Listening to the Republican candidates for president warn against "socialized medicine," you might believe that national health insurance is really a plot to institute Soviet rule in the United States. The most feverish rhetoric comes from Mitt Romney and Rudolph Giuliani, both hoping that their shrillness will prove that they are truly and deeply right wing -- all while trying to avoid honest debate about the future of American health care.

            For Romney, health reform is double-edged: As the former governor of Massachusetts, he claims credit for that state's new universal care program -- which he calls "fabulous" -- but he fears being labeled liberal. His solution is simply to ignore the basic provisions of the legislation that he signed. "This is a country that can get all of our people insured with not a government takeover, without HillaryCare, without socialized medicine," he proclaimed during a Republican debate this past spring. "We didn't expand government programs."

            Actually, his fabulous Bay State plan is based entirely on governmental action, from mandating insurance coverage and minimum coverage requirements to subsidizing insurance and imposing fines on those who fail to comply.

            Perhaps Romney needs medical attention himself, since he already seems to be suffering from Alzheimer's disease. This isn't the first time his capacity to recall facts about his own career has dimmed out.

            As for Giuliani, he, too, sees the frightening specter of foreign ideology in proposals for universal health care, which he denounced the other day as "socialist" schemes that "would bankrupt the government." According to him, Democrats are conspiring to impose the kind of care preferred by citizens across the industrialized world. "That is where Hillary Clinton, Barack Obama and John Edwards are taking you," he thundered. "You have got to see the trap. Otherwise we are in for a disaster. We are in for Canadian health care, French health care, British health care."

            Giuliani's alternative is a retread of rejected Bush administration proposals, dressing up more tax cuts for the affluent as "health savings accounts." Knowing that this would do little to cover more than 45 million uninsured Americans, he also suggests a federal subsidy to help people buy insurance. But he won't say how he would pay for that plan.

            Neither the Romney nor the Giuliani proposal would accomplish the modernization and reform that the nation needs, and neither would ever reach universal coverage. What they might achieve, however, is a multibillion-dollar giveaway of taxpayer funds to the insurance industry. In Massachusetts, the bids for subsidized coverage from major insurance companies are already much higher than Romney predicted, and many fewer uninsured have enrolled than he once expected.

            An honest discussion of the American health care system would begin by recognizing that government plays an important role and will continue to do so. No candidate is proposing to do away with Medicare, Medicaid and the Veterans Administration. Despite their consistent underfunding, those systems achieve efficiencies that the private sector cannot match.

            So when politicians decry health care in France, Britain, Canada and other industrialized countries as "socialist," they're insulting the intelligence of voters. They assume nobody here knows that voters in those capitalist nations overwhelmingly support the national health systems -- which happen to spend far less money per capita than ours while providing more care. Even the most conservative politicians in Europe don't dare to suggest replacing those universal public systems with a system of expensive, privatized chaos such as ours.

            While health care is a highly complex matter, the reason that other countries can afford to cover all of their citizens -- while spending a smaller portion of their national income than we do -- is fairly simple. As a study by Physicians for A National Health Program revealed, more than 30 percent of health care costs in the United States represent profits and paperwork. Roughly 20 percent goes to insurance companies alone, which burn enormous amounts of money finding ways to deny care to their policyholders. Remember that every hospital and doctor must cope simultaneously with the demands of numerous insurance companies. The result is an ongoing nightmare of corporate bureaucracy and paper-shuffling waste.

            Americans have endured the excessive costs, skewed priorities and terrible inefficiencies of our outmoded health care system for decades while other advanced nations surpassed us. Now our basic industries and our future solvency are threatened by our failure to address this problem realistically and fairly. We need reforms that encourage preventive care, wring out bureaucratic waste, utilize information technology and guarantee the security of every citizen. Scary talk about socialism won't get us there.

            Joe Conason writes for the New York Observer ( To find out more about Joe Conason, visit the Creators Syndicate website at COPYRIGHT 2007 CREATORS SYNDICATE, INC.