As Congress and the president prepare to discuss universal health care again, it is interesting how opponents still commonly resort to using the term "socialized medicine" in voicing their disapproval. Socialized medicine as a political brickbat has a long history that originates in the early 20th century, when opponents of what then was known as "compulsory health insurance" likened such a program to those of socialized systems in some European countries.1 As various administrations proposed universal health coverage, opposition groups-including major physician organizations-have used the term in attempts to defeat such proposals by conjuring notions of Soviet-style communist central control of the health system.

Socialized medicine is a vague term that generally refers to any medical care system that is publicly financed, government administered or both. To most health policy experts, it is a fairly meaningless term because of its imprecision. Most frequently, conservatives and objectors to universal health care coverage use it pejoratively in political discourse to discredit supporters.

Anachronistic Term, Modern Concern
I find the use of this term in today's debate on health care reform both curious and quaint. Curious, because its use implies a certain degree of ignorance about the U.S. health system. When one understands its structure and major components, one realizes that we already have a system that is more than a little socialized. Medicare and Medicaid, the State Children's Health Insurance Program and other federally administered health subsystems stand as evidence of a well-developed-dare I say socialized-form of health care delivery. Quaint, because socialized medicine as a political provocation hardly applies in a world with few communist societies, reflecting its failure as a social and economic system.2

The world was quite a different place when the American Medical Association invoked the term to oppose the passage of health care insurance legislation during the FDR administration in the 1930s, and periodically through the 1960s to oppose the passage of the Medicare Act of 1965. Throughout this time, organized medicine strongly opposed any form of universal health coverage. Ironically, Medicare's establishment turned out to be a major income booster for physicians. To resurrect this antiquated slogan suggests that opponents of universal health coverage are bereft of better ideas.

The AAPA's position paper on health care reform states that the academy "recognizes that the inequitable distribution of care and the rapid acceleration of health care costs demand a thoughtful, coordinated re-evaluation of the entire system of health care. . The AAPA believes the primary goal of comprehensive health care system reform is to ensure access to quality, affordable, and cost efficient health care for all residents of the United States."3

This is a broad and general statement, and the devil always is in the details, but it is important for PAs to know the AAPA's position on this vital topic. It also is good to know that PAs are in favor of insuring that basic health services are available to all citizens, not just those with the financial means to buy insurance.

Primary Care PAs Could Fill the Gap
One possible outcome of universal health care coverage would be increased demand for PA services. In this scenario, universal coverage would include a guarantee that a basic package of primary care services would be provided, thus creating an even higher demand for primary care providers, which PAs could help fill. One issue, however, is PAs' trend to specialties. Only 37% of PAs now work in primary care. Were PAs to meet the anticipated demand, new incentives for PAs to enter and remain in primary care practice would need to be created.

Enactment of universal health care coverage will be a monumental political fight, with the outcome still very much uncertain. Hostility to ostensible socialism remains a common basis of objection to universal health care by opponents of government expansion and monetary redistribution policies.1 The debate should be based on the relative merits of the proposals, without name-calling.

Let us hope that the socialized medicine scare tactic, thankfully, has run its course.

James F. Cawley is professor and director of the PA/MPH program at the School of Medicine and Health Sciences at The George Washington University in Washington.

References
1. Greenberg D. Who's afraid of socialized medicine? Two dangerous words that kill health-care reform. Slate. http://www.slate.com/id/2175477. Published October 8, 2007. Accessed March 9, 2009.
2. Leibovich M. 'Socialism!' Boo, hiss, repeat. New York Times. March 1, 2009: WK1. http://www.nytimes.com/2009/03/01/weekinreview/01leibovich.html. Accessed March 9, 2009.
3. American Academy of Physician Assistants. Comprehensive health care reform [position paper]. Adopted 2005. http://www.aapa.org/manual/02-CompHealthCareRef.pdf. Accessed March 9, 2009.