Ask Rockridge: The Meaning of Socialized Medicine

The Urban Institute, a liberal-leaning think tank in DC, is holding a debate titled "Is SCHIP (State Children's Health Insurance Program) Expansion a Step Toward Socialized Medicine?" If one wants to counter the conservative strategy of portraying SCHIP expansion as moving us closer to "socialized medicine" and successfully obtain more funding for children's health insurance, is framing the question in this way (ie, let's debate whether it is or isn't a move toward socialized medicine) a good idea?

Rockridge Nation member inclusionist

America has been running an alternative to corporate/insurance health care for as long as I've been alive--at least. Every member of the military and their dependents receive government health care at military hospitals and clinics. I grew up using the system for medical, dental, and vision. I'm sure millions use it right now. Couldn't we tap into an enormous community with a lifetime of experience with this alternative?

Rockridge Nation member DA12

We have grouped these two closely linked questions together for a joint response. The first about the framing of the SCHIP debate raises a generalized framing question that we will answer first. But both questions raise the deeper question of how to overcome resistance to an expanded government role in funding healthcare.

inclusionist is right about the poor framing of the debate at the Urban Institute. It falls right into the "reactive trap" that we discussed in Thinking Points (Chapter 1: Winning and Losing):

9. The Reactive Trap. For the most part, we have been letting conservatives frame the debate. Conservatives are taking the initiative on policy making and getting their ideas out to the public. When progressives react, we echo the conservative frames and values, so our message is not heard or, even worse, reinforces their ideas….

By invoking the conservative epithet of "socialized medicine" the title invokes a powerful conservative frame, which in a single phrase activates conservative attitudes about the respective roles of government and private insurers in connection with healthcare. A more benign title might have been, "Is SCHIP expansion the best way to protect poor children?"

The more fundamental question pertains to the impact of the slogan, "socialized medicine." This is a surface frame that activates deep frames relating to the supposed superiority of the "free market" over government programs. (See Thinking Points, Chapter 3, pp 28-33 for a discussion of the relationship between surface and deep frames.) These deep frames trace back to the 1920's when conservatives began to use "socialized medicine" as a pejorative reference to similar programs in Communist and Socialist systems. When government healthcare programs were first proposed, the AMA proclaimed that socialized medicine would undermine our democratic form of government. These appeals successfully shaped public attitudes, which only deepened during the long Cold War. They still persist and candidates regularly appeal to them.

"Socialized medicine" suggests the false dichotomy that the only two possibilities are a private health insurance system or a system like those in Canada or the UK. In fact, opponents of SCHIP expansion speak explicitly of the slippery slope toward socialized medicine.

Those who decry government health programs refuse to acknowledge that providing adequate healthcare to all is foundational to a vibrant and well-functioning society. If they acknowledged this fact, then "socialized medicine" would make as much sense as "socialized police," "socialized drinking water," or "socialized library." We don't refer to any popular government service or program as "socialized." It is only trotted out to stir up negative and reflexive emotional reactions to government programs. See this article from today's Washington Post.

And yes, DA12, VA hospitals are great examples of successful government-run healthcare. Notwithstanding the lingering public perception (see "Born on the Fourth of July" and the recent Walter Reed fiasco) that VA's deliver poor care, the opposite is true. This article in the Washington Monthly suggested that VA hospitals are an example of what a quality government healthcare system looks like. If progressives talked about the excellent care now being provided in VA hospitals or about the popularity of Medicare (which differs from the VA because Medicare pays for, but does not provide healthcare), we would start to erode the deep frames that "socialized medicine" activates.

Rockridge is working on a major healthcare project, which will explore these and related issues in greater depth. Look for this in the next few weeks.