Finding Common Ground Between Public Option Advocates and Single Payer Advocates

A heated argument is going on about the right health insurance model between those those who believe in a public option and those who believe in single payer.

Or perhaps I should say between those who are willing to take what they can get -- a public option -- and those who want to hold out for what they consider the best option, single payer.

By way of reconciling what differences can be reconciled, let me ask a question of each side.

A Question for Public Option Advocates

Do you want to eventually have a single payer or a comprehensive system like the French have? If not, why not?

A Question for Single Payer Advocates

Are you willing to fight for a public option which could eventually lead to single payer or a comprehensive system like the French one? If not, why not?

At this point what I'm seeing is both sides retreating into moralistic screaming.

The public option folks are saying: "It is better to save some lives than none, and if you single payer purists don't support a public option which will save even a few lives, you're responsible for those deaths."

The single payer people are saying: "The public option is so watered down that all it will do is discredit real public reform, aka single payer. You public option folks are settling for so little that the few lives you might save are outweighed by all the lives you won't save and the damage to the chance at real comprehensive health care reform."

Both sides are assuming the other side is operating in bad faith. The public option folks assume the single payer folks just want to be pure rather than saving lives, the single payer that the public option folks are just sell-outs shilling for a bad bill.

But what I'm seeing, as someone with a foot in each camp, is that both sides are (mostly) sincere.

Now there is one group that can't be reconciled. People who want a public option so weak it either won't survive, or can't be used as the basis for a comprehensive system. The usual suspects -- Insurance company executives, for example. But also some people in the Obama administration, such as Health Secretary Katherine Sibelius, the health secretary, who said that the plan would be drafted specifically so that it could never become single payer.

But for everyone else, for those acting in good faith, there should be some common ground from which we can work together. Let's start by recognizing that the battle over public option vs single payer is a distraction away from what we could accomplish if we worked together.

United we stand a chance. Divided, we will lose our chance at health care reform.

(Originally posted at Open Left)

Comments

[SoulKeeper]

I am for single payer but am willing to settle for a public option as long as it is a STRONG public option. If there is no public option or a weak one I hope the President vetoes it, period.

So far what I have heard sounds like insurance regulations, not health care reform. Show me single payer or, as Chelsea said, "EXPANSION OF MEDICARE FOR ALL WHO WANT IN WITH NO TRIGGERS/F­IREWALLS," that'll work for me.

[ChelseaC]

Indeed,It's a sell out.

[ChelseaC]

I agree with Former Editor in Cheif of the New England Jornal of Medicine Dr. Marcia Angell when she states that a "public option" is vague. I also agree that with the insurance companies still left in the driver's seat (instead of just the supplement guys for the extras perks--such as a private hospital room) it will "hobble" the so-called "public option."

This whole public option business has been vague with no name--and nobody is asking questions, Americans are just eating it up without asking the hard questions--WHAT IS IT?

Single payer is the only way to insure all AND save money.
As long as you have the "for profit" model, our system will continue on this failing path.

If the "public option" was the EXPASION OF MEDICARE FOR ALL WHO WANT IN WITH NO TRIGGERS/FIREWALLS, I would be for it.
But it's not. And anyone with an ounce of intelligence can see through this.
Bernie Sanders is serious about reform--he made a bill--as did John Conyers and Dennis Kucinich.
I'm not buying into a vague idea.
HR-676--I know, read the bill, support it.
"Public option" has no name or details.
Wake up people!

http://www.pbs.org/moyers/journal/07242009/watch.html

[vanmungo]

PART II
The financing of the French health-insurance system is 100-percent NONPROFIT. The main public funding, according to Medical News Today, "is supported by employers, employee contributions, and personal income taxes. The working population has twenty percent of their gross salary deducted at source to fund the social security system."

These funds are disbursed by several quasi-public NONPROFIT funds that act in concert to achieve de facto single-payer leverage over costs--the reason that France has HALF the per capita costs of the United States with BETTER health outcomes--better life expectancy and lower infant-mortality rates.
Coverage, both medical and drugs, is comprehensive.

According to the report, "about seventy five percent of the total health expenditures are covered by the public health insurance system. A part of the balance is paid directly by the patients and the other part by private health insurance companies that are hired individually or in group (assurance complémentaire or mutuelle, complementary insurance or mutual fund)."

For serious and/or long-term illnesses, coverage increases on a sliding scale to 100 percent.

Citizens can purchase supplementary coverage for the other 25 percent from private insurers, but they are all NONPROFIT as well--by law.

It is preposterous to equate this predominantly public, nonprofit system with the U.S. public-option farce, which creates an enfeebled pseudo-public HMO alongside 1,300 other for-profit HMOs, which continue to bloat costs and deny coverage in this dysfunctional U.S. system.

[vanmungo]

PART I
Ian Welsh's blog post is grossly misleading on all critical points.

The two main goals of health reform are (1) containing runaway costs and (2) significantly expanding coverage. The enfeebled public options contained in these bills does neither.

On costs: In the words of PNHP's Kip Sullivan: "any insurance program, public or private, that has to compete with other insurers is going to have overhead costs substantially higher than Medicare"s. (It is precisely because Medicare is a single-payer program that its overhead costs are low.) Second, the multiple-payer system [that the public option] would leave in place would continue to impose unnecessarily large overhead costs on providers.­"

On coverage: The House bill would leave 17 million uninsured; the HELP bill would fail to cover 33 million. http://www.pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%%E2%80%9Cpublic-option%E2%80%9D-was-sold/)

These farcical "public options" have been cynically crafted to present NO real competition to the HMOs and no real benefit to ordinary Americans: not surprising considering the millions of health-industry dollars lapped up by members of both parties, including Waxman, Rangel, and Kennedy, who share one key objective with the Blue Dogs and Republicans: retaining the HMOs' chokehold on our health-care system.

The only way to break that chokehold is nonprofit Medicare for all, as fifty years of experience in the rest of the industrialized world has proved.

[satorist]

Unfortunately the one group mentioned, whose differences cannot be reconciled with advocates of a single payer plan, includes Secretary of Health Sibelius--which is to say, the Obama administration. A public plan that hasn't at least the potential to become a de facto single payer by undercutting private insurer's pricing/services isn't a competitive alternative, it's a safety net.

Single-payer advocates are entitled to at least be suspicious of congressional motives. Their proposal was drafted considered or scored by CBO so that comparative judgments could be made regarding coverage and cost benefits. The only health care proven effective throughout the entire civilized world is "unthinkable" to our Congress. Amazing.

That failure was a huge benefit to the Medical Industry. It effectively eliminated the greatest threat to the status quo of their bottom line and established a public plan as the default liberal (i.e. "extreme") position, allowing "centerists" to demonstrate their "independence"by weakening it further.

The notion of "bipartisan" agreement is disingenuous, manufacturing a need for compromise on an already weakened bill with those opposed to all reform--in effect, intentionally starting with half a loaf and negotiating down to the crust of the heel. Democrats can plausibly argue to big industry donors that the legislation would have been more harmful to their interests (i.e., more effective and fair) if they hadn't rigged the debate from the beginning and solicit more funds as the process continues.

This is a sellout.