Health Care Reform: Failure of "public option" might open the door for single-payer

The key battle for single-payer health insurance is in the House Energy & Commerce Committee. There, the chairman, Henry Waxman (D-CA) -- my representative -- showed his true colors by ending a committee meeting early in order to shut down Rep. Anthony Weiner (D-NY) who had the temerity to offer an amendment in support of single-payer (the fear is that it might pass, just as Rep. Dennis Kucinich's amendment to let states adopt single-payer healthcare passed the House Education and Labor Committee last week by 25-19). Waxman justifies keeping single payer "off the table" by citing the need for compromise if anything is to get done in Congress. Trouble is, since he and Barack Obama, NancyPelosi and Chris Dodd "compromised" by closing the door on a single-payer system before negotiations with the conservatives even started -- 86 House Democrats had already signed on to a single payer bill (HR 676) before the current process began, by the way -- all the leaders have left to offer up in a compromise is the so-called public option.

The public option, an insurance provider supported by taxpayers to compete with private insurers, should have been a final offer, if it was presented at all; it should never have been the opening bid. It is beginning to look as if the endgame on health care will come down to a choice between a bad plan and no plan. If there is no plan this year at least the door remains open to real change down the road.

In any case, with the Obama-Pelosi-Waxman public option now likely to fail, there is another, possibly last, chance for single payer. If ever there was an issue worthy of a revolt by the rank and file, this is it. The physical health and financial welfare of tens of millions of Americans are being sacrificed to protect a hive of economic parasites. Obama, Pelosi et al know this, even if they are unwilling to take on the special interests who profit obscenely now. At, a site that services the Democratic wing of the Democratic Party, a chart divides the Democratic members of the Energy & Commerce committee into four categories: supporters of single-payer; those leaning in that direction; the public-option-only crowd (combined with a few profiles in courage who "won't say"); and the Blue Dogs, House members who are so conservative they really shouldn't be allowed to pass as Democrats, but are too smart to make believable Republicans.

No matter what their current position, all these elected officials will get a boost from hearing from you, the supporting and leaning no less than the rest; the public-option-only supporters, some of whom have bet on single payer in the past, may not have a horse in the race much longer and may be salvageable. Rep. Jane Harman is among the leaners, so if you live in California's 35th it might be worth your time to give her a call (other leaners are Diana DeGette-CO, Christopher Murphy-CT, Frank Pallone-NJ, Bobby Rush-IL and Peter Welch-VT). Rep. Waxman's office phone is 202-225-3976: the chairman is probably too invested in the leaders' plan to have his mind changed by calls from mere voters, but at least when the Democrats lose the House in 2010 and the Oval Office in 2012 he won't be able to say he couldn't see it coming.

A new webpage makes finding members' office numbers easy and, as a bonus, offers a "lobbying phone log," a simple way to create a public record of your exchanges with congressional aides. If you want also to submit a written advocacy message, click on the "AFTER recording" link on the page. But don't fail to take advantage of the form for documenting what the people's representatives say to you and how you are otherwise treated.


Anonymous said...

I'm a republican (ok, ok call me stupid and let's move on). Single payer systems work great in other countries, where the population is not as great as it is in the U.S.; no argument there. So, as alternative to single-payer, I propose:

(1) Outlawing for-profit healthcare operations: every healthcare provider should be non-profit.

(2) All doctors should accept all insurance, whether state funded or private non-profit and there should be flat rates.

(3) To address the uninsured in this country, let's increase funding for the state-funded insurance programs and not allow doctors and hospitals. This would increase taxes (remember, I'm a Repub), but I think it would be cheaper than instituting a single-payer system. Like the President has been saying, it's much harder to start from scratch.

I anxious to have people shoot holes in my ideas, so fire away!

John Gabree said...

I think your first idea is interesting. A medical doctor writing in the New Yorker (June 1, 2009) contrasted medical care in McAllen, Texas, one of the most expensive health-care markets in the country, with the area around Rochester, Minnesota, one of the places were health-care costs are relatively under control. Both areas are similarly well-supplied with services and technology, but in Rochester, where the Mayo Clinic is dominant, medical care is largely collegial, and many of the doctors hold staff positions, while McCallum is highly competitive, and the doctors own -- and profit from -- the facilities they utilize and prescribe. The actions of the insurance companies in attempting to maintain profits by rationing care demonstrates that profit and health care may be incompatible. At the least, medical personnel shouldn't be allowed to invest in medical facilities, equipment, drug companies, etc. See, for support of your position.

As far as your second point, I'm all for controlling the rates of insurance providers, but imposing a regulatory overhead on top of the insurance industry's overhead isn't going to do much to lower the cost of health care. On the other hand, if you eliminate the insurance companies altogether by establishing a single-payer system, you lower health care costs by nearly third in one fell swoop.

I wouldn't oppose expanding funding for state programs, but only if the states are required to provide their residents with equivalent levels of care. Wouldn't funding have to be pretty high to assure that health care wasn't dependent on the vagaries of state budgets? (Also, did something drop out of your post: "and not allow doctors and hospitals" to what?).

Single-payer doesn't have to be started from scratch: we already have Medicare, a single-payer system.

Sorry about the crack about Republicans. It was really aimed at the BlueDogs, anyway.

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