Why Not Single-Payer?

I want to take a moment and address those of you who have been asking why Health Care for America Now is not focusing on creating a single-payer health insurance system. First of all, here is HCAN's official position:

The goal of Health Care for America Now is to build a national movement to win the implementation of health care reform that meets the principles in our Statement of Common Purpose. We believe that a properly designed single-payer bill is one way of doing that but not the only way. Many of the organizations that belong to HCAN support single-payer reform and have endorsed HR-676. But in joining HCAN, they recognize that the major focus needs to be on winning quality, affordable health care for all rather than advocating for only one approach. Health Care for America Now believes that the big divide in our country on health care is between those of us who believe that there needs to be substantial government involvement in guaranteeing quality, affordable health care for all and those who think that the solution is to rely ever more on an unregulated private market.

I was a leader of the fight for single-payer reform during from 1988 to 1994. I co-wrote with Richard Gottfried -- then and now the Chair of the Health Committee of the New York State Assembly -- the only fully-financed single-payer bill to ever pass a state legislative body in the country. I shared the responsibility with Assemblyman Gottfried for presenting single-payer at twelve debates sponsored by Governor Mario Cuomo in 1991 on healthcare reform proposals. I wrote a training manual and talking points for candidates for Congress to use in running on single-payer in 1992. I could go on, but you get the idea.

So what happened to me? Five years ago, I sat down to write a history of the struggle to win a single-payer system. (Will it be Déjà vu All Over Again? Renewing the Fight for Health Care for All Tales, Hopes and Fears of a Battle-Scarred Organizer [pdf]). Here's what I wrote in the preamble to that article:

I intended to write this piece as a cautionary tale for both the new generation of organizers for universal health care and the veterans of the last fight. To my surprise, the writing led me to a fresh understanding of the paradox of achieving universal health care in the United States: the political debate about health care reform is turned upside down once the debate turns from the problem state to the solution stage. At that point, people become more scared about what they will lose from reform than what they will gain. This conclusion led me to reframe my view of how we go about organizing for universal health care, and -- to my even bigger surprise -- to outlining a new proposal for comprehensive reform.

I wrote at the time: "So here's my proposal, in a nutshell: provide everyone in the country with the option, and the means of paying for, coverage through Medicare or through private insurance."

One point of this approach was not to scare people away from reform or to make it easier for the opponents of reform to panic the public. I realized we could reassure people about change by building on what people are familiar with -- both private insurance and Medicare's public insurance plan.

A lot of what I wrote at the time also had to do with the need to reaffirm the positive role of government in America. To do that, we need to demonstrate that government can better people's lives in real ways. Even though it might make us feel good, stating our ideological position in the hope that people will eventually come around is not effective. We need to win real changes that show government can work in positive ways.

Our goal is to have the United States provide a guarantee of good, affordable health coverage to all its residents. That's the bottom line. A national health insurance plan (single-payer) is one way to accomplish the goal, but it's not the only way. In fact, one of the myths about health care around the world is that "everyone but us has single-payer." In fact, single-payer is the way Canadians provide a government guarantee of good health coverage. Other countries -- including the European countries usually held up as models -- do it differently, with all sorts of variations of public, private, and non-profit insurance and socialized medicine. But what's true in all these countries is that health care is guaranteed and regulated as a public good.

We need to keep our eye on the prize and on the real debate. It would be great -- a progressive dream -- if the political debate were between putting everyone into a government health insurance plan (single-payer) and having a very large public insurance plan along with regulated private insurance (which is what the HCAN principles say). But the real debate is between those of us who believe that health care is a public good where government has to guarantee quality, affordable coverage and those who think that the problem with the health care system is that the market's not working, and if we gave people a voucher to buy unregulated private insurance, it would solve everything.

That's why the focus of our grassroots campaign in 2008 is our Which Side Are You On? statement. It lays out two very different visionsfor reform: "Quality affordable health care for all" or "On your own with private insurance". That's what America has to decide.

Late last year, I wrote an article that lays out in a lot of detail the argument for Health Care for America Now's strategy: Winning Quality Affordable Health Care for All [pdf]. I hope you'll take the time to read it. For now, I want to share with you the last two paragraphs from that piece:

We have to start where the American public is today. After seven years of the George W. Bush administration and 30 years of conservative dominance the American public is fearful about their economic status. Most Americans see the government as being corrupt, ineffective and on the side of wealthy special interests. People do not trust the government and that do not think that the government is on their side. Health care reform contains the promise to turn this around, to demonstrate that government can work for all of us, which the public interest can trump corporate interests and the "you are on your own" ethos of the new gilded age. Health care reform holds the promise to create a generation of Americans that support a government that works for everyone, just as the New Deal's advances led to four decades of activist government for the public good.

Coming off more than a quarter century of conservative domination of American politics, I am reminded that Karl Rove's hero, William McKinley, was followed by Theodore Roosevelt and the Progressive Era. Our job is to build a movement for health care reform that ignites the hopes and aspirations of the American people, the American values of opportunity and fairness. Winning real health care reform will requires a clear vision, a persistent, strategic energy and a belief in the miracle of change.

(Also posted at the NOW! blog)

Comments

[HR676fan]

Mr. Kirsch and his Hacker/Herndon/HCAN coalition claim to offer us a "choice" of health plans, but they leave an important option off the table. On HCAN's web site, a poll asks respondents if they would prefer an all-private plan, or a public-private combo. How about an all public, single payer plan? Oops--sorry folk! You can't check that box.

Single Payer, as detailed in HR 676, has been designed and analyzed by clinicians, health care experts and economists. It has been tested and proven to work in other free-market democracies. It would be as simple to implement and run as traditional Medicare (before the incursion of Plan D and those private dis-Advantage plans).

A note to NYpoet22--It would be difficult to implement single payer in the smaller states. We'd need to dismantle the mixed federal-state funding for Medicaid and SCHIP. (The for-profit HMOs have their tentacles in those programs too.). I think it would take the combined clout of all states to deal with those issues.

The Lewin Group reports that a taxpayer-funded plan would save trillions and control future costs. Mr Kirsch seems to overlook those findings. I suggest he get off the "focus group, framing, feasibility" bandwagon and do some real research. Let's hope the facts will lead him back to his single-payer roots.

Call your Congressperson and ask him/her to sign on as co-sponsor of HR 676. .

[beaupritchard]

when you go with what you've always gone with ... you'll get what you've always gotten.

If the current health care education systems works for you ... why worry. If not bandaiding the current system system is worthless.

[beaupritchard]

I guess I should weigh in with something constructive every once in a while(its hard just being clever and goodlooking on the post ... well the clever part is debatable ... and the good looking part ... well that might be debatable too ... hmmm ... maybe I should get to the point of this post) ... this idea about fixing health care medicare ... the real answer instead of trying to fix an already bloated and unwilling to go away beauracracy is to just go around them.

The answer to fixing health care is the same as Obamas answer to fixing education ... free education for anyone who wants to be an educator or a doctor.

When you yourself or your neighbor or the guy down the block may have some idea of what might be wrong everybody wins ... except those who want to limit the supply of doctors and educators for their own purposes in the face of ever increasing demand.

When everyone(well most everyone ... how about a lot more of everyone) has some education about health care or education everybody wins.

[tommybones]

An NBC-Wall Street Journal poll found that over 2/3 of all Americans thought the government should guarantee "everyone the best and most advanced health care that technology can supply;" a Washington Post-ABC poll found that 80 percent regard universal health care as “more important than holding down taxes”; polls reported in Business Week found that 67% of Americans think it is a good idea to guarantee health care for all U.S. citizens, as Canada and Britain do, with just 27 5 dissenting; Pew Research Center found that 64 percent of Americans favor the “U.S. government guaranteeing health insurance for all citizens, even if it means raising taxes” (30 percent opposed). By the late 1980s, more than 70 percent of Americans “thought health care should be a constitutional guarantee,” while 40 percent “thought it already was.” Despite the overwhelming public opinion in favor of a universal, single payer government run health care program, the issue is not even on the table in mainstream political discourse. As John Kerry described it during the 2004 elections, a universal system is “not politically viable,” (read: not acceptable to corporate America).

Obama has put forth a sufficiently power-worshipping mutant form of “universal” health care plan, which caters to big pharmaceutical and Insurance companies, while McCain continues the tradition of putting forth fear-based “privatization” plans geared toward filling the coffers of wall street, and all but ignoring the harsh and deadly realities of such profit-driven systems.

[beaupritchard]

Not sure I like either formalized plan ... I'm old enough to remember a doctor coming to the house regularly to look in my ears ...check my tongue ... listen to my chest. We were not rich ...

I would like that for my kids.

[Pquilson]

Canada anyone? The designer of their single payer system recently declared that it was FUBAR.
Do we want a system like that here?

[utd]

Ya, well I have good insurance here in the US. It took 3 months for me to get into see a neurologist, and not the one I wanted to see, it took 3 months to see the earliest available appointment from anyone. In that time I suffered irreparable damage to my body from an insurance system that I pay a lot of money for that failed me. I am not alone.

How about a quote and a source while you're at it BTW?

[dagnew]

Single-payer is the only solution to our healthcare mess, and I wish O would realize it. Health insurance should not be tied to one's job. It's hard to meet those COBRA payments to keep your insurance if you lose your job. We already pay Medicare tax, so why not pay a little more so that we can all be covered. It's the only way that makes sense! If we can spend billions on an unjust war, we can cough up the money to pay for a single-payer healthcare system.

[Sundialsvc4]

Here's the bottom line, Richard...

You can get "health insurance" fairly easily, until and unless you actually need it.

Health insurance companies, like any other insurance company, exist for profit and therefore for controlling what they deem to be "risk." Unfortunately, the people who need health insurance are the ones who don't have it ... because they can't get it ... because they are "a risk."

In other words: they actually have a medical expense.

If it were "profitable" for health insurance companies to insure the folks who actually need it, they would have done so. Instead, these companies hire large numbers of people to help them justify the denying of claims and applications.

The health-insurance industry is right now doing precisely what it thinks it is supposed to do: maximizing monetary return for its shareholders. Companies do not exist for their customers, seeing them instead as "a necessary evil," especially in the case of insurance, where every customer is a potential "expense."

Therefore, I argue, any system that's based on the existing health-insurance industry cannot work. Either the industry must be forced to take-on policies that are "unprofitable," or the Federal Government with its Magic Money-Bucket must pay the bill (and therefore must regulate prices).

[metalpipe]

Agreed, and the Govt money bucket will have to be controlled by people with dedication and integrity, and protected with strong oversight backed by a lawful justice dept. The lobbyists for the insurance industry will do everything in their power to stack all legislative decisions in their favor.

The health fund will also have to be sheltered from politicians hungry for any available money they may deem fit to use elsewhere; see Social Security fund misuse.

It all seems so improbable.

[CrzyRussell]

Let's fix Medicare first. The US govt can't run medicare effectively wasting billions of dollars. Nor can they run the VA system which is exactly what you would get. The VA sucks- 3 months is the typical wait time for an appointment and you can't even choose the date half the time.

Fix those first. Show us that they can run our health care first.

[bgregs]

First, the VA is NOT a single payer system! The VA is a government run health CARE system. And you're right, it's not doing well. Do you know WHY it's not doing well? Because bush did something right, he ordered the VA to cover ALL veterans returning from Iraq and Afghanistan for a minimum of two years after they get out. They didn't do that before, you had to be declared service connected disabled. However, when bush did something right, he also did something wrong. He refused to admit that it needed to be PAID FOR. Therefore, when he has been making his budget, he's been going on an extrapolation of prior years, BEFORE he gave that order! So they are doing the best that they can at the VA while being EXTREMELY underfunded!

Second, Medicare spends about 3 cents of every dollar on administration and waste. Compare that to the BEST insurance company, spending around 15 cents of every dollar! That's the BEST that they can do! MOST insurance companies are around 25-30 cents per dollar. And the worst that I've heard of was almost 50 cents!! Think about that, this one company takes in $10,000,000, and spends almost $5,000,000 on non health related expenses!!!!! Tell me again how Medicare is being run poorly??

[CrzyRussell]

One, the VA was way worse before Bush was elected. Under Bush it has improved some, but it still needs work.

Medicare pays too much and doesn't manage it's money well. The insurance companies pay less for things like oxygen concentrators than Medicare does. The $5000.00 toilet seat waste applies to Medicare as well.

[Linda Bergthold - Huffpost Blogger]

This is a very practical and reasonable way to approach the universal coverage issue. HCAN is to be commended for creating a big tent, staying flexible on the "tactics" to achieve the overall strategy of coverage for all. There are a lot of ways to get to universal coverage around the world, as you point out. If HCAN can remain open minded about the steps to achieve it, the goal may well be achievable! I hope this is the year we move this along. Too many Americans are suffering.

[NABNYC]

We need the government to provide healthcare for everyone. As part of that program, they should require the medical schools to have bigger classes, or provide assistance for new medical schools in this country. More doctors would mean lower wages for doctors, more affordable for patients. We need restrictions on drug prices too. And please don't tell me about their years of research trying to find a cure for cancer. As far as I can tell, all the disease research is paid for by me, and the drug companies spend their time researching how to give men bigger and harder Cheneys, how to reverse male-pattern balding, and how to make women want to have sex with old fat guys.

Back in the 1970s, people didn't want to have to go sit in a doctor's office or clinic, wait for treatment. That's back when we were given medical care as part of our employment. No more. Today, people would glady go sit somewhere if they could get medical care. People die because they can't afford it.

Anyone who wants special treatment can pay extra. Most people would willingly take a government-provided healthcare system. After all, how many seniors turn down Medicare, and say no thanks, I'd rather pay for it all myself?

The biggest obstacle is that our politicians take bribes from doctors, hospitals, insurance and drug companies who do not want government regulation of what is currently the massive underserving of citizens with grossly excessive charges.

[PigLipstick]

We will never have a single payer healthcare system in this country as long as we continue to have endless discussions with various special interest groups that have narrow economic interests, it's called 'Design By Committee' and the only thing that ever comes out of this process is the resolution that the committee chairman supports. We will continue to have an overpriced fragmented abortion of a system as long as we continue to let private insurers cherry pick healthy customers while dumping the less healthy and elderly on the various county healthcare systems. This is the most expensive healthcare because those denied coverage through traditional delivery methods have to wait for coverage through the over taxed public financed county system, thus their conditions worsen and become more time consuming and expensive to treat.

In general, if we don't take back our government and straighten out our elected officials to the fact that we, the citizens of this country, set the agenda, we will continue to have a system with ongoing wars that 78% of the population rejects and 45 to 65 million Americans who are denied even the most basic medical coverage. This change will never happen until we start demanding the end of compromise in the halls of Congress, the late Sen. Jesse Helms was absolutely right in that something worth fighting for can never be compromised.

[liberalghost]

You need to grasp one simple point, in single -payer (aka medicare) there is no room at the table for a $10,000,000 a year CEO, a $5,000,000 CFO, and "golden parachutes." Get it? Got it? Good.

[bgregs]

Sure there is. They get to buy "supplemental" insurance! Then they use THAT to pay for the gold plated windows in their private hospital room!

[wayoutleft]

the unfortunate problem is- that doesn't mean no ceo's- it means no public health care.

[tompoe]

I can pay premiums to a corporation, which will include profit above and beyond costs. Or, I can pay the government premiums wshich will include costs, but no profits. I suspect the premiums without profit built into the premiums will be lower.

I can pay premiums to a corporation, who is costing administration based on a staff that handles all administrative duties for customers of that corporation. Since that corporation has a proportion of the market, that means multiple staffs doing the same work. The healthcare industry then reports all of the staff costs paid by all of the participants. Or, I can pay premiums to the government, who maintains one staff to handle all administrative duties for customers. As we see in the Medicare program, the administrative costs percentage, compared to the private sector, the administration costs are lower, and significantly so.

This is a no-brainer, when one realizes that private corporations are also billing Medicare, thus overlapping administrative costs on top of administrative costs. What seems to be the obstacle preventing some folks with a vested interest in serving the public from stating the obvious? Single payer insurance solves the problem of lowering healthcare costs, and managing our country's universal healthcare responsibly.

[Plowboy]

Look to the big big money being spent to control "our" Congress and to influence them on this issue. Is any of it spent by any companies expecting to to profit from single payer?

[FogBelter]

Mr. Kirsch, Single-payer is the only rational approach for Universal Health Care in this Nation. It would turn Health Care into what it should be in this country ... A Right. Any other approach is simply another case of Corporate Socialism ... making the middleman, more important than the Doctor, Patient, and the medical care provided.

One other aspect of the problem that needs to be considered as well ... the Number of Medical Schools should be multiplied to accommodate the training of the medical professionals required to meet the needs of all Americans in all parts of the Nation ... because of economics there are currently some areas of the country that have woefully inadequate access to medical care. To fill these Medical Schools with talented students, the US Government should pay for the Medical School Tuition for any student who has the aptitude and grades to become a Doctor or Nurse ... no longer should economics keep talent out of the Medical Profession ... and as Michael Moore pointed out in an Interview with Larry King when "Sicko" came out ... the AMA should not be the sole decider of how many Medical Schools are operating in the United States.

Single-payer Universal Healthcare for Americans MUST be the goal, for it is in the long term interests of the country.

[tbone99]

Doctors have been one of the main forces fighting a universal system - they want to have that ability to make that half million. Of course, the costs they incur paying for school bolsters their argument.
Its just now that paperwork and the workers required to process it , along with the need for even more expensive equipment has started convincing many that it's just not worth it.Not to mention the lawsuits they open themselves up to , when they must rush through more patients to meet the overhead.

The whole system is sick!