In Saturday's Republican presidential debate, Ted Cruz warned of the dangers of a government-led healthcare financing system.
“Socialized medicine is a disaster. It does not work. If you look at the countries that have imposed socialized medicine, that have put the government in charge of providing medicine, what inevitably happens is rationing. You have a scarcity of doctors. You have rationing. And that means the elderly are told, we're going to ration a hip replacement, we're going to ration a knee replacement. We're going to ration end-of-life care," he said.
"We're right now heading into a medical system with about a 90,000-doctor shortage in America, and socialized medicine, whether proposed by the Democrats or proposed by a Republican, would hurt the people of this country.”
This is just the start if Vermont Sen. Bernie Sanders beats Hillary Clinton for the Democratic nomination. Such speculation will inevitably grow following his expected victory in New Hampshire.
“If Sanders was the Democratic candidate, the word 'socialized' would appear everywhere,” said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. “The (Republican) response would be very similar to when Walter Mondale ran (as the Democratic nominee) in 1984 and they attacked him over and over for extreme liberalism. They will say the plan is too expensive and will involve rationing.”
As we know from the “death panel” controversy fueled by Sarah Palin in 2009, sounding the alarm on rationing medical care is extremely explosive in American politics and such criticism spreads quickly. While that charge was completely bogus, the problem for Sanders and other proponents of single-payer health insurance is that countries with government-run or -organized healthcare financing systems, such as Great Britain and Canada, do limit some services that are deemed too expensive, not medically necessary or lacking sufficient clinical evidence. Canada, for instance, has struggled with reducing patient waits for elective procedures such as joint replacements.
Of course it's also true that there are plenty of nongovernmental forms of healthcare rationing in the U.S., based largely on patients' ability to pay. In addition, it's worth remembering that surveys have consistently shown that people in advanced countries with national health insurance systems, including Canada and Great Britain, generally express greater satisfaction with their systems than Americans do.
In the Democratic presidential debate last week, Sanders promised to push for a single-payer system without “dismantling” the Affordable Care Act. He reminded viewers that he helped write the ACA as a member of the Senate Health, Education, Labor and Pensions Committee.
“The idea that I would dismantle healthcare in America while we're waiting to pass a Medicare for all is just not accurate,” he said. “The Affordable Care Act has clearly … done a lot of good things. But what it has not done is dealt with the fact that we have 29 million people today who have zero health insurance. We have even more who are underinsured with large deductibles and copayments, and prescription drug prices are off the wall.”
Blendon said there are few if any political scientists who believe that a President Sanders would come into office with a solid Democratic majority in both houses of Congress enabling him to pass a single-payer plan in 2017. “It would take a different Congress, maybe in 2018 or 2020.”
Princeton University health economist Uwe Reinhardt said Sanders' plan would be “dead on arrival” in Congress. “Politically, you cannot legislate what rationally makes perfect sense.”
Meanwhile, Republicans continue to vow, in Cruz's words, to “repeal every word of Obamacare.” Given that political reality, someone needs to ask the Vermont senator how as president he would defend the Affordable Care Act against those relentless attacks while fighting an uphill battle for his even more ambitious healthcare plan.