Single Payer vs. Piecemeal Reform

Throughout this summer’s debate and under all the noise, there’s been a slow, steady drumbeat for single payer health care to replace the piecemeal reforms on the table.

I like single payer. I like the concept and I like the idea of paying a flat amount each year to know that if I get sick, I get treatment. If I were crafting a system from scratch, I’d surely start with single payer.

Health care reform could have been as simple as opening up Medicare to everyone with a corresponding payment via payroll deduction or other means, but if you think the public option was demonized, imagine what would have happened if this were the proposal on the table.

Here’s the problem: It’s idealistic to imagine that a national single payer system could be implemented in one fell swoop. Aside from the administrative nightmare, insurance companies would do their level best to kill it, and it would always be subject to the political whims of the party in power. (Witness the efforts of the Bush administration to privatize it via Parts C & D, as an example).

While I admire the single payer advocates for their passion and dedication to the cause (and have made contributions to them), I wish they’d be a bit more practical. The most pragmatic thinker around this concept is Dennis Kucinich.

Kucinich has proposed a state-by-state single payer system at the option of the states which, if adopted, would conform to the requirements for Qualified Health Benefit Plans under HR3200 and the HELP committee’s sister bill. The advantage to a bill like this is that it is a more self-determining type of approach, where each state can simply choose to allow insurers to cover health benefits or implement single payer models. Theoretically, as states opt for those models and they succeed, more states will implement them. This is what Canada did, and it’s why the Canadian system is now single payer nationwide.

One of the biggest misconceptions about single payer health care is that the payer is the government. That’s not necessarily true. Kaiser, for example, is an example of single payer health care. The best health care I ever received was via a single-payer medical group, subsequently acquired by HealthNet and made into an odious HMO with all of the for-profit insurance aspects that killed its usefulness.

What we’re going to get from Congress is piecemeal reform, and frankly, I think it’s probably the best we will get on the Federal level. My prediction is that we will see an end to pre-existing conditions exclusions, recissions, and cancellations when one becomes ill. What we won’t see is a meaningful competitor on the Federal level to force insurers to play on a level field.

This is where Kucinich nails the approach. Let reform pass Congress without a public option, and then push states to implement single payer. A few already have: Vermont is one example. As people, regardless of what party they belong to, begin to realize that access to insurance doesn’t guarantee affordability, they will push states to implement single payer reforms as their “public option”, and as those reforms take hold and succeed, there will be a push nationwide. This also remains consistent with the view of states-rights advocates, who oppose any form of Federal government involvement in health care.

President Obama’s speech tonight will not be the make-or-break that the media and other organizations (including certain members of Congress) think it is. I believe he’ll frame the initiatives and the issues, and push for resolution toward a bill which passes both houses. What passes will be imperfect, but it will open the door for states to initiate their own alternatives to the Federal plan.

Just for perspective here, President Clinton couldn’t even get bills reported out of committee and onto the floor of the House and Senate for a vote. Already, much progress has been made. Regardless of what happens with Congress, we should all be pushing our state governments to adopt the Kucinich approach and shift to the single-payer model.

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cross-posted to US Health Crisis

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