Luke Michell, in Hapers, discusses the largely ignored orphan of health care reform, a single payer system that has the government covering everyone.
The argument for single payer is straightforward. When everybody is in, you don’t have to spend a lot of time and money deciding who to keep out. You also don’t have to worry about what to do with the people you’ve kept out when they get sick anyway. (Uninsured sick people cost insurers nothing, but since they often end up seeking expensive emergency-room treatment, they cost taxpayers a lot.) If you want to quit your job and work someplace else, you can do so without fear of losing your health insurance, which means that labor is more mobile. And employers don’t have to carry the burden of benefits, which means that capital is more mobile. If you get sick, you don’t have to worry about losing your coverage or your house. Your insurance is paid for through taxes. And your taxes don’t go up just because you have a preexisting condition; under single payer, there is no such thing as a “preexisting condition.” Moreover, your provider—the single payer—has an incentive to keep you healthy your entire life, rather than just getting you to age sixty-five and then dumping you into Medicare. And if the experience of most other countries is any indication, the whole thing would cost a lot less than our current bloated mess of a system.
Despite its rationality, the fact that now-President Obama, and many Democrats, used to be for it, and that polls show widespread support among Americans, single payer is being largely ignored. No supporters were ibvited to this week’s White House Summit until the threat of a protest outside led to a last-minute change. Rather, only “market-oriented” solutions are being considered, despite their obvious problesm:
This preference for markets is common, but it is not wise. The health-care system is not at all like other markets, because health, for obvious reasons, is not at all like other goods. (The demand for not dying, to give just one example, is pretty much unlimited.) And in America, market-based solutions very often end up involving the government anyway, as has been made evident most recently in the aftermath of the failed deregulation of Wall Street….
Nonetheless, Democrats clearly do not want to discuss the role of government in terms that could be understood as unfriendly to the market. “We all have to keep an open mind on all this stuff, figure out how to get to yes. Everything is on the table,” Baucus had cautioned. “The only thing that’s not on the table is a single-payer system. That’s going nowhere in this country.”
Mitchell, in this article, tries to find out why the best is being ignored:
Which is why I was in Washington. Even the new president, with a near landslide victory and a huge congressional majority, sees an intraversable divide between what he himself has claimed to understand as the best approach and what can actually be done. I wanted to know what defined that divide, and why single payer fell on the far side.
One thing he finds is that the country is moving toward a form of “socialized medicine”, but it will be designed to guarantee that a large percentage of our money goes to insurance company profits:
The preference for markets is more often claimed than felt; the preference for profit is far more sincere, and the method by which it is achieved—competition, bribery, lobbying—is a secondary concern. After Ignagni and I met, when the Obama transition team had made clear that some form of universal health care was forthcoming, she announced that AHIP would support a law requiring private insurers to provide insurance to all people regardless of their medical condition—a form of insurance known as “guaranteed issue”—if Congress would in turn require all Americans not covered by government insurance programs to buy some form of private insurance. This combination of guaranteed issue and individual mandates would add up to a system wherein the government requires healthy people who do not want insurance to buy it anyway, in order to subsidize unhealthy people who need insurance but can’t afford it—which sounds like what most people would call “socialized medicine.”
Mitchell goes on to ask:
If the insurance companies themselves were openly endorsing a non-market solution—albeit one that required millions of new customers to buy their products—then what else could be preventing Americans from embracing single payer?
He then goes on to skeptically explore various proposed high-tech, corporate driven solutions to health care. In the end, the reform we get will depend upon the mobilization of our citizens to demand real change, or not.
You can also check out Mitchell’s interview on Democarcy Now!
And I think there are a couple of reasons why they’re so explicitly rejecting it. One of them is that it’s a threat to a great deal of people who are making a lot of money right now, which is to say the insurance companies. A single-payer system would take a lot of money out of the insurance system, the private insurance system. And it’s also something that a lot of people in Washington understand as ideologically threatening, that is to say, they equate a single-payer system with what they call, quote, “socialized medicine,” unquote.
So I think what Obama is trying to do is neutralize that threat and get, as he said, the imperfect rather than nothing. And maybe he’s right. There’s clearly a massive resistance to single payer on the Hill.
March 7th, 2009