One of the many frustrations for advocates of single-payer health care is the relentless drive to marginalize us, not only by conservatives but also by members of our own party.
Case in point: the accounting arm of Congress, the Congressional Budget Office, has yet to perform a financial analysis of the cost of implementing single payer, a system whereby taxpayers--businesses and individuals--pay into a single general fund which covers everyone's health care for the rest of their lives, regardless of job or health status. Studies in California and Colorado have shown that a single payer system would save money for businesses, families, and government by eliminating private insurance overhead and creating enormous purchasing power that would drive down the costs of care.
I wanted to know why we don't have federal government cost projections for single payer, so I called the Congressional Budget Office -- and reached an answering machine.
Two days later, Melissa Merson, the Communications Director with the CBO, called me back and left a polite message, explaining that the CBO takes its orders from Congress, specifically the leadership, (House Speaker and Senate Majority Leader), as well as the chairs of various committees:
Finance (H-Barney Frank, D. Massachusetts; S-Max Baucus, D. Montana)
Health, Education, and Labor (S-Ted Kennedy, D. Massachusetts)
Budget (H-John Spratt, D. South Carolina; S-Kent Conrad, D. North Dakota)
Appropriations (H-David Obey, D. Wisconsin; S-Daniel Inouye, D. Hawaii)
Ways and Means (H-Charles Rangel, D. New York)
Energy and Commerce (H-Waxman, D. Los Angeles)
"We are fully aware there are members of the public who would like us to provide a cost estimate of single-payer," said Merson, "but we are inundated with requests from committees of jurisdiction. The priorities are set for us by the Congress."
Now, single-payer activists, rallying behind Progressive Democrats of America and the California Nurses Association, are demanding the congressional leadership request a CBO analysis of single-payer. Not projecting the costs is another way to marginalize the growing single-payer movement.
On the other hand, we do know the cost projections for the current proposal, the Affordable Choices Act, a hybrid concoction of private insurance and the so-called "public option" which funnels $2 billions into private for-profit insurance companies. In a June 15th letter to Senator Kennedy, the primary sponsor of this legislative effort, Douglas Elmendorf, the Director of the Congressional Budget Office, estimated the proposal would result in a trillion-dollar federal deficit over a ten year period. And that amount could only be offset by increased taxes, payment penalties for the uninsured, and cuts in Medicaid--hardly the way toward health care for all.
Instead of taxpayer money paying for actual health care under the public option, most of it, according to the CBO letter, would pay insurance companies to pay for health care. To make matters worse, this subsidy to the insurance industry requires dramatic cuts in Medicare, a program that should be expanded, not curtailed.
But here's the real kicker. At the end of the decade, in 2019, under a private insurance/public option proposal, 36,000,000 Americans, as opposed to the current 45,000,000, would still be uninsured, according to the CBO. Because the draft legislation includes an "individual responsibility" clause, anyone who couldn't afford to pay for coverage could face steep fines. Much like mandated drivers' insurance, this system would be a boon to private insurers reaping the benefits of the new law requiring everyone to get health coverage.
On top of that there would be more marginalization. Cancer patients who couldn't get private insurance coverage on their own would be pushed onto the public rolls, thereby saddling taxpayers with having to subsidize insurance policies for the seriously ill. In time, the public option, weighed down by this tax burden and unable to fully exercise bulk purchasing power, would collapse amidst a fiery congressional storm over the cost of the public option, thus legitimizing arguments that publicly-funded health care is a failed idea.
Which begs the question, why is the health insurance industry pushing back if the public option would be such a bonanza? Is it because the insurance industry is scared of the unknown or is it because the industry would prefer to narrow the debate to two choices: the public option or business as usual? I would argue the industry's biggest fear is a frank and open discussion about the merits of single payer -- a system that would put health insurers out of business. Hence, the insurance industry, in Academy-award winning style, paints the public option as the false boogie man and bores in for the kill -- the death of anything public.
HCAN (Health Care for America Now) television commercials pitching the public option urge Americans to embrace this hybrid solution--a moderate, reasoned approach--because others "would like the government to take over health care." We know who those marginalized "others" are -- the single payer advocates who can tell a snow job when they see one.
For those hoping the "public option" will be a vehicle for getting single payer, Health and Human Services Secretary Kathleen Sebelius recently set us straight.
From National Public Radio:
Asked if the administration's program will be drafted specifically to prevent it from evolving into a single-payer plan, Sebelius says, "I think that's very much the case and again if you want anybody to convince people of that, talk to the single-payer proponents who are furious that the single-payer idea is not part of the discussion."