Health care got some attention in Saturday night’s GOP presidential debate. And when it was Texas Sen. Ted Cruz’s turn to speak, he started by cataloging the alleged evils of “socialized medicine.” Here’s the full quote:
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. ... 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.
Every single sentence in that quote is misleading or flat-out false:
1. "Socialized medicine is a disaster."
Presumably Cruz is using “socialized medicine” as a euphemism for any kind of universal health insurance -- in other words, any system in which the government guarantees health insurance to all people, either by providing that coverage directly or through some kind of private intermediaries.
The Affordable Care Act, which Republicans have pledged to repeal, is an attempt to build the foundation of such a program here in the U.S. But every other developed country already has such a system in place. And it’s hardly been a disaster.
In those countries, people are far less likely to struggle with medical bills. And contrary to conservatives' claims that the quality of medical care suffers in those countries, the U.S. consistently lags behind other developed countries in “mortality amenable to health care,” which is one way researchers measure the quality of health care systems.
It’s not a perfect statistic and there are some things the U.S. health care system happens to do really well. But overall the countries with “socialized medicine” seem to be getting results that are as good if not better than what the U.S. gets from its health care system -- and they do so while spending far less money.
2. "It does not work."
See above.
3. "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."
This is opponents' favorite scare tactic: Establishing universal health care will lead to rationing. But of course rationing takes place in every country, and that includes the U.S. The difference is that, in the U.S., rationing tends to be a function of income and insurance status. People who can’t pay for their medical bills have limited access to physicians and to services.
4. "You have a scarcity of doctors."
Physician supply isn’t such a great way to measure a nation’s health care system. But, for the record, in a 2014 comparison of physician supply in 34 developed countries, the U.S. ranked 28th. (It had 2.5 physicians per 1,000 people; the average was 3.5.)
5. "And that means the elderly are told: We're going to ration a hip replacement; we're going to ration a knee replacement."
Hip replacements are more common in Germany, Switzerland, Sweden and eight other countries, according to the Organisation for Economic Cooperation and Development. The rate of knee replacement really is highest in the U.S., as Cruz’s answer suggested, but other countries, including Austria and Finland, have rates that are nearly as high.
Cruz’s broader point here is that, in countries with universal coverage, government agencies or some other kind of democratically accountable organizations make decisions about what treatments to cover, and under what circumstances. He’s right about that.
But all insurance systems, public and private, make such decisions. It is true abroad and it is true in the U.S., and always has been. If you’re on Medicare, then the federal government is making that decision; if you have private insurance, then a private insurer is making that decision, subject to whatever regulations are in place.
6. "We're going to ration end-of-life care."
This should sound familiar, because it was conservatives' big lie in 2009 and 2010, while President Barack Obama and the Democrats were trying to get health care reform through Congress. But Obamacare never had any "death panels." And while some other countries make tough rationing decisions based on a variety of criteria, largely because they've decided to keep spending at very low levels, in other countries -- like France, for example -- insurance systems cover the elderly in pretty much the same way Medicare does in the U.S. If there are differences in treatment patterns, they have more to do with cultural differences -- the attitudes of doctors and patients -- than insurance coverage per se.
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