Put Single Payer Back on the Table

By Dr. Quentin Young of PNHP

One year after its much-ballyhooed launch, the Obama administration’s approach to health reform is now in serious disarray.

The president’s health care summit on Feb. 25 is being portrayed as a last ditch bid to find some common ground with his “just say no” Republican opposition. He also faces an increasingly wary group of disgruntled Democrats, whose memory of the Massachusetts massacre — the election of a Republican to Sen. Edward Kennedy’s seat — remains fresh.

The summit proceedings, which will be televised in the name of “transparency,” will no doubt be laden with a formidable amount of stagecraft. They will be preceded by the unveiling of the president’s own legislative proposal — presumably the odious Senate bill with some tweaks — a few days before.

But it’s almost certain that this latest White House initiative, undertaken with the stated goal of salvaging and passing at least some elements of the stalled congressional bills, is foredoomed.

The House bill, contrary to many who believe otherwise, is disastrous. And if such a thing is possible, its Senate counterpart is even worse. Both would shovel hundreds of billions of taxpayer dollars into the coffers of the private health insurance industry. Both would make it a federal offense, with fines, for a person to fail to buy the insurers’ shoddy products.

Even so, at least 23 million people would remain uninsured under the new law. And those who have insurance would remain vulnerable to extort premium increases, not unlike Anthem Blue Cross’ recently announced premium hikes of up to 39 percent in California.

While one could imagine the enactment of certain piecemeal measures that might ameliorate our condition — e.g., a simple prohibition of insurance company denials of coverage because of pre-existing conditions — these are precisely the stand-alone measures most stubbornly opposed by Republicans, conservative Democrats and their corporate patrons. Such concessions, in their eyes, must be linked to shoring up the very culprits who are most responsible for our health care mess.

The presence of the for-profit health industry — the private health insurance conglomerate and the Big Pharma drug companies in the first place — in the legislative process has certainly been “transparent” from the get go. Through their lobbyists and campaign contributions, they shaped a bill that would enhance their domination of our health system. They are at the root of the catastrophe that passes for health care financing in the United States today.

Of course, the conspicuous omission in the debate has been single-payer national health insurance proposal, an improved Medicare for All. This was assured on the Senate side when the powerful chairman of its Finance Committee, Max Baucus, D-Mont., informed the world that everything was on the table but single payer.

How the chairman of a congressional committee, however powerful, can set the terms of debate in a democratic society by excluding such a popular and well-substantiated solution is hard to rationalize. Baucus did, of course, prevail, and what came out of the Senate was execrable. Like the House bill, it fails the three tests of genuine reform: universal coverage, quality improvement and cost control.

One can reasonably suspect that President Obama now wants something — anything — to pass in Congress as evidence of the fulfillment of his campaign pledge to accomplish health care reform. But if he looks to the House and Senate bills as the starting point, his efforts will be in vain.

It’s not too late for the president to re-embrace his earlier support for single-payer national health insurance and set the nation on the right path. Were he to lay out the facts to the American people and provide energetic leadership for this eminently rational proposal, he would get strong, grassroots support from the public.

We’re now spending $8,000 per capita annually on health care, $2.5 trillion in total. That’s nearly one-fifth of our GDP. Yet our health outcomes rank among the lowest in the industrialized world. Some 45,000 people die each year chiefly because they have no health insurance, and medical bills and illness are now linked to nearly two-thirds of personal bankruptcies. This reality in the richest country in the world is unnecessary and intolerable.

I suggest the president look to an improved and expanded Medicare program as the solution. Medicare, which was enacted in 1965 and which has served our elderly and the totally disabled so well, is a solid foundation to build upon.

Enactment of an improved Medicare for All would save our nation $400 billion annually by eliminating the bureaucracy and paperwork inflicted on our system by the private insurers. That’s more than enough to provide universal, comprehensive care to everyone and to eliminate all co-pays and deductibles. A single-payer system would also allow us to rein in costs and better allocate resources.

We have a talented health care workforce. But to fully unlock their potential, we need to get out from under the greedy dictates of the health industry.

Mr. President, it’s time to put single payer back on the table.


  1. Leon on February 25, 2010 at 2:52 pm

    Until proof that single payer can repair the economic costs of lost labor, lost job growth, lost entreprenurial startups, decreased buy-power, tort damages, and lost lives and turn them into a greater boost to our economy than the profit of insurance our voices are dust.

    Make the plutocrats see a healthy populace at work is worth more money than a health bottom line for insurance and big pharma.