Universal Health Care and Socialized Medicine

Politicians and pundits may toss out terms like universal health care and socialized medicine as if they were synonyms, but the terms represent fundamentally different political and economic approaches to providing for health services.

Universal Health Care

Universal health care simply means that every citizen has a realistic ability to access basic health care services.

It does not mean that only the government pays for that access. In fact, most of the countries around the world that guarantee universal health care use a combination of public and private coverage. Furthermore, in most cases, the providers and facilities are privately owned services.

Although doctors in the United States may refuse to treat people who can't pay for their services, under the Emergency Medical Treatment and Labor Act (EMTALA), hospital emergency rooms cannot even ask about a person's ability to pay until after the person has been medically stabilized by a physician. However, most experts do not believe that EMTALA in itself signifies "universal health care."

In a strict sense, universal health care is all about access to emergency and preventive health services. Under this definition, the United States enjoys universal health care. However, the term is often constrained to reference access to health insurance—in which case, the United States does not enjoy universal health care.

Single-Payer Health Care

Contrast universal care with a single-payer system. In a single-payer system, everyone gets coverage that fully pays for all services and the government provides for this access. As with universal health care, even though the government pays for coverage, providers and facilities are mostly private services, not owned by the government—although some health care services are government run, like the military's Tricare system or the Veterans Administration medical system.

In many single-payer systems, individual citizens cannot pay out-of-pocket for extra services not otherwise guaranteed by law.

Socialized Medicine

Socialized medicine in its strictest sense, is a single-payer government-run and -delivered system. In a socialized medicine model, the government provides all services from your doctors and providers, to the hospitals and other facilities, and all payment for those services. Some looser translations of socialized medicine allow for private providers and facilities, but that practice is not the usual; typically, private payment and independent for-profit providers are either discouraged or forbidden.

Language Games

The difference in meaning among the terms universal health care, single-payer health care and socialized medicine are clear. However, in the ongoing debate over health care reform, initiated by the passage of the Patient Protection and Affordable Care Act and persisting through the "repeal and replace" attempts of the early Trump administration, pundits have played on people's hopes and fears by carefully misusing the language.

Commentators on the right conflate single-payer with "socialized medicine," a concept ill-defined in the popular imagination but linked to countries like Cuba—a socialist dictatorship—and Canada, which has notoriously long lines and relatively less patient autonomy.

Commentators on the left conflate single-payer with "universal health care," suggesting that only a single-payer system can justify the much-desired "universal" label.