Obama should back single-payer again, and do it NOW

Assuming we’re all agreed that Barack Obama is going to be the president, there’s one thing I wish he’d go ahead and do right now: Return to his onetime support for a single-payer health care system.

As you know, I came to two conclusions awhile back:

  1. That only a single-payer plan would solve our country’s problems paying for health care. Anything short of that just further complicates the problem. We miss the mark by talking all the time about the "uninsured." It’s the majority of us who ARE covered, but increasingly can’t afford our health care bills anyway, who are the much greater problem. We need to eliminate the for-profit middlemen in the equation.
  2. The only way we’ll get single-payer is for someone to RUN for president on that platform and win convincingly. If Obama (or, to stretch a point, McCain) announced AFTER getting elected that he wanted a single-payer system, Congress would tell him to go fly a kite. The private insurance industry — folks like my old friend Joel Wood — have WAY too much juice on the Hill for a president to make than happen unless he has a clear electoral mandate to do it.

As I wrote in December of last year:

    And the operative word is “bold.” Why? Because unless we start the conversation there, all we might hope for is that a few more of the one out of seven Americans who don’t have insurance will be in the “system” with the rest of us — if that, after the inevitable watering-down by Congress. And that’s not “reform.” Actual reform would rescue all of us from a “system” that neither American workers nor American employers can afford to keep propping up.

A lot of people have high hopes for Obama changing this country for the better. There is no more dramatic way he could do so than to win after coming out for a REAL health care solution.

No, he’s not going to do that. He’s way too cautious, far too deliberate. He sticks to his game plan. He’s not going to rock that boat now. If I thought I could convince him — and thought he could win — I’d urge McCain to do it. As we know, he’s far more willing to throw the dice (can you say, "Sarah Palin"?). But he’s never shown any interest in single-payer. But as Hillary Clinton pointed out back before the S.C. primary, Obama used to be for it, before he was against it.

But I wish he would. I think he’d still win, and then he could do some real good on this, our most important domestic issue.

26 thoughts on “Obama should back single-payer again, and do it NOW

  1. Doug Ross

    Just like your blind allegiance to McCain, your blind allegiance to an unworkable single payer healthcare system keeps you from seeing reality.
    Every time you bring up this pie in the sky idea, I ask you to answer four basic questions:
    1) Who will pay for healthcare and how?
    2) Who will determine what healthcare costs (doctors, prescriptions, hospital rooms, etc.)
    3) Who will decide how services are rationed (because they will be in your model)
    4) Will you mandate that all doctors will participate in this model or will they have the freedom to do what they believe is best for themselves and their patients?
    (You do understand that there are surgeons who will not accept your plan. Many of them wealthy enough to stop providing their services for below market rates)
    How about this: we’ll implement single payer when we see Medicare work without
    a) artificial price controls that are set well below market value
    b) huge amounts of fraud and waste due to no accountability
    The government has ZERO track record for doing healthcare right.

  2. Doug Ross

    Quoting an article:
    ” Indeed, even if some physicians did drop out of Medicare, the cuts’ greatest impact would likely be on the mix and volume of services physicians offer. For example, in 1998, changes in Medicare payments made house calls profitable for many physicians, and house calls predictably surged… Since Medicare forbids physicians and seniors to negotiate prices themselves, those cuts could eliminate many house calls – regardless of their value.
    In other words, Medicare’s physician-payment system doesn’t do much to contain spending or to promote quality.
    The Medicare bureaucracy is somehow supposed to divine the correct prices for more than 7,000 distinct physician services in each of Medicare’s 89 physician-payment regions (yep, some 623,000 separate prices). And – unlike market prices – these price controls don’t automatically adjust to reflect the value of goods and services. As a result, quality suffers.
    In fact, Medicare pays low-quality physicians the same amount it pays high-quality ones – and sometimes pays them more. Several studies by John Wennberg and his colleagues at Dartmouth Medical School suggest that the quality of care in Medicare is well below what it could be – and that quality is lowest in areas where Medicare spends the most. ”

  3. Brad Warthen

    1. We will, through our taxes. And like in all those other countries that do this, we’ll be paying a hell of a lot less than we’re paying now, and getting more in return, because the multiple layers of for-profits middlemen — layers whose only practical function is to add cost to the process — will be eliminated.
    2. The gummint. (Which means different things to you and me. To me, it means a system that is accountable to me as a voter through the process of representative democracy, rather than only to its shareholders. To you it’s OMG the gummint! So I thought I’d keep it simple, and let you go ahead and freak out about it.)
    3. The gummint.
    4. Docs can do whatever they like. But the only way most of us will be able to pay them is through this system.
    Simple enough? Any further questions?

  4. Doug Ross

    If you really want to have a meaningful discussion on healthcare, please address these issues with factual information:
    from http://www.capmag.com/article.asp?ID=5329
    Health care was much more affordable in the 1960s. The government paid for less than 10 percent of all health care. Then the federal government created Medicare and Medicaid and wrote 130,000 pages of Medicare regulations. Now the government pays for 50 percent of all health care.
    Has that fixed health care, or broken it?
    In the same period, state regulation of medical insurance rapidly expanded, adding many coverage mandates that each policy must comply with. In some states you have to buy coverage for electric shock therapy, or in vitro fertilization, or acupuncture, or chiropractic, or hairpieces, or a social worker, or a marriage counselor, or a long list of other things, whether you want such coverage or not. And new mandates are added all the time, driving up insurance costs every year. Moreover, you are not allowed to buy better priced insurance from a competing provider in another state.
    Has that fixed health care, or broken it?
    The government could easily make reforms that would reduce the cost of insurance without any additional spending: Basic policies without mandates. Tax deductible premiums. Competition between insurance companies across state lines.
    Why is it, then, that the more government controls health care in order to fix it, the more expensive health care invariably becomes?
    Politicians who broke health care and now complain that it is broken do not want people to be able to afford reasonable insurance. They see that as an obstacle in their path to eliminate all private insurance. They are not in favor of fixing anything, but of making us all dependent on the favor of politicians for our health and well being.

  5. Doug Ross

    Okay, since you can’t actually provide facts, how about going into a little more detail on this one:
    “Who will pay for the healthcare?”
    Answer: We will, through our taxes.
    Ok. Take that a step further, please.
    What percentage of our paycheck will go for this system? Will it be the same for percentage for everyone? Will there be a minimum payment? How about a maximum? Can I opt out of the system?
    Let’s see you think this through.
    Here’s why I don’t want your system. I went to the doctor two weeks ago for a routine check. I paid my $15 copay and got my two prescriptions refilled ($5 generic and $15 non-generic). Within 10 days, my insurance company had processed the claim and reimbursed me my $35 directly into my checking account from my taxfree healthcare reimbursement account managed by my employer.
    Are you seriously going to tell me that the government can do better than that?

  6. Lee Muller

    In the industialized socialist democracies which have government medicine, those who can afford to, some 20 to 25% of the population, purchases private medical insurance, because “single-provider” is so unreliable and inferior to private treatment.
    Canadian politicians fly to the USA every time they get seriously ill, leaving the stupid masses to die in waiting rooms.
    The rest of Europe tries to get to the US if they have time, and Switzerland if they don’t.
    In the rest of the world, the wealthiest purchase additional insurance to have a private jet rush them to out of there and to America for superior medical care. American and European consultants working in even the most modern cities of the Middle East have evacuation and treatment in American written into their contracts.

  7. Capital A

    I’m enjoying the debate, but I lean more towards Warthime’s viewpoint in this issue. Maybe he should stick to domestic, rather than foreign policy?
    Doug, where in sheoal did you find an insurance company that reimbursed you in 10 days? In my experience, that is as rare as a lucid thought from Lee.
    Was that a one time deal or have they consistently moved that quickly? I’m interested.

  8. Lee Muller

    As a consultant, I revamped a program for an insurance company which reduced its reimbursement time to 24 hours, for 455,000 patients and all their physicians in 38 states.
    Socialist medicine is more expensive overall, more expensive to those who actually work and pay taxes, and the treatment is vastly inferior to what we have in the US. Only a small number of people cannot afford the insurance – many just prefer to have someone else pay their way through life.

  9. Doug Ross

    Capital A,
    The quick reimbursement is the norm. The company I work for is in the Fortune 500, very profitable, and understands that the best way to remain that way is to offer employees an excellent benefits package that includes health insurance. Brad gets on this kick about single payer because his company does not have the same attitude toward insurance. I guarantee you that there are MILLIONS of working Americans who are satisfied with their insurance. Brad wants to blow up the entire system because he is not.
    I’ll let you know in two weeks what the change in our rates will be for 2009. Last year, my premiums went up by $1 per paycheck.
    There are easier solutions than turning the whole system over to the government. Here are seven rules from the article I mentioned in an earlier post:
    The first simple rule: Make all medical services, insurance and personal savings for such expenses exempt from all federal, state and local income and payroll taxes. Those who complain about the cost of medical care and insurance must be confronted with the fact that if we cannot afford medical care, we surely cannot afford to pay taxes on the money we set aside for it.
    The second simple rule: Allow an individual or corporate tax deduction equal to double the value of the service for all charity care by medical care providers. At one time America had a vigorous network of private charity care, which was largely destroyed by the government barging in. We need to restore that environment of private charity, which was more efficient, effective and compassionate.
    The third simple rule: Pass legislation now proposed in the U.S. Congress that would give every individual or business the ability to purchase insurance in a national market, from insurance companies in any state. That would allow for ownership of health insurance that is more affordable and can follow individuals from job to job and state to state. The increased competition between insurance companies would restrain the cost of insurance.
    The fourth simple rule: Allow the purchase of basic health insurance with high deductibles and low premiums that covers major illness or injury and annual exams, in conjunction with tax-free accounts for out-of-pocket expenses, such as deductibles. That, more than anything, would make insurance premiums more affordable for Americans who fear the financial consequences of health misfortune.
    The fifth simple rule: Broaden the availability of optional coverage provided by Medicare Advantage, but allow for additional tax-deductible premiums to be paid by those seniors who elect such options. More choices from more options should be available to retirees—but not paid for by taxpayers. This would allow for expanded and more efficient coverage, and reintroduce an element of competition to those who seek to provide health care to seniors.
    The sixth simple rule: Allow Medicare patients to utilize their Health Savings Accounts to pay for services from their Medicare physicians. This could bring thousands of doctors back into the Medicare program overnight and eliminate the ridiculous and unjust prohibition on those who want to spend their own money on their medical care.
    The seventh simple rule: Limit non-economic or punitive damages in all malpractice or other litigation against medical providers or drug and medical equipment firms to a maximum of $250,000 (indexed for inflation). This would wring the bonanza for a few law firms out of the current ocean of litigation—and the high cost of “defensive medicine” now practiced by providers as protection against such legal extortion. The effect would be a reduction in the cost of medical care and insurance for everyone.

  10. penultimo mcfarland

    “Assuming we’re all agreed that Barack Obama is going to be the president …”
    Man, why do you write garbage like that? First he has to win an actual election, and then he needs a majority in the electoral college.
    I mean, heck, you’re supposed to be a journalist. Rule 1: Journalists do not assume.
    This half-hour Obama show on every network that’s just now starting might make everybody so sick of him they vote for McCain.

  11. penultimo mcfarland

    “Only a single-payer plan would solve our country’s problems paying for health care.”
    Nah. The best solution is what drove gas prices down during the last month: reduced demand.
    Eat healthy, exercise, stay thin, sin in moderation, sleep well. As doctors’ offices and hospitals empty, prices will come down. And Brad’s allergies won’t cost him so much.
    By the way, Brad, if Obama gives you and your allergies single-payer health care, can those of us who don’t use the medical system so much get a tax credit or a check in the mail or just something, you know, free postage for a month, to reward us for paying your way?
    It would show just how fair The One is, don’t you think?

  12. KP

    Doug, how nice for you that you have a great insurance plan, with a responsive company, that your employer helps to pay for. Obviously people like you aren’t the reason we need health care reform.
    It’s the millions of others who don’t have it so great. I just raised my deductible from a ridiculously high $1,500 to a ridiculously higher $3,500 so that I can continue to pay the monthly premium for a bare-bones policy. That means I’d have to pay $19,500 every year for myself and my children before insurance covered a dime. And the premium goes up — a lot — every year. Eventually I won’t be able to pay it no matter how high the deductible goes.
    I’d heap rather take my chances with the gummint.

  13. Doug Ross

    Are you saying that those of us who are happy with our insurance should be forced by the government into another program?
    Why doesn’t the government just allow you to purchase the same healthcare our Senators and Congressmen have? Nobody has ever explained why that can’t be an option. Increasing the pool of insured by millions should drop the price even more.
    Or do you just want it to be “free”? And by “free” you mean people who make more money should pay more for the “free” healthcare?
    I’ll support a single payer system if everyone pays the same amount for it. But that’s not what Brad wants. He wants me to pay more than he does and he wants others to not pay anything at all.

  14. Lee Muller

    $3,500 to $5,000 is a reasonable deductible for family medical insurance. It is supposed to cover major illnesses or injuries, not colds and scratches.
    Most of the uninsured can afford it and choose to spend it on recreation or a new car instead.
    We need to be moving away from the old WWII model of medical insurance and retirement plans being provided by employers, and freeing up workers to be more mobile by owning their own insurance and retirment.
    Instead, the Democrats and socialists want to go even more backwards, to having the government take away our choices in medical care, and take away our retirement plans.
    Just because some people lack the personal responsibility to take care of themselves is no reason for the rest of us to create a paternal government based around their immaturity.

  15. Don McCanne

    In response to Doug Ross: 1) We are already spending more than enough to provide all necessary health care services to everyone, and 2) The majority of Americans believe that everyone should be able to obtain necessary health care without having to face financial hardship.
    The goal then is not only to have everyone covered with insurance, but also to make sure that insurance is effective in preventing the consequences of medical debt. We have a rapidly expanding epidemic of underinsurance, and the proposals of Doug Ross and the libertarians he cites would expose the majority of us to the potential of excessive medical debt were we to develop significant medical problems. Policies with affordable premiums work for those who remain healthy, but most of health care spending is for those with major acute and chronic problems. The deregulated insurance plans and HSAs proposed by Ross and many others cannot ever effectively address the problem of how we are going to pay for most of the health care in this nation.
    The most efficient and effective system would be to establish a single risk pool covering everyone, and fund it equitably. The libertarians do have a problem with “equitable.” That would require a transfer from the healthy to those with greater health care needs. But the United States has an additional unique problem. Since we spend twice as much per capita as the average industrialized nation, each person’s share (national health expenditures divided by the U.S. population) is no longer affordable. For a family of four, that would be over $30,000 when median household income is about $50,000. So an equitably financed system in the United States would also require a transfer from wealthier individuals to the majority of us. Libertarians and egalitarians will never agree on the appropriate course. All other nations tend toward an egalitarian approach.
    The World Health Report 2008, published by the World Health Organization, singles out the United States for its exceptionalism – a system with “singularly high additional private expenditure” that persistently underperforms “across domains of health outcomes, quality, access, efficiency and equity.” Everyone should read this report. Very brief excerpts and a link to the full report can be found at:

  16. bud

    Doug, I guess this comes down to something very simple. You are satisfied with your healthcare insurance and don’t want it tampered with. I’m not very happy with my healthcare plan but don’t really have any options. I doubt if I could get a job with one of the Fortune 500 companies that has a good plan. I would just like a bit of peace of mind when in comes to my healthcare bills. Something that won’t destroy my family budget if someone does get sick. I’d like something that’s predictable that I can actually understand. So far the complicated mess I’ve dealt with for years just doesn’t cut it. If there is an option that doesn’t require a single-payer solution then by all means I’ll consider it. For me socialized medicine doesn’t look so bad.

  17. Doug Ross

    Are you willing to pay the same amount for the same coverage as everyone else or do you expect to pay based on your income?
    Like I said, I will support a single payer system if everyone pays the same amount (not the same percentage of income). Is that not fair?
    I already pay more than the average person does in property taxes for the same services (schools, fire, police, libraries, parks) everyone gets. Now you’re suggesting I should pay more for healthcare as well with no additional benefit.
    What’s next?
    A higher food tax (everybody needs to eat) based on income?
    Higher gas taxes based on the value of my car (everybody needs a car to get to work)?
    Where does it stop? At what point can we ALL be equal participants in paying for the same government that serves us? Why do we punish success and hard work?
    Tell Lindsey Graham you want access to the same healthcare plan he has at the same cost he pays.

  18. Doug Ross

    I want to emphasize this point:
    With my current employer, we all have the same choices and pay the same rates for coverage — from the CEO down to the janitor. I can choose from about five different plans with varying deductibles, copays, and covered items. I can even opt out and get my employer’s contribution deposited into my paycheck if I want to take that risk.
    Why can’t we have a single payer system that does the same thing? Multiple options for coverage levels, no pre-existing condition exclusions, same price for everyone.
    For the truly needy, fund their coverage using tax cuts of other government programs (department of ed, etc.) that are not as important.

  19. Lee Muller

    In FY 2007, Medicare had 31% of its entire budget stolen or spent on untraceable items.
    That waste alone is more than enough to buy insurance for everyone who ACTUALLY cannot afford it through no fault of their own (laziness, spent the $$ on vacation).
    Except for one thing… if the government can’t manage Medicare, after 40 years of trying, does anyone believe they can manage another healthcare program?
    Of course, if you are counting on getting your care “for free”, at the expense of real taxpayers, you don’t care about what it costs them, or the quality, or the waste, fraud and corruption.

  20. KP

    It’s $3,500 per person in my family, Lee. That’s $10,500 total.
    I’m certainly not proposing to get health care for free, and neither, I’m sure, is Brad. And I’m definitely one of the realest taxpayers I know — I pay taxes all the time. Really, all I want is health care coverage I can conceivably even begin to afford over the long term. And I don’t think it’s too much to ask.

  21. bud

    Why can’t we have a single payer system that does the same thing? Multiple options for coverage levels, no pre-existing condition exclusions, same price for everyone.
    How about this with one caveat. Remember my four tiered plan. Tier 1 simply mandats universal coverage for any citizen, anywhere, anytime funded 100% by the government. Tier 1, if you recall, is any sudden illness or accident that ALWAYS gets treated, by law. Whether the bum on the street or the POTUS these events are ALWAYS treated and paid for by somebody. If it’s the law for hospitals to treat these illnesses why not just skip all the middlemen and pay directly. The other 3 tiers, including all chronic illnesses, can be addressed in some fashion as you suggest.

  22. Lee Muller

    You don’t get choice from the government.
    Only the free market gives choices, because it creates new products and services immediately to meet what customers want. The experts run the business.
    Government programs are run by those unfit to work in the industries. They have no incentive, or ability to deliver quality service for a fair cost.

  23. Lee Muller

    KP, you don’t say why your medical insurance premiums are so high, but it must be because you have serious medical conditons.
    I am sorry for you, but that is not my fault, and I have no obligation to pay any part of your bills.
    It is immoral for you or anyone else to try to force me to pay for your medical care, or your food, housing, automobile, stereo, or vacations.


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