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One of the issues the presidential candidates like to debate is health care. And when they do, the term socialized medicine gets drawn around a lot. It's not exactly a compliment.

And as NPR's Julie Rovner reports, the politically loaded term means different things to different people.

JULIE ROVNER: When Democratic Senator Hillary Clinton unveiled her health plan in September it included a requirement that all individuals have health insurance. Her Republican rival Mitt Romney was quick to criticize it.

Mr. MITT ROMNEY (Former Republican Governor, Massachusetts): It's a European-style socialized medicine plan. That's where it leads, and that's the wrong direction for America.

ROVNER: Romney's fellow Republican Rudy Giuliani extends that label to all the Democratic frontrunners' plans, even though Senator Barack Obama's wouldn't require everyone to be insured.

Mr. RUDY GIULIANI (Former Republican Mayor, New York): Whether it's Hillary care or Obama care or Edwards care, the idea that it's not socialized medicine is a trick. It's a massive growth of government control of medicine.

ROVNER: But what is socialized medicine?

Professor JONATHAN OBERLANDER (Health Policy, University of North Carolina): The term socialized medicine, technically, to most health policy analysts, actually doesn't mean anything at all.

ROVNER: Jonathan Oberlander is a professor of health policy at the University of North Carolina. He says the phrase actually dates back to the American Medical Association's fight against national health insurance in the early 1900s.

Prof. OBERLANDER: The AMA used it to mean any kind of proposal that involved an increased role for the government in the health care system. And they also used it to mean things in the private system that they didn't like. So at one point, HMOs were a form of socialized medicine.

ROVNER: In terms of government programs, Oberlander says…

Prof. OBERLANDER: It was used against Medicare in the 1960s. It was used against prenatal care in the 1920s and 1930s. So it really is a term that is very flexible. And because it means nothing, precisely, you can define everything by it.

ROVNER: Oberlander, however, says these days, there is one potentially accurate use of the phrase. To make the distinction between a so-called single-payer health care system - where the government pays all the health care bills - and a truly government-operated health system.

Prof. OBERLANDER: When you talk in Europe, and you talk about a British system where the hospitals are owned by the government and the doctors are directly employed in most cases by the government, then you might say that's socialized medicine.

ROVNER: Which is different than what most single-payer proposals would do.

Prof. OBERLANDER: There, you would essentially have government financing, just like you do with Medicare, but you would continue to have private practicing physicians and private hospitals.

ROVNER: None of the leading Democratic candidates, however, has proposed anything like a single-payer system, much less a fully government-run program like Britain's National Health Service.

One candidate, Congressman Dennis Kucinich, does support the leading single-payer proposal in Congress. But that bill would also give the federal government authority to determine the number and location of health facilities. So it would go quite a bit further than other single-payer systems like Medicare in the U.S. or even Canada.

In a forum with health reporters earlier this fall, Kucinich was asked directly if that meant what he supports wasn't more like England's government-operated system than Canada's single-payer plan.

Representative DENNIS KUCINICH (Democrat, Ohio): Is it like the UK's? You know, somewhat similar. And that's similar to - in form to many of the industrial democracies of the world, which provides health care for their people.

ROVNER: Still, health policy Professor Oberlander says the phrase socialized medicine is one that's meant to polarized debate, not facilitate it, and he'd like to see it retired.

Prof. OBERLANDER: The Cold War is over. The Soviet Union is gone, so it's long since overdue to put away the label socialized medicine and start talking about the real issues.

ROVNER: Given how long the phrase has hung around, though, that seems unlikely.

Julie Rover, NPR News, Washington.

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