I haven't seen a single persuasive argument against single payer on the merits. What I have seen are political arguments (won't pass, the insurance companies are too powerful), ideological arguments (the private sector is always more efficient than the government), and arguments about the difficulty of transition (will put a lot of people out of work, will bankrupt some insurance companies).

The point is, none of these arguments answer the claim of single payer proponents that this has been demonstrated to be the best way to deliver health care. Indeed, I can't think of a single reason why you would want an insurance company to be sucking up large portions of the health care dollar for administrative costs. (Believe it or not, not only does the left understand this, but conservatives understand this too-- the whole point of Medical Savings Accounts, however flawed the proposal is on the merits, is to direct payments directly from consumers to providers without the inefficiencies and externalities of insurance.)

I have a feeling-- though nobody says this-- that much of the opposition to single payer among many Democrats is much more based on a vague notion that a government takeover of health care seems too "left", too "socialist". This is not the only issue where this plays out-- does anyone doubt that many Democrats gave zero thought to the practicalities and potential problems with the Iraq war before deciding to support it? After all, opposing it looked too "dovish", too "peacenik", too "left".

I think there are a lot of Democrats who like to think of themselves as smart and realistic and the Dennis Kucinich wing of the party as dumb and pie-in-the-sky. Single payer health care comes out of the Kucinich wing, it's a big government policy, therefore it must be a bad idea. Better to do something that relies on "public-private partnership" and "managed competition". It's the "third way".

The truth is, single payer will work if we pass it. We know that because it works in other countries. Sure, it will be hard to pass, and there will be pains in transition, but once we get it going, it will deliver quality medical care efficiently.

In contrast, there's no proof that any of these "managed competition" plans will work. There's no proof that they will cut costs and no proof that they will deliver quality care. So why endorse the unproven over the proven? Is it more important to make it clear that we don't agree with the unreconstructed Left than it is to do the right thing?

Jon, the question you pose to Greg is one of the ones I keep coming back to.

If the entire premise of the system now from the standpoint of private insurance companies is that there are powerful incentives for them to cherry-pick customers or else get bled to death and go out of business, the responses to that seem to be primarily twofold.
One is that we can try to regulate the hell out of the private insurance companies to try to both cover everyone and get costs under control. Others with more expertise than this Joe Citizen can comment on how likely it is that there are approaches discoverable by very smart human beings which can accomplish this. Going this route does not necessarily make such an approach impossible to explain well enough to members of Congress, the media, and ordinary citizens. But it would seem to make that crucial task more difficult.
The other basic option would be to relegate, through adoption of some form of "single-payer" plan, private insurance companies to the market for covering benefits not covered as part of the basic options offered under the new system.
Re the consensus or lack of consensus on universal coverage as a goal, universal, as in 100% of Americans actually enrolling for health insurance coverage, may not be a practical goal. There are just too many ways for individuals to fall through the cracks. What would count as universal coverage? 98%? 95%? I support the goal of seeking to make coverage easily available to everyone, recognizing some do not even use the health care system for a variety of reasons and that lack of access to health care providers located anywhere near them is one reason why.
I don't see how employment-based plans can get us the crucial benefits of greater job mobility and one less important barrier to entrepreneurship than exists now. If you have as many concerns about the middle class job base in the US over the next few decades as I do, that should count for quite a bit I would think. Most Dems are, like me, committed to universal coverage on basic social justice grounds. But the economic appeal of single-payer seems to me to cut across political ideologies. If it's pretty much a consensus among the sane that as the middle class goes so goes the country (later if not sooner), there ought to be a premium attached to whichever health care approach is most likely to get us good economic growth.

Likewise, from the standpoint of getting costs under control, having most of the system's financing administered by or through the government would seem to provide more direct, less complex, and in these senses more practical ways of getting control over costs than trying to do so by regulating the mishmash in place now. The sheer complexity of the system makes the law of unforseen consequences even more difficult to escape than usual if we try a regulatory route. It seems like one giant shell game, except there are so many shells no single policy expert or groups of experts can even know where they all are.

Your idea at the close of the post about opening up Medicare and transitioning more gradually in that manner sounds attractive from a policy implementation as well as an advocacy standpoint.

But I say again I am just a Joe Citizen who is basing my take on all this from the standpoint of what a common sense, broad public interest standpoint seems to point towards.

 
Steve Chapman has a pretty good argument against Canada's single taxpayer system in today's Chicago Tribune.

http://www.chicagotribune.com/news/columnists/chi-0506160113jun16
,1,2419018.column?coll=chi-homepagenews2-utl

I'm more on the incrementalist/voucher side than the single payer side, because I agree with Howard Dean: first you get everybody into the system in the simplest, fastest way possiblele; and then you can have your big, knock-down drag out fights about how best to reform the system.

It's fine to create & propose your ideal single-payer or voucher plans, but you should make clear your highest priority is the uninsured, and not more fundamental, ambitious reforms of the entire health-care system.

The political advantage of vouchers is that it doesn't require a fight to the death with the insurance companies. The political advantage of single-payer is that it doesn't require raising taxes. Which is politically easier depends on whether you think it will be harder to raise taxes or harder to force the insurance companies (and their employees) out of business. I personally think raising taxes will be easier.

More broadly, any political push for health care has to clearly answer the voter's two basic questions without getting too bogged down in detail: 1) What'll it cost? 2) What do we get for it?.

As for what it costs, Brad Plumer has suggested a 100 billion bucks as the cost of universal health care. That comes to about 300 dollars per American citizen, maybe 500-700 dollars per taxpayer.

As for what taxpayers will get for it, I think the best answer is in this report from the Institute of Medicine of the National Academies:

http://www.iom.edu/report.asp?id=17632

"Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States"

That means, perhaps, that by insuring the uninsured, we can save 18000 lives a year.  That's like preventing six 9/11's a year. And of course, we can also make the case that most voters benefit personally as well, perhaps by having expanded access to preventive care, and also from the peace of mind of having guaranteed access to affordable, quality health care in case they get sick.

Wouldn't it be interesting if the Democrats, on behalf of those 18000 people whose lives are endangered, threatened to filibuster all non-security legislation unless & until the Republicans addressed the issue of health care?

I didn't find that editorial to be particularly impressive. But then, I have lived in Canada, have enjoyed the benefits of their health system, and can make a direct comparison.

I agree with sparre that we shouldn't impose such stringent cost controls that innovation by pharmaceutical companies and medical technology companies is stifled. But (1) where's the evidence of this actually happening, anywhere, (2) as long as the rest of the civilized world has cost controls and we don't, we are simply paying a huge subsidy to the rest of the world and allowing them to free ride off our inflated medical prices, and (3), most importantly, what the heck does preserving the role of insurance companies have anything to do with that? Indeed, HMO's impose cost controls now. The only difference is, the savings go to HMO's, rather than being directed towards covering more patients.

The other thing sparre argues is that nobody gives a crap about universal coverage. That may be quite true as a matter of spin, but the fact of the matter is, universal coverage benefits everyone, and not simply because people lose their jobs as sparre mentions. Universal coverage also increases the risk pool and ensures that sick people don't get adversely selected out of insurance. And universal coverage is also a non-negotiable moral principle-- nobody should die or suffer debilitating illness because of a preventable or easily treated medical condition, simply because they don't have the money to pay for care and their employer does not provide health care. Such moral arguments sound too much like "socialism", I know, but the fact is, there is a moral principle at stake here and we ought to stand on that principle.