Wayne M. O’Leary

Death of Single-Payer

The single-payer is dead; long live the single-payer. It appears the health-care dream cherished by a generation of political progressives, the hope that America would eventually join the community of advanced nations in enacting a universal, government-run medical-insurance system free of private-interest domination, has gone a-glimmering.

The defining moment in the single-payer’s demise was probably when Hillary Clinton, presidential candidate of the Democratic establishment and presumptive nominee of her party, proudly announced with great fanfare a health-care plan that was “not government-run.” In this, she joined Barack Obama and John Edwards, whose proposals, while different in detail, share a similar reliance on the existing private structure and do not directly threaten for-profit medical insurance. The Democratic Party is on record, therefore, through its three leading candidates for the White House, against any fundamental revision of health-care coverage.

What Democrats are now committed to is a universal health-insurance system, not a national health-insurance system. There’s a difference. A “universal” system means medical coverage of some sort for everyone, regardless of how it’s achieved; a “national” system, which is what 62% of Americans said they wanted in a 2003 ABC News poll, means a universal system financed by the federal government. Of the candidates, only Dennis Kucinich, bless his heart, remains an uncompromising advocate of true national health insurance, one reason why his quixotic campaign should continue.

The consensus Democratic position begs the question of why the option most rank-and-file Democrats (and most Americans) would prefer has been rejected out of hand. One reason is politics. Republican Rudy Giuliani, a possible 2008 nominee for the nation’s highest office, had this to say in July about any single-payer health-care scheme: “That’s a European way of doing something. That’s a, frankly, socialist way of doing something.” Giuliani and other Republicans, who favor giving tax breaks to the uninsured to purchase their own insurance on the open market, would doubtless hammer Democratic opponents on the issue. Rather than take the heat, Democrats hope to disarm the opposition by proposing something relatively unthreatening. It’s a forlorn hope; Republicans will call whatever they offer “socialized medicine” anyway.

The upcoming election would be a perfect time to engage in a forthright national health-care debate, drawing clear lines between the GOP’s market-oriented, tax-cut/voucher approach and a Democratic nonprofit, government-based approach. But Democratic leaders don’t want this debate, and the unavoidable suspicion is that after the Reagan years (government is the problem) and the Clinton years (the era of big government is over), they have ceased believing in large public programs on the order of Social Security. Certainly, evidence to make the single-payer case is abundantly available. Medicare, often hailed as a model government program, is simply a single-payer plan for seniors, so the precedent has already been set. What’s absent is a desire to engage the argument.

More than a reluctance to take on Republicans, however is an obvious Democratic aversion to confronting the organized financial power of the private-insurance industry. There was a time when elected Democrats fought big-money interests. No longer. Many of them, by virtue of their incomes, are now big-money interests themselves. And in a town (Washington) where there are 25 lobbyists for every congressperson, it’s not even necessary to have money to be influenced by money. The Clinton campaign, in particular, has said that lobbyists are just regular folks whose views should be heard and whose political donations are not tainted; they deserve, the candidate has implied, a seat at the table in formulating health-care policy.

Reinforcing systemic corruption is the recognition that bucking the vested interests of the insurance industry would be difficult -- too difficult in the minds of many Democrats. Any attempt to enact true national health insurance would necessarily produce retro “Harry and Louise” ads and hysterical claims that the American way of life was in peril. Corporate lobbies and think tanks, as well as right-wing talk radio and television, would go into high gear. Establishment of a single-payer health-care system would come only after the toughest, nastiest political fight of our lifetimes, and Democrats, quite clearly, don’t have the stomach for it.

So, we’re left with what could be called Hillarycare 2009, a plan benign enough to gain the support of the insurance industry or at least mute its opposition, a plan that treats medical insurance like auto insurance and places the main responsibility of obtaining coverage for the uninsured on the uninsured themselves. In essence, what the Democratic establishment has settled on is a variation of Republican Mitt Romney’s Massachusetts formula of major individual and minor employer mandates supplemented by government subsidies and penalties. Democrats will include a public-plan alternative to the mandatory purchase of a private plan (an Edwards innovation), but they will essentially “build on” the existing employer-based and profit-oriented insurance structure.

Family medical costs, now estimated at $11,000 per year on average and rising at two to three times the rate of inflation, will not be substantially reduced. Private health premiums, which have risen 87% in the last six years, will not stop climbing. Deductibles and copays will continue their inexorable upward trend. And the wasteful 15% or more insurance carriers spend on administration (compared to the estimated 2% spent by Medicare) will not diminish.

On the other hand, we will have the satisfaction of knowing we have cobbled together an “American” solution to the problem of health coverage that preserves free enterprise, not a “foreign” solution imported from north of the border or across the Atlantic. If the political class, including Democrats, is lucky, the public will not notice that very little has changed. And for those who value symmetry, it will be apparent that America has achieved a rare harmonious balance: a Medicare drug benefit written for the pharmaceutical industry and a universal health-care program written for the insurance industry.

But perhaps, like Mark Twain, reports of the single-payer’s death are exaggerated. (The inclusion of a single-payer option in both the Edwards and Clinton health plans keeps it on life support.) If the American people really want genuine national health insurance and are willing to demand it, they can still make it happen. It’s up to them to pressure Democratic politicians to abandon the path of least resistance and enact meaningful reform.

Wayne O’Leary is a writer in Orono, Maine.

From The Progressive Populist, November 15, 2007

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