Senator John McCain has been repeatedly suggesting that his Democratic rivals are proposing a single-payer, or even a nationalized health care system along the lines of those in countries like Canada and Britain.
The suggestion is incorrect. While both Senator Barack Obama of Illinois and Senator Hillary Rodham Clinton of New York are calling for universal health care and an expanded role for government, they stop well short of calling for a single-payer plan.
Mr. McCain has made the assertion several times in recent days, even as he and the Republicans have made repeated calls for accuracy on the campaign trail. They have been complaining indignantly that the Democrats were grossly distorting his position by suggesting that he favors a “100-year war” in Iraq, when he has simply said that he would be fine with stationing troops there for 100 years as long as there were no more American casualties.
Yet on repeated occasions, Mr. McCain, of Arizona, has inaccurately described the Democrats’ health care proposals, using language that evokes the specter of socialized medicine.
“There are those that want a massive government takeover of the health care system in America,” Mr. McCain warned Thursday in Des Moines, as he made the case for his more market-based approach. “Senator Clinton wants to make it mandatory, and, as I understand, they might even garnish somebody’s wages if they didn’t comply. I mean, a remarkable statement. And Senator Obama has basically the same kind of government massive intervention and takeover of health care in America.”
“But before you decide to sign on to that kind of a program, go to Canada, or go to European countries that have government-run health care systems,” he continued. “My friends, they don’t work, they’re inefficient, and they end up in a two-tiered system where the wealthiest can afford to pay for their own health care and those with low income sometimes wait six or eight months for a routine kind of treatment. And that’s what I’m not going to let happen to the United States of America.”
Earlier in the campaign Mr. McCain made the accusation more explicitly. “There will be efforts to have a single-payer big government solution by the Democrats,” he said at a debate in Orlando, Fla., in October. “They’ve already espoused those causes. If you believe them, please take a trip to Canada or England before you decide to support such a thing.”
And in August when he was interviewed by Charlie Rose on PBS, Mr. McCain said: “Look at what the Democrats’ proposal is. It’s a government-run, single-payer system like they have in Canada and like they have in England.”
Mr. Rose interrupted: “But I beg to differ. They will say that it is not that at all.”
Language, of course, is a potent weapon in the battle to shape policy. And Mr. McCain’s effort to cast the Democrats’ plans as a government takeover is just the latest example in a long tradition of using similar language to characterize proposals to change the health care system, said Robert J. Blendon, a professor of health policy and political analysis at Harvard.
“In the campaign, what Senator McCain tries to appeal to is a general antigovernment feeling, a sense that we shouldn’t be doing things too big,” Professor Blendon said. “In a sense he’s appealing to a value that may or may not relate to the policies being discussed by either of the candidates.”
The only Democratic presidential candidate to propose a true single-payer, Medicare-for-all type of health plan in this election cycle was Representative Dennis J. Kucinich of Ohio. Mr. Obama’s and Mrs. Clinton’s plans do not call for a single-payer system like Canadians have, or a government-run national health system like the British have.
Both candidates have called for universal health coverage, with Mrs. Clinton saying she would require everyone to have insurance and Mr. Obama saying he would mandate coverage for children. Both would maintain the existing private insurance system, providing government subsidies or tax credits to help the low-income uninsured afford premiums. And they would give consumers a new option to buy insurance from the federal government, with policies along the lines of Medicare.
Some opponents — and even some supporters — of such universal health care proposals believe that they could eventually lead to something like a single-payer system.
Tucker Bounds, a McCain campaign spokesman, noted that Mr. Obama had called himself “a proponent of a single-payer health care program” in 2003. And he noted that just this week, Mr. Obama had spoken favorably of systems in Canada and Europe and said, “If I were designing a system from scratch, if I were just starting from zero , I would probably set up a similar system, just a Medicare-for-all plan.”
But Mr. Obama has even stopped short of mandating health insurance for everyone.
Mr. Bounds said that Mr. McCain’s characterization of the Democrats’ plans was completely reasonable. “While their proposals may not outline one to the finite extent, they clearly suggest that the movement toward a single-payer system is in their overall interests,” he said.
Democrats and Republicans view health care differently, polls suggest. Surveys have found that the most significant health concern voiced by Democrats is expanding coverage for the uninsured, while Republicans and independents are more focused on bringing down health care’s cost.
Even the phrase “socialized medicine” means different things to members of each party. A telephone survey conducted earlier this year by the Harvard School of Public Health and Harris Interactive found that 70 percent of Republicans thought that “socialized medicine” would be worse than the current system, while 70 percent of Democrats thought that it would be better.
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