Sometime ago, Rudy Giuliani was campaigning in New Hampshire in order to convince the common folk that he is a Republican. He had a bare acquaintance with the GOP while in New York City, and at one time he even supported liberal Democrat, Mario Cuomo for governor. He also supported strong gun control, abortion, and gay marriages or unions. Those themes played well in Manhattan, but not too well in the other boroughs of the city and the nation. Now he has picked two themes: his Churchillian leadership after 9-11 and his disdain for Hillary Clinton, especially Hillary-Care. Hillary-Care is defined as government sponsored health care which other people (not me or Rudy) may have.
The big difference between both parties is universal medical coverage; the Democrats favor it while nearly all the Republicans do not. Likely GOP nominee, Rudy Giuliani has attacked what he called Hillary’s “socialized medicine.”
What exactly is “socialized medicine?” It means a system where the government totally controls medical care, such as in Great Britain, Canada, and most of the civilized Western world. Hillary and John Edwards do not propose such a centralization of care, although she did—back in the early 1990s. A pertinent question is this: do we in America already have “socialized medicine?” First, nearly everyone over 65 has Medicare—an entitlement program. The very poor have Medicaid, and many who have coverage somewhere in between use emergency rooms as primary care—a necessary expedient but a terrible waste of national resources. Also, a good portion of lower income families’ children are covered by a special program for children such as the State Children’s Health Insurance Program (S-CHIP) or Medicaid. The battle now in Congress is waged not over how to disband it, but rather, what level of income should mark the cut off point for benefits?
Several years ago, the President and a Republican Congress extended pharmaceutical coverage to seniors with an enormous profit advantage to the pharmaceutical companies. In addition, we have in place separate programs for veterans and a hospital system that often duplicates civilian health institutions. Not a single candidate for president, except probably for Ron Paul, would dare propose ending those government programs. Does that mean we have socialized medicine already?
Recently, I learned that the Summit Medical Group in New Jersey has indicated that it will not accept Horizon Blue Cross/Blue Shield from its patients (customers); yet, nearly all those doctors practice in hospitals built with Hill-Burton federal money or other U.S. government programs. Private hospitals are the beneficiaries of money from the very wealthy whose tax rates are adjusted in order to give them an incentive to donate. That is, in effect, a government subsidy that benefits all of us—including doctors.
It is easy to gain comfort in calls for rugged individualism and small governemnt. Giuliani recently said to that same audience that he would cut down the federal bureaucracy by freezing nearly one half of all openings coming due to retirement (about 40 percent of the staff total). That figure includes researchers and staff at the National Institutes of Health, Food and Drug Administration, the Center for Disease Control, as well as other agencies that all of us, including the medical profession, benefit from. If we have learned anything in the last year, it is that e-coli in our meat, chemicals in our milk, paints on our children’s imported toys are all increasingly important problems which we must address; therefore, the latter mentioned federal agencies and institutions are vital to keeping us safe and healthy. What is good for isolated voters living in the New Hampshire hills or the Iowa plains is not necessarily good for those of us in metropolitan or urban areas.
When he was asked once why he was running for President of the Untied States, John F Kennedy said he wished to lay before the American people, the great unfinished business of his generation. That call to common sense, to civic virtue, to serious dialogue is something both parties need to concentrate on. Come on, candidates; treat us as adults, starting with medical care.
Michael P. Riccards is Executive Director of the Hall Institute of Public Policy – New Jersey.