Given the failure of similar programs in states, single-payer should not be thrown aside for this battle.

For advocates of guaranteed truly universal healthcare the debate over Obama’s reform efforts have been rather disappointing.

Despite the fact that a clear majority of Americans prefer joining the rest of the developed world and having a comprehensive government plan that cover everybody, President Obama and most of Congress, all of whom have received large sums of campaign donations from the drug and insurance industries, have made a government run plan that would not sell healthcare as a commodity to make profit, a non-starter. As a result, single-payer healthcare advocates, despite having overwhelming grassroots support, have been dismissed in Washington.

Now, with few other options, liberal members of congress and advocacy groups have largely focused their advocacy and money behind what appears to be the most heated battle over possible healthcare reform this summer: the fight to include a “public option” to compete with private plans in the healthcare package.

Predictably, ideologues opposed to any kind of government involvement in healthcare are fighting tooth-and-nail to oppose this option, ridiculously, calling it a step towards socialism. But as much of the left rallies to counter these shameful distortions, they may want to consider a very important question. What exactly are they fighting for?

By taking single-payer off the table at the start, Obama and his supporters may have put all of their fuel into a sputtering vehicle. To date, two state governments Massachusetts and Vermont have attempted to implement “hybrid” pseudo-public solutions to major healthcare problem. Both of these plans have been floated as possible templates for national reform; the Mass plan is often cited as a possible angle, and Rep. Peter Welch, D-Vermont, has introduced legislation for a public option that is somewhat similar to Vermont’s state-wide plan. Sadly, in both cases the results of these efforts have not been promising.
Those of us living with the new and once-highly touted Massachusetts plan, which aims to cover everyone by requiring that everyone buy insurance (and providing subsidies for those who cannot afford it), have become all-too familiar with the problems of this arrangement, which was worked out in 2006 between Mitt Romney and the Legislature.

The Boston Globe’s recent front-page article highlighting how Boston Medical Center, which provides more healthcare to the poor than any other hospital in Massachusetts, is facing major deficits largely because the 2006 healthcare legislation has bled money from the “free care pool,” is only one example of how this legislation, well-intended it may be, is not sustainable.

By June 2011 enrollment in the plan is projected to be 342,000 people at an annual expense of $1.35 billion up considerably from the original projections of covering 215,000 people at a cost of $725 million.

Moreover, because so much of the funding for the plan has come from the state’s free care pool, many low-income residents who were once able to get care, now face unaffordable co-pays, premiums and deductibles (which have already risen 9.4 percent since passage of the reform.) According to a study done by the Physicians for a National Health Program, if a middle-income person on the cheapest available state plan got sick, he or she could end up paying $9,872 in premiums, deductibles and co-insurance for the year.

“The Massachusetts reform law is not providing universal access to care even in a state with highyl favorable circumstances including previously high levels of spending on health care for the poor, high personal incomes, and low rates of uninsurance,” the report said. “It is not a model for the nation.”

A recent New York Times article, aptly titled “Massachusetts Takes a Step Back from Health Care for All,” reported problems as well. The July 14 article states, “The new state budget in Massachusetts eliminates health care coverage for some 30,000 legal immigrants to help close a growing deficit, reversing progress toward universal coverage just as Congress looks to the state as a model for overhauling the nation’s health care system.”

Vermont’s Catamount Health, public-private hybrid effort to cover the state’s uninsured population now at 11 percent is also failing. Passed in 2006 as a compromise after Gov. Jim Douglas vetoed single-payer legislation, the bill, unlike the Massachusetts plan, does not mandate residents buy insurance. Instead it offers residents a chance to purchase healthcare from Blue Cross Blue Shield of Vermont with help of government subsidies based on income. But the plan, even according to its own advocates, does little to solve the problem.

One reason: the plan is unaffordable for many working Vermonters. Even those with no income must pay a monthly premium, and someone earning $30,000 a year still must pay $160 a month for coverage, plus monthly deductibles and co-pays for prescription drugs and doctor visits. Accordingly, less than a quarter of those eligible have signed up for the plan. Catamount can also deny coverage for pre-existing condition and the recently unemployed must wait a year before they are eligible for the program.

Since Vermont, like Massachusetts and so many other states, is facing dreadful revenue forecasts, the co-pays and premiums may well be raised in the near future, or services cut. A Democratically-controled Legisalture was able to avoid cuts in the most recent state budget, but more cuts may well be needed during the year, according to Tom Kavet, Vermont’s Legislative economist.

As Peter Sterling, Catamount Health’s outreach director told Seven Days, Vermont’s largest weekly paper, “It doesn’t solve the big problem, and we know that.”

Sterling’s words, and the failure of both of these reform efforts, could serve as a warning for healthcare activists as the national debate over a public plan reaches critical mass. Putting all of our muscle and money into a potentially doomed public option something that “doesn’t solve the big problem” may yield little benefit in the fight for universal healthcare. Worse, if Congress pushes through a failed public option, neutered by congressional Republicans, it could give the concept of public healthcare an undeserved black eye in the eyes of many Americans.

In fact, a more intriguing consolation prize in Obama’s health reform bill could come from Sen. Bernie Sanders (I-Vermont) who has a plan to fund pilot programs for universal healthcare in five states — one of which would be a single-payer plan. This could prove to be a sterling example of the cost-effectiveness of such a program. If Sanders’ home state, Vermont, were to implement state-wide single-payer, it would save the tiny state a sizable $51 million a year, according to a study commissioned by the Vermont Legislature in 2006. Predictably, however, the Senate has not been very open to this idea, moderate as it may be, and voted it down in committee. One can only hope this idea will resurface as the debate rages on.

Despite such unceasing opposition from Washington, giving up on single-payer healthcare is not a wise move. As healthcare costs continue to skyrocket, the likelihood of a single-payer plan becoming reality in the US will only increase. The United States currently spends about 6 percent of its GDP (and rising fast) on healthcare more than any other country in the world and still has embarrassing rankings on infant mortality, life expectancy and overall healthcare rankings, according to the World Health Organization and BMJ, a peer-reviewed international medical journal. 46 million are left uninsured with many more underinsured, and an estimated 18,000 people die each year from lack of insurance.

Since nearly half of healthcare costs go towards corporate profits and administrative waste, two expenses that are virtually eliminated by implementing a single-payer system, in time some kind of not-for-profit government-run system is the only option that will make any fiscal sense. This reality should not be lost in the battle for a doomed-to-fail half measure that may or may not be attached to healthcare reform in the coming months.

Further Reading:

About The Author

Michael Corcoran is a journalist who focuses on business, media and public affairs. He has written for the Nation, the Boston Globe, Common Dreams, Alternet, Campus Progress and elsewhere.

13 Responses

  1. Lucas

    Not everyone who opposes single payer healthcare is simply an ideologue. There are a lot of legitimate concerns about a single payer system and what it would do to real access to a doctor as opposed to just having a card that says you’re insured, the actual cost of care, progress in research and development of both drugs and medical equipment, and making certain types of care unobtainable for patients when the government doesn’t feel like paying for them.

    The ‘rest of the developed world’ which you vaguely refer to has had plenty of problems with their single payer systems. In one survey of citizens 80% of Americans said that the current system needs to be reformed or rebuilt, with only %20 saying they liked it the way it is. But when the same question was asked of citizens of the UK, Canada, Australia, and New Zealand, which all have single payer national healthcare, the distribution of answers was the same. Even with national coverage, patients still want massive overhaul of their healthcare systems.

    To say that a single payer option is the only that makes sense, or that ‘not for profit’ automatically means that waste will be eliminated is just silly, especially when no evidence is provided. Anyone who’s ever paid any attention to how the government spends money knows this.

    For anyone interested in hearing real researched arguments against single payer healthcare, a good place to start is:

    http://www.cato.org/subtopic_display_new.php?topic_id=80&ra_id=6

    My reference to the 80/20 survey comes from their podcast about the Massachusetts healthcare model.

    Please read and consider the information there and elsewhere before simply writing off anyone who doesn’t agree with you as an ideologue.

    Reply
    • Michael Corcoran

      Lucas,

      Thanks for engaging me and my comments. I am going to respond in detail to some of your point as soon as I get done with a deadline assignment.

      Thanks for readind and I will post something by early evening.

      Best,

      Michael Corcoran

      Reply
    • Marjorie Power

      What Lucas leaves out is the next question that resident of other countries with single payer health care are asked, whether they would rather have a system like the one in the U.S. After they stop laughing, they answer with a resounding, “No.”

      I lived for nearly 20 years under the British National Health Service. I knew that there were many reforms that could have improved this wonderful system, so I would have answered as did 80% of my fellow NHS patients. But never, not even under waterboarding would I ever preferred a U.S. style system. The British NHS is hands down superior to what we have here at home (and the British system is not even ranked as the best of the single payer systems).

      So I will say that single payer is the only financing system that makes sense. Been there, done that and it was great! We should do it here.

      Reply
      • Lynne

        How much did the Democrats pay you for your comments??. I frankly don’t wish to be counseled how I should end my life because I am not worth the costs of extending my life for maybe just a few more years. I think the HMO’s in this country are wonderful for seniors and I do not see any need for change. I personally don’t want to go to a doctor and think I am at the Department of Motor Vehicles or at the U.S. Post Office! I have heard horror stories from my relatives in Swindon, England and relatives in Toronto, Canada. This health care plan is all about CONTROL of our lives.

      • Michael Corcoran

        Lynne,

        The Democrats were the target of my piece, as they have shown no interest in a single-payer system. Regarding Canada, England, etc …

        I don’t doubt you name some anecdotal stories about people who had bad experience with their systems. But there is quantifiable data on on a range of issues: expenses, life expectancy, percentage of uninsured, wait times, infant mortality rates, and most notably, support for the system, etc ..

        And those countries fare better than we do, despite the fact that we the riches nation.

        People in the countries you names are much more satisfied with their systems than those in the US, who, in fact, hate their system more than any other developed nations.

        I can understand not trusting the govt, but why put so much faith in private insurers — who in fact deny treatment all the time to sick people, leading to death, all the time?

        I don’t love Uncle Sam — but do you want CIGNA making those decisions, knowing that when they deny care they increase personal profit?

    • Michael Corcoran

      Lucas,

      thanks again for your critique of my piece. I commented and addressed many of your points, with citations and so forth, but for whatever reason, lenght perhaps, I don’t know, it has not showed up.

      Please consider clicking here — http://michaelcorcoran.blogspot.com/2009/07/lefts-public-option-problem.html .

      This is my response to you (look at update following piece). Hopefully, in time, the response will show up at Blast. Feel free to respond! I enjoy the dialogue, which is healthy as the nation has a major debate on the issue.

      Reply
  2. jacksmith

    THIS IS IT!

    The healthcare reform bill released by the House Of Representatives is an excellent bill as I understand it. It is carefully written, and thoughtfully constructed, informed, prudent and wise. This bill will save trillions of dollars, and millions of your lives.

    This is the type of bill that all Americans can feel good about. And this is the type of bill that has the potential to dramatically improve the quality of healthcare for all Americans. Rich, middle class and poor a like. Democrats, Republicans, Independents, and all other party affiliations. This bill has the potential to dramatically improve the quality of life of every American.

    The house healthcare bill should be viewed as the minimum GOLD STANDARD by which all other proposed healthcare legislation should be judged. All supporters of true high quality healthcare reform should now place all your support behind this healthcare reform bill released by the United States House Of Representatives, as the minimum Gold standard for healthcare reform in America.

    You should all now support this bill with all your might, and all of your unrelenting tenacity. This healthcare bill is a VERY, VERY GOOD! bill for all of the American people. Fight tooth, and nail for every bit of this bill if you have too. Be aggressive, creative, and relentless for this bill.

    AND FIGHT!! like your life and the lives of your loved ones depends on it. BECAUSE IT DOES!

    SPREAD THE WORD

    (http://www.youtube.com/watch?v=RSM8t_cLZgk&feature=player_embedded)

    God Bless You

    Jack Smith — Working Class

    Reply
    • Michael Corcoran

      Jack,

      I have not read all of the details of the House bill, but it is better than it could have been, based on my recent statements.

      There are still some problems: One the Senate is likely to nueter it. The HELP Committee just rejected a very moderate provision sponsored by Sen.Sanders, that would allow some pilot programs for states, and generally speaking the Senate is more status quo than the House (which, has 90- co-sponsers of HR 676 – the best piece of legislation in either body.

      Still, it does include a problematic mandate — a gift to private insureres who see 46 million uninsured as potential customers who will now have to pay for overpriced HMO’s. Further, it looks like employers, not individuals, can choose to buy into public option; so it does not give the average American a chance to choose the public option.

      All that said, I do hope some kind of public option passes – at a minimum. I do not, however, think progressives should assume the public option will solve the crisis. Most people will remain on thier employer-based HMO’s even is somethign reselbming the House bill assess (again, the Senate will likely do some damage to it). Which leaves the problem of underinsurance. Even those with insruance often end up in bankruptcy due to limits to coverage, high-co pays, rejections of certain procedures etc …

      It is imperitave that progressive move to eliminate the profit motive from healthcare, if we are to keep costs down to a managable level. I don’t want the GOP to win this fight, but the real fight is for Medicare for All – which will save the country billions and insure everyone.

      The Senate, the White House and much of the House refuses this option, and progressives must keep this option alive.

      The health share of GDP is expected to continue its historical upward trend, reaching 19.5 percent of GDP by 2017. this is astonishing and scary and we must fight for guaranteed coverage for all. The House bill would improve healthcare in the US. It does not sovle the problem. Hopefully it passes; the Dems have major majorites. The public, however, must keep fighting for single-payer healthcare! healthcare is a human right, not a commodity.

      Reply
  3. Reggie Greene / The Logistician

    We have a tendency in America to argue for or against a concept based on our own personal philosophy or view of the world, what advances our personal interests, or the interests of our party, family, organization, or region. Perhaps viewing the issue from a management or systemic perspective might result in innovative approaches to the issue. The American national mindset, citizen philosophy, lack of citizen motivation to be proactively healthy, and governance model make the socialization of health care in America very problematic, particularly at this point in time. A country needs to know its limitations.

    Reply
    • Lynne

      Yes, we Americans are all not numb-minded Government Robots yet!! There are still a few of us who can THINK!

      Reply
  4. Rich Austin

    Poll after credible poll show that *59 + % of the people support single payer.

    Now here we are playing the fool’s game. Many of the same 59 + % who support single payer have retreated to quibbling over which horribly-flawed “public option” would be best! What a target! Let’s shoot for the best of lousy!

    There needs to be a new question. It should be asked of Congress. And we must demand answers.

    The question: “A large majority of the people want single payer. Why are you refusing to represent them? Why, in a nation with a [supposedly] representative form of democracy, has Congress elected to rule rather than represent?”

    That needs to become a key question.

    * Associated Press – Yahoo 65%
    Los Angeles Times – 53%
    CBS News Poll – 55%
    CNN Poll – 64%
    National Small Business Association – 60%
    New York Times Poll – 64%
    Recent New York Times / CBS News Poll:

    The Question. “Should the government in Washington provide national
    Health insurance, or is this something that should be left only to private
    enterprise?”

    Poll results:
    32% Private enterprise
    59% Government
    9% Don’t know

    Case closed! Demand representation!

    Reply
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