What happened to single payer?


As Congress dives head first into what has fast become a thorny debate over health care reform, the key Democrats in the discussion have insisted that all options remain on the table.

All, that is, except one.

Universal, single-payer health care — the idea that the government will cover everyone’s medical bills using taxpayer dollars — was dismissed by leading Democrats long before any details of their reform plans have been finalized. In the Senate Finance Committee, for example, a series of health reform discussions this year included input from academics, retirees, health insurers and other industry representatives, but no single-payer advocates were invited. Last month, the White House’s top health official told lawmakers that President Obama rejects the model altogether.

The dismissals have confounded supporters of the single-payer system, who contend it’s the only strategy that ensures universal access to care while minimizing expenses within a health system where costs are skyrocketing.

“Attempting to reconcile the dual imperatives of universal coverage and cost control through alternative methods besides single payer is an exercise in futility,” Walter Tsou, advisor to Physicians for a National Health Program, told lawmakers Wednesday during a hearing of the House Education and Labor Committee’s health subpanel. “When some congressional leaders declare that single payer is off the table, they are in effect saying that insurers will be protected, leaving the pain to patients, taxpayers and health care providers.”

The debate over the single-payer option highlights the difficulty facing the young White House and other Democratic leaders as they prepare to tackle health reforms this year. Quite aside from the cost concerns associated with the overhaul — and separate from the lobbying dollars that are pouring into Washington from the many medical industries — there’s also the ideologically driven fight over what a sound health care system looks like. From the right, Democratic leaders are being blasted with charges of too much government involvement. From the left, the same leaders are being attacked for not going far enough to provide government help. Somewhere in that mix, they’ve got to produce a proposal that can get 60 votes through the Senate. Many observers say that doing away with private insurers, as the single-payer model would — even if it’s done in the name of better, expanded health care — is simply too radical a concept to push through Congress.

Outside of Washington, the concern might focus on whether health care is available and affordable. But on Capitol Hill, the debate is emerging as an ideological battle — one pitting free-marketers against government interventionists.

“Creating a new, one-size-fits-all health care system modeled on Medicare is a recipe for disaster,” said Rep. John Kline (R-Minn.), the senior Republican on the health subpanel. “It would ration care while empowering bureaucrats.”

Not that the public is opposed to the idea. A December 2007 poll conducted by Yahoo and the Associated Press found that 65 percent of respondents thought that the country “should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.”

Citing that and similar polls, Rep. John Conyers (D-Mich.) wondered aloud Wednesday why Democratic leaders have been so quick to dismiss the single-payer option. “If you take the most popular health care reform measure and take it off the table,” Conyers said, “heaven knows what it is … you think you’re left with.”

Conyers has introduced legislation that would offer health care to everyone, paid by the government but privately administered. In the upper chamber, Sen. Bernie Sanders (I-Vt.) has introduced a similar proposal. Both lawmakers argue that private insurers, who have a fiduciary duty to shareholders, are the wrong folks to dictate who receives what care when.

“The function of a private health insurance company is not to provide health care; it is to deny health care,” Sanders said last week. “Every dollar of premium that a health insurance company does not spend on health care needs is a dollar more in profits.”

But the Democrats drafting the party’s health reform proposal have other things in mind. On Wednesday, Rep. Frank Pallone (D-N.J.), who chairs the House Energy and Commerce health subpanel, conceded the system is broken and requires an overhaul. But the reforms, he added, should build on the existing systems — Medicare, Medicaid and employer sponsorship of private plans — that have taken decades to evolve. The single-payer model, Pallone said in an interview, “is off the table.”

Much of the reason stems from the declination of the White House to get behind the concept. On the campaign trail last year, President Barack Obama conceded that single-payer might be the best idea out there, but adopting it right away, he said, would cause too much disruption to “a whole system of institutions that have been set up.” Last month, Kathleen Sebelius, the newly installed head of the Health and Human Services Department, told House lawmakers that the single-payer model “is not something that the president supports.”

Instead, party leaders intend to revamp the system by piling reforms onto the institutions that already exist, including a continued emphasis on employer-sponsored coverage and a continued reliance on private insurance companies to pay for care. Many Democrats, including Obama, are also hoping to include the option of a government-sponsored insurance plan that would compete with private companies. Even that concept, however, has drawn intense fire from across the aisle.

Rep. Tom Price (R-Ga.), an orthopedic surgeon who heads the conservative Republican Study Committee, said during Wednesday’s hearing that the right to have access to government funded health care “is a right to get in line.”

“Choices are always limited by government intervention,” Price said.

On Wednesday, Price and other free-marketers found a powerful ally when the American Medical Association, the nation’s largest doctors’ group, came out against any public plan option at all.

“The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans,” AMA wrote in comments submitted to the Finance Committee.

Yet that argument doesn’t go over well with many other health care professionals, who say they’ve grown tired of haggling with private insurers over whether certain services for certain patients should be covered.

“The current system rations care based on an ability to pay,” Geri Jenkins, co-president of the California Nurses Association and National Nurses Organizing Committee, told lawmakers Wednesday. “Right now we are the only nation on earth that barters human life for money.”

Mike Lillis is Congress reporter for the Washington Independent.

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