Talk:Socialized medicine/Archive 1

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Extremely biased

This article loses wikipedia some of it's credibility. Admins have to be objective and clean these articles of their one-sidedness. —Preceding unsigned comment added by 74.76.253.228 (talk) 03:11, 6 November 2007 (UTC)

Criticism Section MUST BE CHANGED

The section on criticism is completely, painfully biased. That you've provided criticism of the criticisms as a sort of final talking point is absurd. Delete them, or I will.--J.Dayton 12:53, 1 November 2007 (UTC)

Calm down. We've put a lot of work and debate into that section, before you got here. Almost every WP article has a criticism section. If you want to do something constructive, try to improve it. (And if you do, you'll see how difficult it is to write a fair, balanced, NPOV criticism section.) It does need rewriting, but blanking out the section is vandalism. We'll revert it.

And when you add a new comment in the talk section, you should add it to the bottom, not the top. That's what the "+" tab at the top of the page is for. Nbauman 14:34, 1 November 2007 (UTC)

Nah, I've been on the page for about a month now. This is the first time I've tagged with a handle. Sorry about the top/bottom thing; but the section should be removed. It isn't vandalism to remove it; it's making a criticism section a criticism section, instead of a criticism of criticism section.--J.Dayton 21:56, 1 November 2007 (UTC)

Criticism section totally biased

Refutations of the criticisms are presented as the final word, most of them nothing more than assertions and shifty rebuttals that don't address the criticisms they say they do. —Preceding unsigned comment added by 65.207.7.91 (talk) 12:49, 29 October 2007 (UTC)

Everything about this article is completely biased, but you're right - the criticism section is particularly heinous. How do you go about requesting the deletion of an article?--J.Dayton 12:50, 1 November 2007 (UTC)

Opponents of socialized medicine

Opponents of "socialized medicine" pretend that all "socialized" systems are like the British NHS. This is not true and makes for biased commentary. David.Monniaux 10:24, 1 Apr 2004 (UTC)

Why the hell is there "commentary" at all? Also, the POV I see in this article all seems to be coming from the author of the article. Personally, I think the whole thing should be trashed.--69.253.92.203 22:47, 26 October 2007 (UTC)

I'm puzzled by the penultimate para suggesting that British medicine is somehow segregated. AFAIK that's wrong; traditionally consultants have been very involved in the NHS and private practice, and currently there is some intention to have junior consultants wait longer before going completely mixed. The beds situation is mixed (perhaps less so than was?); the real political bone of contention seems to be the fourth option, of NHS patients being treated via spare capacity in the private sector. Anyway, I don't find the way it is put very convincing.

Charles Matthews 14:00, 7 Apr 2004 (UTC)

Opprobrium

Users of Wikipedia may be unaware that "socialized medicine" carries political overtones and messages of opprobrium. Those associations began in the mid 1930s as the (U.S.) American Medical Assciation reacted with a public relations campaign to proposals emerging from the Committee on Economic Security headed by U.S. Secretary of Labor Frances Perkins[1]. The short article that has been inserted to replace the former redirect to Publicly-funded medicine is intended to describe controversies involved with the phrase.

Craig Bolon 14:24, 16 April 2006 (UTC)

Regardless, many sources online that define the term do not suggest that it is necessarily derogatory, but is more commonly used literally, to describe a type of health care system. Therefore, I do not think it is appropriate (NPOV) for Wikipedia to define it as such in this article. Of course, we should have information in the article about the origins of the term. Kborer 00:37, 17 January 2007 (UTC)

Do you remember back in the 80s when Predisent Reagan stated that "...progressive tax is rooted in Marxism..."? I don't, because I wasn't born yet. But I have heard about it. What Reagan was doing was using fear/negative association tactics to prevent a rational discourse on the subject from taking place. People thought, "...well it must be bad because it comes from Marxism..." -- something that was still quite feared in the US in the 1980s. The point I'm trying to make is that Socialism in the United States remains somewhat of a "bad word". When conservatives refer to the term "socialised medecine", they are attempt to instill fear into their viewers/listeners by having them think "Yikes, univseral healthcare means socialism...". Most political scientists would agree that universal healthcare is reflective of socialism, but it's the way the term is used that leads me to believe it should be noted that it can be used in the pejoritive sense. At least in the United States. In Europe as we know, socialism is more accepted, so the same condition does not necessarily apply.(EnglishEfternamn 19:18, 18 January 2007 (UTC))

Dude. The term "socialism" isn't used negatively because Republicans actually believe its a good thing but want to smear the hell out of it. They, and most Americans, believe that socialism will actually tank the economy and destroy our society. They have historical evidence supporting the fear (Germany, Russia, China), and a bunch of Democrats touting socialist principles. Also, universal healthcare is a form of socialism. Why are we pretending it isn't? This is the problem with Wikipedia: a bunch of people with very strong political ideas trying to re-write history and re-define words and terms to fit their agenda. --69.253.92.203 16:01, 23 October 2007 (UTC)

You make your own point very nicely :) --Tom 21:14, 23 October 2007 (UTC)

I can't find a specific quote from Ronald Reagan attributing progressive taxation to Marxism, but I know that is a common belief. According to Herbert Stein's review of an edition of The Wealth of Nations on the Wall Street Journal editorial page, it was Adam Smith who first advocated progressive taxation, because those who benefited most from society had an obligation to bear a disproportionately greater proportion of the cost of running society. Curiously the Wikipedia pages on Adam Smith and Wealth of Nations don't mention that. Nbauman 23:38, 14 February 2007 (UTC)

It isn't curious at all. None of this shit is information; it's wikimation, and that means liberal: especially when you happen upon an article like "socialized medicine." --69.253.92.203 22:50, 26 October 2007 (UTC)

Your first point is that the term still carries negative connotations. However, if you observe present day discussions of health care you will see that many proponents of socialized medicine refer to it as such. They point to the social health care systems currently implemented in various nations as examples of good health care policy. Furthermore, most resources that define the term do not even insinuate that it might be used disparagingly. Your second point is that it is important for the article to recognize that the term can be used in a denigrating way. I agree that this should be included in the article as a historical note. I do not think it can be justified to include it as part of any definition, especially in the introductory paragraph, as that immediately colors the term in a way that is not consistent with common usage in a very biased way. Kborer 01:01, 19 January 2007 (UTC)

Proponents of "socialised medicine" refer to it as just that? In the United States, or in Western Europe? Because I am fairly that doing so in the former region will only hurt your argument, again, think negative associations. Conservative radio host Michael Savage stated that "...universal healthcare is just a propaganda term for socialised medicine...", I doubt he was using the term in a favourable sense. The term is used at times to try to devalue the argument for public healthcare and this is why I don't think it biased to include this information in the introductory paragraph.(EnglishEfternamn 05:10, 19 January 2007 (UTC))

I think these comments are indicative of the confusion that surrounds this particular topic. Universal health care and socialized medicine are distinct ideas. It is true that when a government socializes the medical industry, it generally does so in such a way that the benefits are universal. On the other hand, a government could mandate universal health care without socializing the medical industry. You are correct that someone who is in favor of socialized medicine might call it UHC, and I think a discussion of this would be an excellent addition to health care politics. Furthermore, it is important to understand that the reasons behind these semantics go beyond the simple fear mongering of the last century. However, the point of this article is to explain what socialized medicine is. Defining it as a pejorative phrase in the introductory paragraph gives the wrong impression to the reader. I think that these points are more appropriate in sections on the history and politics of socialized medicine, both of which could link to more involved articles. Kborer 19:04, 19 January 2007 (UTC)

Oddness

This page is a bit odd. It reads a little like somebody has just invented definitions for things and decided to write about it. The lack of references reflects this. The "Universal health care" section, defined as different to "socialized medicine" because the former isn't required to "be controlled or funded by the government" is one of the oddities, for instance. I don't know of any universal health system that isn't "funded" by government, and certainly can't even imagine one not in some way "controlled" by government - even US health care, which is certainly not universal - is regulated by law. I suggest changing this, or if I'm wrong, putting references in. Wikidea 18:20, 21 May 2007 (UTC)

Just for notice, the German public health insurance system is neither funded nor run by the government or an government institution. The somehow 200 public insurance companies finance themselves exclusively through the contributions of those insured, and they are run by them (the managers of the insurance companies are elected by those insured, thats why they are called public). They underlie, of course, heavy legal regulation. But the great problem with defining socialized medicine is, that there probabily is no unique definition, as it is used to label quite different things. Jonas78 17:01, 27 July 2007 (UTC)

Where?

Being an Australian I have never heard of this term before. Is it used any where outside of the US? Ozdaren 02:19, 28 June 2007 (UTC)

I'm British, and have only ever come across it in an American context. To generalise to the extent that it is "often used to describe publicly administered health care systems such as the British National Health Service" is simply not true: the phrase is barely ever used by Britons. I'm going to change it to "often used in the United States". 86.132.137.231 00:57, 26 July 2007 (UTC)

Introduction

The introduction, as it is currently written, is confusing. Was socialized medicine originally a used as a term to invoke contempt? Yes. Is that fact so important that it needs to be injected into the opening sentence that gives the definition of the term? No. The other claims that were added are also out of place. The first priority of the introduction should be to explain what people are referring to when they say socialized medicine. Kborer 14:25, 16 July 2007 (UTC)

I think it's important to mention in the lead that it's pejorative. I agree that the first priority of the introduction should be to explain what people are referring to when they say socialized medicine. But every time people mention socialized medicine, they are communicating the fact that socialized medicine is bad (except for Reinhardt, who was picking up on the term that somebody else used pejoratively). It's not a formal term used in medicine "socialized+medicine" If a word is pejorative, that's an important part of the meaning. See Nigger.

The Reinhard paragraph probably should go further down in the article, though. Nbauman 17:48, 16 July 2007 (UTC)

Stedman's does define the term socialized medicine, and you can verify it online at http://www.stedmans.com/section.cfm/45

Comparing the term socialized medicine to nigger is a joke. This is a term used in everyday conversation, in the media, and by politicians. The only negative connotation that the term socialized medicine carries is from association with socialism. If you like socialism then socialized medicine will have a positive connotation. Opponents of socialized medicine tend to use the term in the United States because socialism has a negative connotation there.

Your reference above simply states that socialized medicine is a synonym for state medicine, and then gives a similar definition to the one given by Stedman's. Neither of these references mention that the term has negative connotations. Kborer 13:08, 18 July 2007 (UTC)

socialized medicine the organization and control of medical practice by a government agency, the practitioners being employed by the organization from which they receive standardized compensation for their services, and to which the public contributes usually in the form of taxation rather than fee-for-service.

OK, I'll accept that. But PubMed shows that it's not a term used in the formal language of medical journals.

You agree, don't you, that the term "socialized medicine" is used primarily by people who oppose it, that its use signals the author's disapproval, and that it's pejorative, as documented in the body of the entry? You agree that that's part of its meaning, right?

The only point of difference between us is whether that part of its meaning is important enough to include in the introduction, right? Nbauman 19:16, 18 July 2007 (UTC)

Regardless of whether the term is pejorative, the idea that people who oppose government health care call it socialized medicine should be included in the article and expanded upon. As you said, my primary concern at this point is how this information should be conveyed to the reader.

As it currently is, the article treats the term as if it is were some sort of slur. This approach is counterproductive. The term has a legitimate meaning that is currently disregarded, along with its history and political nuance.

The opening paragraph should start with only a definition of the term and an example to make it easy to read and understand. Other information should come later in the article, be it in the opening or in separate paragraphs.

I will rewrite the introduction to show what I mean and we can go from there. Kborer 13:48, 22 July 2007 (UTC)

Of course it's a slur. Here's an article in the current issue of the British Medical Journal:

[2] doi:10.1136/bmj.39279.711748.47
Observations
Atlantic crossing
Getting America to take the shame
Uwe E Reinhardt, James Madison professor of political economy, Princeton University, Princeton, NJ, United States
Film maker Michael Moore is to be thanked for holding up mirrors to the US healthcare system
Long before American film maker Michael Moore's Sicko opened at cinemas around the nation on 29 June (review BMJ 2007;335:47), his oeuvre had triggered a firestorm of protests from the right of the political spectrum. Its inhabitants still unquestioningly regard America's health system as the best in the world and routinely write off all other nations' health systems as "socialised medicine," a derogatory label in these latitudes.

I challenge you to find a verifiable source on the Internet that I can look up in which someone uses the term "socialized medicine" who supports it.

There is a value to doing it your way. Anyone who starts to read this article will immediately realize that this is a biased article, hostile to government-run medicine. It's better than putting a Disputed tag at the top of the article. Nbauman 04:49, 24 July 2007 (UTC)

It is clearly perjorative and widely recognised as such. As several non US editors have said here on this talk page, the very term socialized medicine is not used in the UK, Ireland or Australia and to them sounds odd and loaded. I also found this interesting link with some history. I personally think the fact that it is used perjoratively to sway opinion is something that should be mentioned. http://encyclopedia.thefreedictionary.com/socialized+medicine --Tom 23:59, 5 August 2007 (UTC)

The reference listed above by Tom is a site that copied an old version of this article. Kborer 11:43, 17 August 2007 (UTC)

Graphic

Congratulations Kborer on your new graphics editing program.

What is the system in the quadrant labeled "government monopoly"? Where is there a system with private financing and government employment? Nbauman 19:24, 1 August 2007 (UTC)

It does not happen with the health care industry, but an example would be the United States post office. Kborer 20:42, 1 August 2007 (UTC)

Re Kborer edits of August 5, 2007

To Kborer. I am tempted to revert all your edits of today. I need to understand why have you stripped out huge chunks of my edits without explanation. To understand where we differ perhaps you will be good enough to explain, point by point which of the following statements you object to and why?

1 Socialized medicine is one where the government contributes towards health care (The American Heritage® Dictionary of the English Language http://ie.thefreedictionary.com/Socialized%20medicine)

2 Socialized medicine (is contrary to 1. above) used by some people (hereinafter called the contrarians) to mean only systems where medical workers are not employed by the government.

3 Single Payer is where a single body, assumed to be the government, contributes towards health care costs

4 Single payer is a form of socialized medicine according to the definiition in para 1. above but not according the contrarians

5 There are two extreme models of public funding for health care depending on whether the medical work is done by government workers and not billed to patients (eg the UK's NHS) and one where the work is done by private practioners and billed, in whole or in part, to the government (e.g. Canada's Health care system). The contrarians as I have defined them call the first socialized medicine and the second single-payer

6 In Single Payer systems proposed by the contrarians for the US, public money will go into the hands of private medical providers.

7 In forms of socialized medicine (as defined by the contrarians) where all health care workers work in public institutions, no money passes through the hands of private insurers or private medical practice, and there is no billing for health services, either to the government, the patient, or to an insurer.

8 The UK NHS system has only one payer, the government

9 Two-tier health care (a mix of public and private health care) is the form that is used in most developed countries.

I can't wait to hear your reply.--Tom 23:19, 5 August 2007 (UTC)

While I was not specifically removing edits that you made, and these points do not seem directly related to the text that I removed, I'll be happy to discuss them with you.

1 - This would mean that everything besides free market health care is socialized medicine, which is not the case.

2 - I think you mean the opposite of what you said, and if so I agree with you.

3 - Single payer is when the government is the only contributer.

4 - Some people will call a health care reform "socialized medicine" when they mean that it is "moving closer to socialized medicine".

5 - Right.

6 - People who call single payer 'single payer' have proposed single payer? That is true.

7 - Yes.

8 - I'm not sure.

9 - No country that I know of uses purely one system. Even in Canada, where it is illegal to have private health care providers, they have a mixed system. Kborer 16:54, 6 August 2007 (UTC)

So fundamentally, you do not disagree with anything I wrote, but somehow you accidentally managed to removed all my edits that make these things clear. How interesting! I could put them back, but on balance I'd be more favourable to the idea put forward by Gregalton that we cut the article to the bone. (See also my edits of earlier today). --Tom 14:52, 7 August 2007 (UTC)

Currrent article deficiencies

I made the comments 1-9 in the section above on the basis of looking at the differences between the edits one-by-one. Having just re-read the final article I have some comments (A-F) below on why the article is still poor

A. The dual axis graphic now does not agree with the text.

B. The dual axis graphic did not achieve consesus on the Talk page for its inclusion and should be removed from the article.

C. It is very obscure to start talking about single payer when in most countries with socialized medicine, single payer is not the most common model.

D. It would be much better to have a section on funding (where sources of funds for socialized medicine could come from, e.g. patients, insurance funds, employers, state or federal taxes etc.) and another section on dispersals (payment to public hosptials, payment to private hospitals, payment to physicians, payments to pharmacies etc).

E. As medicine is almost always socialized (as you call it) to make it universally available, this just needs to be mentioned in the header with a link to universal health care. There is no need for a seperate section on this.

F. The triple axis graphic has no relevance to the article and merely obfuscates matters.

Comments on A-F above are welome from all editors --Tom 01:48, 6 August 2007 (UTC)

I think the key point for this article is the section on the meaning of the term; for the most part, there is no meaning beyond the pejorative way it is used, and an intro to that effect and links to other relevant articles is all the article really needs.--Gregalton 07:58, 6 August 2007 (UTC)

@Gregalton - Is there another term for types of health care systems with public financing and public employment? Socialized medicine is used to refer to that, but if there is some other more common term I think that is an important point we are missing. It seems that at some point socialized medicine just meant public/public health care. [3] Kborer 16:54, 6 August 2007 (UTC)

A - The dual axis graph does not agree with the text after someone removed referenced text without discussion.

B - There was no discussion of whether it should be included or not.

D - or maybe just one section describing how financing works as a whole.

E - agreed.

F - I am fine with that if other people agree with you. Kborer 16:54, 6 August 2007 (UTC)

Is there another term? State-run health care. And the definition as public financing/public employment is not broadly accepted (to the point that the term is predominantly used, and only in the U.S., to refer to the Canadian system, whereas as you point out the public financing is not entirely accurate, and the public employment massively inaccurate). The problem is, as far as I can tell, and as documented by Reinhardt and others, socialized medicine appears to be a term originally used solely to characterise (negatively) public / universal health care (no matter how broadly defined) as socialist. It has essentially no meaning outside of that context. (For example, to my knowledge was not used in any purportedly socialist country to refer to their medical systems - although I must admit, it may have been used, in the same way that the fire service, heating service and virtually every other service/industry was referred to as 'socialist.') It was only ever a pejorative term with no precise meaning. To include a lengthy article on anything except that etymological origin is misleading. IMHO.--Gregalton 17:20, 6 August 2007 (UTC)

"State run health care" would mean a class of systems where the government employs the medical professionals. That could be socialized medicine or government monopoly, but not single payer insurance or free market.

I do not agree that the term has no meaning outside of negatively characterizing public / universal health care and, if you would like, we could discuss that in a separate section.

Also, is it not obvious that people use the basic terms for the status quo, and then add modifiers for things that are different? If a country started using a private defense system, people would call the new system "privatized" rather than calling the old system "socialized". Kborer 18:15, 6 August 2007 (UTC)

gregalton, it's well known that insurance is a risk management system, whether public or private. If it's a public system in which participation is enforced by law, that's socialism. If it's optional, it's capitalism. Pay attention to the premises and you'll make more sense here. --65.78.214.195 04:17, 7 August 2007 (UTC)

I stand corrected! Clearly we have been insufficiently vigilant about the rise of the pernicious compulsory automobile insurance bolshie revolutionaries, whom I presume are the vanguard.

But seriously, my main complaint is the complete blandness of the opening definition: "Socialized medicine or state medicine is a system for providing medical care by means of government regulation and subsidies derived from taxation. [1] Socialized medicine can refer to any system of medical care in which the government helps to meet the health needs of the population." This is so broad as to apply to virtually any medical system in the world, hence, it approaches a state of utter meaninglessness. Is there a proposed definition that is actually precise enough to mean something?--Gregalton 13:04, 7 August 2007 (UTC)

I agree, the definition was better a few days ago. I am going to change it back, since it was referenced and not discussed before deletion. Kborer 00:41, 8 August 2007 (UTC)

To User 65.78.214.195. By that argument the US has socialist fire departments and a socialist road network, because these are forcible funded from taxation. Most people on the other hand would think of these a public service provided for the people, by the people, and under the democratic authority of the people. This is how countries that have provided universal health care through public hospitals view these services.

The difference between countries that have public funding through either a "single payer health care" system or a "socialized medicine" system is this.

• Socialized medicine is like the non-toll road network; it was paid for out of taxes but everyone knows its there and can use it for free. You still have the choice to use a private road and pay the operator's toll if they have covered all or part of the same route but the government won't pay the toll for you.

• Single payer medicine is, using the same analogy, as though all roads were built by different private companies and there were no toll-free roads. You get to choose which road to take. You can get the toll re-imbursed, in whole or in part, by sending the receipt to the government. However, you will only get reimbursed at a basic rate per mile and only if the route is one that meets the rules layed down by the government. If you choose the wide fancy road with the higher toll you have to pay the difference in cost or make a mistake and choose a route not covered by the refund rules, you'll get nothing back.

Defenders of "socialized medicine" prefer the first of these two options because it is more efficient. --Tom 13:49, 7 August 2007 (UTC)

To Kborer. Like Gregalton and several other contributors (and confirmed by dictionaries), the term "socialized medicine" is deliberately perjorative and is not used outside of North America, and certainly not in any of the places that have implemented it as public policy. So I agree with Gregalton that the article should be stripped down and the details moved to an article with a more widely understood and neutral name. I would prefer "Publicly managed health care" myself as it would be less confusing to US and Australian readers of Wikipedia for whom the word state can refer to "nation state" or "territorial state", and would cover countries like Finland where the hospitals are owned and run by the municipalities. The services of the veterans hospitals would be a good example of publicly managed health care in the US. As for your argument that state run health care could mean public monopoly health care, we have already agreed that this does not exist anywhere in the world (as far as anyone has yet determined), which is one of the arguments put forward for the removal of the graphic. That could easily be explained in the moved article.

To Gregalton. As for definitions I'd suggest that we create an article Publicly managed health care which defines it as "health care that is managed by public bodies established by government under democratic accountability". Apart from losing the perjorative connotation, that is what "socialized medicine" really is. So really all this current article needs to say is that "Socialized medicine is a perjorative term used in North America for Publicly managed health care. It should then discuss the history and use of the term, but information about the various types and styles of public medicine should go into the new article. The arguments used in the US debate are more appopriate to the specific article on health care in the United States --Tom 14:13, 7 August 2007 (UTC)

A reasonable suggestion (but then, I agree with you), and expressed far more eloquently than I'd have done. Publicly managed health care (or just public health care?) is certainly better than state-run. Of course, if there is a more standard term I'd be fine with using that as well.--Gregalton 14:47, 7 August 2007 (UTC)

@Tom's above post Well, there are several sources that do not define or use socialized medicine as degrading. Regardless, if there is a more commonly used term for publicly funded, publicly operated health care, then we should use that. Kborer 00:41, 8 August 2007 (UTC)

I included the term "managed" because it distinguishes it from other forms that are publicly financed but not publicly managed. I was thinking along the same lines myself after I instinctively used the term "public medicine" in my edit of 14:13 (UTC). Do the US editors here think that so called "single payer" health care could be confused with "public medicine"? "Public medicine" is snappier than "Public health care" or "Publicly managed health care", but I think the later is more self explanatory. --Tom 15:30, 7 August 2007 (UTC)

Given the ambiguity and overlap, I think either would do, and shorter is better. I personally think 'public medicine' sounds odd - medicine is rather more clinical, but this is just an opinion.--Gregalton 15:48, 7 August 2007 (UTC)

"National health service" is the term that the British uses for their health care system. I think most English-speaking countries use that term for government-run health care systems. "Public medicine" has a specific meaning of public health interventions like vaccinating populations and providing good sanitation.

Wikipedia has a rule against neologisms, so you can't create an article heading with a phrase that isn't in common use already. Nbauman 17:02, 7 August 2007 (UTC)

The rule is to "avoid". This may be one where we have to compromise based on a range of views because essentially the same thing is referred to by people in different English speaking nations using different terms. In the UK people we refer to the choice alternatives as being "NHS or private", shorthand for "using the public health care system or using the private health care system". If there is to be a general WP article on the concept then it would not be acceptable for it to be called "socialized medicine" because for people outside the US (and I suspect for some inside too) it is not NPOV. There is already an article called National Health Service which is about the specific UK system. --Tom 17:38, 7 August 2007 (UTC)

Saying that the term itself is not NPOV is absurd. Kborer 00:41, 8 August 2007 (UTC)

Hah! I just look at the oldest edit for the page (back in 2002) and apart from the history, it says much of what needs to be said. If we now get rid of those graphics and the unnecessary reference to that ambiguous term "Single Payer" (which adds nothing IMHO) I think it would be a much better article. --Tom 18:00, 7 August 2007 (UTC)

I'm more depressed. If you look at the article history, this whole discussion has been gone through several times in very similar forms. Wikipedia is doomed to repeat its history cycles, seems to be the lesson.--Gregalton 19:32, 7 August 2007 (UTC)

Clarification: do you really mean to say that the term socialized medicine is neutral? That is the meaning of pejorative. Do we need to discuss how "socialized medicine" sounds like "socialism", and the use of that word in political discourse in North America?--Gregalton 04:24, 8 August 2007 (UTC)

As far as I can tell it is not pejorative by definition. I am willing to debate this in a separate section if you would like. Using the term in certain ways might violate NPOV guidelines, but the term itself does not inherently violate them. Kborer 16:02, 8 August 2007 (UTC)

Can 'socialized medicine' be a neutral article title?

All right. I submit the term is pejorative by definition. Other definitions of the term are vague and imprecise, as previously discussed. The usage as an article title (about health care, rather than as a politically-charged term) gives credibility to a term that has no credible meaning or definition in an encyclopedic context. Its use originates in, and is defined by, attempts to discredit publicly funded or managed health by association with socialism. Attempts to use it in a non-pejorative sense will necessarily fail, and not be understood/be misunderstood outside the context of the USA (and possibly Canada, by media overlap) due to a) the vagueness and b) the political context. By analogy, one cannot use a racial epithet in a neutral way; in the only country in which it is commonly used, the origin of the term is dominated by the loaded context of socialism (i.e. opposition to).

Clearly, this requires some potential tests as to whether I may be wrong. So I'll suggest the following:

1. Usages outside North America that are not loaded or in reference to North America.
2. Precise usage of the phrase that may permit a reasonable definition of what the term means (preferably outside a for/against context).
3. Consistent usage by health/public administration professionals/economists in a precise, non-pejorative sense, and without qualification to more precise terminology.

These are just some initial thoughts on the issue; my gratitude that you're approaching this in good faith. While looking at the NPOV policy, the best directly relevant part I could come up with is this:

"Sometimes the article title itself may be a source of contention and polarization. This is especially true for titles that suggest a viewpoint either "for" or "against" any given issue. A neutral article title is very important because it ensures that the article topic is placed in the proper context. Therefore, encyclopedic article titles are expected to exhibit the highest degree of neutrality. The article might cover the same material but with less emotive words, or might cover broader material which helps ensure a neutral view (for example, renaming "Criticisms of drugs" to "Societal views on drugs"). Neutral titles encourage multiple viewpoints and responsible article writing."

As per above, my interpretation is that 'socialized medicine' as a title is so inherently loaded that it effectively is akin to titling the article "Government health care equals socialism." (Okay, I'm exaggerating a tiny bit, but see the comment by the IP user above). If the article simply refers to other, more neutral terms, that are also more precise, the encyclopedic approach would be better served. Or, to refer specifically to the policy, socialized medicine as an article title "suggests a viewpoint against" the issue.--Gregalton 18:10, 8 August 2007 (UTC)

I agree with Gregalton on all his main points. I happened to disuss this with some Finnish friends and asked how the Finns distinguish these things. The answer came back solidly from several people that it was public health care (julkinen terveydenhuolto) versus private healthcare (yksityinen terveydenhuolto). When I told them that in North America the term coined was socialized health care (yhteiskunnallistettu terveydenhuolto) they too thought it was odd and even caused some mirth. One of the reasons we decided, and is the same in English as it is in Finnish, is that these are transitional state attributes derived from a transitional verb, themselves derived from a permament state attribute. Using an adjective or attribute from a derived transitional verb is OK to describe a changed state attribute but is never used to describe the permamant state attribute. If that sounds like gobbledygook, look at this way.

The start attributes in English are "public" and "private" and it's easy to create the transtional verb "privatize". "Publicize", though already has a different meaning so the term "socialize" has been used in the US (though the Brits would used terms like "nationalize" or "communalise", which happens to be the way the Finnish word yhteiskunnallistettu is derived (from yhteiskunta, community).

The transitional state attributes are then "privatized", "socialized", "nationalized" and "communalised". But once the state is permanent, we revert to permanent state attributes again. Hence its once again OK to talk about "private hospitals" and "public hospitals". And by extension "private health care" and "public healthcare". We do NOT talk about "socialized health care" 50 years after it happened! It's a linguistic perversion.

Once a state is established, we even drop the attribute. Hence Americans will not talk about the public fire department, or a public army because there are no private fire departments because private armies and fire departments are a thing of the past and common parlance assumes the attribute.

Some editors may be thinking that this does not solve the problem of what to call "public funding of private hospitals" to distinguish it from "public funding of public hospitals". I personally think these 5 word phrases are just fine and self explanatory. One suspects that terms like "single payer health care" (4 words) and "socialized medicine" (2 words) are just there to obfuscate (i.e. To make so confused or opaque as to be difficult to perceive or understand). These were in fact clarifications of meaning that I added to the article that kborer's edit of August 5 accidentally dropped. The article needs to go back to saying the bare minimum. "Socialized medicine is a perjorative term used in North America to refer to publicly funded medicine where the employees are working in publicly owned establishments" (24 words and no graphics!) --Tom 20:32, 8 August 2007 (UTC)

I won't try to debate the finer points of Finnish grammar (is it 15 or 16 cases?), but would note that single-payer is a concept that is frequently used and that I don't believe to be confusing (it is reasonably precise). In public policy/economics, the distinction is made between two (broadly hypothetical) solutions to the adverse selection problem in health insurance: i) compulsory insurance (which may be multi-payer, as with e.g. compulsory automobile liability) and ii) single-payer (which is really also compulsory insurance, but recognises that if insurance companies are deprived of the abiility to select their risk, there will not be much incentive to compete on price, and the incentive becomes one of denying claims, introducing another set of problems). The distinction is rarely quite so stark in the real world (e.g. hybrid systems). Another argument used in favour of single-payer is that it provides economy of scale for administration and considerable purchasing power (even monopsony power). At any rate, all that to say that I don't share the skepticism towards the term single-payer - although I still don't think it requires detailed text in this article.--Gregalton 06:34, 9 August 2007 (UTC)

Yes, you are right. I was being a bit brutal. The term "single payer" is not intended to obsure to the source of the funding but rather to stress the common pooling of risk, but it does not say how the pool is funded. However, I do think the "socialized medicine" is because the epithet "socialized" which is not used for commonly accepted public services such as roads, police, fire services etc. Lets see what kborer has to say.--Tom 07:52, 9 August 2007 (UTC)

I think the "how it is funded" question essentially becomes irrelevant - if it's a separate fee or funded out of general revenues, it still boils down to a tax (internal govt accounting issues are a separate matter). As I recall in Ontario, it was initially structured as an obligatory fee, but eventually just folded into general taxation. I don't have up-to-date info on what other jurisdictions do. And the 'single payer' issue actually has a meaning that is more precise: there is one authority that pays providers of medical services, regardless of where the funding comes from (in Canada, the provinces are the paying authority, either directly or through some specific agency, but the funding is a complex mix of federal/provincial).--Gregalton 08:23, 9 August 2007 (UTC)

Irrelevent except to the extent that the choice of funding model chosen may affect individual groups in society differently! But I think I see what you mean. The Canadian model is geared to the money coming out of the fund to be equitable distributed to health care users across the nation based on need and right to access under the payout rules, even if that means the by the funding arrangments, some provinces can be proportionately paying in more or less than they are taking out (assuming it was 100% efficient).--Tom 00:52, 10 August 2007 (UTC)

I am not currently arguing that socialized medicine is the best title for publicly administrated, publicly financed health care. I am only going to argue that socialized medicine is an acceptable article title. I contend that the following points are true, and being true make socialized medicine an acceptable article title.

1) The term describes the subject for which it is a title.

2) It is does not suggest the value of the subject.

Socialized medicine refers to publicly administrated health care that is also publicly financed. These references define it as such.

[- 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.][- A government-regulated system for providing health care for all by means of subsidies derived from taxation.][- A system for providing medical and hospital care for all at a nominal cost by means of government regulation of health services and subsidies derived from taxation.][- 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 usually by assessments, philanthropy, or taxation]

Of those references, none describe the term as pejorative. Kborer 02:17, 10 August 2007 (UTC)

You miss the points made and discuss something else. We are not talking about the article title but its content. It is clear that there other dictionaries DO make a reference to the way that it is used as a perjorative (and I probably don't need to point them out to you, though I will if you insist) and it's etymology is clearly perjorative. So the reference to it being POV is not irrelevant.

Gregalton makes the a very good point that a racial epithet cannnot be used in a neutral way. The WP article nigger is about the use and history of the term nigger. It is not appropriate to use the article to talk about niggers in general. It is offensive, especially to the niggers themselves. OK, I have just used offensive language in the preceding sentences, but I've done so to highlight the point. Your addition of the graphic and the discussion of related topics such as single payer gives unwarranted encylopedic credibilty to a term which it does not deserve it. It is as offensive to some people (who have no prejudicial feelings towards public health care run by the state), as it would be if the information in the article african american was moved into the article called nigger. That is why the article should just explain what the term is and how it came to be used.--Tom 10:57, 10 August 2007 (UTC)

I restored some of the material and cleaned up some of the additions. The term is not exclusively used negatively, which I thought the article was too one sided as stating this as a fact. Talking about its historical usage, is more NPOV. However, it should be pointed out that many supporters of universal health care, advocate it using the term socialized medicine. Michael Moore comes to mind.Giovanni33 03:12, 11 August 2007 (UTC)

@Tom - I am not ignoring the previous comments, I just wanted to put my opening statement out and give people a chance to discuss it before responding to Gregalton's. Kborer 07:30, 11 August 2007 (UTC)

This is my response to comments made initially by Gregalton. The only thing that I had intended on discussing in this section was whether socialized medicine could be an appropriate article title, but I am willing to debate other topics in different sections.

Gregalton makes these claims:

1 the term is pejorative by definition

2 Other definitions of the term are vague and imprecise

3 the term that has no credible meaning or definition in an encyclopedic context

4 Its use originates in, and is defined by, attempts to discredit publicly funded or managed health by association with socialism.

5 Attempts to use it in a non-pejorative sense will necessarily fail, and not be understood/be misunderstood outside the context of the USA (and possibly Canada, by media overlap) due to a) the vagueness and b) the political context.

I agree that if the above claims were true, that the term would be an inappropriate title. However, I believe that all of these claims are false. My reasoning is as follows:

1) Not one of the definitions that I cited above claim that the term is pejorative.

2) The term is well defined, again, as per the definitions cited above.

3) The term has credible meaning, as evidenced by current definitions, current usage, and historical usage. For references on current and historical usage see:

You can see from the above that socialized medicine has been used in an economic and medical context in a precise and fair way. A better example of a pejorative term would be "Red Medicine", used to associate socialized medicine with communism.

4) The term originates from the health care systems implemented by socialist countries. As you can see from the above references, it was not merely a political gimmick, but a term used earnestly to discuss a different way of providing health care.

5) This is untrue, as seen by the following reference.

It seems that some people feel that the term is used pejoratively, but it appears that there are few examples of it and fewer definitions indicating such. While some people are confused about exactly what socialized medicine means (are any terms that are perfectly unambiguous?), but that it is most commonly used to mean a health care industry run in a socialist manner, meaning financed and controlled by the government. Kborer 01:23, 17 August 2007 (UTC)

term 'disparagingly' in intro

I think there have been a significant number of quotes tracing back the origin of this term; we can certainly try to track down more. As for support for the comment "often used disparagingly", I should think this article and series of quotes should support this - the term "socialized medicine" is clearly used as a form of guilt by association with socialism: Giuliani attacks democratic health plans as 'socialist'. Or to quote directly: "That's why when you hear Democrats in particular talk about single-mandated health care, universal health care, what they're talking about is socialized medicine." The previous sentence makes the link explicit: "The American way is not single-payer, government-controlled anything. That's a European way of doing something; that's frankly a socialist way of doing something."--Gregalton 08:11, 11 August 2007 (UTC)

We don't need a lot -- just one reference that supports that the term is "often used disparagingly" to talk about government run, government financed health care will be fine. Kborer 14:27, 11 August 2007 (UTC)

Incorporated inot the article. Note if you would like to see more.--Gregalton 14:50, 11 August 2007 (UTC)

I meant a reference that talks about how the term is often used disparagingly, not an example of it. If you find it, just stick it as a reference right after the phrase so that the phrase itself is referenced. Kborer 23:21, 12 August 2007 (UTC)

I'd be happy to oblige, but would also welcome any suggestions as to the types of references you might find acceptable. For example, googling for socialized medicine and socialism makes it pretty clear that there are many, many examples, and few are positive. Leaving out socialism doesn't substantially alter the frequency of the use of the term in a negative context. Quoting a presidential candidate making a direct, clearly negative link does not directly demonstrate frequency, but does demonstrate that this view is certainly not rare. But honestly, if you have suggestions on the type of source that might be acceptable, I would appreciate - statistical analysis of "positive/negative" is not really my field.-- Gregalton 04:46, 13 August 2007 (UTC)

There are two problems. The first is that anecdotal evidence is not effective. The second is that when someone expresses a negative opinion about something, it does not necessarily mean that whatever term they use for it is pejorative, disparaging, etc. I am going to remove the claim until it is referenced, since the definitions that I have found have not even insinuated that the term could be used in such a way. Kborer 23:54, 16 August 2007 (UTC)

Criticism section

To Giovanni33 Why have you removed the criticsm section? The entire history of the edits to this article has been littered with criticism of the use of the term. It is right and proper that the criticism of the term should be aired. Your edits and those of kborer have just led to the removal of issues negative to the term socialized medicine and left in all the edits that mentioned the way it was used. One could be thinking that the edits are motivated by something other than achieving clarity to the article.

To other editors here. Should this article have a criticism section?--Tom 11:11, 11 August 2007 (UTC)

I explained why. Criticism sections are discouraged. I still incorporated these points within the body of the article, under historical usage of the term. But you are turning the entire article about one of criticism, and doing away with all other sections? That is major POV pushing, and as I said above, very one sided.Giovanni33 14:46, 11 August 2007 (UTC)

I agree that the criticism section can perhaps be left as 'history of the term.' I find the phrase 'types of socialized medicine' as a section heading below still effectively has the effect of describing the types described below as 'socialized' (i.e. 'socialist.') The discussion above outlines why this is POV itself. There is no reason to classify single-payer health care as 'socialized' in the original term (i.e. nationalized in the socialist sense), nor universal health care. It is clearly a loaded term.--Gregalton 14:57, 11 August 2007 (UTC)

I disagree with Gregalton regarding the criticism section. The points made in the criticism section will not sit easily under history.

As for Giovanni33's points about criticism, I think he is mistaken. I think that WP policy is talking about critical analysis of the subject. My section was a explanation of the term and its use, pointing out how it has been seen and describing the inconsistencies of use. The WP policy article is about criticism of the subject of the article and I was neither talking "socialized medicine" up or down. I would therefore strongly disagree that it was POV.

To allay these concerns I will see if I can find another title under which to group them. Maybe it was the word criticism that you disliked so much. I'll see if I can find another term for it--Tom 17:00, 11 August 2007 (UTC)

My other problem is one of undue weight. For have various sections talking about problems with the use of the term gives undue weight to this POV, i.e. criticism of the use of the term. Each criticsim doesnt need its own section, as it then dominates that article and thus gives undue weight. That point is best made within the body of the article under the category "usage of term." That is what I have restored.Giovanni33 19:37, 11 August 2007 (UTC)

I undid your reversions of my own edits. The points I made are fair ones and they are not so much criticisms as illustrations of use and non-use according to user, topic. I added some counters to the overwhelming number of references the article has that are illustrations of negative use and which, as I demonstrated to Nbauman in earlier discussions on this page, are unbalanced, POV, and often downright misleading (e.g refernces falling off the Cato web site). The balance is still way in excess of references to negative usage and there are no sections at all that put down the arguments in favour of "socialized medicine". Would you like me to add one to balance it up? We can argue about whether they need to be sectioned off, but I would not say they are POV in any way. Just fair and balanced. The article is not very long and sectioning them off makes then easily seen in overview form. They are under "usage of the term", and that is indeed the right place for them. --Tom 20:11, 11 August 2007 (UTC)

I see that. I dispute your changing the structure of the article, and I stand by my comments that doing so is POV pushing. You don't need a new section for every critical comment/example about its negative use, esp. when its one sentence, and even somewhat trivial. Also, you are deleting other sections that add information. Contrary to what you claim, they are not irrelevant. This article is entitled Socialized medicine, not "Criticism of the use of the term." But since we disagree then let me point out that you dont have consensus to make these major changes, and the version/structure I will revert to is the long standing version, and is supported by myself and the other editor here. Until you obtain some consensus for your major changes (many of them I incorporate happily into the article), you can't expect to get your way by edit waring.Giovanni33 03:10, 12 August 2007 (UTC)

I think including information on arguments for and against socialized medicine is out of place in this article. There are terms that are accurate and not pejorative, and well covered in those articles. Rather than repeat those points here, we should minimise the for/against socialized medicine and link to other articles.--Gregalton 04:54, 12 August 2007 (UTC)

To Giovanni33. I removed the section on UHC because its not deserving of a section for much the same reasons as you are arguing against sectioning the sectioning of usage. It makes the article unbalanced and, to me, just seems to be trying to tie together the term SM with UHC (in much the same way that SM was being tied to SPHC. But we are still discussing the UHC section below so I will let that one play out a bit first and see how the arguments for and against its inclusion as section develops. I reconstructed the criticisms and put them in a usage section, which actually seems more appropriate because it is the usage of the term that is disputed. I said that we can perhaps argue about the points being sectioned off individually. So why did you not just remove the section headings? Which edits were trivial? I am not sure I deleted any very relevent information that cannot already be gleaned from the linked articles such as Universal health care. --Tom 19:23, 12 August 2007 (UTC)

To Gregalton. When I thought about the issues, they were indeed not criticisms of SM as such but the usage of the term such as its associations, its contextual placing, the inconsistency of use, its non-use outside the US and so on and the contraversy surrounding them. These are relevant because the article is in fact about a term for something, not the something itself. The WP criticism policies that were pointed out to me are in fact about the latter and not the former. Discussion of this is quite important. See section below on Usage sections. --Tom 19:23, 12 August 2007 (UTC)

Single payer and Socialised medicine are not connected

US health care professionals have a clear definition of what "Single Payer" means. It is

• An approach to health care financing with only one source of money for paying health care providers.

In other words it is a pooling of risk cover into a single fund. It says nothing about the role of government, whether as the provider of finances through taxes and nothing about whether the money can only be spent in government administered health care.

Similarly there is little doubt that "socialized medicine" is about

• government financed, government regulated, and potentially publicly managed health care

So single payer is, by its very definition, not connected to the term "socialized medicine". Tying them together sows confusion rather than delivers clarity. --Tom 15:39, 11 August 2007 (UTC)

That's ridiculous. "Government financed?" Where does the government get the money? The government gets its money from the people... in a "Single Payer" situation. Why are we pretending that the systems aren't socialized? There's one reason - this isn't a discussion, it's a debate. There are a bunch of people trying to distance socialized medicine from the word "socialized" because they believe in it, for America, and they know that Americans are weary of socialism. --69.253.92.203 16:06, 23 October 2007 (UTC)

I think you missed the point completely. Of course the government gets its money from taxes! Who is saying otherwise? The point is that the term "Single Payer" references a single source for paying out for health care. The íssue is that the term is used in the US to imply that a single entity, the government as a centralised insurer pays out money to hospitals for health care provided by them. In other words, as the term "Single Payer" is used in the US, in means replacing the multitude of insurers (who pay out money) with a single insurer, but the insurance principle remains. The point I was making is that socialized medicine is also a single payer in that there is ultimately just a single entity that controls the flow of money, but there is no insurance principle being applied. So it is also Single Payer in principle, if not Single Payer as the term has its narrow interpretation in US health politics. Of course, whether in an insurance based system or a tax based system, there are many payers (policyholders/taxpayers. That is not in dispute and is not what was being discussed. The issue came up I think because there was a graphic that segmented socialized medicine from single payer, but logically there is an overlap because socialized medicine is logically also single payer (though not in the narrow sense as it is used in the US), --Tom 19:53, 23 October 2007 (UTC)

I assumed you meant "wary" of socialism rather than "weary". The parallel to socialism is one of the emotive drivers to the the term socialized medicine and is not reflective of fact. The most populated socialist country, China does not have a "socialized" medical system for all its citizens, but many capitalist countries such the UK, Spain, Japan, etc. do. People in these capitalist countries do not regard it as a socialist arrangement to fund health care in whole or in part from taxation, just as a person soemwhere in say, New Jersey, would not think that he or she drives every day on socialist highways or sends his/her kids to a socialist high school or uses a socialist library. --Tom 20:51, 23 October 2007 (UTC)

Those are good points, but I disagree that is has nothing to do with each other. Alghouth its true that single payer is clearly defined, socialized medicine is more broad and applied generally to programs that guarantee universal health care, no matter the form. Its the same with socialism, which are broad enough to encompass varous forms and means to acheive a social end. I'm ok with removing the "types" section, as long as the article links to the main article on these types.Giovanni33 19:40, 11 August 2007 (UTC)

Tom is right about those definitions. Socialized medicine and single payer health insurance are types of single payer systems. The confusing part is that some people use the term single payer to refer to single payer health insurance. Kborer 23:29, 12 August 2007 (UTC)

Just to be clear, I disagree with the statement that "socialized medicine and single payer health insurance are types of single payer systems". You can have socialized medicine with multiple funds (that are not single payer, as in Germany) and socialized medicine with single payer (as with the UK and Canada) and socialized systems where there are still multiple payers (for example most countries apply charges to users as well as funding from either one or multiple funds which may or may not receive tax funding). And of course multiple payers with non-socialized systems as in most of Africa. The terms are logically independent. Putting them together is a bit like saying some homosexuals are pedophiles. Sure, some are, but most are not and the two things are not connected because most pedophiles are heterosexual and most hetrosexuals are not pedophiles. It adds nothing to the sum of knowledge. We need more clarity here not more confusion. --Tom 08:57, 13 August 2007 (UTC)

I think the real confusion stems from the fact that countries usually use various types of hybrid health care systems rather than purely using free market, single payer insurance, socialized medicine or government monopoly. When a system is close to one of those, people tend to categorize it as such. As far as your definition of socialized medicine, please provide some sources so that we can include them in the article. Kborer 23:49, 16 August 2007 (UTC)

Kborer/Giovanni33: Do I take it that you now agree that the terms are logically independent? I must admit I do not understand WHY Giovanni33 believes they are connected. I think you can have socialized medicine (through government regulation) without a single fund. Incidentally, I assume that in the US you have government rules about what minimum insurance cover is necessary when driving on the public roads in case you cause damage or injury to other people or their property. Is that called socialized traffic insurance? What is the right term for that? Compulsory medical insurance in Germany I believe is run on the same lines. Everyone has to have it but there are multiple funds.--Tom 17:34, 20 August 2007 (UTC)

Kborer. I have seen several definitions of socilized medicine. Some that just mention regulation and do not suggest government ownership of facilities (e.g that at http://ie.thefreedictionary.com/socialized%20medicine (and several other sites that seem to have the same definition), and this seems to agree with many of the articles that talk about socialized medicine in Canada (e.g. those awfully biased Cato institute references). And there are some that do imply that there is government ownership of the facilities and employment of the doctors (e.g. that at http://www2.merriam-webster.com/cgi-bin/mwmednlm?book=Medical&va=SOCIALIZED%20MEDICINE). For this reason I think both defintions should be in the header. --Tom 17:34, 20 August 2007 (UTC)

You are right about the definitions, but there is no need to change anything since you are saying exactly what the article says. Socialized medicine consists of two parts: government control and government funding. There are different ways for the government to control the industry, ie, employing all the workers, or heavily regulating them. With socialized medicine, the government is paying for the health care so it is single payer. That is the connection. Kborer 00:56, 21 August 2007 (UTC)

To Kborer. I am sorry to have to bang on about this point but you undid my edit which said that the Canadian health care system

is more often categorized as single-payer health care because there is a single pool of funds to finance an agreed set of services.

to read

is more often categorized as single-payer health care because, while there is a single pool of funds to finance an agreed set of services, the health care industry remains private.

It seems to me that the sole reason for your re-editing is that it makes sense in line with the graphic you have been trying to add. Surely the Canadian system is called single payer because it is a single payer system! (i.e. the costs are met from a single source). To think otherwise is stretching the imagination beyond that which is justifiable in the circumstances.--Tom 15:52, 26 August 2007 (UTC)

Please see my recent edit, which I hope might be acceptable to both "is more accurately characterized as...". There are also some wording changes I have made for accuracy, comments welcome.--Gregalton 18:31, 26 August 2007 (UTC)

Thanks Gregalton for your efforts. It seems OK except it had too many clauses so I split it up but retained the main information. I simply think people tag it as single payer because it is (er.. how can I put this delicately?) single payer. I don't think its called single payer because it isn't socialized medicine in the British sense (which I think is Kborer's point). I suspect that people clearly do call it socialized medicine for the reason Kborer gave before, i.e. because it's heavily regulated and publicly financed. Hopefully its OK now.--Tom 19:06, 26 August 2007 (UTC)

I tweaked a bit further, and thank you - it had indeed grown into a monster sentence. I have edited the reference before ('a Canadian doctor') - it does not seem to support the text (all it says is Cdn socialized medicine is 'government run'), and does not seem to me to define the term in any useful way.--Gregalton 20:25, 26 August 2007 (UTC)

Relation to universal health care

The revisions are going from bad to worse. The first section is now headed Relation to Universal Health Care but goes on to give a reference to North Korea and talks about expropriations, but at the end the editor comes clean and says that few UHC systems have been achieved through the use of nationalization. Why on earth bring it into the article at all? Its another example of the article being expanded to associate it with language likely to introduce feelings of negatively. --Tom 17:39, 11 August 2007 (UTC)

"Universal health care is typically the goal of socialized medicine" ... is that true? The socialised medicine represented by medicaid and medicare and the provision for veterans has not produced and was not aimed to produce universal health care. Neither do tax deductions which is a form of state finance in the form of foregone tax dollars. I think this statement is misleading. --Tom 18:03, 11 August 2007 (UTC)

I see your point, and I agree there is now a problem with that section as it stands. But, just to clarify some points, I think it true that universal health care is typically the goal. Universal health care is certainly a goal, and socialized medicine is the means by which it can be obtained, i.e. society, collectively, taking charge to make sure everyone is covered, hence socialism or socialized medicine. Medicare is limited by age restrictions, so its universal only to that segment of the population. I'll take a look and see how this can be fixed.Giovanni33 19:46, 11 August 2007 (UTC)

The points referred to by Tom could easily go in the usage of the term or an etymology section. The point is that socialized medicine comes from the term socialization, which was originally a euphemism for nationalization / expropriation. The North Korea quote was a pre-emptive citation, to show that this is where the term is from (any other similar citation would do). How does it relate to universal health care? Barely. As the paragraph makes clear. Hopefully ;) --Gregalton 20:01, 11 August 2007 (UTC)

If "Universal health care is typically the goal of socialized medicine" (and I concede that it usually is) then it belongs in the header paragraph, not in a sub-section. --Tom 17:56, 12 August 2007 (UTC)

The statement about politicians is rather loose right now. What percentage of say, politicians in congress, confuse the terms "socialized medicine" and "universal health care"? If it is very small, then perhaps it is not a very relevant fact. Usage by certain politicians is an example of "usage" and belongs in that section. --Tom 17:56, 12 August 2007 (UTC)

I think that pre-emptive reference to North Korea is going a bit too far! None of the bills in congress as I have heard them would require the government to nationalize or expropriate any assets. The insurance sector might loose the right to trade in sectors they now trade in freely, though this is actually not a feature of Socialized health care, but more a feature of one of the bills layed before congress. In the UK for example, medical insurers can compete in direct competition with the state sector for health care of all kinds. But I agree with Gregalton that the association is there to add negative emotions and it therefore belongs with the etymology as a perjorative under the "usage" section. --Tom 17:56, 12 August 2007 (UTC)

The point of that quote is only that socialization was originally a euphemism for nationalization, and now the term is being used - pejoratively - to refer to something (universal health care) that does not correspond to the meaning of the word. As you point out, virtually none of the systems in operation or the proposals to implement can be described that way.--Gregalton 04:06, 13 August 2007 (UTC)

Usage section

I added a section called usage and sectioned it off into sub sections. I'd be grateful if editors would look at the section as it was sub-divided at close of play on August 11 and how it looks now. Is it better with or without the subdivision? I would argue the sub-division is helpful. Here is my reasoning.

The prejudicial nature of the term SOCIALIZED MEDICINE is at the heart of its use, non-use and (I would add) abuse. This was very effectively described in the sectioning and content of August 11. A lot of the power of the edit and some content has been lost in my opinion by the recent edits of Giovanni33 which now makes it much harder to see the different ways in which the way the term is used, not used and abused. They are now much less visible. One has to wander through a wafting text to understand the points, and conseqently the facts have been buried and in some cases cut.

I agree that there has been some edit warring going on. I am accused of pushing POV but I equally will argue that the present article is POV. I think some editors are deliberately trying to use the article, its sections and the references to push an agenda. If this article was really about socialized medicine, it would actually discuss the subject, would it not?

It is important. The term "socialized medicine" seems to have been in use in the US for so long that people may be blind to the way it is or has become prejudicial. These things usually happen the other way around. Terms like "insane", "mentally defective" and so in the field of mental health were meant to be descriptive but it took a long time for people to realize how language led them to isolate these people and lock them away as no-hopers instead of realizing that these conditions could be treated or ameliorated. Conversely, loaded terms such as "socialized medicine", created to deliberately associate the idea with negative feelings, seems to have shaped peoples thinking for the worst.

And here is how I gained that perspective.

Articles linked from this article carry statements like "I wouldn't trust the government to take care of my health - government can't do a damn thing right", or words to that effect are witness to how powerful this false imagery can be. The reality is, however, for me as a user of "socialized medicine" that I put my faith in publicly paid for doctors, just as I would if I were consulting a private doctor. They all sign the same hippocratic oath. It makes no difference to him or her whether I can afford the treatment being given or if I have an insurer to do it for me. And the statistics show that socialized medicine works and provides good outcomes at very low cost. It is because people seem to have been misled about the truth about socialized health care that I am so passionate to make sure the article is more balanced.

I have more than 50 years of experience of so called "socialized medicine" in the UK and the articles I have read following the links in the article paint a picture of health care in the UK that is a million miles away from the truth. Reading back over the history of this article, I see that many other editors, especially from the UK, have had similar objections to the article for much the same reason. Most people seem to have given up making edit corrections that then get changed about and eventually dropped. But the evidence is there to see. Being semi-retired and seeing what I perceive to be ignorance and misconceptions of "socialized medicine" in the US (yes this statement is POV but are we not all here editing WP to enlighten people rather than to confuse or mislead them?) I want to do something about it, and can now do so that I have the time. But I prefer that we get there thru consensus, hence this posting seeking support from other editors. --Tom 20:03, 12 August 2007 (UTC)

Proposal the graphic should be removed

The graphic it should be deleted because it does have much bearing to the real world, because

1. "socialized medicine" does not mean health workers only work for the government, and even if it did, there is no example of a health system anywhere in the world using it
2. "socialized" medicine is not the polar opposite of free market as the graphic implies. The free market can and does operate alongside "socialized" medicine in many countries
3. The quadrant "government monopoly" does not exist in medicine anywhere in the world
4. The terms "Single payer" and "Socialised medicine" are, by definition, not connected. (See section above)

For these reasons I think the graphic should be removed.--Tom 14:55, 13 August 2007 (UTC)

I do not think it adds much, and since this was previously discussed with no compelling reasons to maintain were found, was a little disappointed to see it pop up again.--Gregalton 15:24, 13 August 2007 (UTC)

I agree. Nbauman 15:52, 13 August 2007 (UTC)

Socialized medicine involves both government financing and government control.

The graphic was discussed in the context of single payer health care and removed. Since this article is about one of the terms in the graphic, it is probably inappropriate to use that as a rationale for removal. I would greatly appreciate suggestions for improving the graphic. In any case, I will defend its content.

The graphic illustrates four definitions.

1) free market health care is when there is no government control, and no government financing.

2) single payer health insurance is when you have no government control, but government financing.

3) socialized medicine is when you have government control and financing.

4) government monopoly is when you have government control but no government financing.

None of these systems current exist in practice to my knowledge. People categorize actual systems by which of the first three they are most like, or they categorize an actual system as a hybrid of the various systems. So, while not all of Tom's points are wrong, the only one that is correct (#3) should have very little bearing on inclusion of the graphic since it technically applies to all of the terms.

That all, of course, is why the graphic is not bad. The reason it is good is because it clarifies what is meant by those four terms by putting them together. It clearly shows the major differences between the systems in a completely neutral way, something that no Wikipedia article has been able to do with text. Kborer 01:39, 17 August 2007 (UTC)

Presenting the terms in this fashion may be simplifying something that does not actually deserve simplification. You risk telling a false story if you do. The Canadian model of health care is very often called socialized medicine. But it does not fit the graphic which would regard it as Single Payer because the practitioners are private. It is also, surely, unrealistic to have "single payer" with no goverment control. Most single payer articles I have read assume the government is the payer and it would be irresponsible for the government to meet the cost of private medicine without there being any government controls. I am sure that happens in all single payer systems. The UK has a free market in health care which competes with the NHS "funded from taxation" service. It has NHS patients treated in private hospitals and private patients treated in NHS hospitals. The NHS is Single Payer in concept (because there is one fund and pooled risk) but this does not meet your definition. The German system has multiple payers and private providers but lots of government regulation so it is not free market. The truth is that the real word does not map to the model you present. Not the UK system. Not the German system. Not the US system. Not the Canadian system. I kind of agree that it would be nice if these terms were easily understandable, consistently used, and readily recognizable to real world examples. But unfortunately they are not like that. --Tom 01:12, 19 August 2007 (UTC)

You raise an excellent point: not everyone agrees where on the graph real systems would lie. That is another reason why the graph is good, it does not try to plot any real systems. It merely illustrates four ways in which systems are categorized. Kborer 02:59, 19 August 2007 (UTC)

Good? I would humbly argue that it is a reason why it is bad. There are real world articles that talk about Canada in the context of socialized medicine. And Britain is often characterized as socialized but there is quite a lot of private enterprise working within the NHS system. I always thought usage determined defintion, not the other way around. Now that I understand what Single Payer really implies, and seeing how the medical profession uses it, I have absolutely no doubt that the UK's NHS is a single payer system because it achieves UHC through a common funding pool. But it does not fit your model. As in science, if the theoretical model bears no relation to observed reality, then its a good idea to junk the theoretical model. These terms are confusing enough - simplyfying them in a way that is misleading is in itself misleading. --Tom 13:50, 19 August 2007 (UTC)

What you are saying is not that the graphic is misleading, but that the articles are misleading. Many articles on Wikipedia categorize real health care systems as one of those four categories or as a hybrid. They make a strong claim that system A is category A. While people might not agree what category specific systems belong to, the definitions of the four categories clearly place them in those four quadrants. If the article about the NHS miscategorizes it as socialized medicine, it is not a problem with the graphic, but a problem with the article. Kborer 14:36, 19 August 2007 (UTC)

Not exactly. In a nutshell I think your view of things is wrong because it does not match how I see the term being used. The published articles I have seen use the various terms in a different way to the one you describe. Does that mean that they are wrong because they do not fit your model? I think not. From the way I read those articles, it seems to me that most people use the term "socialized medicine" to describe a situation where a government agency is involved in whether and when you get treated because the funding is coming from general taxation and the rules are there to ensure equity amongst all taxpayers. That is NOT what your defintion says. But it does explain why people use SM to refer to the Canadian system. Also I think "single payer" is a system where there is a pooling of risk and a pooling of funds into a single common pool. Now it happens that the particular kind of single payer system proposed by the PNHP for example, happens to assume that hospitals and practitioners stay in private hands, just as happens in Canada and many other countries. But just because the type of single payer being proposed in the US does not envision the creation of publicly owned hospitals does not mean that national or local health care systems like the UK and Finland are not Single Payer Systems. Clearly they are, because they pool costs and risk in the same way. It more difficult to argue the toss about this one because "Single Payer" is a singularly US term, but I argue quite strongly that its roots are in the pooling of funds and that is what it really means. So I think that the graphic IS misleading. I would be interested to hear the views of other editors about this. --Tom 15:15, 19 August 2007 (UTC)

Your definition of socialized medicine agrees with the graphic. Your definition of single payer is correct also agrees with the graphic. Remember not to confuse single payer health insurance with the more general term single payer.

When one person calls the Canadian system "single payer health insurance", they mean that it is more publicly financed than privately, and more privately controlled than publicly. If someone calls it "socialized medicine", they mean that it is more publicly financed than privately and more publicly controlled than privately. This makes perfect sense with regards to the graphic: one person would plot the Canadian system above the horizontal axis, and another would plot it below. There is nothing wrong with that. Kborer 17:13, 19 August 2007 (UTC)

I think you could have a single payer scheme with compulsory insurance where the government does not add finance except perhaps to insure the uninsurable or those in poverty. Government control could then be minimal. When you take the scalars in isolation, as you desribe it above, all is OK, but the problem is that you have super-imposed the two at right angles when it is not appropriate to do so. In that sense this graphic is a piece of original research or POV. It neither quite matches reality or a common perception. That is why I oppose it. If, as you say, two people can view the same system and plot it on your graphic in different places it proves my point. The Canadian system IS socialized medicine AND single payer. The NHS in England IS run in partnership with private businesses, it IS single payer and it socialized medicine. In other words, it can be in 3 of the quadrants at the same time. Because that is the case, the graphic is more confusing than meaningful. These labels are meaningful but they do not arise from the segmentation you ascribe to them. --Tom 17:58, 19 August 2007 (UTC)

Like I said before, try not to confuse single payer and single payer health insurance. The reason you can have socialized medicine and single payer at the same time is because socialized medicine is a subset of single payer.

You claim that it is inappropriate to superimpose financing and regulation at right angles -- please explain this because I have no idea why this would be.

The graphic matches reality and common perception. This is true because the information used to create the graphic comes directly from the definitions of the four terms. A real system cannot be in more than one quadrant. However, people might disagree over which quadrant it belongs in. That is normal and does not invalidate the graphic whatsoever. Kborer 18:48, 19 August 2007 (UTC)

Kborer: I strongly disagree. Earlier you said "Single payer is where there is no government control but government financing". Where is the evidence for that? Most definitions that I see seem to just imply being rid of the current system of multiple private insurers. You already seem to accept that people talk about the Canadian system as "socialized" but try to justify that if it fits your model by saying that "well they might as well be government employees, given that they are so heavily regulated and paid by the government". I would say that is POV.--Tom 19:53, 20 August 2007 (UTC)

Single payer health insurance is where there is private control but government financing. If you would like evidence for that claim, see the references on the page single payer health insurance. If someone says that the Canadian system is single payer health insurance, that is their point of view. The graphic does not make this claim, so that is not a problem with the graphic. Kborer 01:02, 21 August 2007 (UTC)

The article you are referring to has been proposed for deletion and I have no intention if wasting my time chasing rabbits. The graphic is in any case no longer in the article so I am going to save my effort and stop arguing with you. But don't take that as meaning I agree with you. I do not.--Tom 16:51, 21 August 2007 (UTC)

Inclusion of table

I like the table very much, but since it is already used (prominently) in another article, repeating it here seems excessive. In general, it appears to me odd to attempt to add more to the section on universal health care if the link with 'socialized medicine' is simply that the latter tends to be a slur regarding the former. In other words, the usage section seems to be the most crucial (and could be cut down further by excluding text on whether or not 'socialized' medicine is good or bad). Other views?--Gregalton 00:26, 14 August 2007 (UTC)

I await the opinion of others but maybe I can say a few things.

1. To be honest, I agree with your point about the slur - I do not think the article needs a section relating to a relationship to UHC... it can (and once was) said in a single sentence in the header.

2. I agree the useage is more crucial. It could indeed be trimmed and shhould be higher in the sequence of sections

3. Re the table. IF a section on the relationship to UHC is needed, I thought it might be useful to show how the country with the most socialized model (the UK) seems to deliver a more universal coverage and more bangs-for-buck. The table is interesting because it contains countries using diffrent models ... multiple payers with private hospitals under formal rules (Germany), with single payers under formal rules with private only providers (e.g. Canada) and multiple payers with private providers and little formal rules (the US). Refering to that in the article might seem like OR so I resisted mentioning it.--Tom 21:26, 14 August 2007 (UTC)

So let's drop the section and the table. The point can be made in a sentence - "socialized medicine is sometimes used to refer to universal or government-run health care." And then start cutting unnecessary stuff, as we previously proposed and discussed. Most of these points can go in the universal health care article.--Gregalton 02:55, 15 August 2007 (UTC)

Definition

The definition now seems to have dropped the duality of meaning issue (any "state finances/control regardless of who employs the worker" verses "state finances/control but only where the workers are public employees". I am not sure why the editor responsible has taken the alternative meaning away. Should it be reinstated?--Tom 21:32, 14 August 2007 (UTC)

There seems to be a problem with terminology. Perhaps employed is the wrong word to use, since people might miss the point -- in a sense those two definitions are the same. Ideal socialized medicine would indicate public employees, but socialized medicine in practice could mean private employees who must abide by many government regulations and get paid according to government standards, ie, are effectively government employees. Kborer 01:46, 17 August 2007 (UTC)

You refer to "ideal socialized medicine"? Whose ideal? Yours? Mine? You argue that doctors in Canada are "effectively government employees". That is your opinion and I would strongly disagree. There is a connect between "salary" and "fee for service", of course, but efficiency and profit outtake are part of the equation. No reasonable person would expect taxpayers money to be used to pay for inefficiencies or excess profits. I doubt very much that doctors in Canada think they are working for the government any more than road contruction workers are, even though they have to build roads to government standards and the money comes from taxation. Its still a highly competitive business. But the key point is that Wikipedia should reflect the real world and if the term is used in two ways by different people, we should reflect that. --Tom 08:08, 17 August 2007 (UTC)

Ideal in the sense that a system which is completely government funded and government controlled is just an idea, just like the other extremes. As far as what the Canadian system is, that is something we could discuss in a different section. Just to clarify, my opinion is that it started out in closer to single payer health insurance, and has moved towards socialized medicine but was never one extreme or the other. Kborer 11:56, 17 August 2007 (UTC)

I think you are not disputing that the term has been used in two ways, so I will probably add that back to the definition. I am not sure what you found so problematic with the refrence that was added. Perhaps you can explain. It looked quite typical to me. I am not entirely sure that that anyone here is even doubting the perjorative nature of the term so I am not really clear that we need any references anyway. We had a dictionary reference at one time that cited it was perjorative, and personally I would think that was enough.--Tom 23:51, 17 August 2007 (UTC)

My opinion is that socialized medicine is any system with government financing and government control, whether the control be directly through government employment or indirectly through heavy regulation. A system with government financing and private control is not socialized medicine, but rather single payer insurance. I do not believe that the term is pejorative by definition. If you could recover the dictionary reference that you mentioned, I would be very interested to see it. As I have stated elsewhere on this talk page, all of the definitions that I have seen have not stated that the term is pejorative. Kborer 02:14, 18 August 2007 (UTC)

By your definition, the Canadian system is single payer because its practioners are private. If you are arguing, as I suspect you might be, that Canadian health care is so heavily regulated that it comes under your category "indirect employment", I would say that is POV.

I queried the placing of a "citation needed" marker against the sentence reading "In the United States, the term is used pejoratively". One would have to be blind not to see how the term is used perjoratively. Just try a Google search and virtually all the articles will associate "socialized medicine" with some kind of negativity. I will grant you that most definitions I can access on-line are indeed neutral, but notwithstanding that, it is also true that the term has a perjorative history and is still used perjoratively to this day, which is all the header paragraph says. Incidentally, I have also noticed how professional medical and research articles do not use the term "socialized medicine", which I think was a point made on this talk page by someone else. --Tom 15:27, 18 August 2007 (UTC)

I imagine that more people who use the term are opponents of its implementation and vice versa. It seems likely that this is due to the fact that many proponents avoid using the term -- preferring to talk about the "universal health care" it would create. Kborer 03:12, 19 August 2007 (UTC)

Pejorative / Uwe Reinhardt

Kborer, what's wrong with the reference to the Uwe Reinhard letter in the WSJ? Nbauman 17:31, 19 August 2007 (UTC)

There is nothing wrong with the reference per se, it just did not support the claim. Kborer 18:35, 19 August 2007 (UTC)

The claim is that socialized medicine is a pejorative term in the U.S. Reinhard says:

As an immigrant who has lived in the U.S. since 1964, I still cannot figure out what makes Americans tick. On the one hand, they incessantly demagogue "socialized medicine" as the ultimate bogeyman of health reform....

That seems to me to support the claim that "socialized medicine" is pejorative. Why doesn't it seem that way to you? Nbauman 21:40, 20 August 2007 (UTC)

That particular quote seems to say this: "Americans say bad things about socialized medicine.", not this: "Americans use the term socialized medicine pejoratively." Kborer 01:07, 21 August 2007 (UTC)

Could the link to the WSJ letter be put here please?--Gregalton 14:58, 21 August 2007 (UTC)

Just add it back. I think its perfectly OK. Uwe Reinhard is not an average Joe.--Tom 16:55, 21 August 2007 (UTC)

Here's the reference: [http://online.wsj.com/article/SB118411829790962883.html Letters: For Children's Sake, This 'Schip' Needs to Be Relaunched, Wall Street Journal, July 11, 2007, Uwe E. Reinhardt and others.

Kborer, if Americans demagogue "socialized medicine" as a "bogeyman", they clearly have a negative opinion of it and regard it pejoratively. You're raising frivolous arguments. There's no point in arguing with you. We just have to vote and go with the consensus. 23:02, 21 August 2007 (UTC)

Right, it says that Americans have a negative opinion of socialized medicine. However, it is not saying that the Americans often use the term pejoratively, which is the claim that was being supported. Kborer 23:57, 21 August 2007 (UTC)

I raise the question again: what would constitute a credible reference that it is often used pejoratively in your view? I also find the argument that finding many, many references where it is used in a clearly negative way is not sufficiently strong evidence to support the adjective "often" is a bit weak. How many would you like? (Unfortunately I don't have access to the Reinhardt article at WSJ, it's paid content).--Gregalton 06:42, 22 August 2007 (UTC)

Considering that all the references currently support a non-pejorative definition, I think we would probably need to reference some sort of study if we want to keep that claim in the introduction. We do not need references like the Reinhardt one or the one where Rudy Giuliani implies that socialized medicine is bad because these references only say that some Americans have a negative opinion of socialized medicine. If we want to keep the claim "the term is often used pejoratively", we need references that say "the term is used often used pejoratively", which is different than "people say bad things about socialized medicine". Kborer 11:37, 22 August 2007 (UTC)

I disagree. Citations that show use of the term pejoratively (such as the Giuliani one) clearly demonstrate pejorative use and support the statement "the term is used pejoratively" sometimes. The only point in question is whether often is reasonable.

The Reinhardt statement - which I have only seen partly out of context - also appears to support; it is not demagogy to claim socialized medicine is bad (inefficient, whatever), it is demagogic to play on fears of socialism when talking about e.g. universal health care. From the definition of demagogy at wikipedia: "Demagogy (Demagoguery) (from Greek δῆμος, "people", and ἄγειν, "to lead") refers to a political strategy for obtaining and gaining political power by appealing to the popular prejudices, fears and expectations of the public — typically via impassioned rhetoric and propaganda, and often using nationalist or populist themes." Unless I have seriously misinterpreted the context, this is precisely what Reinhardt is referring to: appealing to popular prejudices and fears via propaganda (against socialism).--Gregalton 12:08, 22 August 2007 (UTC)

At any rate, here is a citation that I hope should make this sufficiently clear: "The standard propaganda devices include: 1. Name-calling: giving an idea (or person) a bad name, so it will be rejected without examining the evidence - 'socialized medicine'". The Sociology of Social Problems By Paul Burleigh Horton, Gerald R. Leslie, see here for the excerpt. So, 'socialized medicine' is literally a textbook example of name-calling - a bad name, and hence pejorative.--Gregalton 12:49, 22 August 2007 (UTC)

That reference looks good. Let's use it for now, until someone can take a more detailed examination. Also, if you would like, we can continue to discuss whether the first two references show pejorative use of the term. Kborer 13:08, 22 August 2007 (UTC)

Which two references are you referring to? I presume one of them is the Reinhardt WSJ quote. Note that the original text has "socialized medicine" in quotes, clearly because the term is pejorative and its use in this way constitutes demagogy (in his opinion). For a more complete quote, "U.S. residents "incessantly demagogue 'socialized medicine' as the ultimate bogeyman of health reform" [4] It seems clear enough.--Gregalton 15:08, 22 August 2007 (UTC)

See also: other types of health care systems

Two links were removed from the see also subsection for other types of health care systems: free market and government monopoly. The comment about the edit was that these articles are not about health care specifically. We should leave these links in, even if the articles are not dedicated to health care, since their material is relevant to this article. Kborer 00:21, 23 August 2007 (UTC)

David Gratzer article reference deleted

I have removed reference to an article by a person of the name David Grazer.

The primary reason for this is that the article is full of falsehoods and some dubious statements. For example "Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled — 48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. In France, the supply of doctors is so limited that during an August 2003 heat wave — when many doctors were on vacation and hospitals were stretched beyond capacity — 15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren't available."

The so called facts here were discussed in another talk page so I will not repeat them here. You can see them at http://en.wiki.x.io/wiki/Talk:Single-payer_health_care#CPA_link_removed.

I did a bit of digging recently about David Gratzer and I seemed to get contrary information about him. His bio at the Manhattan Institute says he won the 2000 Felix A. Morley Journalism Competition. But according to awarding institute's own web page, the award that year went to one Jason Brooks, a law student at the University of Toronto. http://www.theihs.org/grants_and_contest/id.903/default.asp They are not one and the same person because both Jason Brooks and David Gratzer got prizes in the 1998 competition. Brooks got third prize and Gratzer was a runner up.

He may have won a prize for journalism but I would have thought that a good journalist should check his facts before going to print. --Tom 16:58, 8 September 2007 (UTC)

I did a bit more digging and, to be fair to Gratzer, I thought I'd point out that I also found a very thoughtful podcast interview with him as a guest (and a transcript of the interview) at http://www.thehealthcareblog.com/the_health_care_blog/2006/10/podcastpolicy_a.html. I thought it was a different person, but then he was debating with someone who really know the UK and US systems and who undoubtedly would have been able to challenge some of the more egregious claims his makes in the written articles. --Tom 18:50, 8 September 2007 (UTC)

Tom, I'm replacing the David Gratzer link, for the same reasons I gave in Single payer. I'm very familiar with Gratzer's writings, in the Wall Street Journal editorial page and the Manhattan Institute publications, and I can make a better argument about why he's wrong than you just did.

The reason he should be included is not because he's right, but because he represents one of the loudest critics in the U.S. of the Canadian health care system. It's important for people who are following the health care debate in the U.S. to know what his arguments are and the reasons (and they are many) why he's wrong. The main problem with Gratzer is that he has never published anything on health care policy in a peer-reviewed journal (according to PubMed). He cherry-picks his statistics, for example using WHO statistics from several years ago showing that survival in breast cancer is longer in the U.S. than in Canada, without mentioning that survival is longer in Canada for other cancers, such as leukemia, and overall survival for all cancers is about the same. I could go on (and I have).

Wikipedia rules such as WP:NPOV and WP:WEIGHT require us to give all significant viwepoints, and Gratzer certainly meets this qualification, in my opinion. If you disagree I'd like you to read WP:NPOV and WP:WEIGHT. Nbauman 19:14, 8 September 2007 (UTC)

P.S. He did win the Felix Morley Journalism award in 2000 [5] If you look at the Institute for Humane Studies you'll understand why. Nbauman 19:20, 8 September 2007 (UTC)

Maybe I am being a bit thick. I do realize that this is not a prize competiton for real journalists but a way of giving away money for writing stuff that the IHS supports. But the link I gave was to the IHS web site which actually names a different winner for 2000. I see the claim that he did win the prize (he claims it on the Manhattan Institute web site and it is in that newsletter from his old university) but the evidence I gave came from the IHS's own web site, and it seems to refute that. The main problem as I see this is that people do read Wikipedia and follow links therefrom. I accept he gets publicity for his views way beyond what he probably deserves and it is a great shame that papers like the WSJ allow him to OpEd. Not many people buy the WSJ, but a lot more people read WP and therefore will get to read this stuff as result. External links in WP to articles like that should be referenced with a warning. We are leading people to believe that the person is a respected journalist. He just isn't. The award he got is parochial at best. And it is appalling that he can tell such attrocious untruths and get away with seemingly ununchallenged. Good journalists check their facts. I do think we do a disservice to WP readers by linking to such articles. I am sure that there are many genuine reasons to be concerned about the exercise of public policy on health in the UK and Canada, but they are exaggerated beyond all belief by this man. Perhaps he deserves a WP article all of his own. --Tom 12:52, 9 September 2007 (UTC)

I added the page David Gratzer with background from his own bio page at the Manhattan Institute. If he is as well known as you say (and he has indeed authored two books) he probably does deserve a WP page of his own. There was one before of that name but it has been deleted. I guess it was for someone else of the same name. For the time being I am leaving in the claim he makes about the Felix Morley Journalism award for 2000. I hope that we can get this cleared up soon as possible. —Preceding unsigned comment added by Hauskalainen (talk • contribs) 14:12, 9 September 2007 (UTC)

Rvt addition of 'common features'

I've removed the following text:

Common features. All implementations of socialized medicine have some common features. The first is that all citizens are invited to enjoy the benefits of the system at little or no direct cost, which leads to a state of universal health care.[9] The second is that all wealthy citizens are required to help finance the system through taxes. The third is that government rations available health care by making patients wait for weeks or months to receive treatment.[10]

To go one by one through these points and why I don't feel they should remain:

1. All implementations: massive generalization, since 'socialized medicine' is a term primarily used pejoratively in US political discourse, this will misread any readers that assume socialized = universal. Or, be more specific: to the extent this refers to specific systems, name them.
2. All citizens are invited to enjoy benefits at little or no direct cost ... universal health care. Sounds like this just means universal health care; not necessarily true in some systems considered 'socialized medicine' in countries where the term is used (even if inaccurately).
3. Wealthy citizens required to help finance the system through taxes. This point is banal, it would be true of any system supported from tax/income tax revenues (e.g. medicare in US is supported by all citizens who pay taxes, and more so by the wealthy).
4. Rationing: the specific point made is not supported by the reference, and not demonstrated to be common to all implementations, nor demonstrated to be distinct from non-socialized health care.

In sum, none of these points are really shown to be common to all implementations, the implementations referred to are not defined, and some points are inaccurate/undocumented.--Gregalton 03:52, 25 September 2007 (UTC)

I too support the revert. It tells a few truisms then a whopping lie! The argument is usually put forward that because health care is free it must be rationed and that governments do this all the time. But it is complete poppycock. The demand for angioplasties does not go up just because they are free. In free market medicine the cost of medical treatment and the supply is determined by pure supply and demand, so there will always people who need treatment but cannot afford to pay for it. Their queue time is determined by the time it takes for them to raise the money to get treated, but no authority records who they are they are, they are not counted anywhere and nobody knows what their average wait time is. The systems in Canada and the UK are at least honest and fair in this respect. If you are in need of treatment, you are listed as needing it, and you will be seen according to your relative need rather than the thickness of your wallet.

The length of the queue is to some extent determined by political choice expressed democratically. People elected Blair in the UK in part because he promised to spend more on health and cut waiting lists, and in large measure this has happened.

People in the UK (and I suspect Canada also) do not regard queueing as rationing but just rational. In a non-universal system as in the US it is perfectly possible that one person with moderate earnings and insurance is in hospital getting his hemmarroids treated within a week whilst another person on a low wage and no insurance is still working hard in a battle against time to stay healthy for long enough to keep working to save the money needed to get a developing bowel tumor removed. That's the difference. --Tom 16:38, 26 September 2007 (UTC)

I actually have no strong opinion on the rationing issue (to some degree, waiting times do represent a rationing measure), except that it should be fairly treated, and the source did not actually state what the text claimed. The problem is the use of the word 'rationing' is loaded, as if we were talking about lines for bread in the soviet union. Some degree of waiting (rationing also) exists in any medical system. If not, it would be an indication of massive overcapacity. Not having a heart-transplant centre in every small town or village is also a form of rationing, but nobody finds that strange. (Were circuit-riding Methodist preachers 'rationing' the Lord? No, it was just an acceptable trade-off between costs to the community and the level of service needed at the time)

A prof of mine (well known health economist) pointed out that 'free market' systems (if they in fact do exist anywhere for health care is a separate issue) also implement rationing: one exchanges pieces of govt paper for a good or a service. Those without sufficient govt-issued paper do not qualify. Just because the government is not directly distributing the paper does not mean there is not a form of rationing going on - there is a limited good and it is distributed amongst the populace according to some system.

The government is also rationing a whole bunch of other goods (public and otherwise): next time you're stuck in traffic, complain that the government is "rationing" roads. Next time we wait for the army to show up in an emergency, remember, it's because they rationed defence. In the US, for some reason the word rationing is reserved with special care for the health care debate. It rarely surfaces in other contexts or other countries with universal health care/socialized medicine - or when it does, it's understood that it's relatively normal for government to ration access to a good it provides for free (UK quite advanced in deciding how to ration / what procedures govt will pay for: essential medical procedures).--Gregalton 19:10, 26 September 2007 (UTC)

Well maybe we can agree to differ, but I don't think there is a conscious rationing in the sense of "well you can't have what you need" which is what the use of the word implies. It is that "we recognise that you need this, but we don't have the capacity to give you what you want at the same instant that we recognise that you need it (either immediately or soon), especially if there are other people with greater need ahead of you". So people wait. That is honesty. The deception that is put about by socialized medicine's opponents, as you recognise, is that there is no queueing in a free market. Clearly there is. I had thought about the universal insurance based systems, and how resources might be allocated, but I had no idea how these judgmenets are made 'cos I have no experience and no familarity with research material. You seem to imply that in such systems there is much less queueing. You may be right given that this type of system might not distinguish (as my example did) between putting a rating on a tumor removal relative to a hemmerroidectomy or whatever it is called or is spelled, but the profit motive might encourage hospitals to be available to do all work. But is there any direct evidence of this I wonder? I have heard anecdotally that French hospitals often have more slack periods and there was talk of inviting NHS patients to take their treatments in France if they wanted to get their treatment done more quickly. That was a few years ago before the current reforms started to bite.--Tom 21:28, 26 September 2007 (UTC)

I actually don't think we're disagreeing. In strict terms, universal health care/socialized medical systems do not ration: in the narrow sense, to ration means a fixed portion, like a pound of bread a week. In the more general sense, it means to restrict or confine, to limit, or to allocate. So in the narrow sense, universal/socialized systems do not provide a fixed portion (e.g. four units of medical care per year): they provide as much as is needed, subject to available resources and some definition of need. All systems restrict, limit, allocate or confine access to medical care, subject to available resources: market-based systems do so solely on ability to pay (at least in theory, not true in practice). So, 'rationing' is untrue in the narrow sense, and utterly banal in the broad sense.

The judgments about how to allocate resources under a universal system are difficult, and not common to all systems. One result may be queueing in some areas due to resource allocation decisions - is this rationing? Again, only in a broad, banal sense. Canada's allocation process has (generally) resulted in fewer MRI machines being available, and longer waiting times for MRIs (at least for non-critical reasons): some other expenditures have been prioritised over MRI machines (that may be a bad decision, of course, and indicate some problem with the allocation system). By the same token, a market-based system may allocate fewer resources to preventative medicine and a different public system (as implied by the French case you mention) may allocate more resources for 'extra' capacity for hospital space.

My understanding is that the UK system (and an Oregon system that had a similar basis) for allocating resources is fairly rigorous in the sense that it imputes notional monetary values to various diseases, loss of life, limb, etc., and compares these to the cost of the procedures/resources that should be allocated, and as a result prioritises expenditures and investments. In other words, cost/benefit analysis. But the main difference with other public systems is that the UK system has made this analysis quite explicit - other systems are doing the same thing, explicitly or not.

'Market-based' systems do this with the old invisible hand trick. That has certain failings, generally recognised, such as not providing extra capacity for e.g. public health disasters. Hence, "government" provides some of the back-up, such as stockpiling treatment for epidemics, Centres for Disease Control system and FEMA. This happens everywhere - it's just a question of degree.

At any rate, my point is that all systems ration in the sense of allocate resources, none ration in the sense of providing a fixed portion. So to say govt health systems 'ration' health care is at best inaccurate or blindingly obvious, but in reality constitutes an attempt to establish guilt by association.--Gregalton 06:47, 27 September 2007 (UTC)

Good. We do seem to be in agreement. In essence there is explicit rationing in a univeral system and implicit and hidden rationing in a free market system.

Having recognized that free-market systems do have unsatiated demand (i.e. hidden queueing), the important issue is whether the allocation of resources set by the price-level in free market systems is set more efficiently than in socialized systems. By its nature, the allocation to an individual in a free market system is likely to be based on ability to pay rather than need. As you say the overall allocation of resourcesis done by the "invisible hand" in a free market (i.e. at the point where supply and demand reach equilibrium) and in socialized systems it cuts off at a level set by professionals based on an acceptable level of quality/length of life degradation by those yet to be treated. I know for a fact that the recent investment program in cancer care in the UK was based on this kind of periodic re-assessment. You raised the issue of MRI and it is interesting to see how MRI investment varies globally. The US does indeed have more MRI than Canada and Japan has considerably more MRI investment than the US. I actually suspect that the reason is that in the US, an MRI is considered as being a "must have" investment by the hospital to gain credibilty, whereas in the UK, if a patient is in an NHS hospital without MRI he is just ambulanced to the nearest MRI unit if an MRI diagnosis is needed. In other words I expect that MRI units are just used more efficiently in the UK and Canada than they are in the USA and Japan. Does any editor know of any research in this area? Do US hospitals I wonder, charge the patient for an expensive MRI when a cheaper x-ray or CT scan could have done the job? It would be natural for private hospitals to do this to recoup their MRI investment. --Tom 19:34, 27 September 2007 (UTC)

To Kborer: You raised this issue. Maybe I can ask you two questions

Do you accept that in a free market system there is rationing and hidden queueing based on affordability? (i.e. there are people in need who, for whatever reason, cannot get the funding for the care that they need and have to wait until thay can get the funds?)

Am I right that professionals in hospitals in free market systems are treating people with non-life threatening conditions like hemmaroids whilst others are dying of more serious conditions because they are denied insurance cover or merely cannot afford it? Or does medicaid prevent this from happening in ALL circumstances? If the latter, why would anyone buy insurance if medicaid is there to rescue you from the moral hazzard of, say, choosing to pay for a better education at the expense of not paying for medical insurance?--Tom 19:34, 27 September 2007 (UTC)

I can give you some verifiable examples of the free market.

The Wall Street Journal had a story a few months ago about a rural family in China with an 11-year-old boy who had leukemia, which in the U.S. or other developed countries is curable with about an 80-90% cure rate. They brought him to an urban hospital, which demanded $20,000 (several years' income) before they would treat him. The family couldn't raise the money, so a hospital employee yelled at them for not having the money and kicked him out.

A doctor in California wrote a letter to the New England Journal of Medicine about free-standing MRI centers. She called up several centers, gave them the symptoms for a brain tumor (sometimes curable), and told them her she wasn't insured, and her doctor had told her to get an MRI immediately. The centers told her she would have to bring $500 cash for a deposit before they would deal with her. They suggested she go to UCLA (her own hospital, where she knew they didn't give MRIs to patients in a situation like that). Then she called the same MRI centers, told them she had a sprained ankle, and wanted an MRI (which would be useless), and gave them the name of her actual health insurer. They were ready to give her an appointment immediately.

Then there's the story of Shirley Lowe, the breast cancer patient, from the WSJ, which they put on their free site here.

I'm not sure that you can say that the government systems ration care. The UK has had court cases which prevented the NHS from rationing care for expensive drugs like herceptin, in my understanding. And in the US, the military medical system has essentially a blank check in treating injured patients. A soldier was vaccinated for smallpox, and his infant son got infected with the virus that they use for the vaccine (which used to happen occasionally when everyone was vaccinated). The son had a life-threatening reaction, and they must have spent at least $1 million to save him. Science magazine had a good story. Nbauman 20:51, 27 September 2007 (UTC)

Again, the point above is that 'rationing' is a loaded term. All systems 'ration' in the sense of limit or allocate. Government systems may not limit the amount spent on an individual case, but they will limit the use of e.g. non-proven or unnecessary treatments, as would an insurance program; a pure cash payment system would allocate based on willingness or ability to pay, not need - if you want an MRI, you got it. Even where they don't restrict access or spending per patient, under any system they don't build heart transplant centers in every village, 'limiting' access (by not providing infrastructure that may exceed any projected usage in a cost/benefit sense). For the Veteran's administration, they may not have intended to limit access to specialists in amputations/traumatic brain injuries prior to the Iraq war, but may have underestimated the eventual need (or simply been unable to expand their capacity quickly enough). Resources are limited, and hence must be allocated according to some system, including projected need.

And again, no systems of which I am aware 'ration' in the sense of providing a fixed allocation of resources (one major surgery per year and that's it for you!). So 'ration' is either untrue or utterly banal, but for some reason it is used almost exclusively to refer to govt-funded systems in the debate about universal health care.--Gregalton 03:09, 28 September 2007 (UTC)

I thought the article could use a section describing some common features of socialized medicine. With socialized medicine, demand always rises beyond supply and then the government always needs to curb demand. This is always done through market based reforms and rationing in the economic sense of the term (http://www.answers.com/rationing?cat=biz-fin).

With socialized medicine, the government decides how much health care people get, which is rationing. With the free market, people decide how much health care they get, which is not rationing because it is unregulated. Just because rationing is a loaded term does not mean that it should not be used in the article.

I will rewrite the section using your feedback. Kborer 23:59, 28 September 2007 (UTC)

Since the 'commonalities' appears to primarily consist of generalizations about unspecified (theoretical) systems that can't be expressed without using loaded terms, it may be better to leave it out. Even your statement above "with the free market, people decide how much health care they get" leaves out the important qualification "if they can pay for it."

As noted in the references, rationing in the strict sense limits quantities (e.g. pound of eggs a week), possibly with a correction for need (extra protein for children and the old). No system limits medical care according to fixed quantity, nor even with an adjustment for need (only one major operation for the sick, one minor operation for the poor). So rationing is a poor choice of terminology: it is loaded and inaccurate.

Besides, you talk about 'common features' of socialized medicine, without identifying which systems you're referring to (some idealized platonic socialized medicine)? Your statements such as "demand always rises beyond supply" is not undeniably true, and amounts to nothing more than a generalization.--Gregalton 09:39, 29 September 2007 (UTC)

To Kborer. Your wording is heavily loaded and is inaccurate. Let me recast and add to what you have said. I'll put it my words so that you can use my text as needed, but it is as well to agree the text here first becuase I just have this feeling that we are not going to agree immediately.

With free market medicine, the cost of medicine seems to rise far faster than in socialized medicine systems and thus beyond the former demand level. Demand is then curtailed in two ways. Firstly, those that cannot afford the new price level will have their demand unsatiated. This is a form of rationing based on wealth. Secondly, the invisible hand of capitalism causes former funders of private health insurance, employers, to question their expenditure on health insurance benefits. Some will cut their health insurance cover leaving even more people with inadequate or no health care. This causes people to question the wisdom of their private medical system which is expensive and has coverage gaps.

With socialized medicine, the people decide democratically how much health care will be funded for the total population, and leave it to health professionals to decide how best to allocate the resources to maximise life expectancy and quality of life. This is a form of rationing based on logic. With socialized medicine, people are still free to decide how much health care they get, within the bounds of their private resources because they can still opt to pay for their treatment themselves. This freedom allocates more funding to health care overall but can distort the logical allocation of total funds and the supply available to the public system. One country, Canada, has chosen to restrict this right within its own borders but most countries with socialized health systems have not done this.

FYI Kborer. Rationing is not a term just used to describe regulated allocation. The term is widely used in describing the function of the price mechanism in the free market. '"Through the free price system, supplies are rationed, income is distributed, and resources are allocated"' - See Free price system. A Google search on "rationing" amd "price mechanism" will also lead you to academic texts which use the word in this context.

I do not think people demand more health care in socialized systems in the sense that they ask for more teeth to be filled, or demand more legs to be put in plaster casts just because it is free to use. Health is not a commodity in that sense. It actually may be the other way round. Because private medicine is expensive people put off going to the doctor and what could have been recrified simply if tackled early on becomes a much worse problem leading to a higher overall demand in the free market system. I find it hard to understand why the US does so many more complex heart operations per head of population than the rest of Europe. Our cemetatries and morgues in Europe are not, I assure you, not filled with people who died of heart failure whilst waiting for surgery. --Tom 11:13, 29 September 2007 (UTC)

Freedomwarrior edits of 9 October

I have reverted the article to the position before these edits. There were quite a large number of individual edits and it is quite hard to work out (a) what they are and (b) what the purpose of each edit was. To Freedomwarrior: Can I ask that we take your edits one at a time and can give a reason for the edit? Ideally here first, but if needs to be to the article it would be helpful if they are done as a number of smaller edits with a reason for each edit.

First, there were two edits, as compared to your numerous previous edits. My edits eliminated much of the original research that you added on here, which is not permitted according to WP:OR and removed biased language, such as "Reports in the press and emanating from pressure groups are often distorted and misleading," according to WP:NPOV. I am not going to take the time to go through each and every single one of these points because I do not have the time. If you believe that something--which you can provide citations for --was removed without justifiable cause, then we can go about restoring it. Freedomwarrior 21:13, 9 October 2007 (UTC)

OK let's consider the "original research", one point at a time. You removed reference to the fact that there are people waiting in free market whose number is not counted whereas in socialised systems they are explicitly counted. Why is that "original research"? Are you doubting the truth of the statement that the untreated in private health care are not explicitly tracked? --Tom 19:48, 10 October 2007 (UTC)

I removed the statement "health care is also rationed in a free market medical system where there are invisible queues" because it affirms or at least suggests that the same factors that impede people from getting treatment in a socialist system--government control through "rational" guidelines, whatever that means-- are the same ones that limit access in a free market system.

Which part affirmed or suggested that the same factors apply?. I thought the explanation was quite clear. --Tom 18:31, 12 October 2007 (UTC)

The word rationed had been linked to the government's actions in a previous section. By saying that health care is also rationed in the free market, it makes it seem as if though health care is unavailable under such a system for the same reasons that it's unavailable in a socialized one. I would prefer to get rid of the word rationing all together and focus to outlining the facts.

On the second point, while there are people who are waiting in a free market system, records are kept on their efforts to procure care through their insurance companies (if it denies care), the hospital (which rejects the patient's efforts to get care), etc. Freedomwarrior 17:22, 13 October 2007 (UTC)

The issue is one of transparency. Socialized systems are transparent in their waiting numbers whereas free market is not. I make this clear in today's edit.--Tom AKA Donald 15:40, 14 October 2007 (UTC)

The issue is that national records of qaiting times in socialized systems are based on actual personal data and informs the political debate on the allocation of resources to health. There are no national records kept in free market systems and therefore the issues about the numbers of people waiting for care in the free market and their level of suffering and premature death can only be estimated. --Tom AKA Donald 20:24, 12 October 2007 (UTC)

If you want to affirm that there are no state records kept in a free market, then you're entitled to do so. However, you cannot affirm that there are no records kept at all. Freedomwarrior 17:22, 13 October 2007 (UTC)

You also removed the statement that "Reports in the press and emanating from pressure groups are often distorted and misleading". This is followed by an example of a distorted and misleading report and an explanantion of why it was a distortion and misleading. Why is that original research? The final report about the incident in France was of course published in French but I did read a summary of it in English a few months ago. Here is a report from the Journal of Urban Health (New York academy of medicine) about that incident. http://wagner.nyu.edu/faculty/files/juhMarch07.pdf As you can see, it contrasts markedly with the distorted report I give in the article which paints a picture of hospitals in France bursting to the seams whilst doctors are on holiday and thousands of people dying in hospital for lack of treatment. If you think this is original research, my name is Donald Duck. --Tom 20:20, 10 October 2007 (UTC)

Hello Donald. Unless you get hard, quantitative data which affirms that such reports are often misleading, you do not have the evidence to sustain such a claim. That said, I don't have a problem with the claim that there are some misleading reports on socialized medicine being produced (on both sides and I don't mind making that explicit).

Are they that uncommon? You proved the point nicely because one of your edits was as to add a Cato Institute article on the "five myths of socialized medicine" which makes numerous outrageous and distorting claims. For instance it says that people do not have a right to health care. But the law in those countries DOES give a right to health care and most people get treated even if they have to wait. In fact the article was actually referring to waiting times and not rights, but ignored completely the waiting times existant in free market health care! In a section on the "myth" that socialized medicine is of high quality it cites an academic paper which points out that the US carries out a much higher rate of "high tech" medical procedures than either Canada or the UK, leaving the reader to conclude that high tech medicine is less available in socialized systems and that they actually provide lower quality care. But in fact, the article quoted (which was mostly concluded that the high cost of medicine in the US was mostly due to higher prices than delivey) specifically says that "these data, of course, DO NOT provide insight on the medical necessity of these procedures", a caution which Cato decidely throws to the wind! I could go on to criticize the other 3 myths, but I think you get the point. As for the need to demonstrate that they are often misleading, I think you just have to do a google search on socialized medicine to see that I am right. The Cato article you quote comes up 5th in the list. The second third and fourth articles cite similar false information. I'd be happy to take a vote on this issue amongst other editors if you like.--Tom AKA Donald 20:24, 12 October 2007 (UTC)

Those claims are "outrageous" and "distorting" to you. First, there is no such thing as a generalized right to get something from someone else (there's no individual between an individual stealing something from someone else and ). Accepting the premise that there is though, I'm not gullible enough to conflate a paper guarantee ("right" to health care) with what goes on in practice.

Nobody is saying there is a genereralized right without the intervention of law. When people have the right in law they can go to court to enforce their rights if they are denied them. The right does not just exist on paper as you seem to imply.--Tom AKA Donald 15:40, 14 October 2007 (UTC)

As you concede, most people get treated, not all.

With regard to the quality of health care in a socialized vs. free market system, the necessity of a procedure is unrelated to the sophistication of the techniques that are employed by doctors.

I agree. But the point is that there are indications that in free markets, there may be a tendency to use expensive and sophisticated medical techniques that are not justified. Is the high use of MRI in the US a sign that hospitals are trying to recoup their investment in expensive medical equipment by charging for MRI when a cheaper alternative would be as effective? Is the high rate of angioplasties in the US a reflection that doctors are behaving defensively against possible litigation? Those kinds of pressures mostly do not exist in socialized medicine. The answer is that we do not know for sure why American practitioners do a lot more expensive medicine than in other countries, all that we know for sure is that they do and that as a result Americans pay twice as much for health care than people anywhere else.--Tom AKA Donald 15:40, 14 October 2007 (UTC)

Anyway, I don't think I have to do anything here. If you want to make such an addition to this article, you need to prove your point through objective, hard data from a verifiable and neutral source. Freedomwarrior 17:22, 13 October 2007 (UTC)

you also removed at least bullet point headings in the edit regarding "original research" which made this section of the article esier to read. Why did you do this? --Tom 20:26, 10 October 2007 (UTC)

Your right about it making the section easier to read. As I was removing "This claim is often made," which was repeated on several occasions, I mistakingly cut it off.Freedomwarrior 04:31, 12 October 2007 (UTC)

Rationing

I am actually rather doubtful as to the claims made about "rationing". It is an emotive term and although it has been used in the health care debate, what is often termed as "rationing" is, in fact, nothing of the kind. The so-called "post-code lottery" is often (wrongly) dubbed as "rationing" (as happens in the Scotsman article). The so-called post-code lottery arises when one part of the NHS (e.g. an individual NHS trust) funds a particular treatment whereas another chooses not to.It can also happen because there is not one NHS but 4 (for England, Scotland, Wales and Northern Ireland). This happens precicely because there is a lack of bureacracy at a national level to control whether a service is or is not allowed under the free NHS treatment, or because there are guidelines but they are interpreted differently in different areas. There will always be borderline issues like this. This kind of issue often arises with expensive drug treatments where the benefit is borderline. One can always pay for the treatment oneself if one has the money and the drug has a safety approval. The issue is whether the taxpayer should fund it. "Rationing" sounds like preventing access and this is not what usually happens. But it can mean blocking the free-of-charge access, and most people think that this is sensible when deciding how taxpayers' money is to be spent. This is effectively what the doctor in the Scotsman article is referring to.--Tom 14:22, 9 October 2007 (UTC)

WHO CARES IF "RATIONING" IS AN EMOTIVE TERM?! IF IT IS WHAT'S HAPPENING, IT IS WHAT'S HAPPENING!!! AHHHH!!! --69.253.92.203 16:09, 23 October 2007 (UTC)

Maybe you should read further on in this section to understand the issue further. Rationing happens in free market health care too, but people who support free market health care either cannot or do not want to recognise this fact, though health economists do understand this very well. Its emotive if it is used to create negative emotions, which is the way the term is used. --Tom 20:26, 23 October 2007 (UTC)

Any sort of "rationing" that happens in a capitalist system that you have to make an argument for is not the same as the obvious examples, by definition, of rationing in places like Canada. If the fact happens to be emotive, it doesn't really matter; it's still a fact. You could make an "argument" that there is still a sort of slavery in America, but there were clear examples of it in America before abolition.

The rationale for the rationing is irrelevant, as is the emotional baggage that the term carries. Kborer 01:40, 11 October 2007 (UTC)

Well it is not rationing in the sense that most people use it. If you visit a national park in the USA are you charged an entry fee? Probably not. But if you visit Disneyland you almost certainly do. Sure, the government could purchase Disneyland and all the other theme parks and let everyone in for free, but it chooses not to. Does that mean that the government in the US is rationing theme park access? People would only think that if they thought the goverment SHOULD buy up all the theme parks. And of course most people do not so nobody in their right mind would argue that the government is rationing theme park access. Rather access is left to the free market price mechanism. But that is all that is happening in the UK when the NHS decides not to fund a particlar treatment. Its allowing the price mechanism to control access. So if you think that a socialised system is rationing at the point when it allows the price mechanism to dictate access, then by that definition, nearly all health care in the US is being rationed. Or have I misunderstood something?--Tom 19:57, 11 October 2007 (UTC)

Have you ever been to a national park? They almost all have entry fees... --69.253.92.203 02:22, 25 October 2007 (UTC)

Health care is rationed in the United States. This happens in public hospitals that provide care for the uninsured and those patients participating in socialized systems such as Medicare and Medicaid. For example, there is a greater demand for dialysis, Xigirs, colonoscopies, and new technologies like HeartMate than what is being supplied to these patients. Instead of spending more money to meet the demand, demand is artificially lowered through denial of treatment or waiting times. This is rationing in the normal sense of the term. Rationing is not normally used to refer to being unable to afford certain health care services in a free market system. Kborer 02:33, 21 October 2007 (UTC)

Well said. So, basically, the only "rationing" happening in the American system is the rationing we see in our socialized systems.--69.253.92.203 02:24, 25 October 2007 (UTC)

I agree that in everyday parlance, "rationing" usually refers to "non-price rationing" because price based rationing is automatic and not explicit. But economists (which would include health economists) are more precise and recognize that rationing happens all the time in free markets through the price mechanism. In the case you give, health care rationing did not begin in the public system but in the private system. The private medical system had already previously denied aid to the Medicaid patient by a form of automatic rationing, the price mechanism. You state that "Instead of spending more money to meet the demand, demand is artificially lowered through denial of treatment or waiting times". But in fact, if you take a wider view, quite the opposite is true. Additional demand which the primary private health care system could not meet was met by Medicaid because additional funds were provided to make more health care available to people who otherwise could not afford it. In the final analysis, Medicaid/Medicare is a form of wealth distribution based on health and wealth in exactly the same way as the NHS is in England and the only difference is which is the primary system and which is the secondary. Rationing happens in both systems and for the same reasons. --Tom 08:42, 21 October 2007 (UTC)

Uh... you're just completely wrong. Admit or don't but move the hell on.--69.253.92.203 02:24, 25 October 2007 (UTC)

No I am not wrong. The argument is sound. Rationing happens in a pure free market medicine according to the supply and demand intersection. But actually there is also bureaucratic intervention in private medicine too. It happens when an insurer refuses to fund a procedure. For example with MRI imaging "preauthorization requirements now lengthen scan turnaround and often interpose gatekeepers with little medical training or diagnostic experience...restriction of technical fees by managed care organizations and government fiat has markedly reduced revenue". (http://www.imagingeconomics.com/issues/articles/2001-05_03.asp). So both HMOs and other insurers as well as governments are rationing health care in the US.Rationing is not unique to socialized medicine. --Tom 12:57, 12 November 2007 (UTC)

Edit of 14 October - waiting times and rationing and some removed text

In my edit today I have (a) put back the criticism headings accidentally removed by Freedomwarror and (b) removed the muddling of waiting times and rationing by the Cato article and discussed by Freedomwarror. I also (c) removed some excessive text on waiting times and (d) added back the criticisms of government role and capacity that are sometimes made.

Re (b) above, rationing determines WHAT treatments are available in the free system, not WHEN they are available. The Scotsman newspaper article is about WHAT treatments are available for free and what should be paid for. I therefore added a section on rationing and put the scotsman article there.

Here is the text I removed, and in italics, my reason for removing it.

Government rationing, is often the result of reshuffling on the waiting lists. http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf

Cato may have said this but if so, then it is deliberately confusing rationing and waiting. Rationing as the term is used in socialized medicine determines what treatments are free and waiting is determined by relative need as determined by doctors (not by government, which was what Freedomwarrior had previously inserted). I know that is not the mormal meaning of the term rationing, but this is what it means in terms of socialized health care systems. If the case is that governments do indeed shuffle the queue in order to ration services then I'd like to see evidence for it. Just because Cato says it happens does not make it true.

You'll have to forgive me, but that's not a definition that I've ever heard nor is it one that makes sense. If rationing were confined to discussing those treatments that are available on a "free" basis, then a state which grants its citizens a "right" to get treatment for anything (regardless of whether it provides such treatment in practice) would be one where no rationing takes place. That would mean, for example, that there is no rationing in Cuba, which guarantees (de jure) all sorts of things (which are not available de facto). Using the more natural meaning of the term is "to restrict the consumption of (a commodity, food, etc.)" then we can include waiting times as a form of rationing because it "restricts the consumption of health care" (on a permanent basis should the patient die).

Well I will forgive you, but if you read the Scotsman article or any professional discussion about rationing in health written by people involved in managing socialized systems it is always a matter of what is "in" and what is "out" of the free service. It is a restriction of a commodity as you say, but it is done in a way to maximise public benefit. So a 72 year old man might get a coronary triple by-pass for free, because he may have 6 more years ahead of him but a 97 year old probably would not because statistically its a bad investment. I cannot speak for Cuba because I know nothing of the country, but the logic I just described is what rules in the UK which is the country where I lived for 48 years. I doubt that Cubans would argue that they do not ration care.. they have a limited pot of money as does the UK and the US. --Tom AKA Donald 20:46, 14 October 2007 (UTC)

You make a rather cynical point about waiting being a form of rationing. Because urgent (life threatening cases) are always treated immediately, people do not normally die on a waiting list because a condition they are waiting treatment for is unavailable, except perhaps for a person awaiting transplant surgery where lack of organs is the key issue. Except in these rare cases, most people on the waiting list are eventualy treated. I challenge you to prove the statement you make (and Cato made) that waiting lists are a form of rationing. Consumers can opt to pay and seek private treatment if they wish if they think they can get it cheaper. Incidentally, I recently broke a tooth here in Finland. The earliest private dentist appointment I could get was 4 weeks ahead. The public dentist wait time was 10 days and he did a cosmetic filling in one visit for just 30€ (about 20 US$ I think). I think that was pretty impressive!--Tom AKA Donald 20:46, 14 October 2007 (UTC)

By the way, if governments determine the allocation of resources that go to the health care system and not consumers, then how is the government not the one determining how much people wait? Freedomwarrior 18:07, 14 October 2007 (UTC)

Because we are only talking about the free of charge public health care system, not all health care. People are free to find a private provider for which the patient may or may not get a state subsidy, depending on the rules.

In response to their critics, supporters of socialized health care affirm that health care is "rationed" or limited in a free market, since individuals cannot obtain care if they are denied funding by their insurance plans, lack adequate insurance, lack personal funds, take out loans to cover their costs or obtain private charity to assist them.

This is replaced with similar text " In free market health care, the price mechanism determines how health care is rationed. Those that cannot afford health care or the requisite insurance may also have their health care needs unsatiated."

Although what you said would be partly true in a purely free market, we live in a world where most governments have adopted interventionist policies in the market. Therefore, the price of health care in most country's is a product of the free market and the added costs of state regulations. I modified the text to reflect that.

I also added the payment options that are available for those who seek care in a free market system. Freedomwarrior 18:07, 14 October 2007 (UTC)

Because every person with a need is recognized (see waiting times above) the forward line of patients is constantly changing as new patients with different priorities join the line. Hospitals that book the entire waiting list therefore risk having to change appointment times as the due date approaches. Most people in the UK opting for non-urgent elective surgery will be given a date within 8 weeks. Those whose surgery is less critical may wait longer but will be given a date within 8 weeks notice of an admission date for elective surgery. However, circumstances can cause cancellations to occur, for example when a theater slot is used for an emergency admission, or if a surgeon or key members of the team is unexpectedly not available. One of the biggest problem is that surgeons contractually only have to give 6 weeks notice of taking vacation and this conflicts with the health service's desire to give the patient 8 weeks notice of intended operative date. People whose admission is blocked are not put to the back of the queue but get a priority for the next available slot, if someone with a higher priority illness does not come forth for treatment.

This was my own edit. It could go back if someone objects but my new revision is much shorted merely saying "Patients in socialized systems are usually tolerant of cancellations because it usually happens only when an emergency case requires a theater slot previously marked for a planned admission." The issue with surgeon's sudden non-availability e.g. through ill-health can equally happen in free market medicine (the vacation issue may be different).

You cannot affirm that most patients are "usually tolerant of cancellations" because you do not have polling data that backs this claim. However, the rest, as an explanation of why there are cancellations in such a system, seems like fair game.Freedomwarrior 18:07, 14 October 2007 (UTC)

Tom, while I think you're making good arguments, a Wikipedia article isn't a personal essay and according to the WP rules, unsupported opinions will be deleted. Could you find a verifiable source to support your arguments?

For example, the Wall Street Journal had a profile of a Canadian nurse who handled operating room scheduling, and thus decided who would be operated on first and who would have to wait. A man was scheduled for coronary bypass surgery, but was repeatedly re-scheduled for more urgent cases. A woman was brought in for an emergency operation. Finally he got his coronary bypass surgery. The reporter asked him if he was annoyed at the delay and he said, no, the woman's surgery was more important.

Can you find something like that with a verifiable source for the UK? Nbauman 18:14, 14 October 2007 (UTC)

I think I once before gave you the example of my own mother who broke her hip in 2003 and was scheduled to get a new one the day after she broke it. Even I was amazed that the new hip would be planned for the day after the break. When I went to visit her post op, the op had been cancelled because the theater was needed. But the op was done the very next day. And Mum was not in the least bit annoyed (for the same reason you cite). Ok this is not reported in the WSJ, but its an everyday occurance and is not really newsworthy. My local newspaper would not have made a story out of it. It just isn't news. If you really think this is news and a paper in the US might be interested in carrying it I can certainly pass on the details to a journalist who could verify the data with the family and the NHS hospital concerned. Sadly, Mum had a severe stroke just a year later and is no longer with us. She was just 75. --Tom AKA Donald 20:46, 14 October 2007 (UTC)

I have since been looking for some public opinion data in support of the argument but cannot find any. The Health Services Commission undertakes a regular survey of NHS users opinions and experiences, but it does not ask that precice question. For that reason I have left the edit out.

Tom, as for your own mother's experience, it is a firm principle in Wikipedia that we can't use personal experiences. That would be wp:or original research. Our own personal opinions are not wp:rs reliable sources. I'm sure you're telling the truth, but it's impossible for me or anyone else to verify it. If your personal experience is common, as I'm sure it is, someone must have written about it in a reliable source, like BMJ or a newspaper. If you want to make that claim, you have to find a published reliable source for it. And there are sources for it. If there's one thing they're doing in the UK about waiting times, they're talking about it. Nbauman 14:12, 18 October 2007 (UTC)

Criticism of socialized medicine

The portion of this article about the criticism's of socialized medicine was simple just one sided. It was disgusting to read this article because there was no support against socialized medicine. One can plainly see that the author of this article if for socialized medicine and it trying to convince people to vote for it. I found to actually criticism's in the section Criticism of socialized medicine, but only arguments for socialized medicine. —Preceding unsigned comment added by Andrew ritchey (talk • contribs) 21:22, 14 October 2007 (UTC)

Andrew. I have added the criticisms that I have read about socialized medicine, many of which contain distortions. I think it is fair to include fair criticisms but not distorted ones. The cancellations criticism for example is a fair one if it can be proved that cancellations happen more frequently in socialized medicine (which I am inclined to believe it does, perhaps because in a private medical system, failure to deliver according to an agreed schedule could be construed as a breach of contract and lead to expensive litigation). That cannot happen in socialized systems as there is no contract. But the story reported of a cancer patient having an operation cancelled 48 times is not symptomatic of a socialized system... it was clearly a teething problem with a new bookings system and the way the story was reported was quite misleading. I can see how some editors here are objecting to my pointing out of these distortions, but clearly, if this article and others like are used to point WP readers to these kinds of articles which are non-academic and contain misleading information, it is only fair to warn readers about these failings. Otherwise we should remove references to these articles completely. The funding of health care from taxation does mean that tax rates will be higher in systems with socialized medicine. That is a fair criticism. And it means that the wealthy and those with above average health will pay a lot more into the system than they get out of it, and conversely the poor and the sick will get more out than they put in. That is another. There are many valid criticisms that one could add and I am not against adding them if they are verifiable or are so logically true that verification is not needed. I personally think that the issue of having, say, a hip replacement operation cancelled because someone needs the theater for a life saving procedure comes into the logic category. A person who objects to that is in need of a common sense transplant. --

Tom 14:06, 15 October 2007 (UTC)

No, Tom. Sorry. The section is complete hogwash. You have a clear political agenda, and because of it your article is crap. A read of the criticism section allows a person to walk away with more information concerning the criticism of criticism than the actual criticism! It's backwards and useless, and what's worse is this: there's no fixing it because the moment someone tries somebody else will erase or edit the bite out of the criticisms provided for fear of, what is it? Oh right, the facts. --69.253.92.203 16:13, 23 October 2007 (UTC)

Where is your proof that it is hogwash? I actually think that Wikipedia should enlighten people to the truth, and all I am doing is pointing out some facts. If I criticise the NASA Apollo mission by saying that in fact, NASA did not send a man to the moon but it was all set up in a film studio, I would rightly be expected to prove the case I am making. So why is that if I expose the falsehoods in the claims made against socialized medicine, then I am following a political agenda? I am actually only interested in the truth and if there are untruths or misleading statements, then it is only fair that they should be exposed or revealed for people to determine the facts for themselves. BTW, it's not my article.... its a collaborative effort. --Tom 20:15, 23 October 2007 (UTC)

Bureaucratic Control

Let's begin by recognizing that not all systems are the same. For instance, once the funding allocations have been approved by the Congress in the United States, it is then up to the civil service to determine what research projects or services get funded. While the health professionals do play a role in the fudning process (through their requests for funds), they are not the ones who are ultimately in control of the process. Freedomwarrior 17:25, 15 October 2007 (UTC)

So who are these people with the ultimate decision in the US? Surely these people making these decisions are professionals and are not making arbitrary decisions. Using the term "bureaucrat" makes it sound like they are not trained. If the government or a government agency was using pen-pushers or someone without professional training or expertise to make these kinds of decisions it would indeed be scandalous and heads would roll. That's why I think "professionals" is a more neutral term. I know that the US has something of a tradition of political appointments in the civil service, especially at the higher levels. That would be considered corrupt practise in the UK and cannot happen there because there is an independent body that makes civil service appointments (The Civil Service Commission) which ensures that only people with the requisite skills get appointed. And as we are talking about socialized medicine it is Canada and the UK seems that most often get discussed, not the USA. --Tom 17:56, 15 October 2007 (UTC)

First, I'd like to observer that most of your edits seem to ignore the very basic fact not all bureaucracies or government run healthcare services operate like the UK's. This is not an article about the UK's health service, it is about socialized medicine in all parts of the world (which includes countries like Cuba, Canada, Belgium, etc.)

With regards to the question before us: I do not ascribe a negative meaning to the term "bureaucrat." However, I have about as much of a problem with calling bureaucrats "professionals," which is a term that socialists borrow from the advocates of the free market to pretend that bureaucrats are somehow as competent as business professionals, as you seem to have with calling them "bureaucrats." Therefore, for the sake of comity, I propose that we use the term "civil servant" instead. Freedomwarrior 20:11, 15 October 2007 (UTC)

Edit war

Clearly, a significant edit war has started. If this does not settle down I would like to take the points at issue to a dispute resolution process. Are you OK to that Freemdomwarror? Perhaps it would be more productive to use this page to agree the points of dispute and our repective postitions and take them to arbitration.

---

—Preceding unsigned comment added by Hauskalainen (talk • contribs) 18:24, 15 October 2007 (UTC)

That's probably for the best. This is a hot topic right now, and emotions are running high regarding it; in addition to an edit war, there's an interpersonal war of social and political differences taking part here, and the article is suffering for it. - Prestonmarkstone 19:27, 15 October 2007 (UTC)

If you insist on disregarding the WP:OR rules, then I would insist on a dispute resolution process because this is not a personal blog where you, or anyone else for that matter, can extol the "virtues" of socialized medicine (without even providing sources) and eliminate all criticisms.Freedomwarrior 19:47, 15 October 2007 (UTC)

As I say, I think there are fair criticisms that can be made, but the criticisms that are often made and peddled here by certain editors contain distortions and there seems to be a huge reluctance to have those aired. I contest that this is OR and would counter that some of other additions here of late by others are also OR (like drawing parallels between marginal tax rates and socialized medicine). Most of the distorted articles I have been referring to have no academic credibility but they are frequently quoted on WP, and thus it is only fair they they be challenged when they mislead. I am not using WP as a personal blog but wish that WP gives a fair and balanced picture of something which I as a European am familiar with. A very small number of editors on the other side of the Atlantic who have little direct experience of this type of medicine are so very fond of criticizing it. It was because the article was so distorting that I got involved in editing it in the first place. --Tom 21:00, 15 October 2007 (UTC)

waiting times over 6 months exaggerated 800 fold

Your edit accuses me of "extrapolating the performance of the NHS over a year from one data point. That's unacceptable". There is no extrapolation going on. The data is what the data is and it represents waiting times as they are today (or at least as far as the last data set was published). There may be a slight change in the number over time since the CPA collected their data but I doubt very much that it has changed 800 fold. --Tom 20:43, 15 October 2007 (UTC)

There is a significant difference between waiting for "some type of care," which is what the Manhattan Institute's report focuses on, and the "hospital in-patients waiting over 26 weeks," which is what the UK Department of Health report touches upon. You cannot compare apples and oranges.

Well, I think that is pushing the limit. How many people are waiting for "some type of care in the free market"? I am giving some hard facts. Whare does the MI gets facts? Does the article comprise OR? If so, does it deserver to be quoted? I had this discussion once before with Nbauman and his view was these views are often reported therefore they should be quoted. But that is frankly nonsense if you can add articles that contain OR and I cannot add information based on hard facts!--Tom 21:09, 15 October 2007 (UTC)

I don't know where the author of the article got his information from since he provides no citations. However, it is worth noting that this article is an adaptation from a larger report on the issue. Anyway, you can eliminate it if you want since I'm not going to search for one that's sourced.

Moreover, I was mistaken in saying that you extrapolated the performance of the NHS over a year. In fact, I do not know the time period over which that data was collected. It could have been since the start of 2007, since the previous year, etc. I don't quite know. Nonetheless, in the absence of the lenght of time that the performance of the NHS was surveyed (both in the Manhattan Institute report and the NHS report), you cannot make a valid comparison of the data sets because that would be comparing apples and oranges (once again). Freedomwarrior 20:58, 15 October 2007 (UTC)

As I say, the NHS data reflects the state at a single point in time. It cannot be extrapolated. --Tom 21:09, 15 October 2007 (UTC)

Then it adds nothing to the discussion, since we do not know whether it's talking about problems over an 8 month period, a year, two years, etc. Freedomwarrior 22:27, 15 October 2007 (UTC)

I added back the statistics. The table in the reference shows the historic trend in the data over 5 years. There is therefore comparable data. Tony Blair's party was elected on a promise to invest more in health and reduce waiting times. That is clearly seen in the trend over the 5 year period. To:Freedomwarrior. You asked me to provide a reference for the statement that national statistics inform the public debate. To me that seems so self evident that it should not need a reference. What kind of reference do you want?? —Preceding unsigned comment added by Hauskalainen (talk • contribs) 17:59, 17 October 2007 (UTC)

Nomination for cleanup

I just walked into this discussion today, but in reviewing the talk page and the history of edits, I get the feeling this article ought to be nominated for cleanup. This is a controversial and important topic, and one that, as a rule, has not been subjected to constructive dialogue; the Wikipedia community ought to be the grand exception to that rule by collaborating to create a fair, comprehensive and useful article. Whether or not it's the case, a talk war over POV and original research gives the article a sheen of propaganda; it might be best to remove that sheen by inviting the extensive community of editors here to help with citation and general cleanup.

- Prestonmarkstone 23:55, 15 October 2007 (UTC)

You want more people to work on this? Did you ever read The Mythical Man-Month? Nbauman 14:04, 18 October 2007 (UTC)

I'm just catching up. I enjoyed the reference Nbauman. Having worked many years in software engineering and in managing software projects I have to agree with much of what the author says. --Tom 11:50, 29 October 2007 (UTC)

I agree. This page doesn't meet basic Wikipedia standards. It needs rewriting - almost from scratch. smb 06:11, 19 October 2007 (UTC)

Can you elaborate Smb? --Tom 11:50, 29 October 2007 (UTC)

Just need cleanup.--Daneynares 20:00, 6 November 2007 (UTC)

I think the people who are calling for a complete rewrite from scratch don't realize how difficult that is. None of them has volunteered to try it.

I would suggest that people try to write, here in talk, an introduction or summary of what the final article will look like. But you must give all significant viwepoints, not just your own. We can critique it. If (by WP consensus) we think it fairly and objectively summarizes the different viewpoints and arguments, you can try to rewrite it in a fuller argument.

I'm only concerned that someone might try to replace this article with a POV article trying to get across one view, and ignoring the other equally valid views. If that happens, we'll revert it. Nbauman 22:03, 6 November 2007 (UTC)

Finland short of nurses? Think again!

I too removed the re-addition of that reference by Freedomwarrior but for a different reason.

International statistics from the OECD data reveals that Finland actually has more nurses per capita than most and considerably more than in the US. See http://www.nationmaster.com/graph/hea_nur-health-nurses. So far from their being a shortage, in theory there ought to be a surfeit! But the hospitals are still claiming they have a shortage of nurses and that the problem is going to get worse. This incredible discrepency has been the subject of some debate here in Finland, but despite further digging by one of the regional universities which was published recently, there has, as yet, been no simple explanation. There is therefore a suspicion that nurses here are just not used as intensively as they are in other countries and that nurses here have a relatively easy time of it. The uses of mass resignation ínstead of strike action by the one trade union that did not sign the recent pay deal (TEHY only accounts for 25% of all nurses) may backfire (there was a report in the newspaper this morning of nurses switching to the other union) but it does seem to have a measure of public support http://www.yle.fi/news/id72739.html. --Tom 16:11, 19 October 2007 (UTC)

As an additional rider, I was informed today that there is a significant political motive for the nurses taking this strike action. In the national elections held earlier this year, the political parties, including the conservative party had promised to significanyly raise the pay of public health care workers. This was popular policy with the electorate and the conservatives ousted the social democrats into 3rd place for the first time since 1962 gaining the the highest number of popular votes and the second largest numner of seats in Parliament. The conservative party leader now holds the national purse strings as the country's Finance Minister. But he and his party are now reneging on their political promise and this has enraged the nurses and is one reason why the nurses have so much public support. The political background to the dispute is for those whose who are interested is to be found at http://www.eurofound.europa.eu/eiro/2007/05/articles/fi0705029i.htm--Tom 19:29, 25 October 2007 (UTC)

Ezekiel Emanuel essay

Here's an essay in the Washington Post that's exactly on point, by Ezekiel Emanuel, who is a medical ethicist at the National Institutes of Health and has substantial credentials. Unfortunately the original link to the Washington Post is dead, but the article has been posted in several other places, including Usenet.

This is a good article for somebody who needs to quote a reliable source to replace their own opinions.

Washington Post

soc.retirement

'Socialized Medicine' Quackery

By Ezekiel J. Emanuel

Monday, October 8, 2007; Page A17

Nearly two decades after the West's victory over communism, one might have thought it possible to discuss reform of the health-care system without invocations of the old saw "socialized medicine."

But no.

"At least Mr. Baucus isn't disguising his socialist goal," a Wall Street Journal editorial claimed about the Montana senator's push to expand the State Children's Health Insurance Program.

"In sum, SCHIP turns out to be socialized medicine for 'kids,' " wrote Post columnist Robert Novak.

Rep. Paul Ryan (R-Wis.) said the "SCHIP bill is not a back door to get socialized medicine. They went straight to the front door."

Rudy Giuliani argued:

"The American way is not single-payer, government-controlled anything. That's a European way of doing something; that's frankly a socialist way of doing something."

Apparently, this old bogeyman is just too tempting.

The U.S. health-care system has two distinct parts -- financing and delivery.

[snip]

Nbauman 23:53, 24 October 2007 (UTC)

RFC

I've added this request for comments in order to facilitate some further productive discussion about this article. I have cited the problems as an ongoing editorial dispute as well as questions about POV, and have invited the community to comment. Prestonmarkstone 00:20, 20 October 2007 (UTC)

I believe this article should be boiled down to the section about its use as a political term and piped to more precise definitions of types of health care systems. This part is well documented and specifically in reference to the term.--Gregalton 17:14, 20 October 2007 (UTC)

RFC Response In my opinion, what is most important is the definitions and types fo health care systems. But as for this issue, the use as a political term is important to the topic and should be included if it can be sourced. All views on that should be able to be sourced. But if it is original research, it should be removed. Edits like this one remove reliable sources, and should not be accepted in this case, as this is clearly sourced to a reliable source. Yahel Guhan 20:40, 21 October 2007 (UTC)

The edit was not supported by the source (Nbauman's reason for its removal first time around). The source did not cite fact, just the opnions of a union official involved in a pay dispute (hardly a neutral view). The edit was also not supported by facts (the reason for my re-removal). I could elaborate, but for the sake of brevity choose not to do so. You can read more on this talk page. --Tom 14:22, 22 October 2007 (UTC)

RFC Response The "criticism" section reads like a POV essay without adequate references. I have added the appropriate tag. --Marvin Diode 13:55, 22 October 2007 (UTC)

RFC Response It seems to me that the primary problems with this article lie in the "popular support" and "criticism" sections, which are essentially a defense of UK healthcare against US criticism. Is socialized healthcare ultimately a UK vs. US issue? Prestonmarkstone 12:07, 23 October 2007 (UTC)

Its a good point. It ought not to be. In my edits I have tried to contrast not UK and US but Free Market and Socialized when dealing with matters conceptually. The UK and the US have both socialized and free market health care, but in very different proportions. As the UK's NHS is the world's largest socialized health care system (it is the largest employer in Western Europe) I think it fair to use data from the NHS when looking at performance of a truly socialized system, e.g. on waiting times, costs, satisfaction ratings etc. I'd like to include data from other countries to be more balanced, but it's hard to find similar information from other countries because its often not in English. I know people often talk about Canada in these contexts, but in reality health providers in Canada are mostly not state salaried so it is not a good example of socialized medicine as such. It is what they call "single-payer". In Finland, the health providers are run by local government and I am not sure if performance data is gathered nationally. I will check, but its almost certainly not in English. If you can think of a better way to get data in English from other countries with socialized medicine, that would be good. The OECD published data on waiting times which appeared to show that the US had smaller wait times, but it was not clear that it was comparing like with like (as the US does not collect statistics on the health excluded). As for the present WP article and mention of the US, I will scan the article to see if I can see any statements about the US and see if they can be made more generalized. I don't think this is a UK versus US matter at all and the article should not read that way. --Tom 12:39, 29 October 2007 (UTC)

Here is the result of my scan. In most cases the U.S. gets referred to because it is where the term originates or is used to contrast U.S. non-socialized with U.K. socialized care/costs/outcomes. I don't think that any of the latter were my edits, so I don't think that I personally made this a US versus UK article. But isn't the comparison hard to avoid? At one extreme, the US represent the most Free Market model. It has mostly private health care providers, a large number of private funding/controlling intermediaries (the insurance companies) and non-coerced ultimate payers (employers, families and individuals). The UK represents the most socialized model. It has a bias in the other direction, with the NHS being a government owned health institution, with no insurance intermediaries and a coercive funding model with the ultimate payers being all tax payers (companies and persons). --Tom 13:24, 29 October 2007 (UTC)

RFC Response An article about a political buzzword -- how could it be anything BUT a soapbox? What's next, an article about compassionate conservatism? Oh, right we've got one of those, check. Dlabtot 04:52, 24 October 2007 (UTC)

My thoughts entirely. The logical thing to do was to leave "socialized medicine" as a bald statement of its history and political references and then move the factual information about "publicly owned and managed, taxpayer financed health care" to another article. The issue then became what title. In the UK "public health care" is a neutral term for this and is pretty much synonomous with the NHS and the topic we are discussing, but I was told that in the US "public health care" apparently just means a system of providing vaccinations and health advice and would therefore be confusing to a US audience. I was then told by one editor that the term "socialized medicine" in the US is not always politically loaded (although most references I have seen clearly are). And we could not invent a word because that would be a neologism. So despite original deep misgivings, the logical answer was therefore to place the facts about "publicly owned and managed, taxpayer financed health care" under the term "socialized medicine". Which is perhaps not such a bad idea, because if US readers want to find out the facts about "socialized medicine" in the real world they can get it here. --Tom 13:59, 29 October 2007 (UTC)

I haven't read this whole talk page so I don't know who it was who said that using the term 'socialized' is not always politically loaded, but I totally disagree. It's one of the codewords that people on the right use - label something 'socialized' or mention 'socialism' in discussing something and you've flipped a switch in the brains of 28% of the electorate. It's almost Pavlovian. Dlabtot 18:19, 3 November 2007 (UTC)

RFC Response I've added a POV tag to the top of this article. I have done so because the article may meet the following Wikipedia criteria for NPOV policy:

• While each fact mentioned in the article might be presented fairly, the very selection (and omission) of facts can make an article biased.
• The text and manner of writing can insinuate that one viewpoint is more correct than another.
• A type of analysis of facts that can lead to the article suggesting a particular point of view's accuracy over other equally valid analytic perspectives.
• The author's own viewpoint is mentioned or obvious.
• Alternate viewpoints are compared in persuasive terms.

-- Prestonmarkstone 04:23, 25 October 2007 (UTC)

The issue as I see it, as an editor here, is that if a criticism is made of the subject, then surely it has to be a fair and honest criticism. The problem as I see it is that the criticisms that are put are often inaccurate and not founded on fact at all, but instead rather dubious data, distorted data, or else they are out and out lies. These will mislead WP readers rather than enlighten them, and if WP is about anything it ought to be about enlightenment. My original view was that unfounded criticisms should be removed, but I was criticized for doing so on the grounds that the criticisms are often made and widely reported and therefore should be reflected in WP. If that is the case then it is only right for the reported information to be challenged if it is demonstrably false. I don't think doing that breaches any of the NPOV codes you mention. --Tom 18:44, 25 October 2007 (UTC)

I agree with you that honest and fair criticism are essential. With that in mind, we must ask why this talk page expresses so many reservations about the article in general, and the criticism section of the article in particular. This is most likely because the article is clearly, and without a doubt, in favor of universal healthcare. The article extensively defends those who think socialized medicine is a good thing against those who think socialized medicine is a bad thing. Specifically, it defends UK healthcare against US criticism. In short, and respectfully, the article obviously contains the author's viewpoint, and the author is clearly someone from the UK who is in favor of so-called "socialized" healthcare. I'm a US citizen who strongly favors universal healthcare; I also favor readers making up their own minds. The persuasive argument embedded in this article attempts to make up their minds for them. -- Prestonmarkstone 15:16, 26 October 2007 (UTC)

I disagree that there is bias in the article in favour of socialized medicine. Where is this? I have placed factual information in the article that dilutes the claims often made about socialized medicine and would prefer to see facts in the article instead of sensational tabloid new articles (on the basis that exceptions do not make the rule). Peer reviewed academic references are fine as are official statistics and the works of respected research bodies such as WHO and the OECD. The claims of pressure groups can be aired here because they are part of the political debate, but then it is only fair to examine the validity of the claims that they make.

Yes I have focussed on UK data because (a) it the system I am most familiar with and (b) it is the most prominant example of socialized medicine in the world. The issue of queuing is more severe in some places such as Canada and Australia, but these are more connected with Single Payer Systems rather than Socialized ones. Queueing was once upon a time much worse in the NHS but then at that time only about 6 per cent of GDP was spent on health. There are many criticisms one could make, that would be valid, but are often not made. For instance, in the NHS, we pay taxes when we are well and working and use the services when we get ill. Very often, we get ill as we get older. But many UK citizens work all their lives in the UK and pay taxes there and then retire to live in Spain or Greece. But if they become seriously ill and try to return to the UK to get treated where they can be close to their family and be in a hospital where everyone speaks English, the NHS has the right to charge them the full cost of their treatment, even if they paid taxes all their working lives. That would be a fair criticism. Here is another. If one chooses to be treated in a private hospital, the NHS does not pay for that treatment unless it offered you the choice of treatment there or the NHS failed to keep its service guarantee and was forced to fund that treatment. But in some systems (e.g. in Finland) it is possible to get some state contribution towards private care costs if one opts for treatment in the private sector.--Tom 13:22, 28 October 2007 (UTC)

• RFC response The problem of this article is that it does make clear enough and restrict itself to the fact that "socialized medicine" is a political slogan particular to the US health care debate (and of course as an article about a slogan it is prone to POV-pushing, but that's a problem of all such articles). Anything else is (or should) be covered in Publicly-funded health care--victor falk 18:10, 26 October 2007 (UTC)

The problem is that Publicly-funded health care is mot the same as socialized medicine. See my precious edit to this page.

• RFC response 2 The criticism section is not much more than a long list of pro and cons and looks very much like a talk page thread... It needs to be structured, perhaps organised in sections such as [[...#Fiscal]], [[...#Medical]], etc. Try to do this with half the current number of words, and it might be good. To summarise is to clarify.--victor falk 13:26, 28 October 2007 (UTC)

Structuring might help. But I think the real issue with that section that lead to the article getting an RFC in the first place is that I have added facts that contradict many of the assertions associated with this slogan (as you called it). Certain people are now objecting to that. If you sloganize a falsehood and say it loud and often enough it can become the truth. Its a tactic that propogandists in Nazi Germany or Stalinist Russia knew all too well. At least I have provided factual backing for my data. --Tom 14:28, 29 October 2007 (UTC)

Neutrality

Someone has placed a marker indicating that the article is not neutral and requested that the neutrality marker is not removed until this is resolved.

I have placed this section here so that we can discuss the issue of nuetrality and determine how we can get the marker removed. --Tom 12:43, 28 October 2007 (UTC)

Weasel words

Someone has placed a marker indicating that the article contains weasel words and requested that the marker is not removed until they are removed.

I have placed this section here so that we can discuss the issue of weasel words and determine how we can get the marker removed. --Tom 12:44, 28 October 2007 (UTC)

Cato Myths - Equality of Access

I have been doing more digging on Cato's claims.... another of the "myths" discussed earlier. http://www.cato.org/pubs/catosletter/catosletterv3n1.pdf I seem to have come across another whopping distortion. This time its the so-called Myth of Equal Access. Cato rightly says that equal access to health care is a key aim of the NHS. It then talks about 2 reports on equality of access to health care in the NHS done in the 1980s and another 10 years later in the 1990s. Basically Cato charges that the first report stated that "things (in the 1980s) were worse than they were 30 years ago" and it claimed that the second follow up report ten years later found "that things had got even worse".

Its B U L L S H I T  !!!

I have since discovered the paper that this brief paper was based upon http://www.cato.org/pubs/pas/pa532.pdf and that paper gives the source reports as being the Black Report and the Acheson Report. And guess what? The papers are not even on the topic that Cato claims it to be! The Black report http://www.sochealth.co.uk/history/black.htm looked at inequalities of health by social class or similar measures. It was not about equality of access, it was about inequalities of health by socio-economic class. It was not about the NHS per se. It showed that there were inequalities in health across the social classes and that they were probably explained by socio-economic environment features (such as work accidents, overcrowding, cigarette smoking) which are strongly class-related. Of course its hard to summarise a large report in this way, but that summary is more accurate than the Cato report. It made many recommendations but they were largely not about improving access. I've scanned through the report and can't find a trace of it implying that the NHS had failed to offer equal access to people in these groups. Ensuring higher 'take-up' of services on offer by the lower socio-economic groups was mentioned, but 'ensuring take-up' is way different from failing to grant equal access. Neither could I find Cato's main conclusion that things had got worse in the 30 years since Britain gave up Free Market health care and introduced the NHS. The Acheson report is not available on-line but a reference to its conclusions and the steps taken by the Blair government followin it can be read here http://www.sochealth.co.uk/news/TacklinghealthInequalities.htm.

Comments welcome!--Tom 17:19, 29 October 2007 (UTC)

There is one place where social class influences and access is mentioned. It reads as follows

4.48 Class differentials in use of the various services which we have considered derive from the interaction of social and ecological factors. Differences in sheer availability and, at least to some extent, in the quality of care available in different localities provide one channel by which social inequality permeates the NHS. Reduced provision implied greater journeys, longer waiting lists, longer waiting times, difficulties in obtaining an appointment, shortage of space, and so on. A second channel is provided by the structuring of health care institutions in accordance with the values, assumptions and preferences of the sophisticated middle class 'consumer'. Inadequate attention may be paid to the different problems and needs of those who are less able to express themselves in acceptable terms and who suffer from lack of command over resources both of time and money. In all cases, for an individual to seek medical care, his (or her) perception of his (or her) need for care will have to outweigh the perceived costs (financial and other) both of seeking care and of the regime which may be prescribed. These costs are class related.

I think the authors ought to have taken a lesson in using plain English. I think it means that rich people can travel further to get better care, have an option not to wait (because they can go private), and because they are often more artiuclate amd knowledgeable, are better able to know what they need and negoitate their way around the system to get it. But that required a lot of reading between the lines. But I still think it does not meet Cato's claims. In any case its more than 25 years old, so is hardly relevent to today's NHS.--Tom 17:53, 29 October 2007 (UTC)

Tax being offset by savings elsewhere

Kborer. I think you are not being neutral in your edits.

1. I did not imply that there was an equivalence in my edit.

2. The evidence surely is that insurance companies are an overhead because they have costs like advertising, administration, and they have profits to be paid to shareholders.

3. Another of their functions, from what I have heard, is to block claims and deny coverage for things like pre-existing conditions, a practise which denies people care and penalises the sick. That does not happen in socialized systems, so its another cost that can be dropped.

4. You make an assertion in your edit summary that there is no incentive to keep costs down in a "socialist system". I hope you meant a socialized system. Anyway, where is your evidence for this? On the contrary I would think that a socialized system where the budget is capped ensures that doctors squeeze the best value out of the money they are given. In a free market system with insurance, there is some evidence that doctors do indeed carry out unnecessary procedures and add to costs. They get paid well for doing things to people but very little for doing basic things like giving advice. As Michael Cannon, Director of Health Policy Studies, at the Cato Institute once said of the US health care system,

I think our system is a mess and spends a lot of money on unnecessary care, and even harmful care, so I think that when you do compare nations against one another its very hard to find any benefit that we're getting for all the additional money that we are spending on health care. I think we spend 50 per cent more than the Canadians or something like that, and its very hard to find any health outcomes measures that would justify that greater expense. I think that maybe the only two are that we have greater access to treatment for chronic illnesses (and thats just access, not even outcomes) and we have higher cancer screening rates which result in lower cancer mortality to incidence ratios. But that's about it.

See http://www.wilsoncenter.org/common/dsp_popup.cfm?media_link=DIR/DIR_2007103.wmv&title=Video%20of%20Event%20%28Windows%20Media%20Player%29

5. Its not supported by evidence. Just look at the money that the UK spends annually on health care. It is way below the US level. If there was a high degree of waste in the NHS, wouldn't the UK public be clamouring for changes in the system? Nurses and doctors are taxpayers too and see the system at close hand.--Tom 19:16, 29 October 2007 (UTC)

I am not sure why this is directed at me. Kborer 20:24, 29 October 2007 (UTC)

NHS wait time statistics

To Freedomwarrior: The linked reference gives a fully adequate explanation of the statistics and even a table showing how the main wait time stats have changed for each quarter over a 3 year period. The stats show a clear trend... a gradual and gentle decline in wait times over that period. You seem to be sowing doubt into the article about the data where none is needed. You seem to be pushing a POV.--Tom 19:45, 29 October 2007 (UTC)

Sorry, but I had to undo your edit once again. The statistics reflect the view of the waiting lists taken at a point in time. A snapshot is taken once a quarter and this is what is reported. The full data for the last 3 years. It is not so difficult to understand. I believe we discussed all this once before in the context of extrapolation which I said was not very meaningful. Is this a classic 3RRR maneuvre you are trying to force?--Tom 20:15, 29 October 2007 (UTC)

I'm not trying to force anything. I'm simply trying to keep you from using wikpedia to peddle socialized medicine.

Very simply, the way that the report is presented in the text of the article is misleading. The reader has to go to the text of the link to find out that the report is a " snapshot is taken once a quarter" that covers a three year period. I'm insisting that it be reflected in the text. That is, I'm insisting that it be explicitly recognized in the text that the preformance of the health service is variable, and that the health service has not always performed as well (or less poorly). Freedomwarrior 20:59, 29 October 2007 (UTC)

I changed the edit for hopefully the last time today to a form of words that I hope you'll be happier with. Of course there has been variation in the numbers waiting over time, and no doubt at some time they will go up. I'll put in the November 2007 statisitic when its published, be they up or down. But its worth remembering that the figure is the average time waiting for those that are waiting. There are those patients that get dealt with immediately for whatever reason and will not have appeared on the waiting list. Thus the wait median time for all patients will be much better than these statisitics seem to show. I'll see if I can get confirmation of that from the contact point given on the stats sheet and let you know what they say. People needing emergency surgery such as happened when my father had stent inserted following a sudden heart attack, and people needing splints, plaster leg casts, removal of embedded foreign objects etc.. will always be dealt with on a triaged turn-up and wait basis. I assure you, they don't need to bring a sleeping bag and 6 weeks' change of clothes! The stent was fitted (at the Royal Surrey County hospital) within an hour of his arrival! --Tom 22:52, 29 October 2007 (UTC)The e-mail was bounced by the server :(--Tom 19:49, 31 October 2007 (UTC)

Cost of regulation

Can regulation in the US private medical industry really cost the industry $339 billion per year (at 2002 prices!)?? The industry only covers 165 million americans! That's almost 2000 dollars per customer! The figure has to be wrong, surely. I have exposed some of Cato's whoppers. Is this another one, I wonder. I am hoping that someone cleverer than me has already tackled this claim and either proven or disproven it. Can anyone help?--Tom 20:47, 29 October 2007 (UTC)

According to the table at universal health care the UK govt. spends $2,063 per head on all government funding for health care which would cover the entire NHS and a bit more on top. Doctors, nurses, capital equipment, medicines, utitlity bills... the lot! But the US medical industry soaks up almost the same amount per head just complying with regulations. I doubt that there is much difference in the regulations....the UK health service has to pay for medical tort and has to comply with regulations regarding sex-discrimination, data privacy, drug safety etc ... Why should the US costs be so much higher? Its a private industry! It should run much more efficiently than the government run NHS if the theory is right that the private sector is more efficient than the public sector. It just seems bizzarre.--Tom 23:31, 29 October 2007 (UTC)

Here's the problem with health care in the US: it's socialized, not private as you seem to believe. In the US, insurance companies are conscripted by the government to act on its behalf. In other words,the US has socialism without direct government control. You are making a straw man argument. Freedomwarrior 23:56, 29 October 2007 (UTC)

Country by country qualifications / socialist and mixed economies

--Tom 20:16, 31 October 2007 (UTC)I believe that the edits made by Freedomwarrior are there only to introduce the word socialism into the article and this is POV pushing. He argues that the US is partly socialized and therefore a mixed economy, and I am sure by that token that Russia and China in their heyday were mixed economies too as there were always some activities that the state did not control. China and Russia today are both mixed economies, it just the degree of state/private mix that varies, so its pretty meaningless to talk about socialist and mixed economies. The two terms cover pretty much all the world's economies so taling about "socialist and mixed economies" is meaningless (IMHO).--Tom 20:16, 31 October 2007 (UTC)

It is not a meaningless distinction, since most people are not acquainted with it. Through your very careful edits, you are trying to fudge the difference between free medicine, that is, medicine in a purely capitalist system, and the crap that is peddled as free medicine in mixed economies so that you can push your POV. Through my edits, I am asking that we be precise and not eradicate clear distinctions when such distinctions exist. Freedomwarrior 01:43, 1 November 2007 (UTC)

Because there is so much variation from one system to another it is makes the article difficult to keep introducing words like "some" / "most" and the article deserves to allow some leeway.It was for this reason that I had tried to talk about "socialized medicine" and contrasted it with "free market medicine" so that conceptually the systems can be contrasted (even if there is no perfect "free market system" and no perfect "socialized system". Making the edits this way avoids the need to keep qualifying phrases with "most", "some" etc... I'd be interested to know the views of other editors as to how this should be handled. --Tom 20:16, 31 October 2007 (UTC)

The solution seems that the article will have to have brief sections on national implementations. —Preceding unsigned comment added by Hauskalainen (talk • contribs) 19:50, 1 November 2007 (UTC)

Free means Free at the point of use and disconnected from contributions to tax receipts

I don't think people that read this article will think that the money to pay for "Free" healthcare was planted by the Health Care Fairy. The meaning as it used in the UK is "Free at the point of use" and though it is less often mentioned it is also "disconnected from contributions to tax receipts". The same is true in Finland. In order to avoid the need to keep qualifying the word "Free" perhaps we need to make this clear just once at the top of the article.--Tom 20:34, 31 October 2007 (UTC)

With regard to Freedomwarriors edit summary regarding contributions towards care (equivalent to co-pays), contradicting another statement, the situation in practice is not contradictory. The state ultimately determines who can afford to pay. For example in the UK, if one is in dire financial need and reliant upon the state for financial support the person will be in receipt of a social security benefit called supplmentary benefit and this entitles the person to free medication (the main co-pay in the UK is towards drug costs). Similarly here in Finland, local social security offices have authority to assist in the payment of medical co-pays if the person can demonstrate financial need. Different systems have different ways to overcome this. Thus services can be 100 per cent free and not dependent on fund contributions (equivalent to insurance premiums). In effect this means that a patient is never denied treatment for personal financial reasons. The bills regarding co-pays can be argued about later. Incidentally, in both the UK and Finland, prescription drugs purchased by the patient are subsidized and each year the total patient spend is capped, even for the richest in society, and the poorest can pay nothing.

Health care "distributed according to need rather than the ability to pay" as a benefit of Socialized medicine

This edit has been taken out several times by FreedomWarrior and added back by me. For the time being I am desisting from playing games with this editor. I ask the community of WP editors (Not including FreedomWarrior) to pass comment. Is this statement about socialized medicine inane and propagandist as FreedomWarrior contests or, as I contend, with evidence given in references to both the British and New Zealand systems, that this is the MAIN INTENT of creating the system as SOCIALIZED SYSTEM in the first place? --Tom 20:47, 31 October 2007 (UTC)

Excuse me? Do you seriously expect me to let you attack my edits and not comment? Despite your continued insistance that the benefits of all socialized health care systems are that "health care is distributed according to need rather than the ability to pay," as I've pointed out in previous edits, this is neither theoretically nor practically true.

First, some countries with socialized health care services do not satisfy all the needs of their citizens in practice. For example, some countries with socialized services do not provide all health services "free at the point of use" to their citizens, since some of them get "rationed" out of the national health service (as the text of the article, which you agreed to, recognizes). What's more, some countries with semi-socialized health services do not even attempt to cover all the needs of their citizens, because they prefer to limit themselves to covering catastrophic problems--which is done in the United States through the Medicaid program.

You are right when you say that distributing health care "according to need rather than the ability to pay" is the INTENT of socialized medicine." However, this is not the intent of all countries with socialized medicine. Again, the United States, which has a considerably socialized health care system--indeed, aside from the numerous regulations imposed on health insurance companies by the central government, nearly half of all health expenditures are paid for by the government--, has not adopted this as a principle. You will doubtless claim that the United States does not have socialized medicine, however, notice the introduction to the article "Socialized medicine or state medicine is a term used principally in the United States to describe health care systems which operate by means of government regulation--which is what the United States has in spades--and subsidies derived from taxation."

That said, I have no problem with you saying that some health care services operate on the principle that "Health care is ought to be distributed according to need rather than the ability to pay." What I object to is your insistence on saying that all socialist systems operate like that. This is not the UK, get over it.Freedomwarrior 01:27, 1 November 2007 (UTC)

That NHS link was to the wrong page, but on NHS core principles they say that the founding principles of the NHS is quality care that "is based on a patient's clinical need, not their ability to pay."

I think the NHS is a reliable source, and that quote is appropriate for a WP article. They certainly do base their care on a patient's need, and not on ability to pay, although other factors may enter into it. I think that belongs in a WP article, and I don't see any reason why it doesn't. If you have any evidence that it's wrong, Freedomwarrier, the proper response would be to add that POV from a RS, rather than deleting the one you disagree with. Nbauman 04:09, 1 November 2007 (UTC)

I have not said that it is wrong, nor have I said that it doesn't belong in the article. I objected to using a quote from the NHS--just one socialist health service--to make a categorical statement about all socialist health services, and the assertion that "health care is distributed according to need rather than the ability to pay" as one of the benefits of socialized medicine, because it isn't distributed on that basis in all countries with socialized medicine.

As I said previously, I have no problem with including something like "the founding principles of some socialist health services are that the distribution of care ought 'to be based on a patient's clinical need, not their ability to pay'" and will add language in that regard tomorrow. Freedomwarrior 04:25, 1 November 2007 (UTC)

Giuliani's unfair criticism of socialized medicine. More lies, damn lies, and statistics!

Speaking in London recently Rudy Giuliani said

I had prostate cancer seven years. My chance of survival in the US is 82%; my chance of survival if I was here in England is below 50%.

http://news.bbc.co.uk/1/hi/uk_politics/7003286.stm

The claim is repeated in his campaign ads where he says

I had prostate cancer, five, six years ago. My chance of surviving prostate cancer, and thank God I was cured of it, in the United States, 82 percent. My chances of surviving prostate cancer in England, only 44 percent under socialized medicine.

The UK Health Secretary responded when prompted that "The British NHS should not become a political football in American presidential politics. Our rate of prostate cancer survival is actually much higher than has been claimed. The latest data shows a survival rate of over 70 per cent – and increasing." The Times Newspaper in London investigated the statistics further. This was what they reported

"US health experts also disputed both the accuracy of Mr Giuliani’s figures and questioned whether it was fair to make a direct comparison. Doctors in the two countries have different philosophies for treating the disease, with the US putting more emphasis on early diagnosis and surgery. An analysis of mortality rates suggests that about 25 out of 100,000 men are dying from prostate cancer each year in both Britain and the US. Brantley Thrasher, at the University of Kansas Department of Urology, told The Washington Post that it was “impossible to say” whether a prostate cancer patient has a better chance of surviving under a “capitalistic” or “socialistic” medical system. Ian Thompson, of the University of Texas, said: “Certainly, if you intensively screen for prostate cancer, you will find early disease. And simply because you find it earlier, you will always have longer survival after the disease is diagnosed”. http://www.timesonline.co.uk/tol/news/world/us_and_americas/article2781602.ece

In other words, even if the UK screened everyone over 50 as is recommended in the US, but treated none of them, it is quite possible, even likely, that the UK statitic would improve and edge closer to the US figure. So why doesn't the UK screen like the US does? Here is the answer (from http://www.cancerhelp.org.uk/help/default.asp?page=2719)

Before screening can be carried out, there must be an accurate test to use. At the moment, there is no single, effective screening test for early prostate cancer in healthy men. The use of the PSA blood test as part of a screening programme is still under discussion in the UK. PSA alone is used in the USA for men over 50, or men over 45 thought to be at high risk of prostate cancer. PSA alone is not recommended for screening in the UK because (1) Men with prostate cancer may not have a raised PSA, (2) two out of three men with a raised PSA do not have prostate cancer and (3) there is uncertainty about the best way to treat early prostate cancer. Generally speaking, the higher the PSA level, the more likely it is that there is a cancer in the prostate. The higher the PSA level in someone with prostate cancer, the more likely it is that the cancer has spread. But there are other causes of raised PSA, such as infection, a non cancerous enlarged prostate and even exercise and sex. In early prostate cancer, PSA levels are relatively low. It is not possible to pick out a particular PSA reading and say “those above this level have cancer and those below do not”. The level of PSA varies from man to man. For one thing, it naturally increases with age.

If PSA was used as a screening test, some men who did have prostate cancer would be told that they didn’t. Two thirds of men with a raised PSA level would go on to have other tests such as needle biopsy and rectal ultrasound when they did not actually have a cancer. These tests can be uncomfortable and many men find them embarrassing. They also have risks. A few men having a needle biopsy may have infection or persistent bleeding afterwards.

When doctors plan a screening programme, they have to think about what happens when the disease they are looking for is found. Is there an effective treatment? What would happen to those people if they were not screened? Prostate cancer is not always an aggressive disease. It can be very slow growing. Many men with prostate cancer don't have symptoms. Prostate cancer grows slowly in many older men and they are unlikely to die from it. These men don't really need treatment. The treatment has side effects and could cause more problems than their cancer.

Other men do need treatment. But, unfortunately, doctors cannot always tell with any accuracy which prostate cancers are aggressive and need treating and which can safely be left alone.

So if prostate cancer screening was introduced (1) some men with cancer would be missed, (2) other men without cancer would be given tests they did not need, (3) some men with very slow growing cancers would be given treatment they did not need

There is still a lot of discussion about prostate cancer screening. Are the risks of not finding cancers (and giving men false reassurance) or side effects from tests greater than the benefits of screening? Will a screening programme using the tests we have at the moment reduce deaths from prostate cancer?

...... and so it goes on.

Not exactly as catchy a soundbite as Giuliani used in London and repeated in his presidential ambition campaign! But it clearly illustrates that British medicine, far from being ineffective is behaving thoughtfully, rationally, and with the interests of patients firmly in mind. The US practice may actually be curing people of cancers that did not need curing at all, and be exposing their patients to unnecessary risks, unneccssary treatments, unneccssary costs, and will create a lot of unneccessary fears about this cancer. Maybe this is an illustration of why the UK spends less on health care than the US but achieves broadly the same or better outcomes overall.

I am likely to be away from editing for a period. If anyone would like to incorporate this into the article (ideally in less detail) during my absence, feel free to do so. --Tom 23:39, 1 November 2007 (UTC)

Socialized medicine in Israel

You tagged this page as though it is part of a WP project regarding Israel. I assume that is a mistake because its mostly a politically charged phrase used in the US against government involvement in health care amd is not per se connected to Israel.

There is a section in the main article for national implementations of socialized medicine and anything you could add regarding Israel would be most welcome.--Tom 10:24, 4 November 2007 (UTC)

I don't see why the section I added on Israel is not relevant here. Canada & UK have sections, and I added one on Israel. Because Israel has always had a system of socialized medicine (where it is not a derogatory term) I believe that adding it to Wikiproject Israel is in keeping with the aims of the project, which is to tag pages that are related to issues that also (though not necessarily exclusively) affect Israel. You are welcome to add any other tags you think are appropriate. --Gilabrand 13:42, 4 November 2007 (UTC)

Retrieved from "http://en.wiki.x.io/wiki/User_talk:Gilabrand"

Ah. I did not see that you had already added the section on Israel to the main article. That is indeed very useful because you are right that it is not exclusively about Canada and the UK!! But my issue is that it does seem odd to me that you tag a talk page which has only tangential relevance to Israel. This article's talk page (and others like it with international content) could easily become very cluttered with tags like this. It may suit your project to have pages tagged this way but it may not suit other readers. Lets see what other editors think about this.--Tom 19:24, 4 November 2007 (UTC)

I removed the tag, only due to the tangential link to the article - put another way, should we tag it for every country where there is discussion about universal / "socialized" health care? Does it help the average reader? For the purpose of letting readers know that there is some content related to Israel, a category tag would probably be sufficient.--Gregalton 20:45, 4 November 2007 (UTC)

I wouldn't call it tangential at all - socialized medicine is a very important aspect of Israeli society, and has been a formative influence since before the establishment of the state, when huge numbers of immigrants, many sick and poor, came to the country. It is a crucial factor in Arab-Israeli relations: Arabs and Jews receive equal treatment, and Israeli hospitals are packed with Arabs, both Israeli Arabs and Arabs from the territories, because they know they are in good hands and will receive the best care possible, no matter what their politics. --Gilabrand 21:35, 4 November 2007 (UTC)

It's not that socialized medicine is not important to Israel; but that only a relatively small number of readers/editors interested in socialized medicine would see Israel as central to the concept. Or to put another way, I'd equally not consider adding the wikiproject Canada, UK, or half a dozen other countries' project flags to this article.--Gregalton 02:46, 5 November 2007 (UTC)

I am glad to see that my introduction of material on Israel, which was so appalling and shocking to everyone, has prompted a section on other countries and an attempt to open the eyes of people who insist that socialized medicine is only something related to their own experience.--Gilabrand 11:06, 11 November 2007 (UTC)

Not sure if I understand: were you offended by something? I for one have no objection to the Israel information (although I personally think the article should be pared to information that the term is essentially just pejorative and has little meaning otherwise), I just thought (and think) the wikiproject Israel tag on the talk page is a little out of place. At any rate, the Israel info remains and appears informative; thanks.--Gregalton 17:30, 11 November 2007 (UTC)

Generalizations and Unsubstantiated Claims

Tom, please stop making unsubstantiated generalizations about socialized medicine that are exclusively based on the UK health service, because you are simply wasting my time and your time. If you want to add something, make sure that it's sourced. Additionally, if you're going to say that something is benefit of all socialized systems, make sure that's the case. The bottom line is that not all socialized systems are the same and not all of them conform to your ideal model--the UK's. Freedomwarrior 17:42, 11 November 2007 (UTC)

They are not based on exclusively on the UK Health Service. See also my warning to you on our personal talk page. I want to make improvements to the article. Your edits (like adding the word some" to my edits, seem to sow doubt and uncertainty where I do not believe that exists. Frankly, I believe that you are just oppposed to socialized medicine and you are making edits to the article that are POV. I said that I was prepared to provide references. Why don't you just add requests for citations instead of deleting and chopping all the time. I really may be forced to make a formal complaint about you. PS How come you managed to delete that WP home page of yours that said something like "WP is not a forum for people outside the US to air their inferiorites"?? I really liked that!! :) --Tom 18:02, 11 November 2007 (UTC)

I don't know what the hell you're talking about, and I would recommend that you show more respect on this forum. Before you put your foot in your mouth, you should you verify what you are alleging because I have never had anything like "WP is not a forum for people outside the US to air their inferiorites" on my home page. Indeed, I am the one who may be forced to file a complaint about your deleting sourced material, your nonsensical edits, for going to other pages and trying to recruit editors to attack the edits I've made, and and for even being so petty as to trying to slander me.

First, this is an article about socialized medicine throughout the globe, not just about socialized medicine in the UK. There are numerous socialized models throughout the world, each offering different "benefits" to individuals. For instance, you cannot claim as a benefit of all socialized health services that "citizens covered by socialized medicine do not have to seek out private health insurance or be concerned about an employer's medical insurance plan," as much as you may want to, because that's not true of all countries with socialized medicine. The US, which has socialized medicine, requires patients to go out and get insurance. As I've said elsewhere, you may disagree with my contention that the US has socialized medicine, but it fits the definition at the top of the page, it operates through government regulation' and subsidies derived from taxation Again, any edits that you make about the alleged "benefits" of socialized medicine is only going to be true of some socialized systems. I am demanding that we talk about the provision of socialized medicine in different countries with nuance, because there is nuance, period. Your claiming there isn't doesn't change the fact.

Second, I delete most of what you add because anecdotal evidence--your opinion and the opinion of two or three others--cannot pass the muster test, notwithstanding any "sources" that you may conjure. For example, regardless of whatever "source" you obtain, you cannot prove a categorical claim like "socialized systems where user contributions are low or non-existent are usually founded on rights and users of the system are not left to feel that they are receiving charity." There will certainly be some moral individuals who will view such a situation as charity, and will oppose it on those grounds. This is nothing but inane socialist dribble, which belongs in a blog. I am not making statements like "free medicine allows individuals to attain moral fulfillment, because they are allowed to show individual charity towards others in need," etc. I would ask you to stop making such statements on this forum, and to take it to a blog.

P.S. I am opposed to socialized medicine, because I think it's an immoral and impractical system. We all have our biases, including you. The difference between us, however, is that I've yet to resort adding information that is irrelevant or unsubstantiated because I don't work in the realm of opinions, I work in the realm of facts. Freedomwarrior 18:52, 11 November 2007 (UTC)

Centre for Policy Analysis Statement

The section begins with "Critics argue that central planning is inefficient and under investment leads to capacity shortages." Tom's misrepresentation of the quote from the Centre for Policy Analysis does not deny that there was a capacity shortage; rather, it simply provides an excuse for it, which clutters the article and makes it more difficult to read. Freedomwarrior 19:17, 11 November 2007 (UTC)

What misrepresentation have I made? What excuse? The quote in the WP article which you have now twice removed was "In France, the supply of doctors is so limited that during an August 2003 heat wave -- when many doctors were on vacation and hospitals were stretched beyond capacity -- 15,000 elderly citizens died". The quoted article is talking about capacity shortages (i.e. "supply of doctors") and a consequence "15,000 elderly citizens died". But this is clearly false. People did not die because there was a lack of doctors. The article is misleading. Ít was the misleading account that was the reason for the edit being in the article. If you have a more meaningful example to back up the claim that there are capacity shortges in all socialized systems then I think you should present it. If one looks at a broad brush measure of capacity, e.g. the number of available hospital beds in the UK and the US, you will see that they are broadly the same. Because free market care is always priced to meet capacity, there must be a shortage of capacity in a free market too, being the capacity that is not provided to meet the health care needs of those patients who ae priced out of the market by the price mechanism. At least people in the UK are not priced out of health care.

Incidentally, MRI investment is commonly cited as big differential between the UK and the US, but can you prove that this means that there is an unmet demand for MRI scanners in the UK? It could be the case that MRI investment is over-provided for in the US. Also Japan, which has mostly a socialized system of health care, has more MRI scanners per head than any other country, including the US. --Tom 20:31, 11 November 2007 (UTC)

You are not denying that the system was stretched beyond capacity, which is what the criticism affirms; rather, you are claiming--without evidence--that their being stretched did not contribute to the large number of deaths. How is what your claiming at all relevant to whether there are capacity shortages? It just isn't.

If you want to include your criticism of the Centre for Policy Analysis's report in this article, it belongs somewhere else in the criticism section and with an academic source which proves that the shortage had nothing to do with the 15000 deaths, which you are not providing.

Finally, this article encompasses more than the UK. There is certainly underinvestment in technologies such as MRI in countries such as Cuba, which has resorted to using "alternative medicine"--i.e. crap that's about as effective as voodoo-- to treat its patients. Freedomwarrior 21:53, 11 November 2007 (UTC)

Exceptions do not make the rule and should not be used to make generalized claims. That applies as much to the text you removed regarding cancelled operations as it does to the French heatwave and supposed capacity limitation. An exceptional incident in one country cannot be used to make such a wide allegation about lack of capacity in socialized systems in all countries. We should be comparing numbers of nurses, or doctors, or hospital beds, or immunizations, or medical consultations per 10,000 of population. That would be a more meaningful measure.

I'm not using the one incident to "make a wide allegation about a lack of capacity," because I didn't even add it, you did. I would never have added something that contradicts the argument that I'm making--albeit I wouldn't be faced with that problem, because I base my arguments on facts and not some socialist fiction. Quite frankly, I don't care whether you think that an exception makes the rule or not. The fact of the matter is that there were shortages, as the criticism alleges, period. Freedomwarrior 15:10, 12 November 2007 (UTC)

You know full well that the reason the reference was there was because, as the text you removed pointed out, there was little connection between the deaths and the shortage of staff during those extraordinary circumstances. And as for drawing conclusions you should re-read what I say below about Katrina. It would be wrong to draw conclusions from one extraordinary incident about the capacity provision of entire system of health care. Also, I would point out that hospitals in France are mostly private entities and the system there is largely single-payer rather than socialized in its normal meaning.--Tom 16:44, 12 November 2007 (UTC)

Whether or not there was a connection is irrelavent (and you've provided no other proof than some fanciful story that you've concoted), there was a shortage, period. The hospitals in France experienced the capacity shortage that the criticism, which didn't make a distinction between "ordinary" and "extraordinary" circumstances, affirmed.

Even if I were to concede that the distinction between "ordinary" and "extraordinary" circumstances was a relavent one, which I'm not, there is no comparing what happened in Louisiana and France. Despite your implicit belief that all "extraordinary" circumstances are alike, they're really not. For instance, the hospitals in France had power and water, which cannot be said of those in Louisiana. The hospitals in France were caught unprepared by the influx of patients, while the hospitals in Louisiana--the few that remained in operation--had to strugge in primitive conditions.

Finally, France's system is still socialized. The state simply conscripts the private sector into doing what it would ordinarily do in the "normal" socialized system. (By the way, normal according to whom?) Freedomwarrior 17:59, 12 November 2007 (UTC)

In exceptional circumstances when exceptionally large numbers of people descend on a medical facility it will of course be highly stretched, and perhaps beyond capacity. A facility would be incredibly inefficient if it had the capacity to cope with such a sudden exceptionally high increase in patient volumes without any difficulty. It would be equally unfair if I were to criticize the level of care in American hospitals and care homes by quoting this story http://www.notdeadyet.org/docs/KatrinaNPRpr0206.html I repeat. The text you removed from the article was not meant to support or dispute the allegation, but to support the statement that reports about capacity can be distorted or misleading. And the article from the Centre for Policy Analysis clearly was misleading (as was the Manhattan Institute's/Rudy Giuliani's allegations about prostate cancer survival rates were misleading). There was ample evidence in the references in the text you removed to support the claim that the official report findings did not indicate that the system needed more capacity. The edit was, in my view, in exactly the right place.

What do other editors think?--Tom 00:47, 12 November 2007 (UTC)

Wikipedia is not a democratic forum, so stop straw polling. You are saying that the report of the Centre for Public Policy is misleading, not because it's based on bad numbers but because it doesn't include, according to you, "all the details." Give me a break. How on earth is that misleading? Just because it reports the facts, but doesn't include the pretty little narrative that you want does not make it misleading. Freedomwarrior 15:10, 12 November 2007 (UTC)

It is normal practice to ask other editors to comment when a dispute occurs! And no, it was not about bad numbers. It was the wrongful connection of two events...the deaths of all those people and the fact that a lot of doctors were away on vacation leaving the reader with the clear impression that the two were connected when they were not.--Tom 16:44, 12 November 2007 (UTC)

You do not deny the fact that there was a capacity shortage (which means that it is not a relevant addition), and you've yet to provide any academic proof that there was a wrongful connection between the two events (which means that it is a baseless accusation as far as I'm concerned). I'm not going to let you add something on the basis of mere conjecture, which has no relevance whatsoever to the criticism that's in the article. Freedomwarrior 18:10, 12 November 2007 (UTC)

As regards your statement about MRIs and Cuba, I am astounded. Cuba is a relatively poor country, made even poorer by an economic blockade which has lasted many decades. Which country would you compare it to? To make meaningful comparisons between socialized medicine in Cuba and and a free market system, say, you would need to compare it to a country with a relatively similar level of national income.--Tom 00:47, 12 November 2007 (UTC)

Cuba, prior to the Revolution, was one of the most economically advanced countries in Latin America, but I suppose you didn't know that. Cuba is only a relatively poor country because of socialists like you who are constantly trying to distrot reality to make excuses for morally bankrupt and inefficient systems. First, get your terms right. Cuba is not under a blockade. There are no carriers or cruisers around its territorial waters. There is an economic embargo on the part of the United States, which has only recently come into effect because the island recieved enormous subisidies from the USSR for almost a quarter century. Second, there are no real countries with a free market for comparison at that level of developement, because most countries at that level of developement tend to be socialist quagmires. If you can find one, I'd be obliged. I don't mind comparing the performance of Cuba's socialized medicine today, when Cuba is a backwards socialist country, relative to other countries in the world with its performance prior to the Revolution, when it was at a higher level of developement, but I suspect that you'd also object, since the two don't have a similar level of national income.Freedomwarrior 15:33, 12 November 2007 (UTC)

You kind of got off the topic of health care but now I now feel obliged to correct you. I am not a socialist or a communist. I do not think it is a good idea generally for land, the means of production and the distribution of goods to be in the hands of the state. I own land and stocks and believe in a diverse economy with a wide range of independent actors. But I do think that some things like roads, police and health care are best organised by the community for the community. I am sorry if that upsets you. I was wondering if there was an economy of similar size to Cuba's in South America, North Africa or South East Asia but with free market health care. --Tom 16:44, 12 November 2007 (UTC)

I don't know, but I suspect there isn't.Freedomwarrior 18:11, 12 November 2007 (UTC)

Centralized Planning and Capacity Shortages

The article currently says "central planning is inefficient and under investment leads to capacity shortages and that a lack of willingness to invest in expensive technology leads to shortages in areas such as MRI scanning." Its another claim made by those right wing think tanks that I thought would be worth investigating.

There actually has been MRI over-capacity in the US. Units are working at about 50% of their antipated economic operating rate. Or as the medical imaging industry would have it, there is under-utlilization, because their response seems to be to want to get doctors to do even more referrals to utilize the over capacity they have invested in. In other words, they want medical costs to go even higher!

Here are some figures. The UK set has both old and new data but the US set has only old data but fairly contemporary with the older UK set I am comparing it to.

US

The average number of examinations per MRI unit per year in the US fell between from 3143 in 1985 to 2361 in 2000 whilst at the same time the reibursement rate fell markedly leaving many US MRI units running way below their capacity. At this low level (in part due to free market/single-payer health care rationing), at 2001 prices, the cost of an exam in the US was 400 US dollars per exam.

Source http://www.imagingeconomics.com/issues/articles/2001-05_03.asp

UK

"...because patient throughput has increased dramatically over the period, the average cost of an MRI scan decreased from £179 in 1988 (=£276 at the 1997 price level or about 441 US dollars per exam) to £115 in 1997 (about 184 US dollars per exam at the prevailing exchange rate of 1.6)."

Source: http://bjr.birjournals.org/cgi/reprint/72/857/432.pdf

The trend in higher throughput rates in the UK has continued. By 2005 the least efficient units in the UK (the lowest 5% of all units) manage to achieve 1956 exams per year and the best 5% managed throughput of more then 6860 exams per year (the median being about 4000 exams per year or almost twice the rate as the machines in the US

Source: http://www.healthcarecommission.org.uk/_db/_documents/Imaging_AHP_report_tag.pdf

So there you have it. The US in 2001 was oversupplied with MRI units and its average cost of delivering an examination was (several years ago admittedly) about double that of the same exam in the UK. It kind of mirrors the national statistics we see on health spending.

This seems to me to be another indication that co-ordinated national health planning can achieve more cost-effective medicine. I'm not saying its perfect in the UK. Hospitals in the UK are sometimes given unexpected windfall gifts of new scanners which can throw their financial planning if they are not gifted the trained staff and funding needing to operate them. See http://news.bbc.co.uk/1/hi/england/3557976.stm

Do waiting times mean there is underfunding? Its a good question but not an easy one to answer. Remember that in the US, rationing is done by the price mechanism and by insurance companies. But in the UK everyone is seen but they are prioritised and that means waiting is caused by low relative need rather than lack of funding. There have been wait times for non-ugent MRI scans in the UK but these are now much better. The waiting list of non-urgent cases (urgent cases are of course dealt with immediately) is at present equivalent to about 22 working days of patient throughput. More than 99 per cent of non-urgent MRIs are now being done within the NHS target of 13 weeks and 78 per cent of those waiting will wait for 6 weeks or less http://www.performance.doh.gov.uk/diagnostics/downloads/monthly/Excel_Download-WEB-Diagnostics_August_2007_Commissioner.xls The fact that there is a waiting list at all does not mean that there is an investment failure. Under-investment can be deliberate policy option because it always ensures that the equipment you have is working to maximum effect, and this is especially important with equipment like MRI that has high capital costs. Not all MRIs are so urgent that they must be done immediately.--Tom 16:14, 12 November 2007 (UTC)

I've repeatedly objected to your using the health care system of the United States as a stand in for free medicine, and I shall do so once again, because it does not have a free market health care system. Once again, the United States, like most other developed countries, has socialized medicine. The only significant difference between the United States and other countries with socialized medicine is the degree to which it is socialized and also the areas that are socialized. Accordingly, you cannot use the US to claim that socialized medicine is better than free medicine, because the US has socialzied medicine. You are criticizing one brand of socialism to promote another, not the free market. Freedomwarrior 18:37, 12 November 2007 (UTC)

You deleted my edit with the question ... over investment? according to whom? But if you read the link you will find out. Let me spell it out for you. It is in an article in "Imaging Economics" a journal which claims to have, for the past 20 years, been "dedicated to helping radiologists, radiology administrators, and health care executives meet the increasingly complex economic challenges of providing quality imaging in both the inpatient and outpatient settings". It is written by Robert Bell who was at the time president of RA Bell and Associates of Encinitas, California, a consulting company specializing in MRI science and operations. Having discussed the economics of MRI which, as a science and a business, has a proportionately high fixed costs relative to total cost, he says "... a doubling of examination volume from 1,000 to 2,000 per year generates only an 11% increase in technical expenses ($790 x 1,000 vs $440 x 2,000). Thus, low volume facilities that do not have the ability to pass higher costs to the payers must lose money, be supported with other funding sources, or increase volume to lower costs. Paradoxically, the average number of MRI examinations per unit in the United States has declined since 1985 (see Table 2) and appears to be leveling at about 2,300 examinations per system. Reversing this trend is the key to financial viability. (The emphasis is mine). The report includes a table showing average costs relative to utitlization at one, two, three and four thousand examinations per year per unit which gives unit cost per exam at 790, 440, 334, and 281 dollars respectively. Now, if units in the UK are running at 4000 exams per year and units in the US were running at only 2300 exams per year, that is surely a sign that the US facilities are under-utilizing their equipment or in other words they have invested too much in too many units that no longer produce enough revenue. This is actually hinted at in the report's conclusion as it goes on to identify that elderly patient on medicare as a potential source for more MRI scans as they currently are not getting as many MRI scans as the author argues one might expect they should. He goes on to suggest that this will require efforts to understand why the elderly are not being referred and some unspecified form of education (presumably to get doctors to order more MRI scans to reduce the average cost and improve the economic viability of the units). The article even says "To paraphrase the real estate dictum, 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?" (my highlights). In other words, having invested too much money, these unit managers now need to get doctors to make more referrals to their imaging units. In my opinion (and yes here comes an opinion) they are putting the cart before the horse. I think that most people would argue that supply should expand to meet demand. But in this topsy-turvy world of US medicine, it is argued that demand should be "conjured up" to meet an industrial over supply. And this is why it can be argued that centralized planning for MRI is more efficient (the claim which you have now deleted) and why it is actually sustainable from the evidence I have cited. I do not think you can argue that the US is actually socialized medicine. It is clearly partly a private system supported by insurance and partly a single payer system. The UK system is clearly socialized medicine as most health care is centrally or regionally planned to meet demand and does not have the predominance of private providers that exist in the US. You seem to claim the US has a socialized health care system whenever it is pointed out that it is not working too well. --Tom 22:52, 12 November 2007 (UTC)

You are claiming that socialized medicine is superior to free market because of the aforesaid. In making this claim, you use the United States as a stand in for free medicine. As I've told you elsewhere, the United States does not have free medicine. You can claim that some models of socialism are better than others, but not that socialized medicine is superior to free medicine.

Additionally, I've consistently argued that the United States has socialized medicine, and I do so because it "operates by means of government regulation and subsidies derived from taxation." In the United States, insurance companies and medical professionals are required to comply with a complex system of regulations that drives up their costs--costs which are transferred onto their patients. Essentially, they are conscripted into doing the state's bidding, without compensation. This is not free medicine, despite your claims.Freedomwarrior 02:34, 13 November 2007 (UTC)

I am making no claims of superiority. I am just pointing out that the US had a surplus of MRI units at the beginning of this decade and that this had an economic cost. I know that you argue that the US system is socialized, but this article is not here to reflect your opinions. When Guiliani made the false comparison between the UK and US cancer survival rates, he thanked God that he was treated in the US and NOT under socialized medicine. The comparison UK and US is often made in the argument about socialized medicine. Just read the stuff put out by Cato, The Manahattan Institute, and the CPA. Your case is really not strong at all. I will revert the delete you made to my edit.--Tom 05:48, 13 November 2007 (UTC)

This is what you tried to add: "Centralized planning can be more efficient than the de-centralized planning typical in Free market or Single Payer Health care." How is this not making a claim of superiority? You are criticizing the centralized planning that happens in the United States, and saying that it somehow proves that another model of socialism (one, perhaps, with a different structure of regulations) is better. That doesn't prove that central planning is more efficient than de-centralized planning, rather it proves that some forms of centralized planning are worse than others. I don't care that other groups use the United States as a stand in for free medicine, it is not. Indeed, I have already demonstrated how the United States fits the definition of socialized medicine put forth in this article. That the United States has socialized medicine (a variant, which you do not like) is a fact, not an opinion. Again, not all variants of socialized medicine have to conform with your idealized vision. Stop trying to make this article conform to your POV of what constitutes socialized medicine. Freedomwarrior 06:23, 13 November 2007 (UTC)

can be does not mean always is and I did give a specific example with a reason why overcapacity may have occured. It was hinted at in the article I quoted from. i.e. that the imaging industry at one time could raise high fees which made the investment seem worthwhile. But the industry expanded too quickly and prices started to fall so that many units became much less viable and overcapacity (euphamistically labelled under-utilization) then came about. If this was somehow due to socialism, pray tell me how socialism caused these private operators to over provide capacity. I think the example is a good example of the way the free market works. New business come about but as competition grows some firms may have to leave the industry. This is quite normal in new business areas where those early to market get the rich pickings and those late in fail to succeed because the competition has forced prices down. Its not something you as a supporter of free markets should be afraid of admitting. I am not saying that socialized medicine is superior, despite your assertion to the contrary. The widely held criticism of socialized medicine is that it underinvests and that it has capacity and performace implications. The point I was making is that free market medicine can over invest and that can have cost implications if the technology is capital intensive. I guess the other benefit of socilaized systems being slow adopter is that they acquire the technology at a lower average price (prices tend to fall in real terms) and one can plan things centrally so that units are purchased that will be defintitely be utilized because the purchaser is the user. —Preceding unsigned comment added by Hauskalainen (talk • contribs) 13:11, 13 November 2007 (UTC)

This looks like a lot of WP:OR to me - several sources used to create a conclusion. There are many many aspects to a health system, particularly one like the U.S. that certainly is not free market, that could lead to higher prices. I would think that the oversale of MRI machines would actually lead to a decrease in prices in an free market since there is so much competition. I couldn't find it, but does the source directly say that oversale was the direct cause of higher prices? If so, the statement should be attributed as such would be a claim or argument. Either way, I agree with Freedomwarrior on the comparision being made here with centralized and de-centralized. Morphh ^(talk) 16:08, 13 November 2007 (UTC)

I don't think it is original research. There is nothing new here. All I have done is pull togther some data to determine utilization levels and shown that utilization levels are higher in one socialized system than in another system which is far less socialized. I know that Freedomwarrior would contend the "less socialized" point. But that is not how users of the term "socialized medicine" categorize it. If Freedomwarrior really thinks that socialism in the US system created the overcapacity (I prefer "overcapacity" to "oversale" because the latter makes it sound like it was the MRI vendors' fault!) then it is not unreasonable to ask how that has happened. The UK has underinvested in new technologies compared to some other countries, but that was not the point of the edit that was removed. The issue was oversupply and and the impact on average cost. I would agree with you that the logical effect in a free market would be for the price of commodities like MRI scans to reduce if there is oversupply. The problem seems to be that this would mean the medical imaging units would make a loss because they would be struggling to recover all of their fixed costs. It seems that companies have been able to charge something approaching their average costs but the business is not very profitable. Hence the suggestions in the quoted article that doctors should be encouraged to send more Medicare/Medicaid patients for MRIs to generate more revenue for the imaging companies. --Tom 20:14, 13 November 2007 (UTC)

To quote from WP:SYN, "Editors often make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article to advance position C. However, this would be an example of a new synthesis of published material serving to advance a position, and as such it would constitute original research.[2] "A and B, therefore C" is acceptable only if a reliable source has published this argument in relation to the topic of the article." Morphh ^(talk) 0:10, 14 November 2007 (UTC)

US and Free Medicine

Tom, you have not refuted, nor can you refute, my contention that the US has a semi-socialized system. Therefore, stop trying to use the United States as a stand in for free medicine. This is a cheap straw man argument, and I'm not going to allow it on here. If you have a valid criticism of the United States' system, then go ahead and add it.

Sadly, most countries in the West have adopted most of the planks of the Communist Manifesto without realizing the full implications of their actions, because most people think that socialism merely involves direct government control. Just realize that socialism is more than just direct government control, it includes indirect government control in the form of regulations, taxes, etc., and stop scapegoating free medicine for the faults of socialized medicine.

Since the implicit definition of socialism you are employing differs from that widely held (per your comment "most people think that socialism merely involves direct government control"), it would seem that the onus would be on you to find some credible sources that say that the US system is socialized or semi-socialized.--Gregalton 12:46, 13 November 2007 (UTC)

Over the months that I have been editing this article I have searched many articles on this subject on the net. The overwhelming number of recent articles, blogs, news stories and usage by politicians etc.. can be traced back to output emanating from a very small number of sources. The three main ones seem to be the Centre for Policy Analysis, another is the Manhattan Institute and the other is Cato. Their reports on socialized medicine do not appear to be peer reviewed yet they are widely quoted. They all refer to health care systems in places such as Canada and the UK as reflecting "socialized medicine" and compare these systems with an alternative system, that in the US, which by their own logic cannot also be regarded as "socialized medicine" otherwise their conclusions would be meaningless. So the assertion by Freedomwarrior that the UK and the US are not at opposite poles on the issue of "socialized medicine" is not in accord with the way users of the term mean it to be interpreted.--Tom 21:01, 13 November 2007 (UTC)

Opening paragraph. Medicaid and Medicare are single payer. Replace with better examples?

At one point in the article it is pointed out that most people would regard Canada's system of health care as being a "Single Payer" system rather than a "Socialized" system. But in the opening paragraph the article boldy declares Medicaid and Medicare as examples of socialized medicine in the US. But aren't these also better describes as Single Payer systems? I would have thought the Veterans and Army Medical Services would be better examples of socialized medicine in the US to be included in the opening paragraph. I know that a certain editor will probably strongly disapprove of that, but it would be less disputable. --Tom 21:18, 13 November 2007 (UTC)

Socialized medicine is a class of single payer health care systems. Whether a particular single payer system is socialized medicine or national health insurance depends on how much government control there is. Unfortunately, there is no easy way to distinguish between the two, since no national health insurance system could survive without a fair amount of government control. Kborer 13:29, 14 November 2007 (UTC)

In some ways, Medicare shouldn't be considered to be single payer, because the insurance benefits are provided by multiple insurance providers. True, the funding comes from the Medicare program, but many of the advantages of a single payer system (dealing with one provider that provides the same level of coverage to everyone), don't exist under Medicare.Steggall 13:59, 14 November 2007 (UTC)

Regulation

There are very two different and contradictory arguments being made for removing the statement that socialized medicine operates by "means of government regulation."

According to Tom, regulation is "not a definitive characteristic of socialized systems." In other words, he seems to be claiming that not all socialized systems operate by means of government regulations--i.e. government directives. This is non-sense. If this were the case, how on earth would individuals working for the state know what is expected of them?

Gregalton, in deleting the same material concedes that regulation is a feature of a socialized system, but that it is not worth mentioning because it is a feature of all systems. Unlike Tom, he is not disputing the factual basis of the claim that socialized medicine is a "health care system which operates by means of government regulation." He is eliminating it because he feels like it, which is not an adequate basis for removing a claim that adds greater precision to the article, and because he insists that all health care systems are also the subject of regulation. This, like Tom's claim that there are countries with socialized medicine with health services that do not operate via regulations, is non-sense. While there is currently no country with a purely laissez-faire health care system, there would be no government regulation of medical treatment under such a system. Freedomwarrior 03:45, 1 December 2007 (UTC)

Tom and I actually agree, you have apparently misunderstood. Regulation is a feature, but not the only feature nor the defining characteristic.

Regulation is a feature of all current systems, hence not specific to socialized medicine, as you have pointed out. If it is a feature of all systems, save fantasy ones, it would be worth mentioning in the lead of an article about the fantasy system, but not in those on most of the others. The article on the medical system of the moon, or some post-conflict society with no functioning government, perhaps.

Put differently: the false dichotomy you are proposing is between so-called socialized medicine and laissez-faire, but there are more choices than that. The way you are defining the question, it is laissez faire and everything else. Which makes it a defining feature of laissez faire, not everything else.--Gregalton 04:14, 1 December 2007 (UTC)

Since I don't need to address most of your points to defend the inclusion of the statement, I will be brief. Even if all currently existing systems have some form of regulation, that is not an adequate basis for removing a factual claim that adds greater precision to the article. Whether or not regulation is a defining characteristic of socialized medicine is irrelevant. Ultimately, that's a matter of opinion. You and I happen to disagree on its importance. As I said though, it doesn't matter because we don't add or remove information here on the basis of our particular opinions, because that would lead to the elimination of sourced material (something that Tom engages in all the time). If you don't object to the factual basis of the claim, then there is no justification for eliminating that statement other than your contention that it regulation is not a defining characteristic. Freedomwarrior 05:09, 1 December 2007 (UTC)

You need to address the issue of relevance, particularly for something you propose to put in the first sentence.--Gregalton 06:00, 1 December 2007 (UTC)

You don't object to the statement on government funding, which like regulation, is "a feature of all current systems, hence not specific to socialized medicine." Either your are applying an inconsistent standard in comparing regulation and government funding, or we should eliminate both statements. Which is it?Freedomwarrior 06:21, 1 December 2007 (UTC)

Under WP rules, the lead must summarize the body of the article, so anything you put in the lead must also be in the article. It must also cite a wp:rs, and can't be your own opinion or conclusions. If you can find a reliable source, then you can argue over whether it belongs in the lead, but if you can't find a reliable source, then any other discussion is moot. Nbauman 06:39, 1 December 2007 (UTC)

Government funding and control are central to the concept.--Gregalton 06:41, 1 December 2007 (UTC)

Ok... so... what is regulation if not government control?

First, the article references regulations about as many times as it does government spending. As such, regulation is something that appears in the text. Secondly, there is a reliable source for the inclusion of regulation--it's the one that you and Tom ignored when making your edits. According to the American Heritage Stedman's Medical Dictionary, socialized medicine consists of "a system for providing medical and hospital care for all at a nominal cost by means of government regulation of health services and subsidies derived from taxation."

If you insist on objecting to the inclusion of a statement on regulation, I am just going to do the same with regards to a statement government funding since, in your own words, both are "features of all current systems, hence not specific to socialized medicine. [and] if it is a feature of all systems, save fantasy ones, it would be worth mentioning in the lead of an article about the fantasy system, but not in those on most of the others. The article on the medical system of the moon, or some post-conflict society with no functioning government, perhaps." As I said before either your are (purposefully) applying an inconsistent standard in comparing regulation and government funding, which needs to stop, or we should eliminate both statements. Freedomwarrior 07:12, 1 December 2007 (UTC)

The second sentence of the article reads "controlled and financed by the government". Does this not address your point? The distinction is that regulation can include regulation of non-government entities, while fully government-controlled medicine does not need external regulation - its own internal rules and decisions suffice. This is not generally referred to as regulation, although a pedant could argue that it's an internal regulation. (Does a 7-11 that has internal rules against long hair have regulations per se? This is not a regulation in the same sense).

And why don't you see about incorporating a comment about regulation in the main text? After that, if it somehow is compelling to include in the lead, we can see about it. At any rate, perhaps you could explain what distinction you are trying to draw between government control and government regulation.

The parallel to government funding is erroneous. The distinction with so-called socialised medicine is that almost all funding is government and almost all provision government (health services provision is nationalised). This really barely applies anywhere, arguably in UK. Interestingly, only North Korea has 100% out of pocket expenditure on health (according to WHO).--Gregalton 07:33, 1 December 2007 (UTC)

Your distinction between "external" and "internal" regulation does not change the fact that the rules promulgated by the agencies charged with implementing socialized medicine constitute a form of regulation.(The example of the 7/11 is a red herring, since we are talking about the "internal rules and decisions" of governments and not or private companies)

What do you call the main text of the article? There is already a mention of regulation in the article...

On the matter of government regulation vs. control, one is more precise than the other. Regulation specifically refers to the rules promulgated to implement socialized medicine, whilst government control--in my opinion--includes the aforementioned rules and the government's control of the financing system.

Finally, socialized medicine, as it is used in this article, does not refer exclusively to fully government funded and controlled national health care services. It is used in a broader sense. Therefore, the parallel stands.Freedomwarrior 08:32, 1 December 2007 (UTC)

In a public policy/economics sense, "regulation" is used to refer to laws and other acts to regulate the actions of other entities. I personally completely and utterly disagree with the article as it currently stands: it should not refer to e.g. Canada's system as socialised, it is an incorrect characterisation. But that's a separate discussion.--Gregalton 09:34, 1 December 2007 (UTC)

I agree with the point that Gregalton makes that the UK rather Canada is dominated by a socialized medicine system. The medicare and medicaid systems in the US seem to me to be a form of state subsidized private medicine which is not what socialized medicine is typically characterized as.

I see four main kinds of regulation in health.

• The first is that which exists to directly protect the public from harm. The regulations regarding new medicines is a clear example. This is applied evenly across all sectors. It is not definitive of socialized systems.
• The second form of regulation, which I suspect that Freedomwarrior would argue exists, is that socialized systems such as England's NHS refuse to fund certain treatments (e.g. chiropractic) and that this is a form of regulation. But that kind of regulation equally applies to private insurers' internal regulations. It is the kind of regulation put in place to ensure fairness for everyone and protect stakeholders' funds. In other words it isn't anything special that marks it out. Its just a standard form of payers' regualtions.
• Thirdly there is another kind of regulation that ensures fair competition between competing services and to make selection easier for the buyer of private health care. An example of this would be the equalization loading applied to many insurance funds in Europe based on the characteristics of the pool members. This is not really associated with Socialized medicine per se but is more to do with implementing consumerism, fostering competition and achieving universal health care. This form of competitive regulation is very common in European business generally - I am not sure about elsewhere. Again it is not specific to socialized systems.
• Fourthly, there is the kind of regulation that stems directly from legislation which forces certain actions as a direct form of public policy. I am thinking here of the laws in the US which force hospitals to provide emergency room services without sight of insurance coverage and the laws in Canada which prevent the insurance companies competing with the Medicare system. We do not have this type of regulation in the UK and it is not a definitive part of socialized medicine.

For these reasons, regulation is not, IMHO definitive of socialized medicine, despite what Stedman's medical dictionary says. If its definition substituted the word "management" for "regulation" I'd be happier with it. In practice in the UK, as I am sure it is in Spain and other countries, health services are run by health professionals working to sensible guidelines to maintain and improve the health of the nation. Government regulation has very little with do it.

The United States does not have private medicine in any real sense, because those little regulations that you support essentially conscript private companies into doing the bidding of bureaucrats. The "private sector" in the United States is oftentimes nothing but a stand in for the state. It is the victim of socialist regulations, which undercut the functioning of the market. Again, stop using the United States as a stand in for private medicine. You are just criticizing one of the available forms for implementing socialized medicine.

Let us begin with the protectionist measures that are designed to "protect the public from harm." Such regulations only came to exist with the spread of collectivist ideologies at the end of the nineteenth century. They are of a distinctly socialist origin. There were no such regulations at the federal level in the United States prior to the turn of the twentieth century. For you to come here and claim that they are not definitive of a socialist system is revisionist non-sense. The rise of such regulations is concomitant with the rise of socialized medicine. That most countries have such regulations is an indicator that most of them have adopted some form of socialized medicine, nothing else.

The second form of regulation is what I was getting at. These regulations are the directives which determine whether and how the national health service operates. These are regulations that do not exist in a laissez-faire system, since the state would not be responsible for the distribution of health care in such a system. They only exist in the variant of socialist medicine where the state has full control.

The regulations placed on insurance companies in Europe and the United States are a way for the government to indirectly control the provision of health care. While not all socialist systems have such regulations, they are part and parcel of the kinds of regulations that are imposed in socialist systems.

Finally, the UK does not have the same kind of regulations that the United States has because you have a different model of socialized medicine. We have our inane regulations, you have your inane regulations.

While there are different kinds of regulations, the fact remains that all countries with socialized medicine have some form of government regulation over the provision of health care.

The fact is that most countries in the world have some form of socialized medicine, because they have some form of state control and funding over their health services. These regulations did not exist in era of laissez-faire. Regulation, like government funding, is a sina qua non of socialized medicine. Whether a regulation happens to be external, which is often the case when the government conscripts health care providers into doing its bidding, or internal, which is what happens when the government cuts out the middle man, does not change the fact that it is a regulation. Your distinction between management and regulation is indicative of what this edit conflict is over: hiding the true nature of socialized medicine. You and your cohort are simply trying to cover up the fact that there are government regulations in socialized systems. What is the basis of those so-called health professionals power if not laws and regulations? How does the state conscript private providers if not through laws and regulations? Blank out. I am not going to stand for such white washing. Freedomwarrior 18:25, 1 December 2007 (UTC)

You are essentially arguing your points from a political POV. Governments control on behalf of the poeple that elect them. If people did not like the controls there would be parties pledging to remove them and people queuing up to vote for them. Personally I am thankful that my medicines are strictly tested for safety and effectiveness before I get to swallow them and that my taxes are not wasted on wasteful and ineffective procedures. And I think most "normal" people would agree with that. Democracy not demagogary delivers the regulations. And I do not think that the USA which has all the regulations you complain of is a socialist state. The basis of my doctor's power to deliver health care to me is indeed laid down in national legislation that makes his employer, the town where I live, responsible for ensuring that I get the health care I need. But beyond that there is very little additional regulation. All I do is pay my taxes and 11€ per visit (and that reduces to 0€ after my first 3 visits in any calendar year). This legislation does not add costs... it just make it clear who has the responsibility to deliver my health care and on what basis it is paid for. In the UK, private providers are not "conscripted" as you put it to deliver care to NHS patients. They are free to negotiate to offer services to the NHS and the NHS is free to engage with them on commercial terms. It is not legislated for, but is on commercial terms. Actually the NHS saves private insurers money. When I was in the UK I had private medical coverage from my employer and only ever used it once; I preferred to use the NHS services on many occassions when I could have claimed on my private medical insurance. To be honest its not worth the form filling and additional expense (as there are co-pays and deductables with the private system but using the NHS costs me nothing). Anyhow, the point is that regulation is not definitive of socialized systems and it is right that reference to it should be removed from the lead paragraph.--Tom 19:20, 1 December 2007 (UTC)

PS As you are so knowlegegable, I'd be interested to learn which of all the inane health regulations there are in the UK is the worst offender in making things worse rather than better. --Tom 19:25, 1 December 2007 (UTC)

My argument for inclusion is based on facts and a reliable source, not my opinion, which is irrelevant. You have not made an argument for removing the references to regulation. You have cobbled together a whole bunch of different and irrelevant reasons for supporting socialized medicine, and used that to claim that regulation is not a definitive element of socialized systems. I don't care whether you like the NHS or not. I also don't care what most "normal" people agree with, the fact is that Wikipedia is not a democracy (that would be kind of pointless, since both of us could fight this out using shell accounts). At the end of the day, government regulations (rules), either external or internal (which are regulations, as the Code of Federal Regulations, for example, covers state run enterprises), are a defining characteristic of systems with socialized medicine. You cannot have a socialized system without some form of government regulation. Your edits, which are removing sourced material, are nothing but shameless POV pushing.

PS Why don't you ask all those young physicians of yours that are coming to the United States. My country isn't the one that's suffering from a brain drainFreedomwarrior 20:00, 1 December 2007 (UTC)

I have quite clearly laid out the case WHY regulation is not definitive and how you can claim otherwise completely baffles me. Some dictionary definitions do use the term "regulated by government" but by no means all do. The problem here is fundamentally this. Regulated can mean "control by the issue of regulations", which is the meaning that Freedomwarrior is using. But it can just me "controlled" in the same sense that every organisation is controlled or regulated by sets of established rules, which is how I interpret the dictionary definitions. In this sense, regulation is every bit the same as the rules followed by practitioners in a private hospital or in a private insurance company. We do not normally, in common parlance, use the term "regulations" to describe these company rules. So why use the term to describe rules within the VA or the NHS? In the context of this article it smacks of the same US based linguistic tarbrushing as the word "socialized". By using the term "government regulation" in the title, it makes it sound as though the minutiae of decion making in socialized health care systems comes from government, which is quite wrong. For this reason I believe that the use in the header paragraph is not justifiable. Furthermore, it is actually misleading.--Tom 22:20, 1 December 2007 (UTC)

WHat do you mean by "shell accounts"? If you imply that I edit here under another name I assure you that is not the case. --Tom 22:24, 1 December 2007 (UTC)

Freedomwarrior is correct on both points. First, it does not matter how the government controls the health care industry. Whether it is "internal" because it is running hospitals and employing doctors or "external" because it puts pressure on private practices to behave in a certain way is irrelevant. Second, socialized medicine does not mean completely controlled and financed by the government, which is why it is understandable that health care systems that are nominally single payer are sometimes exemplified as socialized medicine if the government has a subjectively large amount of control. Kborer 20:41, 1 December 2007 (UTC)

Re the first point. It is irrelevant argument in the context becuase the article we are editing is about socialized medicine, not controls applied to the whole health care industry. The two things are quite different. On the second point it seems to me that the whole tarbrushing of single-payer systems with the term "socialized medicine" has come about as a result of mud slinging. It seems to me that those opposed to single-payer just adopted a term with negative connotations and formerly used to apply to systems like the UKs and re-applied it to the Canadian model. Well, that is a done thing and we must live with it. I'm not sure how that justifies the use of the term "government regulation" in the header if it only applies to the Single payer type scenario.--Tom 22:38, 1 December 2007 (UTC)

It is not at all misleading, because the decision making process in a country with a socialized system is ultimately controlled by the rules which the government establishes for health care providers (where, for example, do those rational guidelines that you're so fond of come from? where do the rules that have to be followed in crafting those guidelines come from? etc.) While providers have discretion in some countries with socialized medicine, they are still bound by the rules that the government establishes. As you've pointed out, we do not typically use the term "regulation" to describe the rules that a private company establishes to govern the conduct of its employees. That term is usually reserved for the "legal restrictions promulgated by government authority." As such, it is the most appropriate term to describe the rules that govern the VA or the NHS. While I understand that you and other supporters of socialism operate on the basis of opinion and not fact, deletions of sourced material are not going to be tolerated. While the United States has certainly strayed from the vision of its founding fathers (the same ones who took up arms to protest a minimal tax), we at least know when to call a spade a spade. Regulation is a fundamental component of socialized medicine. Freedomwarrior 23:38, 1 December 2007 (UTC)

If I followed your logic it would be perfectly OK for me to head the articles Public library, Highway or Coast guard or National Guard of the United States by saying that they are funded by the government and operated by means of regulation! Although technically correct, it would be edited away immediately as a linguistic contrivance that adds nothing to the article. In the case of socialized medicine, adding it to the definition serves no purpose other than to promulgate negative sentiment. As to sourced material I deleted one dictionary reference (which mentions the word "regulated" rather than "regulation"). I did that because I could equally add several other definitions that do not carry the word "regulated" or "regulation". I don't think it would help much to add a long list of different definitions. You have added reference to regulation further on in the article, and I am okay with that. But I stick to my guns here... regulation is not a definitive aspect of socialized medicine and has no place in the opening paragraph of the article. Private health care systems have regulations and public systems have regulations. They may come from government or from a body established by government, but that is simply axiomatic.--Tom 01:07, 2 December 2007 (UTC)

Tom, you can add those other articles however you please. If the inclusion of the fact that socialized medicine operates through regulations "promulgates negative sentiments" against socialized medicine, then so be it. I am not going to tolerate your efforts to erase the inclusion of a sourced, factual statement because you hold it to be an inconvenient truth. The current day systems that you label as private are systems with a substantial degree of centralized control. They are only private in name, and are socialized to differing degrees. For a better perspective on what constitutes a truly private system, one would have to turn to past centuries when the provision of state was done on the basis of laissez-faire.Freedomwarrior 01:45, 2 December 2007 (UTC)

I have not implied that you are editing here under another name. I am just pointing out why resorting to some sort of democratic process on this forum would be pointless. Freedomwarrior 23:38, 1 December 2007 (UTC)

A few quick points:

1. There are broad and narrow definitions of socialised medicine - FW's definition being the most broad, mine being at the other end (where the more specific definition of socialised medicine lies that allows it to be distinguished from e.g. the Canadian, US or even French systems, specifically, government does not just provide money and regulate - which it does everywhere - but actually pays for almost all healthcare and directly provides most of it). There is a difference between nationalised (socialised) healthcare and "everything else", but regulation is not it.
2. In economics (and as far as I'm aware, most other disciplines) there is a distinction between regulation of third parties by government and internal control by government of its own resources. For example, when regulations are made, it is done with full knowledge that they are bound to contradict the economic/financial interests (at least in the short term) of at least some of the participants. Tell a guy to stop selling crack to eight year olds and you are hurting his margins. (Government control of its own resources has its own problems, of course, but they are different problems).
3. Please let's stop with the accusations of POV. It doesn't contribute anything, and usually immediately identifiable under the schoolyard "those what smelt it, dealt it" rule.--Gregalton 08:33, 2 December 2007 (UTC)

As an attempt at a compromise I re-edited the start of the article and added examples of both definitions and even added back the disputed "regulation" word in an attempt to cool matters. But I see that Freedomwarrior (FW) has again reverted it. I agree that we have two editors here with strong POVs and it does not help that we cannot get a compromise position here. The point you make about regulation is much more eloquently and succinctly put than my own, but I think we are on the same wavelength. You seem to be agreeing with me that the term has two distinct meanings and is therefore ambiguous. The intended meaning is "internal control" (which is axiomatic and therefore does not need to be said), but it is (IMHO) being used to imply "economic restriction" which can have very negative connotations, and is not the meaning intended by the few dictionary compilers who have used the word regulation in their definitions. We have two editors are of one opinion and two which are of the other. At this point I now wish to ask other editors to give their opinions on this matter. (I shall ignore FWs strictures that try to prevent me from doing this). --Tom 11:27, 2 December 2007 (UTC)

Question: Should the word REGULATION or similar be used in the initial sentence to define socialized medicine?

NO --Tom 11:27, 2 December 2007 (UTC)

Indifferent: As long as this excessively broad definition of socialized medicine is used, regulation is not particularly problematic.--Gregalton 12:57, 2 December 2007 (UTC)

First, it is not my stricture that prohibits a democratic process, but Wikipedia's (see: WP:NOT#DEMOCRACY) On this forum, numbers are not a substitute for a good argument...

Notwithstanding, as Gregalton has pointed out, there are two competing definitions of what constitutes socialized medicine, with Gregalton's and Tom's being the narrowest and the one that I and Kborer have defended being broader.

The definition that both Tom and Gregalton are pushing defines the term as the provision of health care through a state-run national health service. The definition that I am partial to starts from that definition and expands it to include all those health care systems that are indirectly controlled by the state through regulations (after all, as the Nazi experiment proved: there's a point at which the level of regulation makes the state the de facto owner of the means of production). There are sources to defend both definitions. I have no problem with including the narrower definition, as long as it is not favored over the definition that I am espousing, particularly, since it was the long standing introduction to this article. Freedomwarrior 17:05, 2 December 2007 (UTC)

We have two definitions that have developed over time. Both of which come under the broad category of medical services provided for the community and paid for by the community from taxation. The original definition from the 1930s was of medicine delivered by the state using employees working for the state. The second one has developed more recently and medicine where the government co-opts private entities into delivering health care for the community. I actually think it is pretty meaningless to mention regulation in either case. In the first definition it is axiomatic. We would not say the coast guard or the post office is "operated by means of government regulation" any more than we would say that AT&T "is operated by means of AT&T's regulations". The second form of socialized medicine is rather akin to NASA contracting with Boeing to deliver work for the space program. If you want to do business with NASA you have to meet NASA's regulations. So hospitals that take work from Medicare patients must comply with Medicare's regulations. Its axiomatic. I am sure there are other regulations in health care in the USA but unless they are directly related to programs such as medicare and medicaid they probably have little connection with socialized medicine. Now you may feel like Freedomwarrior does that health care regulation is evil and somehow akin to Nazism and socialism. But it is a completely different issue. This article is about "socialized medicine" not "health care regulation" and muddying the two is not helpful. Regulation is not a definitive aspect of socialized medicine. It is purely co-incidental. By all means mention it in the article, but please, not in the first sentence. The location of the mention does appear to be the nub of the present dispute. --Tom 20:15, 2 December 2007 (UTC)

Sorry, I know I may seem to be changing my mind on this, but I'm not really. The German/Singaporean models do work substantially on regulation: people are required to contribute and be insured, and the latter does use (for example) regulations on supply and pricing. If we are going to call them socialised medicine (which I think patently absurd, as already noted), mentioning control or regulation boils down to the same thing or similar enough it doesn't change much.

If we are talking about the narrow definition, then I agree that regulation is an imprecise term.

I would propose more precision about both the definition and that different interpretations lead to different classifications; one where only e.g. UK has socialised medicine (I'm picking that out of the air), another where just about every country with a functioning government does, including the U.S. (From my reading of the WHO health reports, only North Korea would be the exception, but I may have missed some). If we are going to use this latter definition, it would be useful to point out that the definition does not really coincide with the definition of "socialism" or socialist political movements.--Gregalton 20:45, 2 December 2007 (UTC)

I think you are right. By Freedomwarrior's definition, virtually all health care is socialized if it is not totally liassez-faire. And I do not think that is how most people think about this issue. Also you may be confusing laws aimed at delivering universal health care which are not really connected at all with socialized medicine. The Swiss system has such laws but its medicine is largely not state funded and therefore not very "socialized" (though its the second highest expesive system per capita in the world if I recall correctly). I hope that you have compulsory auto insurance in Canada but I doubt that that the state subsidizes it or anyone calls it "socialized auto insurance". The US could regulate drug pricing this year if it wanted to and abandon programs such as medicare and medicade. They are not logically connected.

The problem with the word "regulation" is that it can mean law making, it can mean internalized control and it can mean contractual rule, it can mean restrictions on economic activity... it can mean virtually what you want it mean! But I take the point that it is very hard to segregate the reasons for health care regulation because almost all health care and health insurance is regulated somehow. It just does not have much to do with socialized medicine. I do not think that there are any government health regulations that apply to the private sector in the UK that do not equally apply to the state sector. It is not a distinguishing characteristic. --Tom 21:52, 2 December 2007 (UTC)

This is precisely my point, yes, the 'socialised' terminology used in this way is not the way most people use it. Singapore's is often considered the leading light in non-government controlled systems (a bit of a nose-stretcher since as far as I can tell it is mostly funded from compulsory contributions), and even the Swiss have a system where more than 50% is funded by government. If broadened this much, the term becomes meaningless (even more so than usual). And again, just about every state has regulation of some kind (if only to license doctors and medicines), so if that is to be the test for socialised medicine, so be it - we all have socialised medicine.--Gregalton 22:26, 2 December 2007 (UTC)

To put it another way, any system that has some consumer choice is not socialized and we all have free market medicine. Kborer 23:40, 2 December 2007 (UTC)

That was not at all my claim or point, which is precisely why I'm saying that the aproach is a false dichotomy (socialised medicine or free market). My point is that socialised medicine (the term) properly applies to a very specific type of system: where the state funds and provides substantially all medical care, which is not so common. I have not claimed that all others represent free market medicine, but systems of various types (e.g. single-payer is not free market, nor is it socialised medicine properly defined). Some have more market elements than others, but it is very unlikely that a fully 'free' market for medical services exists anywhere in the modern world (with a functioning government), only a matter of degrees. And this, in my view, is why it's not very useful to say that any with regulation are socialised: it is so broad as to apply to just about all existing systems.

I also contend that, properly defined, socialised medicine does not rely on regulation in the economic sense of controlling a third party by means of legal restrictions or requirements - because there are few or no significant third parties, so internal control is sufficient.

And there is no necessary contradiction between these various systems and consumer choice: some provide more than others, but there are still limits. Theoretically, socialised medical systems could allow consumers to go from doctor to doctor, or some degree of choice in the type of procedure they would prefer (within a range of options) and most do allow some degree of that (but eventually put limits to contain costs, just as any insurer would do). Even fairly "open" systems tend to balk at allowing consumers to have recreational heart surgery or even (non-life threatening) dialysis, even if they're willing to pay.--Gregalton (talk) 06:01, 3 December 2007 (UTC)

You are correct in that a system is not necessarily socialized when it is regulated. If it has a lot of government control and financing then it is socialized medicine, if it has very little of both then it is free market medicine, and if it has a medium amount of each then it is a hybrid system. Kborer 23:58, 3 December 2007 (UTC)

"Regulation: Rules governing the activities of private-sector enterprises. Regulation is often imposed by GOVERNMENT, either directly or through an appointed regulator." Economist.com Economics A-Z. I've no argument with your split above, just underlining again that, in economics/political economy, regulation is not just a synonym for control. However, socialised medicine (under a precise definition) requires more than just "a lot" of government control and financing, but a specific form and type - that is, direct control.--Gregalton 07:23, 4 December 2007 (UTC)

Economics has specific meanings for many terms, but in this article it is more appropriate to use the generic definition. Also, it does not matter how a government controls the industry. Kborer 13:38, 4 December 2007 (UTC)

This is not an unusual usage, and is standard for public policy, some legal terms, and corresponds well with the regulation article here, even though the latter is not solely an 'economics' article. It is, in other words, an entirely appropriate distinction for an article on health care (public policy).

And of course it matters how a government controls the industry: it could threaten to shoot any executives that don't comply, it could nationalise it by law, or it could use a combination of fiscal and regulatory measures to get the intended results. The costs, effectiveness and long-run consequences would be very different. At any rate, I can live with "hybrid system." Virtually all of the systems here would qualify as hybrid, so I don't think it's a particularly meaningful typology, but we can link to other articles--Gregalton 17:07, 4 December 2007 (UTC)

Following on from Kborer that the generic rather than specific definition of regulation applies in the defintion (which I agree with), then perhaps instead of the article saying "which operates by means of government regulation and subsidies derived from taxation" we can say "which is managed by government and is subsidised from taxation" because the general meaning of regulate is to control or manage. We could then add a sentence that "Some would argue that excessive regulation by goverment in a private health care environment is a form of socialized medicine". This would at least encapsulate both positions and overcome the double meaning of regulation which exists in the statement as it presently stands and which is not acceptable to all the editors.--Tom 19:21, 4 December 2007 (UTC)

The first sentence is a workable compromise, but we should only put the sentence "some would argue that excessive ..." in if some credible sources argue that. I still think it's too broad, but if there's a source, also workable. (And why is this specific to medicine? Wouldn't excessive regulation in any sector make that sector "socialized"?)--Gregalton 20:50, 4 December 2007 (UTC)

How about: Socialized medicine or state medicine is a health care system that is largely both publicly subsidized and subject to public policy. Kborer (talk) 17:53, 5 December 2007 (UTC)

I had just added the definition discussed before into the article before seeing this suggestion. Isn't the problem with your suggestion that it is also axiomatic? Anything that is subsidized by the state is done so for public policy reasons and therefore subject to rules? I think state employment of health care workers is a key factor, but by extension some have used the term to apply to subsidy where there is no direct employment of health care workers. I hope the edit I have just made covers both possibilities.--Tom (talk) 18:13, 5 December 2007 (UTC)

How about we cut the current first sentence and make the second sentence, "socialized medicine can refer to any system of medical care that is controlled and financed by the government," the introduction, while specifying the type of control that we are talking about direct (state ownership) or indirect (significant levels of regulation)?Freedomwarrior (talk) 19:05, 5 December 2007 (UTC)

I'm still rather curious about your use of the term "regulation". Is this any different from an insurance company's regulations about which procedures are funded and which are not? --Tom (talk) 23:51, 5 December 2007 (UTC)

The term regulation is not misleading. It is being used in the same way as in multiple referenced definitions. Kborer (talk) 15:40, 6 December 2007 (UTC)

On the contrary. We have had a long discussion here and it has been shown to have multiple meanings. None of the dictionary definitions refers to regulation of private medicine and I would strongly argue that it refers to simple control of the operation of owned and managed hospitals and clinics, or else the rules for paying out money to private providers. You are using the word as if it could refer to control of the private sector independent of that subsidy or funding. Which is why I asked you about how the regulation you are referring to is any different from the the regulation that any fund manager makes to control the release of funds. The word regulation as you are using it is NOT what is intended in those definitions. If do you think that it exists and IS related to socialized medicine then please tell us what kind of regulation you are referring to. Laws that restrict or force certain actions (e.g. the law that compels hospitals in the US to provide life-threatening emergency care, or the law preventing competition with Mecicare in Canada) are "laws" not "regulations". Otherwise we would say that murder or fraud is regulated and that is patently absurd. --Tom (talk) 16:44, 6 December 2007 (UTC)

I scoured the CATO article on regulation looking for examples of socialized medicine by the means of back door of regulation. The regulations fall into two types. Some are applied to all establishments and therefore are not definitive of socialized medicine. E.g. the rule that says a hospital must employ a translator if the patient speaks another language. The other type, such as EMTALA regulations requiring emergency care to be given regardless of proof of ability to pay, are enforced only on those institutions that receive grants from the government or contract with the government to receive subsidies of their business from Medicare and Medicaid that reduce the bills to their patients. These private hospitals would thus be free of these regulations if they did not take the subsidy. In other words, the government is making sure through contractual ties and rules that hospitals deliver service for the money that they receive. That is no different from what an insurance company does to protect its funds. So far from this being the application of socialism by the back door, these businesses are actively choosing to be regulated and subsidized. Nobody forces them to contract with the government to receive state subsidies. --Tom (talk) 18:41, 6 December 2007 (UTC)

And needless to say regulations such as EMTALA are there to prevent the excesses that would happen if the system was totally laissez-faire. People do not want the hospitals they pay for, which may be bristling with doctors and medical equipment and medicines, pushing the sick and dying onto the street for lack of proof of ability to pay. In other words it is a necessary step to take because the system is NOT socialized. In the UK, we have no laws such as EMTALA. --Tom (talk) 18:51, 6 December 2007 (UTC)

One (perhaps minor) point: I do not understand the distinction you are drawing between a law and a regulation. Some laws impose regulation, some laws do not constitute regulations. But just because not all laws are regulations does not mean all laws are not regulations.--Gregalton (talk) 09:28, 7 December 2007 (UTC)

I think all laws actually impose regulations because they determine behaviour in certain circumstances. But the law does sometimes set up another body to regulate certain activities purely because that is more flexible way to do things. Regulation in financial services is usually done that way. These are non-negotiable rules. The issue I have is that I believe the term "regulation" as used in those definitions of socialized medicine that use it are using the term in the general sense of self-managing or controlling rather than the economists/lawyers term of forbidding certain actions. Also many of the things that could be labelled as "regulation" (as Cato does) are really not more than part of a contractual obligation. For instance, GPs in the UK used to be contractually obliged to provide out of hours services to patients (e.g. emergency home visits) as part of their GP contract. But nobody forces the doctor to sign the GP contract. The law or a regulator did not say that GPs had to provide this service. When the contract was re-negotiated with doctors, the obligation became optional (for a loss of revenue) and rather too many doctors dropped out. The NHS still provides out of hours service but the cost of doing so has risen considerably because the Health Service got its sums wrong. The additional cost has gone to so-called locum firms and therefore right back into doctors' pockets as certain doctors now prefer to run locum services at these higher out-of-hours rates. Similarly nobody forces US practitioners to undertake Medicare work but doing so has certain obligations such as those set by EMTALA. I would agree that this was probably not negotiated but at least the law offers a way of out regulation....don't accept the Medicare subsidy dollars from the government but try to sell your services without the Medicare subsidy. --Tom (talk) 14:34, 7 December 2007 (UTC)

Proposal to remove most of this content

It is mostly repetitive of information in other articles, like universal health care, and generally inaccurate when referring to e.g. the Canadian and many other systems as socialised medicine - doesn't meet the full definition. Most of the discussion of pros and cons is also covered in detail in other articles, particularly universal health care.

The only part of this article I see as actually relevant is the bit about the USSR and its use as a pejorative political term. Grateful other views.--Gregalton 10:28, 1 December 2007 (UTC)

Disagree. The reason I started editing this article is that it was being used as a vehicle for repeating false information about socialized health care system, usually via inserted links to external sites. I do agree that it is a perjorative term though some editors here have disagreed with that. If socialized medicine means what I think it usually means, i.e. medicine provided for the community and funded by the community from taxation, and particularly where the government manages the health care system (e.g. the NHS in UK, or the VHA in the U.S.) then I think it is right to have an article describing how these systems work, how they differ from other forms of medicine and what the advantages and disadvantages of such a system may be. I would rather that this was not under the horrible title of "Socialized Medicine", but if that is the term that is used in a big nation like the US then so be it. We did make efforts to find a better title but we did not succeed. It has been an exausting process getting the article this far, and I am not fully happy with it either. But it would be a tragedy to lose the work that has been done so far. At least the article now gives proper examination of issues like waiting times, choice, cost, incentives, innovation, investment etc.. which are often associated with the term. --Tom 13:31, 1 December 2007 (UTC)

(Your comment about the USSR is puzzling because the article says nothing very much about the USSR as far as I can see). --Tom 13:31, 1 December 2007 (UTC)

Fair enough. I would still prefer that these points be made in other articles where the definition actually fits. That said, could we be much more specific about a strict definition of socialised medicine, vs. the more generalised one that is being used, and be specific about which ones may fit a strict definition and which not?

There is very little about USSR in the article but it at least had a socialised medical system in the actual correct sense of the term. I do not think the Bismarckian system would qualify for example - it was simply a universal health care system.--Gregalton 13:39, 1 December 2007 (UTC)

I too would prefer a strict definition because it makes life difficult discussing a subject that has a wobbly definintion. I wish you luck in your deliberations on this matter with editors who will insist that it is not neccessary for the government to own the health care system for it to be socialized, or indeed that regulated private health care IS socialized medicine because it is regulated. Cranial contusions and the dents in the wall near my PC bear witness to the problems I think you will have.--Tom 14:21, 1 December 2007 (UTC)

The definition is fairly sound, though some amount of confusion arises from the fact that real systems vary continuously on a spectrum of possible implementations. You never get a real system that is completely socialized, completely national health insurance, etc. While it may be frustrating that some people would call the Canadian system "single payer" and some would call it "socialized", we do not really have a problem say what socialized medicine is.

Most of the content should stay, the support and criticisms section could use a good deal distillation. Kborer 20:55, 1 December 2007 (UTC)

To be frank, the Stedman's definition is terrible and hideously vague. By that definition, it would apply to every system in the Western world (and much of the rest). Although if I understand correctly, that is Freedomwarrior's point? But that just calls for the need for a better definition. --Gregalton 21:45, 1 December 2007 (UTC)

Yes, it is. While the health care systems of most countries are currently the object of government regulation and control, such interventionism did not become the norm until the turn of the last century. The prevalence of such regulations is a reflection of how widespread socialism in the provision of health care has become, nothing else. It does not call for a new definition.Freedomwarrior 22:04, 1 December 2007 (UTC)

Well, I'll stick to my point that a better definition could be found, but the onus is on me to find it. And if that's what you consider socialism, then that's your definition of socialism. Sure has resulted in longer lifespans, though.--Gregalton 22:22, 1 December 2007 (UTC)

archive

I would like to archive the talk page in the next day or two, unless I hear otherwise. Kborer (talk) 18:00, 5 December 2007 (UTC)

Please do, good suggestion.--Gregalton (talk) 13:18, 6 December 2007 (UTC)

Opening definitions do not correspond to references

Taking a look at the current version: the first sentence says that socialized medicine is partly financed by the state, whereas the definition linked to says "government takes responsibility for entire population", "at no direct cost or a nominal fee." The entire population point is key, as is the point that substantially all financing is provided by the state.

The second sentence goes on to say "Socialized medicine can refer to any system of medical care that is largely both publicly subsidized and subject to public policy", which does not correspond at all to the reference provided: "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."

In this case the paraphrasing has ended up misleading as to the key points of the actual references provided. Under one definition, the government provides health care for the entire population (essentially at no or cost to them, i.e. close to 100% financing), and in the other, the government controls (directly, not through regulation) all supply. Paraphrasing as currently done considerably broadens the scope of the term, well beyond what these references justify.--Gregalton (talk) 13:27, 6 December 2007 (UTC)

I checked over the references and added some new ones. They are fine now. Kborer (talk) 14:52, 6 December 2007 (UTC)

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