Three Reasons Why Single-Payer Health Care Has Become Possible

While a Democratic polling firm has just found, as pollsters always do, dramatic public support for public health coverage, Democratic leaders on Capitol Hill appear divided, as they have always been, over whether to take a comprehensive approach to health care.

House Majority Whip James Clyburn, D-S.C., said on C-Span recently that incrementalism would suit him better "than to go out and just bite something you can't chew." Clyburn said he opposes any comprehensive approach in 2009. Meanwhile, on Thursday, House Majority Leader Steny Hoyer, D-Md., made a long speech about health care at a Washington conference in which he said, "I am committed to helping bring comprehensive reform to the floor of the 111th Congress."

Now, on Capitol Hill, phrases like "comprehensive reform" and "universal health care" can mean almost anything, including proposals that would likely require comprehensive reform themselves by the time the ink was dry. But there is an opening right now for serious health care reform of the sort that has succeeded in almost every other wealthy country on earth: single payer. Here are three reasons why this is a moment in which single-payer health coverage (private medicine paid for by the government, and the elimination of all health insurance companies) has become possible.

First, the partisan dynamics have changed in Congress. While some Republicans might vote for single payer, they wouldn't need to. The Democratic leadership could persuade enough Democrats to vote to pass it without a single Republican, if they chose to.

In the House, where the Democrats seriously worsened an economic stimulus bill this week in order to win irrelevant Republican votes and then didn't get a single one, they might be in the mood to wake up and begin behaving as the majority they are. In the Senate, there is the ever-present scourge of the filibuster, which allows senators representing 11 percent of the public to block legislation, but the Democrats could change the rule to rid our republic of that anti-democratic blight if they choose to.

This will require placing a great deal of pressure on Democratic senators to persuade them that losing important battles in which they vote well but don't play to win will hurt them as much as it hurts the Republicans who vote against the public will.

That's where the second reason comes in. A massive, well-organized public movement has been built that is pressing right now for single payer. In the House of Representatives, the leading advocate is Congressman John Conyers, D-Mich., whose bill H.R. 676 had 93 cosponsors in the last Congress. Conyers provides a useful FAQ here, and Physicians for a National Health Program has provided a longer one on single payer.

Other advocates include: Labor for Single Payer, Healthcare Now, the California Nurses Association and the Leadership Conference for Guaranteed Health Care, which boasts dozens of major organizational members. Progressive Democrats of America has mobilized tremendous grassroots pressure through its Healthcare Not Warfare campaign. This is essentially a campaign for single-payer health coverage, but it also organizes the peace movement to participate and communicates an important selling point. The financial cost of creating a single payer-system would be a fraction of what we spend each year merely on the occupation of Iraq, which Congress and the president have committed to ending.

Compared to the cost of wasteful programs at the Pentagon or bailouts for bankers, or even the new economic stimulus bill, single payer is a bargain, doesn't kill anyone, saves and improves lives, and even stimulates the economy better than most of the measures being used toward that end. The movement for single payer has organized a lot more than numbers; it has also marshaled persuasive arguments.

The third reason that this is the moment for single payer is that it is so obviously the best solution. When put into consideration with other proposals, single payer wins the debates hands down.

The alternative to single payer is multiple payer. That means massive waste and inefficiency, not what a new government ostentatiously looking for solutions that really work should settle on. It also means maintaining the only things in America less popular than Dick Cheney: health insurance companies, and funding them with public money as well as money directly from citizens. In a multiple-payer system, one of the payers is you If you can't pay, you may be out of luck. If you can and do pay, you are often out of luck as well.

And the bureaucratic waste extends to your own life. You fill out forms for the privilege of paying through the nose for the privilege of being told you can't be helped unless you get a second mortgage. Talking about "universal" systems that are "affordable" is all well and good, but they cannot actually exist as long as the for-profit health insurance companies are running the show.

How does this alternative sound for affordable: Go to whatever doctor you choose, and then go home with no bill and no paperwork? What if such a system could be paid for with taxes on businesses that amounted to less than what most of them currently pay for health care? What if the removal of the profit motive allowed a shift to preventive and truly comprehensive medicine?

This is not a dream. It's far more possible right now than giving trillions of dollars to bankers would have seemed a year ago or polite debates over which torture techniques are acceptable would have seemed eight years ago.

Here's what you can do:

Call Rep. James Clyburn, and ask him to whip his colleagues for H.R. 676: (202) 225-3315.

Call your own representative and ask him or her to co-sponsor and promote H.R. 676: (202) 224-3121.

You can also help by signing the Healthcare Not Warfare petition.


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