No Wrong Place to Start
In addition to thanking Jon for the great book, I want to thank him for doing the thankless job of just showing up at work every day and helping all of us to better understand the health care system through his invaluable writing for TNR.
The debate here on the political viability of single payer is interesting. But under today’s health care system, the single payer politics are not truly relevant. We’ve spent over 100 years creating our dysfunctional system, and the jump to single payer (if that is what the county wants) is something that would take significant policy and systems change. Just some of the prerequisites include reforming health care markets to offer affordable insurance, instituting systems to prevent medical errors, creating a system of electronic medical records, and developing a system where all employers and individuals share fairly in the responsibility of paying for care based on their income. More than politics, the biggest barrier to implementing single payer is the system itself.While some dismiss the prerequisites as “incremental” or “half-steps”, they are all necessary steps on the way the single payer system (again, if that is what you want). More importantly, many of these steps have broad political support. By focusing on reforms that expand coverage and improve efficiency, we can improve health care today. And, we will put the health system on a path to where the only barrier to single payer will be the political debate.
There is truly no wrong place to start on reform. Each positive step that we can take is a step towards a better health system.
Systems to reduce medical error and expansion of the use of EMRs are important goals and should be pursued regardless of how we reform health care financing. But "reforming health care markets to offer affordable insurance" is not a prerequisite of single payer reform. We've been doing that for decades and most parameters are worse.
Most in the policy community who support a single payer model define it to be a single, universal, publicly-administered and publicly-funded health insurance program. You do not get to there through reform of private insurance markets.
The conclusion of an article I wrote on why incremental reforms will not solve the health care crisis:
"Incremental models of reform perpetuate our flawed, fragmented system of funding health care. They perpetuate inequities both in the funding of health care and in the allocation of our health care resources. They limit choice of health care providers. None assures continuity of coverage and care. Many incremental proposals barely have an effect on the numbers of uninsured, and none of them ensure truly universal coverage. All incremental approaches substantially increase health care costs, and most current proposals assure neither financial security nor health security.
"In contrast, a single payer program would provide affordable, equitable, comprehensive care for everyone.
"Whether through tax policy, public programs, regulatory oversight, mandated coverage, or a combination of these and other interventions, the government will be intimately involved in our health care funding. We can no longer afford to dismiss any valid option because it is a government solution, especially in that all proposals are government solutions. We must decide how we can best use our government resources to be sure that we are receiving the greatest value for our health care investment. Limiting our consideration to various incremental solutions closes the door on the health care reform goals of equity, affordability, and efficiency, and it threatens the goals of universality, provider choice, access, and comprehensiveness. When all are readily achievable, why accept less?"
The Journal of the American Board of Family Practice 16:257-261 (2003)
April 13, 2007 3:58 PM | Reply | Permalink
Kudos and thanks to Don McCanne for his comment here and to for Jonathan for writing the book. My thanks also go out to TPM and all the posters on this thread for the much-needed and overdue discussion of this issue.
I agree, we must move to take action and reform the system but we can't accept more tinkering - it doesn't solve the problem, delays the real solution, and often makes things worse!!!
Many of us who've been working in healthcare for years know what Don says to be true, and as someone living with the disastrous Massachusetts health reform "individual mandate" plan these last few months we know it now more than ever.
For a hard-hitting Massachusetts update from a practicing nurse and health justice activist (me) click here http://www.bluemassgroup.com/diaries.do;jsessionid=A127AEBDA2924EA528289D265147EF99
April 13, 2007 10:15 PM | Reply | Permalink
Sorry, the error in the above link is now formatted the correct way below (I hope).
Click it to read a critique of the Mass. health reform fiasco including some of the unseemly "stakeholder" tactics...
Mass. Promise of "Universal" Health Care Forgotten
April 14, 2007 4:05 PM | Reply | Permalink
Gee, why is this not working? (Making a link is not this complicated on other blogs...) But I'm persistent so here's another try: To read a critique of the Mass. health reform fiasco including some of the unseemly "stakeholder" tactics click below...
Mass. Promise of "Universal" Health Care Forgotten
April 14, 2007 4:40 PM | Reply | Permalink