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Giving Single-Payer a Second Look

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As President Obama prepares to address the nation about his vision for health care reform, we should not overlook the last, best truly transformative change to our health care system: Medicare. We have been staring so intently at the lessons of 1993 that we may have forgotten the universal rule of successful lawmaking: "keep it simple."

During the eleven town hall meetings I've held around my district, I've had some direct experience with the anxiety this debate has produced. Much of the fear comes from two groups: those who have Medicare and don't want it changed and those who have never had a government-run reimbursement system like Medicare and are worried about the impact it will have on their quality of care.

In both cases, a calm, reasoned and vigorous defense of the American single-payer plan is just what the doctor ordered.

The truth is that the United States already uses single-payer systems to cover over 47% of all medical bills through Medicare, Medicaid, the Veterans Administration, the Department of Defense and the Bureau of Indian Affairs.

Understanding that these single-payer health programs are already a major part of our overall health care system should help us visualize what an actual public plan would look like. These institutions also provide health care to millions of satisfied customers in every community who would heartily agree that the government can build and run programs that work quite well.

Medicare also provides us with a case study in the hypocrisy of our Republican friends who have built their party on a 44-year record of undermining this popular program. And now their Chairman sees no irony in ripping "government run" healthcare while publishing an op-ed opposing changes to Medicare.

If Medicare has been such a success, why not extend it? Why not have single-payer plans for 55 year olds? Why not have one for young citizens who just left their parents or college coverage?

So far, the answers we hear to these questions have simply not been very convincing.

At one town meeting the President responded that that he was worried about its "destructiveness."

Really? Americans would still go to the same doctor and the same neighborhood hospital. Sure, they would be able to delete the 1-800 number of their insurance company from their cell phones. And doctors would have to get rid of all those file cabinets full of paperwork while their assistants who spend time fighting with insurance companies would be able to actually speak to patients.

But everyone would adjust, I'm sure.

The real reason we haven't seen the Democratic Party embrace the obvious and simpler idea is that it boils down to pure beltway politics.

We've been reluctant to tackle the real inefficiency in the current system, namely, the very presence of the private insurance companies. Too many in Washington would rather stay friends with the insurance and drug companies when real reform probably can't be achieved in a way that makes these powerful institutions happy.

That's not to say we should vilify the industry. When they pocket up to 30% in profits and overhead (compared to 4% for Medicare) or when their executives take multimillion dollar salaries, insurance companies are doing what their shareholders want them to do.

But let's leave it to the Republicans to defend those actions. I, and most Democrats, should not join the chorus that sounds like we care more about insurance companies than taxpayers.

The same is true for Big Pharma. If Wal-Mart can pool its customers to be able to offer the $4 prescriptions, why shouldn't the federal government drive the same hard bargain on behalf of the tax payers so they too get the best prices under Medicare? I pose this exact question at every town hall meeting I attend and if my colleagues and the President did the same on Wednesday night, they would mix good policy with good politics. Instead we have watched a puzzling dance as policymakers have effectively limited the savings we would find in the enormous drug expenditures that are a fixture in our current system. Is it any wonder citizens are confused?

I have no delusions about the muscle needed to overcome resistance from the insurance and pharmaceutical industries. But I believe that for every American we may lose to a slash-and-burn TV ad funded by these businesses, we will gain five among those who are looking for a clear rationale for what we are trying to accomplish and an example for what it may look like.

We also achieve something else: realignment of the political universe. Democrats understand the role of government and are proud of our signature achievement: Medicare. The Republicans care most about big business.

I'll take that fight any day. And I'm hoping that the President will tell us on Wednesday that he is willing to do the same.

Anthony D. Weiner is a Democrat representing New York's 9th Congressional District.