Blog | Friday, October 31, 2014

What would a straightforward referendum on nationalized health care look like in America?


The independence referendum in Scotland got me thinking. I must admit I was glued to the news over the last few days of campaigning. For those of you not following closely, it seemed as if the No camp had a comfortable lead right up until the last week, when the opinion polls suddenly showed the Yes camp pulling ahead. This rattled the establishment. The prospect of my country of birth splitting up rather saddened me as well, and I was fixated on the TV watching BBC world news late into the night as the constituency vote counts came in.

The result in the end was a fairly comfortable No vote. The Union remains intact. In the preceding week, a lot of people in my hospital asked me what I thought of the vote. I had a feeling that the No vote would prevail, if anything because when it comes to a big change, absent an economic catastrophe, people are usually quite conservatively inclined when they reach the ballot box (conservative as in keeping the status quo).

As someone who works in health care, a field where there is a lot of contentious debate at the moment, the Scottish vote also got me wondering what would happen if there was a straight referendum put to the American people about adopting socialized medicine? I found the thought intriguing. I can see both sides of a potential debate having very passionate opinions, as is the case with right versus left politics in general. Leaving aside any discussion on how it uniquely affects doctors and hospitals, I envision the two sides hinging their broad philosophical arguments on the following:

Vote: “Should the United States have a fully socialized, universal single-payer health care system?”

The Yes camp (probably coinciding with left wing politics):
• Every other Western industrialized nation has some form of socialized medicine;
• Older people generally like Medicare, so why not extend it to everyone?
• Health care should be a right and not a privilege;
• The free market does not work for health care; and
• It is the best way to control costs.

The No camp (coinciding with the right):
• Socialized medicine will restrict choice and personal freedom (it is a form of government control over a vital part of our lives);
• Socialized medicine takes away peoples’ own responsibility for their health;
• Socialized anything is very un-American;
• The free market always delivers the highest standards and best customer service; and
• The government does the worst job at controlling costs.

For the Yes camp, the assumption that Americans would want a European-style socialized health care system neglects the realization that the collective American culture and psyche is inherently very different from those countries. For the No camp, the assumption that the government cannot be trusted to deliver health care may not resonate with everyone. In a federal country as heterogeneous as the United States, the debate would be highly variable by region. I’m not even sure the federal government would have the legal authority to poll the American people in this way. Whatever the truth of the matter, it’d be a fascinating referendum. And I don’t think either side could take the result for granted.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.