Socialized Medicine: What’s in a Name?

A sign shows the times of temporary emergency department closures at Eastern Shore Memorial Hospital in Sheet Harbour, N.S., on Aug. 6, 2018. (THE CANADIAN PRESS/Andrew Vaughan)

Last fall, Jim Carrey, the well-known comedian, talked on “Real Time with Bill Maher” about Canadian single-payer medical care.

“I grew up in Canada, OK? We have socialized medicine,” he said.

“I’m here to tell you this bulls**t line you get on all the political shows from people is that it’s a failure, the system is a failure in Canada. It is not a failure in Canada.”

Carrey used an old term for the mascot of Canadian exceptionalism. Twenty years ago, socialism was dead. People avoided calling anything socialized, especially Canada’s crown jewel of post-war welfarism. Even today, people still prefer to talk about single-payer health care. It has ranked between 5 and 25 times more common than socialized medicine on Google Trends since 2004.

Celebrities love to defend socialized medicine. That should not surprise us. But their comfort with the term “socialized” is worth noting. As the New Yorker noted this spring, socialism is back.

A Glorious Beginning

Socialized medicine started in the late 1960s with a promise: care regardless of ability to pay. Doctors and nurses could keep doing what they had always done. And government would pay. Who could argue with that?

The glory days of socialized medicine soon ended.

By 1977, the federal government stopped giving the provinces blank cheques for 50 percent of whatever the provinces chose to spend on medical care. That led to cuts and rationing, which led to hallway medicine and patients being admitted to closets and bathrooms.

Socialized medicine started as a wonderful dream. It has ended up as a harsh reality for many.

Why Call It ‘Socialized’?

The “socialized” component of socialized medicine goes back to Karl Marx. He and other socialists wanted to emphasize the role of society and downplay the role of the state. Marx preferred “socialization” to describe state control of an industry. He avoided using the term “nationalization”—it sounded too much like state control.

The state, according to famous sociologist and political economist Max Weber, is a polity, or group, that possesses a monopoly on violence. If you break the law, the state can send people with guns to put you in jail. The state is a complex apparatus that includes government, regulators, the legal system, and more.

Marx did not like the state but he needed it for his revolution. He and the early socialists believed that workers, who represented the bulk of society, would be free if they could escape the tyranny of business owners. The socialists believed that the only way to free the working class was to use the state to “take ownership of the means of production.”

In other words, Marx wanted to take businesses away from business owners. But Marx also knew that the state could be just as tyrannical and oppressive toward workers. He needed the state to help free the working class in his revolutionary march toward freedom and equality, but he believed in a future where the state no longer needed to exist. True freedom lay in the future with no private ownership of businesses—no private property at all, for that matter—and no state: a collectivized utopia where everyone shared everything and we all helped each other.

Modern socialists realize that they do not need to actually own a business. They just need to control it. So, modern socialist governments take control of an industry, avoid the term “nationalization,” and use “socialization” instead. Thus, we end up with socialized industries, and in Canada’s case, socialized medicine.

So What Is Socialized Medicine?

Today, socialized medicine means state-run medicine. It means centralized control and government rationing of care. It means that patients do not decide when their pain needs treatment—bureaucrats decide whether your symptoms merit treatment or not.

Socialized medicine has become a political football used to win votes and stay in power. In political hands, socialized medicine has little to do with patient care. Patient care, if it eventually comes up after budgets and benchmarks, falls to a footnote.

For policy makers, modern socialized medicine is about wealth redistribution. We take money from the wealthy and healthy and give it to the poor and sick. It is part of an overall plan to level economic inequality in a nation: one plank among many others that form the overall welfare state. Socialized medicine lines up alongside equalization payments, the pension plan, unemployment insurance, and all the other handouts controlled by the state.

Medical Insurance

Most Canadians still support a provincial insurance plan for medically necessary care. Canadians love insurance and medical insurance seems reasonable—except that Canadians do not have medical insurance in the same way that they have any other kind of insurance. Waiting months or years to see a medical specialist does not seem like insurance. Even if we insist on using the language of insurance, Canadians are woefully underinsured.

Canadians support medical insurance, but they have been given managed care. Socialized medicine is not a single-payer, state funded insurance plan. It looked like that at the start. But the true nature of socialized medicine and the original intent of its champions became evident over time.

We should celebrate people using the term socialized medicine again. It lays bare the real nature of our approach to medically necessary care in Canada. An accurate diagnosis is the first step toward treatment.

Shawn Whatley is a physician, past president of the Ontario Medical Association, a blogger at ShawnWhatley.com, and a Munk Senior Fellow with the Macdonald-Laurier Institute. He is the author of “No More Lethal Waits,” a guide to reducing wait times and increasing efficiency in hospital emergency departments.