Again, thanks to Jon for bringing us together into this conversation and for laying out the contours of the problem so succinctly. It’s sobering, isn’t it, to realize how well his description of early 20th Century conditions corresponds to our own situation?

As a staff member for a state senator who is both the author of SB 840, California’s pending single payer legislation, and the Chair of the State Senate Health Committee and, therefore, obligated to work with all due speed for whatever useful reforms can be crafted, I appreciate Jon’s call for healthcare advocates to work in several time frames at once. But I would invert his concerns. While we don’t want to make the perfect the enemy of the good, neither do we want the incremental to be the strangling death of the remedial.

It’s almost once a week that I hear some variation of the ‘single payer won’t pass so why bother’ argument—and the assumptions behind it are more than a little disquieting.

From all sides of the debate, I hear the following question: “What makes you think we can achieve single payer when Big Insurance opposes it?” After all these years, I’m hardly naïve about the role of money and lobbying in the legislative process. Law, sausages, yada. But are we actually willing to concede the boundaries of healthcare policy to a business interest that currently guards its profit margin by seeking to strip health coverage from sick people? (Lisa Girion; Los Angeles Times: Sep 17, 2006; February 16, 2007; March 22, 2007)

First of all, Jon’s right—-single payer makes sense. If we look at a study by the Lewin Group, an independent medical cost/benefit analysis firm (numbers available at www.sen.ca.gov/kuehl), we see that, if we remove the artificial middle-man (private insurance) and marshal California’s purchasing power to negotiate bulk rates for prescription drugs and durable medical equipment, we really can insure every Californian with comprehensive coverage, save some money in the short run and control costs in the long run.

So the question becomes, “Just because this is supposed to be a representative democracy, what makes you think we can achieve a common sense solution if a powerful interest opposes it?” If the answer is, ‘we can’t,’ then why are we even torturing ourselves with this dialogue?

In fact, in large part because of the grass roots support it continues to gain (as well as Senator Kuehl’s acumen in moving it through), SB 840 has emerged as the bill that wouldn’t die. This is the third two-year version that the Senator has introduced, and each year, as the bill stays in front of the legislature and its varied constituencies, it garners more legislative co-authors and a diverse range of endorsers who run from labor to business to nurses and doctors, along with local governments. As other options are raised and defeated (a pay-or-play employer mandate, for instance, was rejected at the polls), and the discussion of concrete solutions continues, single payer is beginning to stand out, in the Capitol building and among advocates, as the Gold Standard to which we are advancing.

Also, as Joe Paduda argues, this isn’t exactly a case of Big Business vs. the Little Guy. This is Big Insurance vs. everybody else. Single payer would save money for almost all businesses that now pay for health coverage benefits, and it would level the playing field for everybody else. As one of our main advocates, John Hughes, President of Rhythm and Hues, points out, California’s entertainment industry is having a hard time competing with those of other industrialized nations (that offer universal coverage)for many reasons, not the least of which is the cost of insuring top level employees. Small business owners, for their part, are healthcare consumers too, with families and health problems of their own. They don’t appreciate being forced to go without insurance or pay whatever a monopolized industry can extract for substandard plans.

To make a more general point: automatic cynicism is as idealistic as reflexive optimism. Batting away any hope for positive change is like refusing to hear bad news—-both reflexes demand a rejection of factual evidence. In truth, change is protracted, difficult and imperfect; and it is possible. Or we wouldn’t have Social Security at all, or, for that matter, universal suffrage.

Last year, California history was made when both houses of the legislature passed this bill. The Governor vetoed it, but he too has acknowledged the need to make healthcare reform a key priority. While, as of this writing, the Governor has not found a sponsor for his own ideas for reform, which combine old ideas, such as individual mandate and pay-or-play for businesses, his own stated goals only make SB 840 look more attractive: affordability, shared responsibility and preventive care/wellness. Single payer answers those needs and realizes two more principles: a mandate for quality care and genuine consumer choice.

Which brings me to my final point of the day. I don’t agree, Jon, that single payer would wipe out “American-style competition” or freedom of choice. If we were all insured, all healthcare providers would be competing for our business. And we would have more personal freedom to make decisions about whether to start businesses, go to school, get pregnant or change neighborhoods, because our insurance would follow us.