulations impose extra costs in free market health care that distort the price mechanism and make health care too expensive". This may or may not be true but it misses the point entirely... socialized medicine is a deliberate attempt to get away from the allocation of resources according to the price mechanism as happens in free markets. The link it quotes is just a set of arguments put forward by those about the single-payer concept and is headlined with the slogan "socialized medicine" presumably to tar it with a term that is supposed to evoke negativity. That link could go into the many already listed as examples of attempts to evoke negativity by association with socialism. But I would argue that the text itself is completely irrelevant to the subject of socialized medicine itself which is not about free markets and price mechanisms at all. I propose that we delete it. --Tom (talk) 18:40, 8 August 2008 (UTC)

Agreed, I will delete. --Sfmammamia (talk) 22:42, 8 September 2008 (UTC)

"government bureaucracy created in socialized systems is less efficient than private providers"

The article says that "the government bureaucracy created in socialized systems is less efficient than private providers in a free market" but no evidence is given to support the claim. Its just wrapped up in a statement that "some have claimed that" so that the evidence of a claim could perhaps be made without the WP article having itself to substantiate the underlying claim. If such claims are to be included in the article they must be substantiated. I ask editors who have evidence to support both the wrapping claim "some have claimed" and particularly the underlying claim about relative efficiencies in "public" versus "private" providers to bring them to the article. Otherwise I think we should delete the claim entirely. --Tom (talk) 11:18, 8 September 2008 (UTC)

Agreed, the statement has lacked a source for months. I will delete. --Sfmammamia (talk) 22:36, 8 September 2008 (UTC)

Controversy in the US

I amended the para at the front of this section because, as far as I can see, no main political party in the U.S. is actually calling for socialized medicine. I know that some extend the definition to any form of financing (in which case the US already has socialized medicine), but I do not see that as a mainstream view. I hope that I have summarized the main parties' views accurately, but if not, please feel free to correct this.--Tom (talk) 17:00, 17 October 2008 (UTC)

article length

I just added the verylong template to this article, as its readable prose is now about 66K. We have discussed the need for greater summary style and splitting off certain sections to other articles before, but have not been able to reach consensus, I believe primarily due to protracted editing conflicts. Perhaps now we have a greater opportunity to edit, condense, and bring this article back to a more appropriate length. My suggestion is to start from the bottom up. I believe the section "Political controversies in the United States" should be greatly condensed, and anything that is not already covered in Health care reform in the United States should be moved there. The "Support" and "Criticisms" sections should also be targeted for editing -- my sense is that there is a lot of overlap and redundancy now between those sections and what precedes them in the article, as well as the debate sections on similar topics in other articles. Other comments? --Sfmammamia (talk) 20:32, 20 October 2008 (UTC)

I am inclined to believe the same. Two observations I would make are that (1) many of the criticisms are those voiced in the U.S. debate and don't really have much relation to socialized medicine as I have witnessed it. They are certainly not much heard in the two countries where I have lived, which makes me feel that they are just overblown. The rightful place for a summarized version of the arguments heard would be in the Health care reform in the United States as you say. I'd rather get them out of the preent article altogether because a lot of those claims don't really stack up or are a kind of warped version of reality. The detailed examination of claims and counterclaims about socialized health care is a worthy endeavour but perhaps WP is not the place to do that. I hope some medical journalist takes up the gauntlet and writes an informed article outside of WP that could merely be referenced from this article. If nobody does it soon I am sorely tempted to do it myself.

Observation (2) would be that the support and criticisms section is essentially the same as the Political controversies in the U.S. section. It got deliberately pushed down the running order in the article by a certain other editor, one suspects because it did examine the voracity of claims made by those wishing the government of health care, and the further down the article the information is then the less likely it is to be read. As you may have noticed I did spend some time yesterday cutting the article back by deleting repeated material and at the same time merginging information back into one section and attemptong to collate information into logical subsections. If that continues the article would be a little shorter but still be quite large. I'd be happy not to have the refute material in the article as long as the article did not continually refer to phrases such as "opponents say..." which then repeats wild claims that are disputed or else are disputable. But I did start thinking more rigorously about some claims that were not examined. The claim that socialized medicine would mean higher taxes might seem logical, but in practise I could not find a single EU country which already pays more per head in tax funding for health care than the U.S. Neither was the Japanese or Canadian systems more tax funded than US health care. If the claim is there then the evidence must be there to support it and if the claim is doubted then the refutation information should be there also - which adds to the length. Sadly though I don't think that we can stop editors from adding material like this if they want to. --Tom (talk) 22:56, 20 October 2008 (UTC)

Tom -- you need to make the distinction between "Cost of healthcare" and "taxes paid for healthcare". The per-capita spending per head in the US is higher, but the taxation rate and the per capita healthcare spending are not the same. The key difference is taxes are mandatory and per-capita spending in some cases is voluntary. —Preceding unsigned comment added by 137.28.228.243 (talk) 23:01, 24 October 2008 (UTC)

Weasel Words in Into

I believe the sentence "Most industrialized countries, and many developing countries, operate some form of publicly-funded health care with universal coverage as the goal. According to the Institute of Medicine and others, the United States is the only wealthy, industrialized nation that does not provide universal health care" contains a a weasel word style implication. The sentence, as it is constructed now, may be true. But it implies "Since all wealthy, industrialized nations have universal healthcare except the US, therefore the US is not a wealthy, industrial nation." While people may hold this belief the implication is an opinion, not fact.

I believe this falls under the category of weasel words, but if I am wrong feel free to correct me. The sentence is in the 4th sentence from the top of the introduction. Thanks —Preceding unsigned comment added by 137.28.228.243 (talk) 22:08, 24 October 2008 (UTC)

Criticisms section

The criticisms section is extremely sloppy. It is formatted like a debate with supporters commenting on every criticism, despite the fact that it is a criticism section. The support should go in a support section and criticism in a criticism section. —Preceding unsigned comment added by 137.28.228.243 (talk) 22:58, 24 October 2008 (UTC)

Rationing - Rationing is more extensive in the private health care system than it is in socialized systems

The rationing argument is peculiar and upside down.

For example in the UK, one of the largest private health care providers is BUPA and here is the list of items that are in their EXCLUSION LIST (taken from http://www.bupa.co.uk/heartbeat/html/not_covered.html)

• dental/oral treatment (such as fillings, gum disease, jaw shrinkage, etc)†
• pregnancy and childbirth†
• temporary relief of symptoms†
• convalescence, rehabilitation and general nursing care†
• drugs and dressings for out-patient or take-home use†
• screening and preventive treatment
• birth control, conception, sexual problems and sex changes†
• allergies or allergic disorders
• chronic conditions†
• eyesight†
• physical aids and devices†
• deafness
• cosmetic, reconstructive or weight loss treatment†
• ageing, menopause and puberty
• dialysis†
• complications from excluded or restricted conditions/ treatment
• HRT and bone densitometry†
• learning difficulties, behavioural and developmental problems
• overseas treatment and repatriation
• AIDS/HIV†
• pre-existing or special conditions
• experimental drugs and treatment†
• sleep problems and disorders
• speech disorders†
• treatment in a hospital that is not a Bupa Heartbeat hospital

† (except in exceptional circumstances)

Nearly all of these are routinely available as NHS treatments! The list contains many of the most common treatments and care that most people will need during their lifetime! Dental care, hearing loss, temprorary relief of symptoms, pregnancy. This list turns the arguments that there is greater rationing in socialized systems completely upside down! It is the private health care system that does the most rationing. The arguments about the rationing of expensive drugs like Herceptin in the socialized NHS are as nothing compared to to the rationing by exclusion in the private health care system of things such as pregancy, dentisty, drugs for home use and the relief of temporary symptoms!

I am not sure whether the same kind of list comparison can be made in other countries with parallel public and private systems, but I suspect that it can. Comments please on how we can best balance the article. --Tom (talk) 10:26, 11 October 2008 (UTC)

I've just checked out some of the policies of Humana (taken at random using the broker www.ehealthinsurance.com) just to see how private coverage seems to operate in the U.S. They seem to have fixed waiting periods for some conditions such os OB/GYN (90 days!) and copays/maximums coverage limits/and deductibles on most conditions (and no doubt there are exclusions on pre-existing coditions).Maternity was not covered at all in the policies I looked at! These seem to me to be financial as well as access rationing. The UK's NHS as an example of socialized medicine in the UK has no mandatory waiting periods for treatments and no copays or coverage limits and no exclusions for pre-existing conditions so rationing is surely LESS PREVALENT in socialized medicine as it exists in the UK than the system of private medical insurance/private hospitals is in the U.S.--Tom (talk) 12:02, 11 October 2008 (UTC)

I feel inclined to delete the Goodman references and the text that goes with them. Goodman gives no evidence for his assertions that waiting lists are used to ration care or that "waiting costs" deter people. The Goodman article states that "in Britain, it is extremely difficult for an elderly patient to get kidney dialysis or a kidney transplant - or any other transplant, for that matter" but he gives no evidence for this. The truth is, however, vastly different from that which is claimed. The NHS says that only the availability of donated organs causes there to be a waiting list for those on dialysis awaiting a transplant. There is no age limit applied to persons awaiting a kidney. The UK matching scheme does tend to favor young adults because a well matched first donation increases the success rate of subsequent donations in those people. This prioritisation, which is on clinical grounds, has slighlty reduced the chances of people over 60 getting a donation. See https://www.uktransplant.org.uk/ukt/about_transplants/frequently_asked_questions_about_transplants/f_a_qs_about_kidney_transplantation.jsp I think we should keep the article factual and should not repeat the wild claims of others that are not well founded. --Tom (talk) 17:49, 17 October 2008 (UTC)

I think this section of the talk page (to which I am so far the only contributor) raises some very key issues and I concerned that it is going to be archived soon with none of it having gone into the main article. Would anyone object if I attempt to put at least some of the arguments here into article?--Tom (talk) 10:13, 20 December 2008 (UTC)

Neutrality

This article unfairly treats the issue by focusing on the benefits of socialized health care and ignoring many of the problems. Even the criticisms section merely lists problems and then explains how they're wrong. This article needs to be changed to reflect a neutral point of view, detailing both positive and negative issues equally and clearly. Ejnogarb (talk) 18:00, 18 December 2008 (UTC)

I reverted your last edit to the article because it quotes David Gratzer as a "doctor". That may be so, but sadly he is not a reliable source because he has a known position as a paid employee of the Manhattan Institute which rails against socialized medicine as part of its policy stance. Gratzer was also the source of misleading quotes about socialized medicine in the UK on the subject of cancer statistics. If you can find a reliable sources for problems associated with socialized medicine you contributions would be welcomed. A word of warning however. Many blogs and articles sourced by certain institutes often cite "factual" data often turns out to be neither factual or generally applicable. Exceptions do not make the rule and people with a policy agenda are often not reliable sources. The issue of waiting times is an interesting issue. As far as I am aware there are no statistics on waiting times for people in need of health care in the U.S. If you can find some inclusive data (which includes people who are poor, or whose insurance or private resources are depleted) that would be great. --Tom (talk) 02:46, 19 December 2008 (UTC)

This article is peppered with unreliable sources or sources with obvious political agendas, such as the Physicians for a National Health Program. If you're going to remove one such source, at least respect the neutrality this article should represent and delete them all. If not, I'll put it back up. Ejnogarb (talk) 04:22, 19 December 2008 (UTC)

Its okay to quote such people when dicussing views or perspectives as long as it is clear that what we are referring to is a perception. It's a different thing when attempting to quote them to assert truths.--Tom (talk) 08:59, 20 December 2008 (UTC)

I agree with you about unreliable sources. The worst one I find there is the Cato Institute that published the John Goodman piece and the National Center for Policy Analysis which Goodman runs. They are full of demonstrable falsehoods. Which ones were you thinking of? --Tom (talk) 10:07, 20 December 2008 (UTC)

To establish a more fair perspective on this subject, I plan on introducing a section about recent measures within countries with socialized health care to promote private health care. If anyone has any opinions on this issue, let's talk. Ejnogarb (talk) 15:43, 19 December 2008 (UTC)

That is fine by me. --Tom (talk) 08:59, 20 December 2008 (UTC) Here is an academic and peer reviewed article on the subject http://www.bmj.com/cgi/content/full/335/7630/1126 and here is one with references from a politically oriented rather than an academic source http://www.labournet.net/ukunion/0610/nhspriv1.html . Hope you find them useful.--Tom (talk) 18:17, 22 December 2008 (UTC)

Cato Institute

Tom,

In the section Socialized medicine#Usage in 2008 U.S. Presidential election we quoted false claims by David Gratzer of the Manhattan Institute, and then quoted reliable sources who refuted him.

If you want to challenge the claims made by the Cato Institute, which are dubious, then under WP rules you must similarly find a WP:RS to quote.

It doesn't do any good to insert your own opinion or interpretation, because readers don't care about your opinion or interpretation. They care about Paul Krugman's opinion.

This isn't a close decision, that's the way WP works.

By inserting your own opinions, you're actually weakening the challenge to the Cato Institute. You're making it more difficult for those of us who want to point out their errors. Nbauman (talk) 13:37, 31 December 2008 (UTC)

I would like you to reconsider this. I was not profering an opinion at all. I have no idea whether medicare is more or less efficient than private insurers when administrative loads on the health care provider is taken into account but then I doubt that Goodman has either. Otherwise he would give us the data. I don't think we should have to wait before someone pops up somewhere with measurements of the relative adminstrative impacts on the medical profession of Medicare campared to other insurers. Frankly, that is unlikely to happen because I doubt that anyone other then Goodman actually believes it. And I don't think a "fact tag" here would be quite appropriate either. It should at the very least be labelled as "an opinion" held by Cato (or probably more accurately by the writer - the article may merely have been reprinted by them as Goodman is not a Cato employee as far as I can tell but is an employee of another pressure group and this paper was at one time also on the CPA website). If we leave the text as it stands the reader could be led to believe that there IS evidence that "medicare is not very efficient" when compared to private insurers. --Hauskalainen 07:08, 7 January 2009 (UTC)

Under WP:NPOV, we have to use the most neutral language possible and can't label it as opinion; that would clearly violate WP:NPOV. We have to find a WP:RS to say so. WP assumes that people can read both sides of the argument, check the sources, and come to their own opinion. We have Cato and Krugman; a reader would have to be pretty foolish to see a Nobel economics laureate on one side, Cato on the other side, and not consider the possibility that Cato could be wrong. They should be able to see that Krugman supplies data and Cato doesn't. You can supply a WP:RS to help them understand why Cato is wrong, and point out Cato's lack of data. But you can't give the reasons why you believe Cato is wrong, including their lack of data. If the reader is mislead, that's the price of free speech and an objective presentation of the facts. Give them more objective facts and WP:RS opinion. Nbauman (talk) 17:53, 7 January 2009 (UTC)

You say "They should be able to see that Krugman supplies data and Cato doesn't". Well they will only know that if they follow the links and think carefully about what they are reading. Not all WP readers have the time or inclination to do that. They surely trust the editors of the article to ensure that the text of the article is supported by the references. WHich is why I think we do have some responsibility here. Whilst it is true that Cato claims that Medicare is not efficient, it does not actually provide any evidence to support that claim. That is why I insist that text should say something like "Cato believes that Medicare is not very efficient" and not that it "argues that it is not very efficient", because that part of its claim is not supported with evidence or any form of logical argument. (The wikilinks would not be in the article edit). Yes, I do have a view about the topic of socialized medicine which is polar opposite to Cato but I don't think that such an edit would be in any way unfair to Cato or expressing POV as you seem to imply. I'm sorry to keep harping on about this.--Hauskalainen 09:27, 8 January 2009 (UTC)

I'm fine with that - but only if we take the same approach to Krugman and everyone else. We shouldn't be in the position, as editors, of determining whose evidence is sufficient. The evenhanded approach is to consistently say "X believes/argues/says . . . " and then, to the extent possible based on the sources, report what they say in support of their position. In Krugman's case it may be that number A is greater than number B in data series C. In the Commonwealth Fund's case it may be "we have a moral responsibility to . . ." In another organization's case (Cato's, perhaps) there may not be a second sentence if all they give is a bare assertion. In that case, the reader can decide who's more credible without our help. But if we try to signal who we think has the best evidence, then we are expressing a POV. EastTN (talk) 16:48, 27 January 2009 (UTC)

I think we can tell the reader that a particular source is a peer-reviewed journal, or that a particular source won the Nobel Prize in economics, or that a particular source is funded by the pharmaceutical industry. Not only can we provide factual information to help our readers make up their own minds on the merits of the case, we can also provide factual information to help our readers make up their own minds on the credibility or bias of the sources. I think that should satisfy Hauskalainen, and I would encourage him to do it.

However, it clearly violates WP:WTA to say that Cato institute "claims" something, as a way of signaling to the reader that they're suspect or wrong. This is a matter of process. Nbauman (talk) 18:54, 27 January 2009 (UTC)

I agree. The key guideline here, as I see it, is "[d]o not use 'claim' for one side and a different verb for the other, as that could imply that one has more merit." If we provide the reader with a clear enough picture of the emperor, they'll be able to determine whether or not he has any clothes. EastTN (talk) 17:38, 5 February 2009 (UTC)

Canada section

The term socialized medicine is most often used in the US as far as I can see when discussing Canada or the UK. The UK section now packed with useful descriptions of process and factual data on costs and performance which are supported by references. It would be nice if similar statistics could be gathered for Canada. Does anyone feel up to the task? I've read that wait times are published, but I have had trouble finding them. --Hauskalainen 02:12, 15 January 2009 (UTC)

You can find information at Canadian and American health care systems compared. Essentially insured people in Canada and the US can expect similar outcomes. However, the US government spends far more money on its programs (Medicare, Medicaid, etc.) than Canadian governments spend on theirs. Health care in Canada is not "socialized", only most health insurance. The Four Deuces (talk) 21:01, 27 February 2009 (UTC)

Duplication

The term "socialized medicine" is not used in many of the article's sources, so might be original research or synthesis here. I believe this article should just explain how various sources define "socialized medicine" ("The term socialized medicine, technically, to most health policy analysts, actually does not mean anything at all.") and provide links to other articles. The examples section should be just a list of possible "socialized medicine" systems: Health care in Australia, Health care in Canada, Health care in Cuba, Health care in France, Health care in Germany, etc.

"Political controversies in the United States" section is needless duplication of Health care in the United States and Health care reform in the United States.LincolnSt (talk) 01:41, 26 January 2009 (UTC)

The point you make has been made before and has been rejected. See the archived discussions. The issue is that although wikipedia has an article on publicly funded medicine this article is the right and proper place to describe government provision of health care. There are many such systems around the world such as in the UK, Finland, Spain, Cuba, Sweden, Norway etc. The term socialilized medicine has a long history. It was created in the U.S. to decribe such systems. Its origins go back to the early part of the 1900s when it was not as pejorative as it was made to become in the 1940s and 1950s. This article looks at the history of the term, and then looks at the implementations of socialized medicine in various countries. It also examines the debate in the US where the term coninues to arouse negative sentiment and where, in recent times, the meaning of the term has been extended by a few to cover all forms of government finance. Therefore the article touches on health care in real socialized systems in the US such as the services for veterans, as well as others such as Medicare and Medicaid. Because those who use the term tend to talk extensively about health care in the UK and in Canada in the context of the term socialized medicine the article also covers factual information about those systems as well as claims made about such systems. There is of course some duplication with other articles which is why there are references to those articles in this article. This article, which is not too long, gives the raw data and leaves it to the reader to explore in more depth if he or she wishes to do so.

As to your point about references the issue is simply this. The main users of the term of socialized medicine are using it with extreme political bias (and factual bias). If we just left this article to refer to others' use of the term then WP would be being used as platform for this one sided view. The present article is balanced in that it shows how the term is used and looks at the implementations of socialized medicine in various countries. People in the UK do not refer to socialized medicine, they use the term NHS. Its a synonym. In Canada they would say Medicare. In Finland, they say "public health system" as opposed to the "private health system". The umbrella term for such systems with the longest history and most understood in in the largest English speaking nation on the planet is socialized medicine. Which it was decided a long time ago to centre the information about such systems here. --Hauskalainen (talk) 02:31, 26 January 2009 (UTC)

Is "socialized medicine" a synonym for "publicly-funded health care"? My interpretation is that it is not ("rarely to describe similar health care programs in the U.S., such as the Veterans Administration clinics and hospitals, military health care,[32] nor the single payer programs such as Medicaid and Medicare").

If it is not a synonym, it is original research to claim e.g. that Israel has "socialized medicine". Who says it has?LincolnSt (talk) 02:56, 26 January 2009 (UTC)

Read the second paragraph in the article. This makes it very clear that some people use the term one way and other people use it another way. There have been many editors to this article and they have been comfortable with the Israel section being here. It would help if you use the talk page more before making radical changes to the article. --Hauskalainen (talk) 03:13, 26 January 2009 (UTC)

If no author says that Israel has "socialized medicine", the section needs to be removed, per Wikipedia:No original research.LincolnSt (talk) 03:30, 26 January 2009 (UTC)

How about an Israeli source? Dr Simcha Shapiro in an English language magazine in Israel? http://shiurtimes.com/private-medical-care-in-a-socialized-medical-system/

Just that kind of sources are needed here. Most of the sources don't talk about "socialized medicine" and many paragraphs don't have ANY sources.LincolnSt (talk) 09:10, 27 January 2009 (UTC)

I looked up the definition of "socialized medicine" in my 1993 Webster's Dictionary and it states: "(1938): medical and hospital services for the members of a class or population administered by an organized group (as a state agency) and paid for from funds obtained usu. by assessment, philanthropy, or taxation". But the people using the term now probably use the term "socialize" to mean "to constitute on a socialistic basis" (same dictionary). So it is a pejorative term and that should be clearly pointed out in the lead. The Four Deuces (talk) 21:21, 27 February 2009 (UTC)

It is already in the second sentence in the lead. --Hauskalainen (talk) 02:13, 28 February 2009 (UTC)

The lede says it is used "often pejoratively", which is not the same thing. The term "socialism" is also often used pejoratively in the US, but is not a pejorative term. If you look at other articles about pejorative terms, like Idiot or hillbilly, they are about the use of the term rather than respectively mental retardation and Appalachia. The same is true of other pejorative terms, which I will not list because most of them are even more offensive. The Four Deuces (talk) 17:09, 28 February 2009 (UTC)

If you look at the archived discussions you will discover that several other editors have argued that it is not a pejorative term and have delivered many references that do not refer to a pejorative use. I was originally of the same opinion as yourself, but I have now been persuaded otherwise. Some usage implies medicine delivered by government employees - i.e. they would not classify Canada's single payer system as socialized because many doctors are private business billing the government - a term which is sometimes known as single payer. But some users of the term such as NCPA and Cato have referred to Canada's system as socialized medicine. Therefore the article has to stand alone and cannot be merged into either article. There is no other article that looks at all forms of government involvement in medicine. It is unfortunate that there is not a less controversial term for this, but there you have it. This article looks primarily at the differences in various forms of public funding/public delivery in different countries and examines the issues that are often attached to the term socialized medicine (such as choice, cost, taxation levels, effectiveness, rationing).--Hauskalainen (talk) 12:01, 1 March 2009 (UTC)

For the record, in case I ever have to look it up, there was a story in the New York Times recently (I think today) about how the Republican Party is using the term "socialism" to attack the Obama policies, without success because nobody takes the charge seriously. This and other articles have said that they are using the term "socialism" incorrectly. It was not a neutral term. Nbauman (talk) 23:05, 1 March 2009 (UTC)

Here's another one: WSJ, OPINION, JANUARY 16, 2009, "Beware of the Big-Government Tipping Point; Socialized health care fundamentally changes the relationship between citizens and state. By PETER WEHNER and PAUL RYAN. (They're both Republicans.) They say that socialism will end health care innovation by discouraging research, give Americans a vested interest in the success of government, and set America on a "glide path towards European-style socialism." Nbauman (talk) 02:11, 2 March 2009 (UTC)

The references to Geier and T Roosevelt in the "Origin" section are misleading. Although Geier used the term "socialized medicine", he was talking about public health. He did not suggest that government should run or pay for health care. The cited source for this was Slate, which quoted a 1917 NY Times article. There is no connection between his use of the term in 1917 and the phrase entering the language in the 1930s. I have now changed the source to the actual original 1917 article. Also, Theodore Roosevelt did not advance public health insurance. I have now added a link to the 1912 Progressive Platform. He was talking about public health, e.g., enforcing health and safety standards. Suggest that both these references be removed.

By the way NCPA and CATO are not NPOV.

The Four Deuces (talk) 17:58, 2 March 2009 (UTC)

I for one do not read the NYT article from 1917 in the way that you do! Geier is certainly referring the "collective action" and "socialization" and speaking about re-organizing medicine along social lines for the collective benefit of the nation. In fact, the way he speaks of harnessing medical knowledge for the collective good is in much the same terms as the report that created the NHS in England. As the earliest use of the term "socialized medicine" it certainly belongs in the article! The 1912 progessive platform refers to "The protection of home life against the hazards of sickness, irregular employment and old age through the adoption of a system of social insurance adapted to American use", in other words National Health Insurance which is about as close to Socialized medicine as you can get. Both references should stay because they are both relevant.--Hauskalainen (talk) 21:33, 3 March 2009 (UTC)

Here's the actual quote form TR:

It is abnormal for any industry to throw back upon the community the human wreckage due to its wear and tear, and the hazards of sickness, accident, invalidism, involuntary unemployment, and old age should be provided for through insurance. This should be made a charge in whole or in part upon the industries, the employer, the employee, and perhaps the people at large to contribute severally in some degree. Wherever such standards are not met by given establishments, by given industries, are unprovided for by a legislature, or are balked by unenlightened courts, the workers are in jeopardy, the progressive employer is penalized, and the community pays a heavy cost in lessened efficiency and in misery. What Germany has done in the way of old-age pensions or insurance should be studied by us, and the system adapted to our uses, with whatever modifications are rendered necessary by our different ways of life and habits of thought. (Before Progressive National Convention, Chicago, August 6, 1912.) Mem. Ed. XIX, 376; Nat. Ed. XVII, 269.

I thought that "socialized medicine" in this article referred to government-funded health care. Or is it broad enough to include any legislation or government or community action related to health (as Geier and TR proposed)? If anything the brief references in the article need better explanation.

Here's the link to the NYT article: "World at War is Facing a Shortage of Doctors". I would appreciate any opinions on this. The Four Deuces (talk) 23:44, 3 March 2009 (UTC)

"a charge in whole or in part upon the industries, the employer, the employee, and perhaps the people at large" sounds like Mr Roosevelt and pals had been reading about the National Insurance Act 1911. This introduced "the panel" system of health care for employed persons funded from insurance on the employer and the employee. The NI contributions from the employees and employers funded the system, though the government provide some funding also. The workers and managers jointly made up the panel in each firm which employed doctors directly and claimed back doctors' fees from the NI Fund which was managed by Commissioners established by the government. By "employed" here I mean that doctors had the choice whether or not to be part of the scheme. The A J Cronin novel The Citadel from the 1930s was in part about that system and also about the corrupt practices of private doctors at the time. Doctors could apply to be part of the scheme, in which case a panel (comprising workers and management) interviewed the doctor before he could be approved as being part of the company scheme. The employees, having paid their insurance from wages, received free medical services from their choice of doctors who were "on the panel". The German system of social insurance informed the drafters of the English bill (see for example http://hansard.millbanksystems.com/commons/1911/may/09/national-insurance-bill-1#S5CV0025P0_19110509_HOC_262), though I don't know how the medical staff were employed. The Bill creating the NHS effectively resulted in the scheme being extended to all residents (not just working men and their families) and also took the hospital system into national ownership (they had mostly been charitable institutions up until then). It seems like socialized medicine to me. It is a form of insurance set up by the government and paid for by contributions from the public, employers, and employees. Whether you call them taxes or National Insurance is not really that important. --Hauskalainen (talk) 03:34, 4 March 2009 (UTC)

I think that the Progressive plank and the the NI Act both were inspired by Germany's health system. Anyway I found an article called "What is Socialized Medicine?" from 1938. http://www.marxists.org/history/etol/newspape/ni/vol04/no12/harvey.htm In it the writer explains how the term has been used. Both James Burnham and Max Shachtman were editors of the magizine. The Four Deuces (talk) 15:46, 6 March 2009 (UTC)

Interesting. --Hauskalainen (talk) 23:12, 8 March 2009 (UTC)

Blocking request for User:LincolnSt

Editors may wish to be aware that I have today placed a blocking request on User:LincolnStfor perisitently vilolating the spirit of editorial co-operation, for demonstrating bias in his edits, for depleting the usefulness of WP articles on health care to its readers and for making changes so rapidly that they seem to be planned aforethought and dumped on the editing community. See http://en.wikipedia.org/wiki/Wikipedia:Administrators%27_noticeboard/Incidents#Blocking_request__User:LincolnSt for examples and to express your thoughts if you have any.--Hauskalainen (talk) 08:35, 29 January 2009 (UTC)

Hauskalainen, you have never argued anything in the talk page. An editor associated with you, Cosmic Cowboy (talk · contribs), has already received a last warning from administrators.LincolnSt (talk) 10:35, 29 January 2009 (UTC)

What do you mean "associated" with me? The user complained about you after you accused him of spam linking. I defended him because I thought you were being unfair. We have had a few public conversations about you and that is about it. I do not know this person and certainly do not edit in concerted action with him. And your comment about the use of the talk page is a bit rich coming from you. I am a frequent user of the talk pages. As far as I can see, none of your considerable efforts in the past seven days have been made with a single prior discussion in Talk. This is why I went directly for the block request to get your edits into the more normal practice of co-operative editing. --Hauskalainen (talk) 17:03, 29 January 2009 (UTC)

Secularizing Catholic hospitals

I noticed that while the expression socialized medicine implies that most private hospitals are purchased by the State, hospitals affiliated to a particular religion (such as those in the Catholic health care system) are forcibly secularized since the government cannot continue to finance such hospitals without violating Church-State separation laws. In Canada, virtually all Catholic hospitals were secularized in the 1960s and 1970s after the government took them over. This has not happened yet in the United States, but it might well begin to happen under Barack Obama, since the recent administration has indicated that it is not willing to tolerate or accept conscience clauses that protect Catholic health care workers from being obliged to proceed to an abortion. ADM (talk) 00:14, 23 March 2009 (UTC)

Extremely Biased

I find this article to be extremely biased and unfair against the US, the tone of the article implies that we are in some way evil or wrong for not having a nationalized health care plan. There is no mention of the fact that that it would cost 1.6 trillion dollars to insure only 26 million people, no mention that only 47 million americans dont have health care and of that 60% are illegal citizens and ten million make 75 grand a year and choose to not have any. There is also no mention that most americans are happy with their health care, or no mention of Brits paying 70% income tax to fund their health system.

So all in all, it is very unfair and considering health care is becoming a top issue here i think journalistic integrity should be applied and just report the facts. The U.S. cant sustain it right now, so dont try to push it to our people like its some great thing we miss out on. I like being able to actually go to the hospital when i need to, not wait 3 weeks to get a cast on my arm. —Preceding unsigned comment added by 208.39.173.54 (talk • contribs)

Where does the "1.6 trillion dollars to insure only 26 million people" figure come from? In Canada, for 2007 the figure was $160 billion to insure 33 million people (see Health care in Canada). I doubt it costs ten times as much to insure fewer people in the US. Further, none of your claims are supported with evidence. For example, where did you get the 70% taxation rate for Britain (see Taxation in the United Kingdom for some details). This article surely needs work, but what you claim in your comment isn't appropriate for the article, especially the ridiculous statement that one must wait three weeks for a cast. Mindmatrix 15:19, 24 June 2009 (UTC)

Neither does the article claim that the United States is "evil or wrong" and nor do I see any reference to a "nationalised health plan". This anonymous IP user is clearly engaging in political action by saying what he says. The highest rate of income tax in Britain is 40% and not 70%. Some people pay no income taxes at all! I am inclined to delete the comment as it has absolutely no reference to the article or any element of reality. --Hauskalainen (talk) 14:16, 15 August 2009 (UTC)

What a muppet! Of course its biased against the USA - that's because some Americans are too stupid or selfish to want healthcare funded by the government rather than people paying for it out of their own pockets and leading to a situation where the rich get better care. Healthcare is a basic human right but it seems not in the USA. So what Brits pay 70% income tax for the NHS? You din't give any examples, that's because there are none. And the NHS is funded through National Insurance and not income tax. You Americans already fork out thousands per capita fighting wars for oil and in the pursuit of American capitalism and the rich spend thousands on their own health care - don't Americans give a shit about the less unfortunate? Even if you're some dickhead investment banker you may feel happy right now but lose your job and pretty soon you'll be without healthcare too. Americans value crap like free speech (i.e. allowing racists the right to abuse people) and the right to own a weapon (despite having one of the highest murder rates and the fact that most murders are caused by family members) yet the right to good healthcare is less important? What a fucked up country!--217.203.133.11 (talk) 14:37, 15 August 2009 (UTC)

While not agreeing with the ranting above this page is in need of serious work; just a couple off the bat as I'm tired. In general the entire page has a rather large slant towards one side of this issue and inadequately represents opposing viewpoints. For example, section "Political Controversies in the United States" much of this section employs dubious sourcing, one sided unfounded claims and misrepresentations. Eg. 1 "Republicans are broadly in favor of the status quot or else a reform of the financing system to give more power to the citizen, often through tax credits" this is blatantly untrue with bipartisan efforts in the Financial Services Committee and two separate Republican bills that have been put forward, generally speaking Republican suggestions cover; removal of inter state insurance purchase restrictions, balancing of the tax code to equalize deductions for individuals and employee plans and removing the linkage between employment and insurance provider.

Eg. 2 Cost of Care Subsection; "Socialized medicine amongst industrialized countries tends to be more affordable than in systems where there is little government involvement." This is a rather laughable line even when not expecting serious economic discourse from wikipedia. First off how the section can fairly compare costs without mentioning per capita income. No one doubts the mandated costs of public health care are cheaper, they simply counter that the difference is paid in full and then some in reduced per capita income and higher taxes, i.e France's structural unemployment rate of 10% and general basketcase economy, (but hey the opening statement would still hold true!)In any case a raft of strong counter arguments are available on the same pages that have been referenced in other area, their omission is highly suspect.

Eg. 3 Quality of Care Section; The use of WHO rankings as a serious source is also dubious, first the reports do not focus on healthcare provided but rather average life expectancy, needless to say when 60% of the adult population is clinically obese and you have the highest crime mortality rate in the world it doesn't matter who is paying for health care. The reports have also come under fire as in normal UN fashion the WTO simply collected data sets from individual governments, i.e Cuba, again all of this is old news within current debate and should not be omitted.

Eg. 4 Rationing Section; this entire section is an absolute disgrace so Ill just post and critique in ()

Some (who?) argue that in countries with socialized medicine governments use waiting lists as a form of rationing but there is little evidence to prove this (Source?). Waiting lists in socialized system record all those in need and give highest priority access to those in greatest need. Some think that this is more humane ('humane' is subjective and regardless humane rationing is still rationing) than rationing via the patient's ability to afford the necessary health insurance coverage and associated co-pays, deductibles, exclusions, and cap excess, and where a person who may have greater need (subjective) is rationed out on affordabilty grounds to someone who may be in lesser need(subjective)

In general the concept of 'rationing' in relation to public health care is not equivocal with denial of service under private systems. Under 'socialized medicine' funding is mandated through taxation and levies to a set budget, this set budget has to be divided amongst X patients, division equals rationing. Do you consider McDonald's refusing to serve a customer with no money rationing? Or would you consider it more humane if McDonalds told paying customers to wait behind a broke man because he was hungrier then you? I hope I've highlighted how "humane" is hardly a word for an objective sentence.

Could go on for ages but will be back after rest. —Preceding unsigned comment added by 123.243.152.114 (talk) 17:33, 18 August 2009 (UTC)