Crisis = Opportunity for Single-Payer

By Roger Bybee, Dollars and Sense. Posted April 8, 2009.

Unfortunately, Obama's statements and key appointments suggest he has already disqualified single-payer as a serious option.

Tom Daschle, tapped for Health and Human Services secretary and "point man" on the health care reform effort until tax problems forced him to withdraw his name in February, appeared unwilling to let the private insurance industry go. His basic policy direction emerged in an interview last May. In a remark that seems staggering in hindsight, Daschle said, "And I would ask the question, if you think our banking system today is reasonably regulated, why not try the same model for our health-care system?"

Obama's initial pick for surgeon general was TV health expert Dr. Sanjay Gupta. Gupta was trounced by Michael Moore in a televised debate over Moore's documentary "Sicko," and was then forced to retract some of the factually inaccurate criticisms of single-payer he had offered.

Another key player is Senate Finance Chair Max Baucus, author of a plan similar to Obama's. Baucus recently dismissed the single-payer option on this basis: "We are Americans; we're different from Canada, we're different from the United Kingdom." Baucus was probably not referring to the United States' poorer health outcomes at vastly higher costs when he spoke of the American "difference."

Promoted by this kind of team, Obama's health-care plan could prove to be the most vulnerable component of his domestic program. The Republicans feel confident about their ability to brand Obama's plan as overly complex and a threat to consumer choice in medical care, as they did so successfully with the Clinton plan in the 1990s.

The Obama plan's "pay or play" component, giving employers a choice between insuring their employees or paying a tax to help finance the government plan, will no doubt open it up to conservative criticism as a coercive, big-government program. This line may also strike a chord among moderate-income citizens who earn too much to qualify for a subsidy and consequently lose enthusiasm for reform once they start to pay mandatory health premiums.

The single-payer approach, on the other hand, would disarm many of the most explosive Republican arguments. It is far less costly to both employers and individuals -- nearly 50% lower per person in Canada than the United States, for instance -- and there is no billing of patients or other complexity. Every citizen enjoys the right to health care and a free choice of doctors and hospitals. Start-up costs would be minimal, especially if Medicare were simply expanded to cover the entire public.

Back in 2003, Barack Obama told the Illinois AFL-CIO: "I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14% of its Gross National Product on health care, cannot provide basic health insurance to everybody . . . a single-payer health care plan, a universal health care plan. And that's what I'd like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House."

Now that Obama himself occupies the White House and health care costs consume nearly 17% of GNP, the new president may rediscover that single-payer is the truly pragmatic course on health care reform. Hemmed in on all sides by the enormous costs facing the federal government, Obama may find -- despite his misgivings -- that pursuing a single-payer reform plan is the sole means of creating a low-cost and appealing alternative to the health-care status quo.

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