Socialized Medicine vs Single Payer vs What We Have Now

Domestic policy blogger Ezra Klein over at the Washington Post is kind of the blissfully nerdy girl's dream wonk. I've never met the lad, but he seems to adore policy and writes about it in clear, sharp and occasionally self effacing ways. Today, he wrote yet another post I wish I'd written first, where he clarifies the difference between various healthcare terms that get bandied around DC. You can read the full post complete with fun graphs here, but here's the bit that clears up a lot of nonsense about healthcare models:

I've been meaning to write this post for some time. The words "socialized medicine" and "single-payer health care" get thrown around with such gleeful abandon that they've both become a bit unmoored from their actual meanings. In the American health-care debate, they tend to refer to "whatever the Democrats are proposing." But that's not what they mean.

Socialized medicine is a system in which the government owns the means of providing medicine. Britain is an example of socialized system, as, in America, is the Veterans Health Administration. In a socialized system, the government employs the doctors and nurses, builds and owns the hospitals, and bargains for and purchases the technology. I have literally never heard a proposal for converting America to a socialized system of medicine. And I know a lot of liberals.

Single-payer health care is not socialized medicine. It's a system in which one institution purchases all, or in reality, most, of the care. But the payer does not own the doctors or the hospitals or the nurses or the MRI scanners. Medicare is an example of a mostly single-payer system, as is France. Both of these systems have private insurers to choose from, but the government is the dominant purchaser. (As an aside here, unlike in socialized medicine, "single-payer health care" has nothing in particular to do with the government. The state might be the single payer. But if Aetna managed to wrest 100 percent of the health insurance market, then it would be the single payer. The term refers to market share, not federal control.)

Socialized medicine is far outside any discussion we're having. Single-payer medicine has a genuine constituency but is also a vanishingly unlikely outcome. But the promiscuous use of the terms has created a rather confused population. "Socialized medicine" is the thing we don't have. In some cases, it's the thing we don't like.