Which Way to Universal Health Care?

By Ezra Klein, In These Times. Posted February 5, 2009.

The numbers have never been this grim. Almost 50 million Americans are uninsured. The average annual premium for a family is nearing $13,000, and racing upward at rates that wages can't hope to match. If nothing changes, by 2050, government health care spending will consume 37 percent of the gross domestic product, and private health spending will be far more. There will be little left for education or wages or leisure.

Economists have a dictum they call Stein's Law, and it is simple: If something cannot go on forever, they say, it won't.

Our health system cannot go on in this fashion forever. It will break the back of the federal budget and crush individual consumers. But between "cannot" and "will not" lies an ocean of impediments and questions.

Some of those barriers seem to be dissolving before the moral force of the issue. For the last eight years, our government lacked either the will or the interest to act on health reform. After Jan. 20, 2009, that will no longer be true.

President Barack Obama has not only stated his intention to reform health care, he has also staffed his administration with eager reformers, notably former Senate Majority Leader Tom Daschle, D-S.D., who has written a book calling for comprehensive health care reform and who will serve as the administration's "health czar," as well as its Health and Human Services secretary.

But if the new administration has the will, few are sure of the way. It's an old debate, and a consequential one. As the saying goes, the status quo is everyone's second choice. And when you have reformers squabbling over what they want, and industry uniting to defeat what they don't want, the outcome is never progressive.

In an attempt to encourage dialogue in advance of the legislative battles to come, In These Times invited representatives from two leading reform groups -- Steffie Woolhandler, co-director of Physicians for a National Health Program, and Richard Kirsch, the national campaign manager for Health Care for America Now -- to talk out their differences.

Why don't we begin with each of you giving us the "elevator pitch" of what your groups are advocating for? Steffie?

Steffie Woolhandler: Our group of more than 15,000 physicians supports single-payer national health care insurance. We support that because it's the only way to affordably cover all Americans. That's because single payer allows you to generate huge administrative savings by going to a more simplified payment structure.

If you don't go with single payer, and you continue with the current system of multiple payers and the participation of private insurance, you continue to have tremendous administrative waste. And then the only way to get more coverage is to spend more money, and that quickly becomes economically unfeasible.

Just so we're clear on terms, when you say "single payer," how stringent are you being? Are you talking just what Canada and England do, or are you also considering Germany and France, which have nonprofit involvement? Do they count as single payer?

SW: Germany clearly would not count as single payer. They have multiple payers. But there are other nations that have, or have had, some form of single-payer systems, not just Canada or England. For a while, Australia had single payer, for instance, and Taiwan has a single-payer system.

Richard?

Richard Kirsch: Health Care for America Now's goal is to have a guarantee of quality, affordable health care for everyone in the nation. And we've come together as a coalition that includes 480 organizations that represent community groups, labor, health care providers and faith-based groups, among a whole variety of organizations on a common set of principles: That everyone should be covered. That the coverage should be affordable based on people's income. That the benefits should meet people's needs. That the coverage should be affordable to employers. And that, in order to do this, we need to have really strict regulation of the private health insurance industry, so that it can't continue to have a business model that drops people when they need health care.

We also need to give people a choice of health care coverage. So, in addition to keeping their own health care coverage, they have the choice of a public health insurance plan. Private insurance isn't the only choice. The primary goal is to look at health care as a public good.

The reason health care in this country costs so much more than in any other country is because we're the only country that treats health care as a commodity.

Your opening statements demonstrate a congruency in values, but obviously your approaches are different. It seems to me you each balance the politics and the policies of the issue differently. So, let me start with you, Steffie: How does single payer pass the Senate Finance Committee?

SW: Well, you build a popular movement among the American people, much in the way that Obama was able to succeed by building a popular movement. If you'd asked me five years ago what was more likely, passing single payer or electing a black president, I probably would've said single payer, and you probably would've, too. But the thing that changed was a kind of populist sentiment in this country, and that's what it's going to take.

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Ezra Klein is a staff writer at the American Prospect who blogs regularly at www.ezraklein.com.

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