Why is single-payer health reform not viable?

A writer for the Billings Gazette wrote an article supporting single-payer healthcare.

Reporter’s notebook

HELENA – When it comes to health care reform in America, there is a relatively simple solution that will cover everyone’s basic health care, control costs and save businesses, most people and the country a lot of money.

It’s called a single-payer health plan, where the government collects taxes to finance national health insurance. The government, which is the “single payer,” covers all citizens and pays the bills when they visit private (or public) doctors, hospitals and other facilities for medical care.

All would have basic coverage, regardless of whether they have a job, or where they work. Nobody gets billed for basic care. No-body goes broke because of medical bills.

Yet this option has been declared “off the table” by Sen. Max Baucus, D-Mont., who’s among those leading the charge for health care reform in America.

Top Democrats who will be deciding policy in America in 2009, including Baucus and President-elect Barack Obama, say single-payer is “not politically feasible,” because the public won’t strongly support it.

What they really mean is that when it comes to health care reform, they don’t want a political fight with some of the nation’s most powerful financial interests, which have the resources and the motivation to turn public opinion against meaningful reforms.

These interests include the health insurance industry, pharmaceutical drug companies, some hospitals, highly paid medical specialists, medical suppliers and others who now profit handsomely from our current system – and who could no longer command those profits under a single-payer system or an alternative form of a national health plan.

There’s no doubt that it would be a huge political battle to attempt to install a single-payer or other national health system in the United States.

But single-payer is not without its prominent supporters.

HR676, which would create national health insurance and a single-payer system, was introduced last year by Rep. John Conyers Jr., D-Mich. and has 93 co-sponsors in the U.S. House. It has not even had a hearing.

Nearly 500 labor unions from across the country have endorsed the bill, as have AFL-CIO units in 39 states, including Montana. There is a national coalition supporting single-payer, led in part by the California Nurses Association (CNA), which has 85,000 members.

Michael Lightly, director of public policy for CNA, said single-payer is “the most fiscally conservative approach” to health care, because by having one payer/insurer (usually the government), you eliminate the profits of private health insurers, you negotiate bulk purchases of drugs, you negotiate reasonable fees with health care providers and you have global budgets for hospitals and large clinics.

Single-payer or a regimented national plan also is how nearly all other developed countries run health care and cover everyone – and at a lower price than we do, because it’s more efficient.

Yet Democratic leaders in Congress, who want to reform health care, say single-payer won’t be an option, because it doesn’t “poll well.”

They cite polls showing that the public thinks single-payer equates with “big government” and taking away what insurance they already have. A majority may like the idea, but that support erodes when asked if they’d pay higher taxes to support it.

This polling is testing the obvious lines of attack that single-payer’s political opponents would employ: big government, higher taxes, less choice.

If single-payer is packaged in that context, of course it’s a loser. But as any skilled politician knows, if you craft a better message and get it out there, you win.

Higher taxes? Not if single-payer all but eliminates the health insurance premiums that you and your employer currently pay.

Big government? In America, the government is the people, and you tell it what to do. It has to be more responsive than big insurance.

Less choice? With single-payer, no doctors or hospitals are out of the network, because there is no network. It’s one system. Everyone gets the same basic care. You might have to wait for specialty care or some tests, but that’s not exactly a deal-breaker.

“The only reason it’s not on the table is because there is a belief that it’s not politically viable,” Lightly said. “That is a miscalculation in our view. We believe that a real policy debate means single-payer must be a part of that debate.”

Lightly also said that even the mild reforms proposed by Baucus and Obama are going to face a political fight from insurers and other interests.

If you’re going to have a fight, why not fight over something worth winning? he asks.

Finally, there’s the simple question of morality: In America, an incredibly wealthy country, shouldn’t we join the modern world and guarantee basic health care for all, regardless of the ability to pay?

As health care writer T.R. Reid told a Helena audience a week ago, our neighbors are suffering and dying because they don’t have decent health coverage.

You don’t believe that? Just open a newspaper or walk into your local grocery store. Every week, you’re bound to see a flier or advertisement for a fundraiser for someone who’s been horribly injured in an accident, or stricken with cancer or other debilitating disease, and can’t pay thousands upon thousands of dollars of medical bills.

Under a single-payer system or other national health care plan, that wouldn’t happen.

But unless citizens apply the pressure to our political leaders, it won’t even be considered.


  1. Jean Esslinger on December 15, 2008 at 12:42 pm

    The morality in question is not whether or not people are entitled to health care (they are not). The immoral issue is forcing the public to pay for a health care plan (yes, the taxpayer pays!) at the point of the IRS gun that they may not want. The immoral plan proposed in this article will deliver lower benefits at a higher cost than a consumer friendly plan that eliminates insurance mandates, allows protability, re-introduces freedom of choice and rewards innovative systems, services and products through the profit motive.

  2. Christy Harris on December 15, 2008 at 1:11 pm

    I would gladly pay higher taxes to avoid the $1450 monthly premium my husband and I pay for health insurance. We are self employed, in good health and yet this is our best option to avoid catastrophic emergency health care that would take away our home and assets if we did not pay the premiums to have insurance.

    Please! The new administration has got to give us some relief!

  3. Ben Marshall on December 15, 2008 at 2:35 pm

    Jean is wrong. Freedom of choice of plans would be fine and dandy, but the problem is, insurance companies deny lots of people. My girlfriend can’t get coverage ANYWHERE right now, and she is only 38, with her only medical issues being a knee repair from skiing and a gall bladder removal some time ago. The reason given by these companies is that they can’t cover any problems with her knee without a rider (waiver) for that body part, and our state (Kentucky) does not allow those riders! It’s insane. I’m a second year medical student right now, but I also spent several years in the military, where I just made an appointment and got care when needed. That is the type of coverage we need.

    Do I sound like a democrat? I’m not! I’m a hardcore fiscal conservative. So why do I support single payer? Simple, because preventative care is good for the economy and the country. If we take care of people now, they will have less debilitating chronic diseases later, lessening the cost of the retired community. Heck, if they are healthier, more people will work past retirement, which means more tax revenues. Also, one of my neighbors had to sell his house to help pay for his father’s brain cancer treatments. They ended up filing bankruptcy because they couldn’t pay their medical bills! In the long term, preventing financial collapse of a family from medical bills will pay a much larger return in the future. They can keep working, keep paying property taxes, and prevent the financial loss that always occurs with bankruptcy.

    Also, if people aren’t “trapped” in a job that has a good healthcare plan, then working conditions HAVE to improve for these companies to keep their employees. That means less stress, less chronic disease, less alcoholism, less smoking. And if the poor and uninsured can see a physician or nurse, maybe they can get help in stopping poor health habits, which decreases the costs when these patients reach Medicare age. That is one of the problems, that some of these Medicare patients have spent a lifetime without preventative care, and then they get cancer, COPD, emphysema, diabetes, high blood pressure, high cholesterol leading to atherosclerosis which leads to many problems, including heart disease. Geez, if we could get these people healthier now, it would decrease all costs in the future. I mean, do you drive your new car into the ground, with no maintenance or oil changes, or do you do scheduled maintenance and checkups, to prevent major problems in the future? Of course, you take good care of your car. And we should be doing the same thing for our citizens.

    People that work in healthcare deserve to make a salary. But there should not be big profits to companies that do not directly contribute to healthcare. They are not “managing” care, they are denying care to people who are a risk to their profits!

    I could go on and on, but I won’t. There is NO GOOD REASON to keep the current system we have, except that insurance company lobbyists pay big bucks to politicians to keep everything the way it is.

  4. Skipper Hammond on December 15, 2008 at 3:16 pm

    Unfortunately, Jean is right. In the good old, rich USA today healthcare is not a right, as it is in most other advanced nations. Only the rich have the right. The rest of us suffer to pay for it or go without. We have no more right to healthcare than we have to decent housing, three squares or clothing to protect us from the cold. The Universal Declaration of Human Rights, adopted by the United Nations 60 years ago says all people have a right to healthcare, but as its author Eleanor Roosevelt said, that declaration is not a treaty or a law. If we want access to healthcare, food, clothing or shelter we have to demand them. We have to create a society where people would scream in horror at a statement like Jean’s that it’s immoral to tax citizens that we might all enjoy good health.

  5. Paul Roden on December 15, 2008 at 5:12 pm

    Single payer, health care is viable if the people wake up and demand it. We have to unite and overwhelm the politicians and fight the insurance, pharmaceutical and health care industry greedy profit mongers. To any politician or Obama Transition Team, it is time to lead, follow or get out of the way. Medicare for All Now! No more middle person insurance company taking profits off of sick and injured people. This is a time for all progressives to unite.

    There is plenty of money to pay for this and cover all citizens. If we stop the war in Iraq, demand that corporations pay their fair share of corporate income taxes, stop the waste of “Star Wars”, $700 toilet seats and hammers, by having a unified electronic medical record, single form, single formulary, preventative care, no deductable, no copay, no preexisting conditions, no coordination of benefits subjudication of health insurance plans and having doctors not accountants and lawyers make the determination with their patients, what is medically necessary, we can have universal health care for all for less money then we are spending now.

  6. Brad Salkind on December 15, 2008 at 9:26 pm

    Jean seems to think that taking care of our most FRAIL as a country is immoral. I happen to believe that a Country is Judged by how it takes care of its weakest and most Downtrodden. We all know the cost of healthcare. The poorest can neither afford it or insurance for it. As for taxes – there will Always be taxes – if not for healthcare then for something else. (Probably building more weapons) The trick is to get something worthwhile for your taxes. Lastly, the poor would ultimately wind up on welfare (taxes) and believe it when they say “an ounce of prevention is worth a pound of cure”. And cure is certainly worth the money too.

  7. Chenyere on December 16, 2008 at 9:50 am

    I am so glad to see so many sane, humane people speaking out for HR 676. As a medical professional I abhor turning people away because they don’t have coverage for physical therapy,or their benefits have run out before they’ve reached their optimal functional goals. Compassion and vision will get us there, people. So many did not believe that Obama had a chance, but what are they saying now? Yes, the leaders of this country will eventually have to give up their calloused, money grubbing attitudes and implement the idea of “One for all and all for one”. The United Nation’s treaty, thanks to Mrs. Roosevelt, is a clarion call to honor and humanity … do the right, moral thing. “Everybody in, Nobody out!”

  8. Timothy Gaughan on December 18, 2008 at 7:15 pm

    Jean, who are you a lobbyist for?
    Other civilized nations are appalled when they hear that the number one cause of bankruptcy in the god-fearing, wrapped in the flag USA is because someone got sick. It happens. It could even happen to you Jean. Let’s euthanize the sick – it’ll be cheaper.

  9. Monica on June 28, 2009 at 3:34 pm

    People need to take personal responsibilty for their health and start taking better care of themselves. Yes, I agree health care cost is off the roof. But if we all take personal responsibility for our health, we can control some of this cost. Our diet, exercise, sleep habits, preventive care, good multivitamin etc…stop blaming the government, insurance company, and rich for all our problems. Oh, and yes I am a democrat. A responsible democrat.

  10. dane ironfist on July 29, 2009 at 3:18 pm

    we need the exclusively rich to keep killing us because we dont fight for health care reform or how about US jobs and if there is a US job we let them import someone from another country to do it hopefully they will keep smashing us into the dirt so that maybe our children will rise up and fight for our real constitution