Should Single Payer Advocates Abandon Their Quest?
Should Single-Payer Advocates Abandon Their Quest?
Few in the healthcare reform movement deserve more admiration, in my view, than advocates of a single payer healthcare system similar to the one across our Northern border in Canada. They have defined the problems inherent in our unaffordable and unsustainable healthcare morass, and have offered us the compelling examples of the rest of the world's major democracies, which surpass us in providing care for more citizens at lower cost, and with better health outcomes. Only some of these nations utilize single payer, but all benefit from the existence of a strong public component to health care that is unavailable to most Americans. Single payer advocates have forced us to face that reality.
Having helped frame the debate here in such a convincing manner, should single payer advocates now declare victory and withdraw? I tentatively suggest they should, in most circumstances and most regions of the country. The reasons are both political and economic.
I believe that except for the most fervent few who see single payer as a religion rather than a policy option, most advocates are coming to realize that this option has never been politically viable in our current legislative atmosphere. Its non-viability is not the result of decisions made by individual leaders, nor of the timidity of congressional majorities, but of the character of the American public, who are wary of radical changes even in the abstract, and particularly wary of those whose opponents can sell as a conspiracy to execute a government takeover of medical care - an attitude reinforced by the reality that most Americans have health insurance and are not terribly dissatisfied with it despite the legitimate alarms sounded over its lack of sustainability in the long run.
Public opinion polls support healthcare reform. In some, a single payer has been supported by a majority when the only alternative is the status quo. Given a multitude of options, however, including a public/private combination, single payer tends to attract only minority support - and that showing is seen even in the absence of a concerted attack on it by political adversaries.
None of the current bills wending their way through Congress entails single payer, and the tenor of negotiations now suggest that it is the strength of even a meaningful public option that is being tested. If that is the case, and if a strong public option is critical for effective reform, much political advocacy must be devoted to its support, and little wasted on policies, however commendable, that have no chance of enactment. I will qualify that recommendation below, but let me proceed to the economic realities that doom single payer for the foreseeable future.
Beyond insurance reform and a need for less extortionate drug costs, healthcare reform, to provide sustainable affordability, must accomplish reforms within the healthcare system itself to eliminate an enormous array of duplicate or unnecessary facilities, services, and treatments, many incentivized by a fee for service payment system. Some of these enjoy excessive profits, but many (e.g., some rural hospitals) struggle to stay afloat financially. A reform that includes both a public option to reduce insurance costs, and a system reform to eliminate these other excesses will be quite radical in its own right. Even while we are in a recession, we must start eliminating many of the costly duplications, and that requires dismantling facilities with a consequent extensive loss of employment for many workers. The difficulty of this task is a reason it is inadequately addressed in all the pending legislation.
Instituting single payer would add to these economic hardships the dismantling of an entire industry - health insurance. Almost all economists believe the recovery from the current recession is likely to be very gradual and incomplete for at least the next 4-5 years, leaving unemployment a major concern until well into the future. Any severe challenge to job growth would be quite dangerous, and the legalization of any policy that threatens that danger would itself be dangerous, even if implementation were undertaken slowly.
Single payer nations and nations with hybrid public/private systems perform equally well elsewhere. I believe our chance to emulate the former will be almost non-existent for a decade or more, but our chance to emulate the latter is viable if we don't let it escape our grasp. One of the potent weapons used by opponents of a public option is the claim that it is a stealth attempt to institute single payer (a "government takeover" in their lexicon). Advocates who lend credibility to that claim weaken the prospects for a meaningful public option. I believe they must consider that in planning their efforts in the coming weeks.
Above, I mentioned a qualification. Much effort will now be spent in states and districts of legislators who are persuadable. Those areas are typified by constituents who are moderate or centrist in philosophy, and reluctant to endorse radical solutions. I believe that these would be areas where single payer advocacy is most damaging to public option proponents. On the other hand, I believe it would be salutary rather than counterproductive for fervent single payer advocates to continue their efforts here and elsewhere on the Internet and in the media to hold up single payer as an ideal, and to utilize it to offer the public a compelling contrast between where we are and where we eventually must go for adequate and humane healthcare for all, whether it be through a single payer system per se or one of the other models the rest of the world provides us for exploiting the virtues of a strong public role in healthcare.
Despite any other differences of opinion we may have on other issues, I agree with every word on this blog.
I believe there is an opportunity for Americans of every political persuasion to get drastic reforms required to fix the system even if it isn't a true single payer solution. We can get the changes we need to start down the long road to structural stability as well as financial sustainability, but only if we adequately position the medicine as something the American people will be willing to take.
Thanks for saying what I have been unable to convey in so many other ways.
August 2, 2009 4:02 PM | Reply | Permalink
There has to at least be a long phased transition from the existing employer provided insurance system to a single-payer system.
If health care expenditures are 16% of the economy, then there must be several percent of the economy flowing through the health insurance companies.
You don't suddenly change several percent of the economy -- not in this economic environment.
August 2, 2009 4:26 PM | Reply | Permalink
NO. Because whatever bill passes isn't going to do the job. It's going to be drastically underfunded. Fred and Jason probably already have great health insurance as do I but none of us are working stiffs in west Texas or rural Alabama. The focus is on reducing costs. We have met conservatism and it has become us (well not me but most Democrats). The bill is not about delivering quality healthcare to all Americans. Nope. It's about cutting costs. It might even do that. Is is going to put a clinic in west Texas? Is it going to put a provider in rural Alabama? Or is it just going to force the working poor in west Texas and rural Alabama to buy an insurance policy.
August 2, 2009 4:26 PM | Reply | Permalink
My insurance actually sucks in a myriad of way, not the least of which is that my wife is worried about having a baby with the plan we have due to the copays involved. We most likely won't without changing insurance providers or without drastic reform of the insurance industry.
Single payer health insurance still won't put medical clinics in rural Alabama or west Texas and does nothing to address the underlying causes of those deficiencies in the system. It won't change the nature of inner city emergency rooms or lack of healthy food alternatives in poor communities across the country.
There is no one solution to this problem and certainly no single piece of legislation will fix all that is wrong with our health care system, so I find any sort of idea that it would to be out of line with what we should reasonably expect from these initial reforms in our current political and economic environment.
August 2, 2009 5:13 PM | Reply | Permalink
I saw a TV ad today for BCBS advertising policies at low rates for people who don't plan to have a child. So I wonder what happens if your plans go awry and what happens to the cost of policies for people who do plan to have a child.
August 2, 2009 7:05 PM | Reply | Permalink
I guess you would add maternity coverage at whatever rate that was offered at. Lots of good question but a dearth of good answers.
August 2, 2009 7:13 PM | Reply | Permalink
No. We absolutely should not.
In fact I would suggest the opposite maybe some of those supporting public options etc should reconsider.
If you don't understand that half measures are going to empower a 'tremendous' political battle for years to come and it is very likely that nothing will be settled for years to come, then I think there are some very naive notions of what the results of a public option will actually be (especially if it does not take effect until 2013 which is part of at least one of the bills so far).
The profit makers in the health care industry are unlikely to accept a cut in their profits and will likely spare no expense in getting them back one way or another. I have little confidence that we will be successful in improving health insurance and health care with a public option.
August 2, 2009 5:38 PM | Reply | Permalink
I am in agreement with Sync here. But, going into states and working at that level is not a bad idea. We have Minnesota and Massachusetts models. I am a beneficiary of the Minnesota Model. And here, at least in my location, it is perfect. No kidding.
Part of me says that if Texas and Oklahoma do not want it, screw em.
Again, I am clearly for a one payer system period.
But working at the state level in the face of a clear defeat is not a bad idea.
August 2, 2009 6:34 PM | Reply | Permalink
Absolutely not.
The health care Lobby is pushing very hard from an extreme position knowing that compromise is found in the middle. By giving up that part of the progressive struggle, you cede ground that should be given grudgingly, and not without extracting a pound of flesh from the other side.
The grassroots should project that a strong public plan is the compromise, not the end goal ... otherwise the insurance companies are going to mop the floor with the public option. Have realistic expectations, but fight like hell for the ideal solution - knowing compromise is in the middle. If you get a chance to speak up in a town hall, make your neighbors THINK about what is possible ... get them nodding along. Don't make it easy on these guys.
Wussing out in the home stretch would be a HUGE mistake by the single payer advocates. There are enough of us who are genuine public option proponents to push that policy. We need the noise further to the left, or our position appears to be the extreme.
August 2, 2009 8:48 PM | Reply | Permalink
I understand your position, kgb999, and in certain venues, I would be inclined to agree. Overall, though, I'm not sure I can agree with your contention that "there are enough of us who are genuine public option proponents". My sense of the public attitude is that the public option advocacy needs every bit of focused support it can get, particularly since the House is currently inclined to propose a weakened version, and the Senate may omit a public option altogether in favor of a much less potent co-op scheme.
Once I'm convinced that a public option is something most of the electorate would support if they reject single payer and are looking for an alternative, I would urge the single payer advocates to keep pushing hard. At this point, I'm afraid that too many members of the public will see a public option as a disguised way to achieve single payer, and will reject both. Supporting a public option entails more than saying "I support it". It requires supporters to be able to explain it in detail to a puzzled public. The more confusion is introduced into the debate by conflicting alternatives, the harder that becomes. Momentum is also a factor. If the public option seems to have stalled, its appeal to the public and legislators alike will diminish, and in my view, won't be restored by a perception that a more extreme view is being touted by single payer proponents.
August 2, 2009 9:22 PM | Reply | Permalink
I'm with you on this. Every time someone asks me, I say that I'm 100% for a single payer plan, but I would consider a powerful public option as a compromise.
I believe that once you cede the ground of wanting a single payer, your position on a public option is subject to be weakened with further and further and further compromise.
Public option co-ops, state programs, none will be influential enough to make a difference.
The compromise is moving my support for a 100% single payer plan to one powerful influential public option.
Not a compromise on that public option.
There's a big difference.
August 2, 2009 9:42 PM | Reply | Permalink
sorry, I meant to say that in terms of my support, the compromise is moving from a single payer to offering Americans a powerful public option to compete with private insurers.
If you don't set the terms of the debate, you lose right away.
That's what happened to the idea of a single payer system. It was not even invited as part of the discussion.
Washington does not set the terms of what's best for Americans.
Americans do. And if it hasn't been that way in the past, it should be from now on.
We've been taken for granted in DC long enough.
August 2, 2009 9:46 PM | Reply | Permalink
That is why I still maintain that the democratic Congress really missed an opportunity to position insurance and provider reforms as the non-negotiable "compromise" to letting Medicare/Medicaid system be redesigned as the public option.
People on the left and right already support Medicare and Medicaid, both programs have existing infrastructure and both are in need of modernization and overhaul to become sustainable. This would have been the perfect way to accomplish many simultaneous goals while limiting political opposition to a common sense and long-overdue reform effort.
We wouldn't even be talking about co-ops if Medicare had been positioned as the public option rather than the basis for single payer. Maybe I am missing something obvious, but I think this sort of game plan would have been more successful than drawing lines in the sand around positions that were never going to be mainstream.
August 3, 2009 8:11 AM | Reply | Permalink
Isnt' it too late to shift the position here?
Obama and Democrats are on the record with the public option being a Trojan horse for single payer. This is now going to spread and get quoted endlessly.
So it's not clear to me how they can back out of it now.
http://www.youtube.com/watch?v=p-bY92mcOdk&feature=player_embedded
August 2, 2009 9:41 PM | Reply | Permalink
Shocking. Barney Frank wants single payer, and so did Obama circa 2003. Truly shocking!
It seems to me, if there is a choice and people won't choose an insurance company's product - that's the market saying their product is inferior. It further seems that if people have a choice, they wouldn't select care that is "rationed" or delivered poorly. The only way a public plan would lead to single payer is if the government, despite your skepticism, provides better service for less cost. As a consumer, I don't see a downside here. As a taxpayer, a government controlled system covering the poor as a pool seems a whole hell of a lot cheaper than getting back-billed $35 for an emergency room aspirin or paying for a bunch of individual policies negotiated in today's insurance market; again not a lot of downside.
Sucks to be a dinosaur, but that's evolution.
August 3, 2009 1:23 AM | Reply | Permalink
I'm beguiled by the last few comments. Some say single payer advocacy will advance a public option as a compromise, whereas others claim that touting a public option is a underhanded scheme to promote a single payer government takeover.
Although the later claim is based on the wishful thinking of extremists on both sides (the right wishing to frighten and the left to encourage), it has enough of a distracting effect to weaken the public option in most states or districts that are in play.
It's not that I haven't wrestled with the balance between single payer as a means of defining the limits of the debate (I stated that in my original post) versus single payer at this point having served that purpose and now undermining public option advocates. I believe that in some political regions, single payer advocacy may still be advantageous, as it is on the Internet. In many critical districts, however, my perspective is that a decisive issue will be whether a public option threatens to evolve into complete government control. Every moment public option advocates must spend explaining why that won't happen is a moment lost in explaining why the public option is necessary. It's already putting some reform advocates on the defensive on the national level.
My overall take on this is that there are benefits and disavantages to a continued single payer push at a high level, but that the benefits that were once the predominant factor have now lost ground to the disadvantages - in essence, single payer advocacy is now tending to discredit the public option in the eyes of too many voters to be as useful as it was in initially framing the debate.
I would add finally that my original post already explained why single payer is not going to be taken seriously for economic reasons unrelated to party politics, and I believe this too weakens the hand of serious reform advocates.
August 2, 2009 10:03 PM | Reply | Permalink
Hooey!
The only reason single payer isn't politically viable is because of people like you who know it is the right thing to do, but who, in their desire to seem smarter refuse to support it and instead back half measures and convoluted, ineffective byzantine plans (such as the beast moving through Congress right now)that cost more than necessary and that keep the malignant current system alive and and well. If people as smart as you would start standing up for what is right and refusing to take no for an answer instead of turning your backs on the appropriate policy option, conceding in advance that you will not win and instead supporting what you think in is a compromise you will have to make we would have had a single player plan in this country decades ago.
I would much rather see the half assed Obama insurance reform plan die and start from scratch in January on a plan that works for America instead of settling for a plan that works only for the insurance and pharma interests.
August 2, 2009 10:10 PM | Reply | Permalink
Oleeb's comment illustrates for me the danger of single payer advocacy as a distraction that will undermine support for a public option. I've also seen it happen in discussions and public forums, where reform opponents successfuly put reform advocates on the defensive by accusing them of secretly plotting a government takeover. That is not a good position to be in. It is much more effective for a public option to seen as enjoying unified and extensive support than for it to receive strong support from a minority and only grudging support from the remaining reformers. It is the unity and the level of enthusiasm rather than merely head counting that will be critical at this point.
As I just mentioned, single payer is not only non-viable politically, but also economically, and I therefore believe that it is best used as a model of what a powerful public component to healthcare can accomplish rather than as an effort in support of a reform that could not actually succeed in the economic climate of the next several years.
August 2, 2009 10:26 PM | Reply | Permalink
I'm tired of running away from a position because of fear of being demonized.
I'm 100% for a single payer plan. I won't be demonized for taking a position that most people believe is the right solution, but are scared in their boots for backing because their afraid of being called "socialists" by extremists.
The single payer plan is not an extremist position. It is a rational position.
August 2, 2009 11:14 PM | Reply | Permalink
Where is the evidence that "most people" support single payer as outlined in the Medicare-for-All bill?
Seems to me that "most people" support significant and serious health care reform efforts, but only a minority support single payer as the answer to our myriad of problems. Not even all democrats support single payer, so I am not sure how you can maintain that most Americans are in support of your preferred solution.
I think the better strategy would have been to combine ALL government medical resources (VA, TRICARE, Medicare, government workers, military, etc.) into a single "Americare" system and position that as the public option. Every single one of those programs is already widely supported on the left and right and all are in need of being brought into the 21st century from a cost-management perspective.
I have yet to see anything that comes close to an innovative solution from the right or left when it comes to health care.
August 3, 2009 8:20 AM | Reply | Permalink
ahh, you caught me using "most people" when I had no right to do so!:))
I hate when that happens.
Maybe you can help me define who I'm talking about. In your estimation, who believes in the concept of single payer?
How would you break down the kinds of people that support the concept of single payer?
-people who believe that's a good direction but it's not politically achievable right now?
-people who believe it's only good in theory but it's not economically feasible?
-people who believe that's a good direction but are afraid to be demonized as "socialized medicine" lovers for saying so?
-people who know in their hearts it's the right thing to do but would rather see special interest money in their pockets?
I know, I have a crude understanding of the specifics of a particular single payer plan and of the people that in theory or practice support it, but I'm trying to learn here.
August 3, 2009 4:01 PM | Reply | Permalink
I think that about covers it and pretty much explains why Medicare-for-All failed to gain traction in the House much less the Senate.
I think the best single payer advocates could have hoped for and should have suggested was the same kind of "public option" I describe in this comment. Imagine how nice would it have been if the single payer crowd had suggested something that was moderate, yet bold and innovative, and likely to be supported by the grassroots of both parties?
Instead we got more of the same partisan tactics and framing. Milton would understand my frustration.
August 4, 2009 11:12 AM | Reply | Permalink
Bah!
You are a defeatist Fred in accomodationist clothing.
You would be a perfect member of the milque toast Democratic Caucus in the House or in the Senate knowing damn well that single payer is the only viable solution and that the "reform" you are supporting is an expensive, cowardly means of trying to eventually, maybe, if everything goes alright back into actual health care reform without pissing off the high and mighty whose money and favor is worshipped and valued more than the lives of those who will die waiting for persons like yourself to have the guts to demand that the right thing be done by every citizen in this country and now.
Well ya know what? The advocates of single payer, those extremists you refer to, are people with the courage of their convictions Fred. They aren't extremists at all. They just aren't afraid to say what they are really for even if the rich and powerful don't want to hear it. They do so because it is the right thing to do. Those without the courage of their convictions abandon them at the first sign of trouble or conflict like the "centrist" or "corporate" Democrats do on every subject that might upset their true masters: the wealthy and powerful. But those who have the courage of their convictions are made of the stuff of leadership. That is what leadership is all about: the courage to do right and yes sometimes even when that position may not win the day today because common sense tells you that if you don't ever fight for what you really want and need you will never get it: never.
Listening to your advice we would still have slavery, child labor, sweat shops and 14 hour days without overtime pay and women wouldn't vote! Abolition of slavery, improving working conditions, wage and hour laws, women voting were all "unrealistic" and politically just not viable positions. Had those who wanted to accomplish those morally necessary measures listened to the kind of advice you hand out where would we be? We'd be in the same spot we find ourselves in regarding healthcare: no closer today than we were 50 years ago because the time has never been just right, it has never been "realistic" or "pramatic" to insist on making sure the health needs of our people are taken care of no matter how little or how much you make.
Leaders are supposed to take people over the tough terrain because that is where they need to go. Leaders lead not because it is easy but because it is hard. Does that phraseology ring a bell with ya? Leaders who only choose the easy path are not leaders at all but manipulators and con artists who sell out those who have trusted them. Our alleged political leaders in the Democratic Party in both the legislative and executive branches are not real leaders and you can tell because they run from every fight no matter how important the subject and always claim their cowardice is really just sensible pragmatism and realism. Leaders demonstrate courage by actually doing courageous things and inspiring others to do likewise by trying to do right and by attempting to lead people in the right direction. And, importantly, when necessary, real leaders fight against those who stand in the way of progress, they fight the liars, they fight the rich and powerful interests whose sole concern is continuing to reap undeserved trillions in profits forever no matter what the human or economic cost to others or the nation. Real leaders also resist the lure of the money and position the powerful can offer them after their public service is finished. That is what genuine leaders do. But it is painfully clear we don't have any of them either at 1600 Pennsylvania or on Capitol Hill.
But you and our faux "leaders" are happy with your personal situation so you can posture as though you are some kind of philosophical and eminently rational policy wonk whilst doing little more than placating the desires of the predator classes. What pretentious hooey! This isn't an intellectual construct for God's sake! We are talking about people's lives man! People are actually suffering and they die because we don't have a decent national health system in this country that covers every citizen like every other industrialized country on earth has and has had for many, many years!
Of course it isn't your life hanging in the balance so it isn't a "real" crisis in your august opinion other than from an intellectual and policy standpoint and that is why you council people not to expect too much and not to demand too much and not to fight too hard but instead to accept some paltry and entireley inadequate subsitute that isn't healthcare reform at all but an insurance subsidy plan that will cost us money we don't have when we could instead quit wasting time and money and lives and make the leap now as we need to, to a rational unified healthcare system with one payer that serves the needs of all our people. It's time to get off that tired old path of accomodation, delay and defeat! You'll be long dead before any real healthcare reform ever becomes reality and so will your children if you stay on that road with the pussilanimous Democrats who caved in to the parasitical insurance and pharma interests before the debate even began. And they orchestrated this whole disaster first and foremost by saying from before day one that single payer is "unrealistic" and not politically practical and thus off the table. Do you not see that it is a red herring and that those of you who sing this song are doing the work of the bad guys for them? The insurance reform plan you support is a pale substitute for what is needed and it only prolongs the pain and suffering the profiteers demand in order to gorge themselves on profits at the expense of other people's actual health!!!!!!! Their health!!!!!!! That is flatly immoral!
How can you be so morally indifferent as to sit back and pontificate day after day about this when you are dead wrong and demonstrably so! This road of capitulation and compromise has never produced a good result in any policy area. It only produces disasters and stalls real progress for the common people of our nation. Typically the purpose of the kind of approach you support is precisely to stall, if not kill, real reform regardless of the policy area. You and your fellow travelers in this pursuit of fruitless centrism and compromise are, despite your protestations, the best friends the status guo has. You are the healthcare policy equivalient of Grima Wormtongue in The Lord of the Rings always whispering defeat and caution and cowardice into the ear of the King of Rohan. Like in the story, eventually the magic spell will wear off and when that happens please and finally just get out of the way.
August 3, 2009 2:24 AM | Reply | Permalink
WOW!
Oleeb, I think you should post these comments as a separate blog so more people will read it.
And thank you for this jolt. WOW!
August 3, 2009 7:54 AM | Reply | Permalink
This is exactly why "liberals" are anything but progressive and continue to fail utterly at shifting this country to a more common sense place closer to the left of center. Using bombastic language and aggressive tactics to force your idea of perfection down the throats of unwilling fellow citizens is the true definition of demagogue or defeatist.
You seek to keep us mired in the past, beholden to "solutions" designed nearly fifty years ago, as if that is the only solution to the problem. Of course, you ignore the fact that only two countries in the world have the type of single payer insurance you are talking about and none of them started with the complexity we are dealing with at the beginning of the effort. We have an opportunity to make government answer to us by coming together over compromises at the grassroots, but you seek to impose obedience to a plan that simply cannot be paid for in its current form.
You advocate a one-dimensional solution to solve a three-dimensional problem and anyone who disagrees with Oracle Oleeb is an champion of the Forces of Evil. Wow. That is some seriously partisan and paranoid ranting, not to mention being exactly 180 degrees out from the tactics necessary to accomplish your stated goals.
I see the Raging Left is as irony challenged as the Rapture Right.
August 3, 2009 8:29 AM | Reply | Permalink
Sorry, first sentence should have read: This is why SOME "liberals" are anything but....
August 3, 2009 8:33 AM | Reply | Permalink
Jason, I'm really not sure, but I doubt very much there are a whole lot of Democratic reps making speeches like Oleeb's. So to say it's his kind of position which has failed the Democrats and the liberals is a bit of an odd usage.
Now, you feel this has never been the approach in great policy-making. But the 30's were the time when many of these policies were put in place, and countries were full of fire-breathing preacher types, who managed to help build the grassroots support and the political platform from which change could be introduced. In Canada, oddly enough, even though universal health came late (the 60's), it was led even then by Tommy Douglas, an ordained Baptist Minister who was a powerful preacher and didn't shy away from moral issues.
And since we're into labelling positions (Raging Left etc.), how about this. I see the Moderate Middle as having little imagination, and no courage. There. That seems fair.
August 3, 2009 1:53 PM | Reply | Permalink
No surprise that I disagree with the underlying idea that progress is made on the wings of protest, though I will admit that protest likely drives the compromises that emerge from Washington.
Our most progressive legislative acts were supported by large portions of the public, irrespective of what was going on Congress and many times in opposition to it. Many of those solutions came over a number of years as well - the New Deal projects come immediately to mind, but Civil Rights was passed in stages as well - starting out as compromise solutions to get the ball rolling.
I think American "moderates" tend to bring our bipolar natures together long enough to make actual progress.
August 3, 2009 2:30 PM | Reply | Permalink
As usual, oleeb, a very well written albeit deeply nuanced response. I agree that this would be well considered to be written as a separate blog, but please don't hold back if you choose to do so. ;O)
It is frustrating when the argument for universal single payer health care is such a slam dunk, and yet the so-called "pragmatists" tell us that we dare not introduce it as an option for consideration lest we upset the monied interests that own this government. I say screw 'em, and serve it all up on a pitchfork if necessary.
If ever there was an opportunity for populism to prevail, this health care debate is it. It also provides additional bonus in drawing attention to the need for campaign finance reform as well. It's far too important to simply give up the fight and agree to a compromise that promises nothing but defeat of any genuine reform.
I admire your passion on this, oleeb. Keep up the good fight.
August 3, 2009 8:37 AM | Reply | Permalink
I third the notion of taking this comment to a blog:)
August 3, 2009 11:48 AM | Reply | Permalink
Amen, Brother Oleeb. You're kicking ass today. q
August 3, 2009 1:44 PM | Reply | Permalink
I don't have time to elaborate, Fred, and I know you're talking about HC here, but I think you're wrong about our adaptability to radical change. Of course, if America is subject to relentless distortions and industry propaganda about what a scary new system will do, many will balk at changing anything.
We've had eight years of the most radical government and economic changes in my lifetime and hardly any of it has been positive change. But people have accepted the most radical government encroachments in the name of security (from terrorism, economic depression, etc.). I believe most Americans realize that drastic change is needed (and, incidentally, voted for exactly that).
Our system is beyond repair. Health care reform cannot just be a bandaid. The only people, it seems, who do not realize what a mess our system is in are the people tasked with fixing it and their well paid corporate friends.
August 2, 2009 10:44 PM | Reply | Permalink
In general terms, Don, I agree with you. However, as someone closely watching the healthcare reform debate, aware of public opinion, and also cognizant of the economic issues involved, I'm confident in saying that a single payer option would be unacceptable to a large majority of the public and an even larger majority of economists. The claim that a public option is single payer in disguise is one of the most serious threats to the public option currently operating.
At this point, the public mood is strongly opposed to anything radical in the direction of more government involvement. This is partly the result of a scare campaign by opponents, but also a reflection of the fact that most Americans have health insurance and are well enough satisfied with it to by very wary of anything radical. That's a reality I read about every day in following this issue.
What is being proposed is not a band-aid but reform so sweeping as to portend a transformative moment in American society. That would be the case even without any public component, never mind single payer. If you read the details of the legislation (HR3200 would take you about three weeks but you could skim it), you will appreciate its magnitude. I believe a strong public option is an essential ingredient, but that will add to the magnitude of trransformation.
That single payer is off the table is not a point that can be argued from a philosophical perspective but requires an unsparingly objective appraisal of eality; what one might wish like can't be substituted. I've already stated why it wouldn't work politically but also economically.
I've appreciated the efforts of single payer advocates, and I believe they have helped inform public opinion. They have now become counterproductive in my view, not for general philosophical reasons but because that's what the evidence tells us, both from polling data and from discussions, forums, and other sources of information.
While single payer is not a realistic option currently, it remains one model among many of what other societies can do that we must try to emulate. A public option remains realistic as long as it enjoys substantial and vigorous support. What I fear is that the support will be drained by the distraction of single payer - both from the efforts of single payer supporters and of reform opponents. I don't want that to happen.
August 2, 2009 11:16 PM | Reply | Permalink
sorry for the typos in that one line - the line should read "reality; what one might wish can't be substituted"
August 2, 2009 11:20 PM | Reply | Permalink
I wish to add one more thing to earlier comments. I not only understand but respect the passion of single payer advocates. I do wish, however, that none would inform me that I personally know single payer to be the right policy to support, as though implying that I'm somehow fearful of expressing that publicly.
I am just as sincere as others here in saying that I believe support for single payer in most political venues is a bad idea. I've given my reasons, and others are free to disagree. I simply ask not to be informed what I really think.
August 2, 2009 11:26 PM | Reply | Permalink
I think folks are saying they feel you believe it to be a better policy choice barring other political considerations. And in all fairness, even your last paragraph on this comment could leave that impression.
Personally, I don't think single payer is the right policy for the current economic situation. But I think you are totally off base tactically.
In my observation the big guns (MoveOn, Howard Dean, SEIU, etc.) and the more organized genuine grassroots (like Hamsher's folks) are pouring in vast resources to frame the private option. A visible articulation that the citizenry want to go even further would be a great tactical advantage and allow legislators to counter: "look, we're already getting killed by our base! What more do you want from us?" when they get back to the table in the fall.
Do you want the debate to be all answering questions about Obama killing people's grandma - or should it be about how the reforms, including a strong Public Option, can effectively provide quality care and across the board savings even if it isn't the questioner's preferred single payer solution? Properly framed intelligent pushes for single payer, especially in a town-hall setting, could be extremely helpful in refocusing the discussion from fear tactics to policy.
August 3, 2009 2:06 AM | Reply | Permalink
Fred, this blog is a nightmare. Really. Your constant push to collapse political options, to narrow things down, smaller and narrower, is the same shit that's collapsed the political possibilities of the Democrats - yet you blunder on, insulting everyone looking for change and seemingly unaware of what you're doing.
How about this. The Dems had a majority, a whopping big mandate for change, and a collapsing economy that (oddly enough) provided all sorts of fiscal room for change.... But people who held YOUR views then took single payer off the table. THEY split the forces for health reform. Was it because the voters knew so much more about some "public option"? Hell no. So YOUR guys took the BETTER-KNOWN option off the table, and split the support for health care reform... but now you feel justified in wandering back and suggesting that single payer backers should shut up and play for unity?
It's obnoxious.
And it's always the same, always arguments like this crap. Where hundreds of millions of people who live in single payer worlds got labelled as "extremist" by people like Fred, who hasn't clue #1 that his own nation, and the perspective he holds on health reform and its viability, is held only by a vanishingly small fraction of educated humanity. But all others are extremists in Fred's world of very very narrow reason.
And now it's backed up by "economists" who fear laying off so many people during a crash. Hmmmm. No economists out there saying we really drastically need to cut costs for manufacturers and businesses? No economists arguing that we have to cut the costs for hard-pressed families so they don't lose their houses? No economists arguing that we need radical surgery on our economy in order to handle the fiscal pressures now rising around our necks? No economists smart enough to say that these benefits are so large we can afford to pay for transitions for these workers?
Not in Fred's world.
August 3, 2009 4:01 AM | Reply | Permalink
GOD SAID TO ABRAHAM KILL ME A SON.
I awaited the second coming. It did not come.
But, damn, Grandma Pelosi read off abunch of changes.
And it was one hell of a list Q.
I mean, there has been enough to piss off the worst damn mother frickers i know, including rush, sean, savagewiener, and a b unch of others.
http://www.youtube.com/watch?v=2BH8U_z7Q6c
Our government works in mysterious ways.
August 3, 2009 4:42 AM | Reply | Permalink
The closest I could find of a country our size on single player is Japan at 123 million, but they have some issues right now keeping it paid for at less than half our size. They didn't replace a well-established (though admittedly broken) private insurance system that most of their citizens were marginally satisfied with, though. Nor did they have an existing and popular government run medical plan that could be easily turned into the public option for the uninsured or uninsurable.
Change the context for any country currently on single payer to one that matches ours and perhaps they come out looking for like the Germans or the Swiss.
Let's compare apples to apples and not oranges to orangutans. Let's also not forget that there have been sustainability issues with strictly single payer systems that don't exist in countries with a hybrid system. Add in our huge population and our general level of (un)wellness as a nation and I don't think advocating a solution that ALL Americans can support is necessarily poor tactics on Fred's part.
Health care reform needs that level of support moving forward or it will fail. Putting a solution in place that can't be supported, either politically or financially, makes little sense to me. Reforming the current system, if possible, is always the most reasonable from a cost perspective as well as a user acceptance one.
I don't think tearing into people who mostly support the big picture goals you are trying to achieve helps your cause any, but then again I am mostly here to piss you off.
August 3, 2009 9:00 AM | Reply | Permalink
There are "sustainability issues" with private insurance. The point is utterly moot.
August 3, 2009 9:02 AM | Reply | Permalink
As it currently exists, perhaps, but not as it is regulated in many countries without single payer. The point is far from moot.
August 3, 2009 9:17 AM | Reply | Permalink
We've had this discussion before, jason, regarding the wisdom of pragmatism over the discomfort created by idealogues. At last, here is the case where the pragmatists have clearly taken a great idea - health care reform - and have managed to steer it into one blind alley after another in pursuit of an easy fix.
It was Obama the pragmatist who eliminated outright single payer, universal health care (SPUHC) as an option to be discussed alongside any other suggestions for health care reform. He knew that the health insurance industry would certainly not sanction nor participate in any discussions that included single payer, universal health care (SPUHC) wherein they would have to justify their parasitic role in the provision of health care in this country. It is a discussion they would lose, for reasons pointed out in my most recent blog post.
The pragmatic Obama calculated that it would be too big a challenge, politically, to confront the health insurance industry with any notion that they represent a lion's share of the problem with the way health care is provided in this country. For this reason, even a discussion of SPUHC could not be allowed, for these insurance companies could not be expected to prevail in arguing against the intuitive logic that says they are wastefully superfluous to any system that would provide universal health care coverage.
Instead, Obama and Congress have attempted to devise a complex, convoluted solution that somehow will get us to universal health care without actually fixing the primary problem. We may not eliminate any of the incredible waste and inefficiencies of the insurance industry that now strangles our health care system, they seem to say, but at least we will arrive at a bipartisan agreement to do something!
This isn't leadership that's being provided. In the end, it isn't even pragmatism that causes policymakers to run hither and yon in search of marginal changes that can be made on the edges of our health care system, just for purpose of gaining bipartisan approval to do something.
No, real leadership would have stoked the populist fires right out of the gate. The health insurance industry presents such a terrific and deserving target that a real leader would have handed out pitchforks and said "Let's have at 'em, boys!" And a real leader would have welcomed opposition from the opposing political party if they, in fact, chose to defend the insurance industry against the righteous anger of those whom they have preyed upon for so many years.
Ultimately, Obama had the choice to allow the electorate to at last exercise power in insisting that their own interests would be served before those of the parasitic special interests who take our health care dollars and offer us little in return. Instead, he has taken the middle road and will seemingly run it until any notion of true health care reform runs completely out of gas.
August 3, 2009 11:15 AM | Reply | Permalink
I think you confuse the desire for a different solution as a desire for no solution and paint all objections to single payer as obstruction. That framing is detrimental to actually getting a reform bill passed that is accepted by most Americans and can actually be successful at reaching our end goals.
Medicare-for-All, as it is currently envisioned and as Medicare itself currently runs, is not a sustainable solution or system. Obama has gone after the health care reform he spoke of during the primary. He has actually succeeded at pushing a divided Congress toward his preferred fixes as outlined in the linked to summary and none of them are easy or the result of blind-alley discussions.
I guess I would refer you to this comment by NC Steve. It really is a better summation than I care to come up with right now.
August 3, 2009 1:10 PM | Reply | Permalink
Jason, what pisses me off about Fred's piece is that what he argues is clearly hypocritical, and that he attempts to position himself as the calm voice of reason, and is in no way aware of the tricks he uses to simply label, smear and insult the other side. On #1, he wants the health reform voice to be unified, and dislikes the confusion caused by having more than one option out there, right? But a while back, it was HIS side of the argument that tossed single-payer from the discussion, and cooked up the public option idea. On #2, he keeps on calling anyone who wants single payer "extremist." I have repeatedly called him out on this, said it's an old political smear, etc. and his response at the time was only that he was glad we "extremists" existed because it helped Obama by making him look so much more moderate. Now however, he's out there appealing to the extremists, now it seems their existence doesn't make Obama look more moderate, etc.
So don't come on all calf-eyed and worried about attacks on dear Fred, he was busy glorying in his name-calling - and continues to do it today, seemingly without even noticing.
As for your argument about size and population, I've responded to it before, and I really really really wish you would go and look at a damn list of nations by population. Why? Because...THERE ARE NO DEVELOPED COUNTRIES WITH POPULATION'S LARGER THAN THE US'S OR JAPAN'S (unless you count Russia, which is just marginally larger, and perhaps may still be considered "developed.") So, I know you really really think it essential that there be a single payer system run in a country that is sized closer to the US, but that can't be done - not because the system won't work, but because developed countries of that size don't exist. It's just China, India, Indonesia, Pakistan, Nigeria, etc. The size/population argument makes no sense anyway, as it's all about cost per person, right?
As for statements like this, "Reforming the current system, if possible, is always the most reasonable from a cost perspective as well as a user acceptance one." - well, that's just ridiculous. Reform is ALWAYS most reasonable and cost-effective? Errr, Jason. In your argument, a movement to single payer or other strong public universal form is, by definition, the most radical response, right? And yet, we now have every other developed nation having taken that "radical" road. And, in every case, their costs are LESS than the US's - even after the US reforms. Also, in every case, the public supports the "radical" system.
In short, your statement should read, "Reforming the current system, if possible, is NEVER the most reasonable....."
August 3, 2009 1:34 PM | Reply | Permalink
I don't dispute that in a perfect world, implementing single payer would save enormous amounts of money over our current system. It would require a huge shift in public perceptions, but it is have the potential to save us money.
I do dispute the notion that it is the only way to fix the system though.
If a single payer plan was run as poorly as Medicare has been or the Defense Department or any number of executive cabinets, such a system would be quickly unsustainable with the fate of 320 million up to chance instead of 100 million of so by creating a strong public option that covers those currently on government plans as well as the uninsured. I prefer one that looks like , but I am flexible about the final form as long as it delivers the desired ends.
I guess I didn't see Fred's blog in the same light as you did because I agree with many of his conclusions.
August 3, 2009 1:46 PM | Reply | Permalink
And don't get me wrong, I DO support the creation of a strong public option. But if created, and left unfettered, I would very much suspect it beats most of the private systems, and forces them to collapse, compete or.... use the legislative system to hobble the public option further. If that's the final choice in voting, I'll take it, ok?
But people who simply say, "lay down your single payer option" aren't necessarily proposing good politics. Sometimes, only the strong stance can really powerfully attack the private insurer interests, for instance. And so, people get to hear that in a way that the Public Option can never say. They can also make the public option look calmer. These can both be useful and powerful roles played by Full Public Insurance folks. As for the votes being there at the end, if the public option looks independent and strong, I'd bet the farm any single payer advocate in Congress would support it.
August 3, 2009 1:59 PM | Reply | Permalink
Agreed, but I don't think Fred was calling for an armistice as much as a shift in strategies based on the context of a given medium and local.
Many moderates won't respond to a single payer argument but very well may buy a public option and regulation of private insurance as a way to fix the current system's major inequities.
I saw Fred as asking single payer advocates to be a bit more cognizant of which frame to use in a given discussion.
August 3, 2009 2:39 PM | Reply | Permalink
We've had this discussion before, jason, regarding the wisdom of pragmatism over the discomfort created by idealogues. At last, here is the case where the pragmatists have clearly taken a great idea - health care reform - and have managed to steer it into one blind alley after another in pursuit of an easy fix.
It was Obama the pragmatist who eliminated outright single payer, universal health care (SPUHC) as an option to be discussed alongside any other suggestions for health care reform. He knew that the health insurance industry would certainly not sanction nor participate in any discussions that included single payer, universal health care (SPUHC) wherein they would have to justify their parasitic role in the provision of health care in this country. It is a discussion they would lose, for reasons pointed out in my most recent blog post.
The pragmatic Obama calculated that it would be too big a challenge, politically, to confront the health insurance industry with any notion that they represent a lion's share of the problem with the way health care is provided in this country. For this reason, even a discussion of SPUHC could not be allowed, for these insurance companies could not be expected to prevail in arguing against the intuitive logic that says they are wastefully superfluous to any system that would provide universal health care coverage.
Instead, Obama and Congress have attempted to devise a complex, convoluted solution that somehow will get us to universal health care without actually fixing the primary problem. We may not eliminate any of the incredible waste and inefficiencies of the insurance industry that now strangles our health care system, they seem to say, but at least we will arrive at a bipartisan agreement to do something!
This isn't leadership that's being provided. In the end, it isn't even pragmatism that causes policymakers to run hither and yon in search of marginal changes that can be made on the edges of our health care system, just for purpose of gaining bipartisan approval to do something.
No, real leadership would have stoked the populist fires right out of the gate. The health insurance industry presents such a terrific and deserving target that a real leader would have handed out pitchforks and said "Let's have at 'em, boys!" And a real leader would have welcomed opposition from the opposing political party if they, in fact, chose to defend the insurance industry against the righteous anger of those whom they have preyed upon for so many years.
Ultimately, Obama had the choice to allow the electorate to at last exercise power in insisting that their own interests would be served before those of the parasitic special interests who take our health care dollars and offer us little in return. Instead, he has taken the middle road and will seemingly run it until any notion of true health care reform runs completely out of gas.
August 4, 2009 8:48 AM | Reply | Permalink
Who do we put out of business next? The pharmaceutical companies or government contractors? How about the petrochemical industry and food manufacturers and General Electric? I bet we could kill every industry we have allowed to get out of control over the last forty years if we tried really hard.
Advocating a heart lung transplant when diet and exercise might cure the symptoms we are experiencing seems a bit extreme to me.
I have commented on this stance by some advocates of single payer in numerous ways and my answer is still the same. Medicare in its current form is unsustainable, so there is serious doubt the government could pull off national single payer and certainly not one based on Medicare. Based on the lack of performance of the government at just about every level gives me serious qualms with throwing all our health care dollars into one basket. Our most successful national efforts in recent years have been small private efforts funded with public dollars. Funds put into research or nonprofit causes have had huge returns.
Bigger budgets lead to more corruption and not less, whether public or private. The Defense Department is one example but there are many others and all are riddled with piss-poor contract management leading to wide-spread fraud, waste and abuse. The health insurance system we have is bad enough as it is scattered among dozens of entities with differing strategies and tactics. Put it all in one place and it becomes easier to loot the system, not more difficult. Look at the Medicare link above as an example of the single largest insured population in America getting snookered daily by medical providers.
Or the Federal Reserve.
Medicare and all the rest of the government health programs have been around for decades and have gotten steadily less sustainable with the exception of the military health care system. I bet TRICARE-for-All would have gotten much less resistance. It is not a money thing with Medicare or an ideology thing. Medicare has plenty of cash and members of parties love it, but it is not sustainable because it leaks like a sieve and flows out into the broken foundations of our health care system to combine with all the rest of our myriad of symptoms.
We can take excess profit out of health care and not kill private insurance companies in the process. We need immediate regulation, set expectations for a minimum allowable plan with a set price and draconian enforcement of those standards. We can fix our existing system using smart strategies that seek to reconcile private businesses with public interests. Maybe this initial legislation leads to a nonprofit health insurance system as being the only sustainable method of paying for health care in a universal fashion. Something more like the Dutch or the Swiss system. This would also cure our Medicare problem because we fixed private insurance to the point that it could be trusted with the public plans.
It would also be a private system, regulated by government, that most moderate conservatives have no problem with. Don't you want a system that everyone in America will support and defend instead of just liberals?
Not all objections to unworkable or untenable solutions are equal to obstruction of health care reform. As far as I can tell, Obama has done exactly what he campaigned on with regards to this particular subject, which is more than most presidents can say over the last four decades.
August 4, 2009 9:45 AM | Reply | Permalink
Don't give me this "OMYGAWD THE SOCIALISTS ARE COMING" fearmongering boogeyman crap that parrots the GOP talking points, jason. I would expect better from you.
The governments of Canada, Great Britain, Germany, and elsewhere do a pretty remarkable job of providing health care to its citizenry. The insurance companies fail miserably. Pretty much end of story if we look past ideologies and into the real world. Sometimes, "socialism" ain't such a bad thing.
August 4, 2009 10:05 AM | Reply | Permalink
Germany, Switzerland, Holland and others have a system closer to the one that I describe than the one your describe. It is your insistence on "Single Payer or Fuck Off!" that is not helping move significant and effective health care reform forward.
August 4, 2009 10:16 AM | Reply | Permalink
Oh, you misunderstand, jason. My position is not "single payer or fuck off!" If necessary because of the sorry state of our pay-to-play politics that we must settle for a "public option," then I am willing to place my bet that the insurance industry will not be able to compete and so I could accept a legitimate public option with faith that we will eventually arrive at a systemic solution as needed. I am just not willing to start negotiations with the "public option" as my position to be bargained away into a compromise. Instead, I seek what I perceive to be the best option and then look to pragmatically consider compromising from there.
But make no mistake about it, I do NOT see the health insurance industry as being legitimate contributors to any sustainable health care system, but rather as a parasitical systemic problem that needs to be cured. And this is ALL about a systemic cure for our health care system, which must be undertaken before we can hope to tinker with everything else that's needed. All one needs do is listen to the Moyers interview that I linked to earlier to see unequivocally that the the health insurance industry is a systemic problem that requires strong intervention.
Is that clear enough now, or do I go for the crayolas?
August 4, 2009 10:42 AM | Reply | Permalink
I understand your position and countered that every industry that has not been properly regulated has been a blight on this country. The answer isn't to shut private insurers down anymore than it was to shut those other industries down. The answer is to harness corporate America to provide for our needs like just about every other country has done with their corporate culture. Encountering the same problems we did, most modern medical payment systems used the methods I have described to fix private insurance nightmares them rather than replace them with single payer.
You misunderstand my position as well I think. We should not compromise at all. There are serious and fatal flaws in the current system that must be addressed. Kind of like when the FDA was created because of massive contamination in Chicago meatpacking plants. We didn't start the Uncle Sam Butchery as a response. We instituted regulations and enforced them for years. It is only recently that the system has really broken down because of the growth in the industry as well ideological crap from the RNC and DLC stooges.
Much the same as the regulations around the financial industry broke down under the last two administrations after sixty years of controlling bubbles.
I think we can achieve an unassailable public plan that ties together all the various and sundry public plans into a single Americare plan and infrastructure. While that system is being perfected we use regulation and enforcement to bring insurance companies under control. If they find that a fair and structured system is not conducive to a profit-driven company, then I suspect that most will go into a new business or they will become non profits.
Either way, we get the ends we need without using a single payer solution that many Americans don't think will work and can't seem to get behind in its current form.
August 4, 2009 11:05 AM | Reply | Permalink
PS: Once again this is a non-answer that uses hyperbole and caricature as a way to offer a argument that is tangential at best (strawman at worst) and not even true in the absolutist language you use to describe outcomes in other countries or how they arrived there.
August 4, 2009 10:36 AM | Reply | Permalink
Not in Fred's world.
I share your ardent desire, Quinn, to see us move toward a society offering affordable healthcare to all. I also see myself as attempting, sometimes ineffectively or even misguidedly, to create a bridge between the world of some TPMers and the real world. This requires an ability to forego wishful thinking and face existing realities without illusion.
I'm pleased this blog has inspired impassioned debate, because it shows how many of us care about this subject. I knew when I wrote my post that many who spoke up would resist my message. Not being omniscient, I can't prove them wrong, but I can ask others to read through what's written here to form their own judgments. Without intending any arrogance, I expect that there are readers who haven't commented but who have perceived at least some wisdom in what I wrote. I expect they perhaps may now be more willing than before to join public option supporters to confront reform opponents with a determined, united front, so that we can all achieve something that is achievable within our reach, and thus move us all closer - much closer - to our shared goals.
August 3, 2009 10:19 AM | Reply | Permalink
For me pursuing the public option is a bit like creating a 'health insurance czar' and a 'war on health insurance malpractice' and creating a never ending waste of time, money, and energy while continuing to struggle with substandard care.
August 3, 2009 10:50 AM | Reply | Permalink
Agreed.
From what I see, we are going to end up with a mess that in NO WAY will have any effect on actual health care! I am terribly disappointed in Obama on this whole issue. His stance is nothing but a big cop out.
What is happening should be called "Health Insurance Reform" except that they really are not even talking about insurance reform--just about making it available to more people who than must buy it whether they want it or not. Insurance is the biggest problem with health care and insurance has caused what health care there is to be pretty awful.
August 3, 2009 2:56 PM | Reply | Permalink
Fred I support a public option and think it's the compromise that's going to be adopted. But like Obama if I was starting from scratch, in a perfect world with an honest opposition party operating in good faith (which we don't have), I'd go with single payer. But I'm not a single payer absolutist who prefers my way or no reform at all.
That said we're going to lose a lot of jobs anyway with the public option. A big part will come from adopting a universal healthcare IT system. That "one form you fill out" that everybody from Gingrich to Hillary agreed we needed last year. If we digitize healthcare records with a system like the VA's open source VistA, (not to be confused with MS's crappy operating system) which is the best in the world, millions of clerks in doctors offices and insurance companies are going to be out of a job.
Regardless we must do it, it's for the greater good. But the point is single payer or public option, those jobs are going away anyway.
I don't think single payer advocates ought to stand down. They add valuable weight to our side of the argument. It makes a strong public option the compromise, the middle choice, instead of the furthest left position. Conceding ground to whackjob Republicans who are screaming we're going to kill grandma at this point is not the way to win policy debates or get legislation passed.
August 3, 2009 10:03 AM | Reply | Permalink
Maybe we can encourage them to become providers instead of administrators? Or teachers or scientists or whatever.
I agree that jobs are going to be lost. Alleviating those concerns may go a long way toward lower opposition to a strong public option.
Great thoughts.
August 3, 2009 10:16 AM | Reply | Permalink
Jason these aren't administrators, they're clerk, actuaries, etcx. Every doctor's office has two or three clerks whose job it is to navigate the maze of insurance forms it takes to get paid. Those jobs are going to go away. When insurance companies can no longer deny care they're going to need a lot fewer actuaries whose job it is to find ways not to pay your bill.
We'll have to have retraining funds. The plus side is without healthcare costs hamstringing the rest of American business so badly, new jobs will open up and the economy should get going again that much faster.
August 3, 2009 12:08 PM | Reply | Permalink
On the up side, there's growing demand for the exact skillset of people in that segment in the legal world. The number of different systems used for billing by corporations and liability insurers is getting worse and worse and no one's going to force uniformity or fairness on them.
In a larger sense, I look at those people as being like all the people in the defense industry who were downsized during the post-Cold War build down. At first, it sucked to be them, but when they took the knowledge and skills they'd acquired building weapons and applied it to providing products and services ordinary people could actually buy and use, they accounted for a significant chunk of the 90s boom (both the good part and the bad part).
August 3, 2009 12:21 PM | Reply | Permalink
Please forgive the shorthand. I know a lot of different types of smart people will need to be directed in a totally new direction. Agreed that the needed reforms should free up the needed cash for it.
August 3, 2009 12:59 PM | Reply | Permalink
Mark: is it not possible that, for every insurance wrangler job lost in an individual physician's office, a job would be created for just such an experienced paper/phone expert with Medicare....if a single payer plan were implemented? I may be mistaken about this, but Medicare offices are located in every state and every city are they not?
August 3, 2009 2:24 PM | Reply | Permalink
No wwstaebler it's not possible to wring cost savings out of the system by standardizing insurance forms and digitizing it all, just like most other businesses did during the 1980s and 1990s, and then hire these same people to shuffle papers. They have to find other work.
The good news is with those cost savings to businesses and individuals there will be more growth and more jobs.
August 3, 2009 2:50 PM | Reply | Permalink
Abandon? By no means! But appreciate the fact that getting a single payer system through this policy window is not possible and beware lest you direct your energies away from what is possible now.
Whatever the outocme of the current push, we can be reasonably certain that the window for additional policy initiatives in health care of a major nature will close.
The key question then is: how does the current legislation and more specifically what in the current legislation helps to put us on a ..hate the term..."glide path" to single payer?
The public option obviously would be a giant step but recognize that policy making at the national level is a messy and difficult business and that the default mode is incremental change.
Windows for major change are narrow indeed
August 3, 2009 11:06 AM | Reply | Permalink
Preview of coming attractions...
Birther socialist crowd at Sebelius/Specter Town Hall
Right Wingers Wreak Havoc on Philadelphia Town Meeting
http://www.huffingtonpost.com/denise-dennis/right-wingers-wreak-havoc_b_249897.html?view=print
August 3, 2009 11:13 AM | Reply | Permalink
The decision tree is pretty simple, actually.
1. If you are actively for the Obama/Kennedy/Waxman/Pelosi ("OKWP")approach, if only because, like Howard Dean, you think giving people a choice between public and private options is the only way to get health care reform to mesh with the American historical and economic matrix and/or it's current political reality, your choice is obvious.
2. If you are a single payer advocate and think that something along the lines of the OKWP approach would inevitably and ineluctably be worse than doing nothing at all, it is incumbent upon you to do whatever you have to, up to and including collaborating (whether actively or passively) with the Teabaggers and AHIP, to kill it.
3. If you are an advocate of single payer and you think that the OKWP appproach will eventually evolve into a single payer plan, just as the Republicans and AHIP fear, there will be a point when you should give up single payer advocacy and start fighting for the public option. Right now, it is up to you as to when to make that switch, but, at some point, sooner or later, the available choices will come down to a choice between a bill with a public option or nothing. At that point, you'll be compelled to get onto the public option train if only because continued single payer advocacy will be futile at best and counterproductive at worst.
Put me in category 1, with, perhaps, a dash of 3. As long as all the other reforms, like banning preexisting condition revocations and risk-pool manipulation, get made and the public option is "real" (i.e. prices on the basis of some reasonably narrow bandwidth based on Medicare pricing), I am completely indifferent as to whether private insurers survive or not. If they can survive in that environment, they'll help keep the government plan on its toes too and, perhaps more importantly, give people somewhere else to go so they don't automatically focus all their ire about the fact that someone they love is sick or dying on the government. If private insurers can't compete with the public plan, then it deserves to die--no tears will be shed by me.
If you're in category 2, go for it. However, I would think you might want to give the question of why you're in that category some hard scrutiny first. If you're in that camp because, after much examination of the facts and the data, you're convinced that the OKWP approach is destined to fail catastrophically and make things so much worse that it destroys enthusiasm for any government involvement at all for decades to come, then go forth and fight it, by whatever means necessary, with a clean conscience.
However, if what you're really afraid of is that the OKWP option will work -- i.e. bring affordable, decent near universal coverage and do so without destroying the private insurance industry -- and, in so doing, destroy enthusiasm for single payer, I'd suggest you consider whether you're really on the morally right side. If what's really driving you is some conviction that the entire concept of private health insurance is fundementally immoral and all of those evil insurance companies need to die, even if, despite being evil, they're (however reluctantly) part of a system that provides decent, affordable universal coverage, I think you're letting your dogma define the outcome rather than letting the outcome define your dogma.
August 3, 2009 12:11 PM | Reply | Permalink
Couldn't have put it better myself and won't even try.
August 3, 2009 12:26 PM | Reply | Permalink
I don't agree that these are our options
August 3, 2009 2:58 PM | Reply | Permalink
They're not options. They're branches on a decision tree for the question "should I drop support for single payer and get on board the public option campaign." If I've omitted a branch, which is definitely not impossible, feel free to identify it.
August 3, 2009 3:20 PM | Reply | Permalink
I think you dig out some of the positions on this well, NCSteve. But I doubt there are that many who would kill a plan with a real public option because they have some comin-to-Jesus belief in single payer. Obviously, a true public option would eventually provide evidence that single payer is best all around.
The insurers in health care are (figuratively) evil. That is to say, they are the problem. It’s not just single payer advocates who think that:
Most people know it's a sytemic problem from experience, but are being frightened into believing it’s still better than nothing (nothing being what they’ll end up with under "government control" of HC)
There is a very real possibility that a watered down bill, disguised to look like reform of the system, will only check the insurers a little bit, eliminate some waste and overlap and perhaps bring a little more efficiency. But it will kill meaningful systemic reform for now and into the distant future. The Senate proposals aren’t out of committees yet, but they may likely vote out a plan that has no public option at all (but a co-op or insurer’s pool). The house plan will be voted on next month, but even Waxman is balking at some of the provisions (i.e. tying public option prices and fees to Medicare instead of having to negotiate them).
I think you imply that strict SP advocates are extremists (collaborating with teabaggers), and while SP has strong support from the left, that doesn’t make it radical (for instance, many HC providers support it, too). As pointed out here, Canada, Britain, etc. are not radical leftist governments. Single payer is no more radical than social security. Yes, there are many people arguing out of ideology. Of course the idea that everyone is entitled to health care is an ideological position, regardless of how one thinks we should get there.
August 3, 2009 5:11 PM | Reply | Permalink
You are spot-on in pointing to the insurers in health care as being the problem. Given the fact that single payer health care is a well-recognized system that is engaged in other industrialized countries, it was simply astounding to see it eliminated as a discussion point before the discussions about fixing our health care system were even begun.
Wouldn't you think all manner of health care systems would be included in these discussions as a way of determining what system or hybrid of systems might work best for us? Why was it so important, then, to ignore this most legitimate of health care systems presently in place elsewhere and avoid it as if it were some third rail that, if touched, would shock the reform effort to its core and threaten its failure altogether?
Unfortunately, the reason single payer was prohibited from consideration is because this was the only way to avoid having to confront a few fundamental questions about our present system, such as:
1.) What role does the health insurance industry play in our present system, and how has it performed?
2.) Does the insurance industry provide anything of real value in our health care delivery system, especially if the objective is to provide health care to all?
3.) Is a "for-profit" approach to providing health care compatible with all other objectives we wish to achieve with this health care plan?
The health insurance industry simply would not survive such scrutiny, especially if such a review of our present system resulted in a high profile examination of the types of abuses and systemic failures outlined in the recent Bill Moyers interview with former health insurance industry executive Wendell Potter. (Thanks to TPM blogger Ramona for directing me to this interview. It is INDEED a "must-hear!")
In listening to this program, I became outraged in seeing from an insider's point of view the way the health insurance industry inherently pursues objectives that are antithetical to genuine health care for all. And it became apparent that there was simply no amount of reform that would allow the pursuit of profit to ever be made compatible with the legitimate provision of health care.
I then carefully listened a second time, concerned that it was my bias that allowed me to hear in this program an unassailable indictment of our present system. I tried with intense diligence to determine arguments by which the health insurance industry could defend itself against the solid case being made for its elimination altogether from our health care system. But the conclusion was unavoidable that, indeed, the health insurance industry is a major systemic problem within our present system that cannot be tolerated if we are to know true reform.
In not confronting this issue in the beginning, I fear we have allowed the health insurance industry to live to fight another day. And fight they are doing! Just witness the way in which - with GOP help - they have let slip the leash on rabid, mouth-breathing mongrel teabaggers to disrupt any attempt at genuine discussions of reform at Town Hall Meetings. They would be completely satisfied, after all, to detonate the health care reform effort altogether, because the present system works so well for them.
Well, it ain't working for the rest of us. And so I, for one, would argue that we should be fighting back with all we got, letting "bipartisanship" and "compromise" be damned in favor of settlng for nothing less than true heath care system reform!
August 4, 2009 9:52 AM | Reply | Permalink
Exactly, and well said. This answers my question: what would SleepinJeezus say?
August 4, 2009 3:21 PM | Reply | Permalink
You make an interesting aside. I recall reading that the only record of Jesus ever becoming angry is the story in the Bible wherein he throws the moneychangers (Pharisees) from the Temple.
I have no doubt where Jesus would stand on the issue of providing health care to all, and especially to the neediest among us. And I also have no doubt that he would draw parallels between the health insurance industry and the Pharisees, with the same degree of esteem for both.
August 5, 2009 8:13 AM | Reply | Permalink
Absolutely, SJ. OT, but I've recently spent a lot of time with a family member in our county hospital, taken over by the Catholic Church a few years ago (along with many others across So. Tx). Not to demean anyone's religion, but the care for poor, county-insured or on Medicaid, has deteriorated tremendously (at least here). People are pushed out as fast as they can be and promised follow-up is often denied or postponed after they're out.
Their mission statement is: "To extend the healing ministry of Jesus Christ." They're big on "advocacy". Their code of ethics, not to be confused with religious beliefs of course, don't allow abortion related and "select reproductive" services. I know people who have had to fight with them to have their loved one's living will executed to allow them to pass on in peace (a horrible thing to do as people are trying to let their loved ones go).
When the hospital was county-run, it wasn't all that great, and I appreciate that they see a need to help the poor and probably support HC reform. I've always felt that the international Catholic Charities is one of the best, but care for the poor seems to have become secondary to spreading their agenda, at least at this hospital, and I see an inherent conflict in religious-run health care.
August 5, 2009 1:02 PM | Reply | Permalink
Thank you for the post, Fred.
Many people take offense at the profit aspect of health care. To eliminate it, I propose:
1. A Congressional resolution giving insurance companies and for-profit hospitals a time-frame within which to restructure into not-for-profit entities or liquidate.
2. The federal government settles up with shareholders by paying a certain amount on the dollar. A bailout of sorts.
3. Extend unemployment benefits and food stamps for employees who find themselves out of work due to the restructuring/liquidation.
4. Give those employees first dibs on jobs to digitize patient records.
That's a start. Whether it's feasible or not, I don't know. What I do know is many more people are going to be disgusted by the profiteering of the insurance companies in the coming weeks.
If there is a clear path toward taking the profit out of health care in the discussion, that brings us closer to realizing it. It's time to get specific.
The other thing I realized after reading comments to Stilli's post is that most people maintain their cars better than they maintain their own bodies. They keep up with their car maintenance so they don't get stranded somewhere.
If people started treating their bodies with the same respect they treat their cars and other possessions, there would be considerably less need for treatment interventions. It's time for a fundamental shift in how we view ourselves, especially our bodies.
August 3, 2009 1:32 PM | Reply | Permalink
You can link to The Real News Network for a video update on what is happening with single payer. It includes a short piece on the recent rally in DC.
Basically it says that the Kucinich amendment (that passed) will allow states to pursue single payer. Also that the house progressives will vote no on the house bill unless a robust “public option” is included.
August 3, 2009 4:08 PM | Reply | Permalink