Put Single Payer Back on the Table
Dr. Quentin Young
Posted: February 22, 2010 02:20 PM
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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.