Why Americans like 'socialized medicine' ... really

Americans really do like socialized medicine. They just don't know it.

The evidence?

I occasionally speak to senior citizens on health matters and usually begin by asking how many are satisfied with Medicare. Almost all hands go up. I then ask how many would favor "socialized medicine" (defined as a tax-supported health plan administered by the government, but with free choice of physician and hospital). No hands are raised.

When I tell them that the "socialized medicine" plan I described was Medicare, there is surprise -- and a few embarrassed chuckles. They might be more embarrassed to learn that the federal government, with its Department of Veterans Affairs, Medicaid, Medicare, public health, military and other programs, already covers almost half of national medical expenses.

All this would be of academic interest were it not for the emergence of health care as a major issue in the coming presidential election. No candidate is without a plan for "universal care" -- usually a patch-and-mend plan to apply vouchers, tax credits, a little more money and then things will be just fine.

Not so.

The underlying flaws of the status quo remain: employment-related coverage and commercial insurers who seek out the healthy and avoid the sick. Behind the reluctance to confront these failings is a history lesson learned years ago by a now-chastened Hillary Clinton: Any hint of the boogie man -- "socialized medicine" -- is certain political death.

Can we reform the system and overcome this albatross at the same time?

Perhaps the answer lies before us: Extend Medicare to all Americans. A trusted program for more than 40 years, Medicare should be the template for reshaping America's health care system.

"Big Government?" Why shouldn't something that is good for those older than 65 be good also for those younger than 65?

Some advantages: Medicare's organizational structure, policies and personnel could be transferred directly from Medicare to a Medicare II over time. Employee-employer taxes gradually would replace private premiums. Physician and hospital choice remain undisturbed. Administrative costs would be reduced.

But a Medicare II needs some tinkering. Separate the plan from direct governmental control. The program should be governed by a quasigovernmental board of health care professionals, medical economists, public and government representatives -- as with the Federal Reserve and other governmental bodies.

Fund the plan adequately. Today's Medicare does not cover actual medical costs. The government's reputation as a financial deadbeat fully justifies the mistrust of physicians and hospitals. Employer-employee taxes would replace private premiums and be required to meet actual costs -- pay as you go. Co-pays and deductibles could be waived for low-income members.

Establish regional quality and use councils staffed by medical professionals to assure reasonable standards and utilization. A single basic benefit package would apply to all, but commercial supplemental plans would be available.

Encourage managed care, but change it. Managed care should be an option provided by physicians groups dealing directly with quality-utilization councils, not commercial insurers. Coverage issues would be determined by physicians. "Skimming" -- selecting healthy, low-cost members -- would be prevented by adjusting capitation payment based on risk factors that accurately predict medical costs.

Above all, avoid the single-payer extremists who seek complete federal takeover of the health care system by pre-empting all hospital budgets, capital expenses and other functions under local control. Such bills, mislabeled as "Medicare for All," are now before California and federal legislatures.

Meaningful change will not come easily or painlessly. Physicians, hospitals, insurance companies and many happily insured Americans have much to lose and will resist. Extending Medicare provides the best, most politically acceptable road to true and effective reformation of America's deteriorating health care system.

Allen, a semiretired Modesto physician, has served as a visiting editor on The Bee's

editorial board. E-mail him at columns@modbee.com.