When physicians and nurses are public employees, hospitals and community health centers are publicly-owned and pharmaceutical drugs, medical equipment and medical supplies are produced by government-owned enterprises and/or purchased at controlled prices – all within a capitalist system – this system is called “socialized medicine.” Socialized medicine exists in the United Kingdom and to some extent in Italy. All other national health insurance systems in Europe and elsewhere are government run or strongly government influenced insurance payment and repayment systems.

There are no out-of-pocket payments at the time of service in any of these systems. The UK system is entirely budget driven, while other national health insurance systems are based on reimbursement through a government system. But in all of these countries there are no private, for-profit insurance carriers. There are no Aetnas or Cignas ripping people off.
In both of these situations, the health care system exists by itself as a socio-economic unit, i.e., housing, education, employment are still largely within the market system of profit. When a labor, socialist or social democratic or similar sympathetic government is in power, health systems are generally supported. For example, in the UK centrist Labor Prime Minister Tony Blair, after trying to privatize the National Health Service, finally relented to massive labor and public pressure and put significant amounts of money into the system.

When right-of-center governments are in power, such as in France and Italy (where national health services are in place, but unevenly financed), health systems face crisis. One example is that in August 2003, over 15,000 people died in France due to heat stress. The loss of life is a direct result of the Chirac policy of underfunding the health care system and limiting public health programs.

And, now with the economic power of the World Trade Organization, the International Monetary Fund and the right- wing drift of the European Union (EU), the attempt to privatize these systems and clear the way for profit is in an advanced state.

Prior to its collapse, the former Soviet Union and its allied countries had national health systems that were totally non-profit and provided health services to everyone. Hospitals were given budgets and physicians and all other health care workers were public employees. Everyone in those countries had the full opportunity to train to become health care professionals. In the Soviet Union, the national government made sure that health services were available in all of the republics regardless how economically backward that republic was. While having unevenness due to development problems, the Soviet health care system had the respect of honest international health experts. The other main difference when a “socialized medical system” operates within a socialist country is that it can operate in conjunction with full public housing, a free educational system, full employment and other social goods.

This system still fully exists in Cuba. And, when people from the former Soviet Union and its allied countries are asked if they would like their health system back, the overwhelming response is: YES!

In the United States, we face the worst of all possible health care worlds: our system is run by and for profit. It reminds one of the comment by Charles Wilson the former head of General Motors: “We are in the business to make profit, not cars.” That is the viewpoint of the health profiteers.

Under capitalism health services are only possible through a market system of profit. That means rationing is part and parcel of the system. There are over 45 million people without any means to pay for health insurance policies that would cover the costs, in part, of health care and another over 60 million with rapidly diminishing benefits. These figures do not count tens of thousands of immigrants. The crisis grows each day.

At the same time the profit, greed and power of drug, insurance and other corporations grows. The clash becomes sharper each day. The media’s dramatic personal accounts of individual and family crises aside, these corporate health leaders simply have no shame.

Because of this, everybody must be involved in every facet of health care struggles for the 2004 elections. All candidates for Congress and the White House, including Bush, must be pressured to give their prescription for solving the uninsured and costs-of-care crisis.

For the people’s health movements there are no blueprints. The massive number of forces at play can work together. The choices abound: “Socialized Medicine,” “National Health Insurance,” “More Incremental Changes,” “Labor Writing National Health Plan for Everyone.” These are all possible within a capitalist system, even ours. The important issue for activists is what motivates the broadest number of people, especially labor union members, to action.

Congressman John Conyers’ legislation H.R. 676 for National Health Insurance and Congresswoman Barbara Lee’s H.R. 3000 for a National Health Service are the touchstones for action. Tactics and strategies must be kept flexible in order to be able to respond to all circumstances. But the goal and vision must remain: “Health Care for the People, Not Profit.” There is no firewall or demarcation between the different levels of health policy struggles. They range from the smallest change to full health care delivery within a socialist system. When dealing with people’s individual and family health, workers are willing and eager to accept and fight for solutions well beyond their own level of political consciousness. Their rage has been shown to be very sharp.

--Phil E. Benjamin is health editor for Political Affairs.