I'm sure I'm not the only reader who noticed the juxtaposition of two front page stories in Sunday's New York Times dealing with health care. The first article cited a new Times-CBS poll showing that 72 percent of Americans favored a government run health plan comparable to Medicare, which would be available to everyone.
The second reported on a rogue radiologist at a Philadelphia VA hospital who botched 92 prostate procedures.
The right will doubtless go to town on that one, as what we can expect of government-sponsored medicine. I'll have more to say about the VA in a moment, but first let's consider the poll findings.
The poll is relevant because Congress will soon decide whether to include the so-called "public option" in the Obama health reform bill. As drafted by three House leaders and unveiled last Wednesday, the 852-page bill would include a government-sponsored, Medicare-like public plan.
Republicans and the health industry have been kicking and screaming that this is socialistic. But the poll suggests that defenders of the public plan have nothing to fear politically, and that Republicans are in danger of getting on the wrong side of a popular issue.
However, that's only the beginning of the story. The reform package, as drafted by the Obama administration and the House leadership, is dubious legislation even with the inclusion of a public option. Basically, it leaves the two worst aspects of the system intact. First, private insurers will continue to dominate. Second, most people will continue to get their insurance through their employers. Given these two bedrock realities, there is no way that the bill can make serious inroads on cost without cutting back on care. The high cost of the approach is already causing key legislators to back off. The current system wastes huge sums, but because it is so fragmented the money flows to profit opportunities and not to the most cost-effective forms of health care.
Also, as my American Prospect colleague Paul Starr warns, a mixed system with a public option effectively invites the most expensive and hard-to-treat people to opt for the public plan, while private insurers will seek to insure the young and the healthy. This is a familiar problem known as adverse selection. The private insurers will then smugly point out that the public plan is less "efficient," when in fact it simply will have a more costly population. The only way to avoid this problem is to have everyone in the same universal plan--what's otherwise known as a single-payer plan.
The public option is a not-very-good second best--because our leading liberal politicians lack the nerve to embrace the one reform that simultaneously solves the problem of cost, quality, and universal inclusion. The policy that dare not speak its name is of course comprehensive national health insurance, or Medicare-for-All. I try to avoid using the term "single payer," because a technical, policy-wonk phrase not understood by most civilians has become insider shorthand for national health insurance. Let's call the thing by its rightful name. Medicare-for-All is something regular people understand.
The Times-CBS poll is evidence that this is what more than two Americans in three really want. Most voters have not followed the nuances of how the public option in the Obama plan would compete with private insurance. The poll simply indicates that voters want access to a straight-up, Medicare-style plan to be available to one and all. In past polls, when Times-CBS pollsters ask whether people favor national health insurance, responses generally favor Medicare-for-All by margins of about two-to-one.
In the current debate, liberals find themselves fighting to keep the public option alive, so that some form of efficient, publicly-run health insurance will stay in the mix--but knowing that it is embedded in a reform package that is far more costly and inefficient than it should have been. Instead of validating the common sense and reformist demands of ordinary Americans and identifying the insurance, drug, and corporate elites as the obstacles to real reform, too many of our liberal leaders from President Obama on down hope to co-opt business elites with a convoluted scheme that undermines the efficiencies of a comprehensive and universal system. And just wait until it gets watered down further in order to retain the support of these same elites. A plan that all of these groups would endorse would not be worth having.
So what's the matter with our politicians? Why are the people so far ahead of their elected leaders on this one? One reason, as usual, is money. The combination of the insurance industry, the drug industry, the American Medical Association, the hospital lobby--all of whom oppose Medicare-for-All--represents a huge amount of political spending. It takes a brave politician to face down all of these industries, even though the people are on the side of real reform. The AMA's position is especially shameful, since the professional societies that represent most actual physicians favor national health insurance.
The second reason that liberal politicians wimp out on single payer is that the self-styled realists in this debate have decided that Medicare-for-All, even if it's the first-best system, is too hard politically. But think about it. Has the administration picked up one Republican vote by supporting the present system plus a public option? Hardly. The current House leadership bill, offering a mixed system, with a robust public option, a requirement that employers provide good insurance or pay a tax, and that insurers not discriminate against pre-existing conditions, is just as heavy a political lift as national health insurance--and far inferior policy. So why not just go for the first-best?
The advocates of Medicare-for-All have become something of an embarrassment to the liberals. The White House forum on health reform on March 5th, which boasted a diverse range of viewpoints, including representatives of the Business Roundtable, the health insurance industry, the drug lobby, as well as a broad spectrum of business, labor and Congressional leaders, left advocates of Medicare-for-All banging on the door. None were included, despite requests for invitations.
When Sen. Bernie Sanders recently arranged for five prominent advocates of national health insurance to have a courtesy meeting with Senate Finance Committee Chair Max Baucus, the story was newsworthy because the political elite usually pretends that this viewpoint doesn't exist, much less that it represents the desires of two Americans in three. The mainstream media have also colluded in the general effort to keep the single-payer option out of the limelight. The organization FAIR recently published an important study in its heroic magazine, "Extra", titled "Media Blackout on Single-Payer Healthcare."
Indeed, the Sunday New York Times-CBS poll didn't even offer Medicare-for-All as a free-standing option. It took the Obama position as the left edge of the debate.
As for that rogue doctor at the Philadelphia veterans' hospital, quality control is not what it should be throughout our fragmented system. And the oases of public medicine are particularly starved for resources. Yet studies consistently find that on average, the VA does more with less than its private sector competitors. Phil Longman has written the definitive book on the subject, "Best Care Anywhere." Here is a summary.
In this case, the offending radiologist, Dr. Gary D. Kao, was actually a contract employee and not a VA physician.
Only by having a comprehensive system can we marry quality, cost-effective care, and universal access. One of these days, a national leader will have the nerve to embrace national health insurance and fight for it. Until then, we will keep paying more money for less care, and liberals will defend reforms they themselves scarcely believe in.
Robert Kuttner is co-editor of The American Prospect, and senior fellow at Demos. His recent book is "Obama's Challenge".
Loading comments… 
http://san
So, let me see: If we exercise our choice to use the "Health Care Option", we will have no choice. So having a choice means we have no choice?
That's like saying, "Because we chose Senator Obama for President, we had no choice."
FreddieVee
Second, the "public option" will neither be available to the public nor optional for those who are on it. Most Americans will be forced by the IRS to buy insurance policies from commercial carriers. You will get to choose who drives you to bankruptcy
In health care President Obama is NOT on the public's side.
after years of private insurers PROFITEERI
theyre bleeding to death financiall
WE CAN'T AFFORD REPUBLICAN
Their privatizat
http://san
If the USA gets universal health care-there will be no need for VA hospitals & out patient clinics. Let veterans be treated where they live in local facilities by local practition
The VA hospital system has been broken for a long time; there is no way to fix the VA's hospitals.
I think that you are the one who is 15 years behind.
The Best Care Anywhere - http://www
Every Democrat should out California and say, “They cut spending, but the spending cuts just caused more layoffs, and with more people out of work the tax revenues decreased, worsening the state's deficit".
"Debt is Debt" whether the debt comes from increases in spending or decreases in tax rates. Here's a hypothetic
Thirty years ago, there was not that much difference between the results of the very different philosophi
FreddieVee
No, you numbers mean nothing.
And by the way. $11,000 is not a bad number when adjusted for what we pay in taxes for medicare/m
I am on your side. I believe in single payer, but I will not play your rainbows and ponies for all game about the costs. Even under the cheapest way to do this which is single payer, healthcare is expensive.
And by the way. $11,000 is not a bad number when adjusted for what we pay in taxes for medicare/m
Those figures don't really add up but even if they did I wonder why Congress go so picky suddenly.
The department of education, which does absolutely nothing, has an annual budget of $67 billion.
I wonder why congress isn't foaming at the mouth to get rid of the department of education?
Canada doesn't even have a department of education and they are far ahead of us in terms of performanc
People called in and instead of arguing with them and making himself out to be a liar he noted that the outcomes at VA were good overall and that the variance in anecdotal informatio
As far as I know, that is correct.
For some reason, probably due to "anglo-cul
The NY Times knows very well that they are distorting the picture with their VA horror story but if it is argumentat
Well, so much for rhetoric.
I thought Obama would be the standard-b
Just when we need a bold leader, we got a weak, bland politician
(1) Media celebritie
(2) The AMA (much like the Catholic Church hiding the priests) does not allow the records of bad doctors to be made public, so these bad actors far from acknowledg
(3)Health-
At some point we the people are really going to have to take a stand and fight the powers that be for what we want - because these people will never concede a thing! And until we really start holding Congress accountabl
That's about $11,000/ye
BTW, I remember when Obama was being questioned for perhaps having too crowded an agenda. The NY Times suggested he put health care off until next year.
Naturally nothing will get done next year because it is election year in congress and nobody wants to go up against the opposition (inisuranc
So, the nY Times was never in favor of health care reform. The result is that our country will go the way of the nY Times and other dinosaurs who could not adapt.
I look at the public option as the last chance we will ever have to solve the health care crisis. Whatever comes out of this process is the last time we're going to do reform, unless the public option is included, and given a fighting chance. On an even playing field, it will prevail, and the private insurance industry will be reduced to gold-plate
But if the public option isn't robust enough, if it is blocked from drawing a cross-sect
But I don't expect the Democrats to hold out anyway. I don't see a public plan at all. And there goes the health care industry, gobbling up the economy just like the financial sector. By 2050 health insurance premiums will exceed the median income of the American family.
Unlike the nonprofit, single-pay
This is consumer fraud that fails to loosen the HMOs' dysfunctio
Public-opt
For a detailed analysis of the pitfalls of the public options, please see the following:
http://www
http://www
Who here has actually written their Representa
I have and I hope you all have or will today.
Time is of the essence.