This is something I wrote for opednews.com
(Update: this article is also available at the web site for Physicians for a National Health Program.)
Hasta la vista single-payer movement?
In September, Governor Arnold Schwarzenegger vetoed a bill that would have resulted in a single-payer health care system in California saying that he " cannot support a government-run health care system."
While the recently re-elected executive is running from the right on several issues, most notably climate change, it appears signing off on something that could be described as a single-payer plan was just too much for this GOP moderate.
But Arnold is tackling the issue again with a new proposal to provide "universal" coverage for California that reflects a growing trend among state governments to reform health care. In many ways similar to health care legislation passed in Massachusetts this spring, the proposal requires consumers to buy insurance while expanding subsidies for low-income families.
Both measures have been praised by many as creative bipartisan ways to provide coverage and in sparking a conversation about the need to reform our countries dismal health care policies, which leave more than 46 million Americans uninsured.
But do these plans offer a real solution? And will they provide "universal coverage" as their architects claim? And should progressives, thinking pragmatically, support such measures as opposed to the single-payer system?
Not according to Dr. Steffie Woolhandler, associate professor of medicine at Harvard University and co-founder of Physicians for a National Health Program who says it is pure "fantasy" to say either of these bills will result in universal coverage.
"Both the MA and CA plans are based on ' individual mandates' ... the idea that the uninsured can buy their way out of their predicament," Woolhandler said in an e-mail. "A good family policy in MA costs $12,000 per year. How many uninsured families have even a fraction of that in hand to purchase coverage? Many families will be forced to buy stripped-down/bare-bones insurance plans, which will have lower (although still unaffordable) premiums, but will leave them unprotected in the event of a major illness."
These new, highly touted state plans, shift the burden onto patients, while letting business off easy. As Art Pulansky, secretary-treasurer of the California Labor Federation, said in a press release following the announcement of Schwarzenegger's plan: "the proposed employer contributions is so low that even Wal-Mart, a corporation known for its minimal employee healthcare coverage, already exceeds the requirements."
Worse, there is reason to be concerned that these state plans could serve to stifle the fight for a national universal health care system. "Finally, the single-payer canard is gone," boasted then Massachusetts's Governor Mitt Romney to The New York Times when the Massachusetts plan passed, seemingly pleased the parameters of the debate on this issue have been narrowed considerably.
Unfortunately, many Democrats seem content to help him do it. "I think the Democrats are concerned lest they seem too radical," said Rep. Pete Stark, (D-CA.) to The Seattle Times. "We've [The Democrats] got to win again in 2008, and I don't think we want to come out and talk about universal coverage or anything that sounds like socialized medicine."
Today's political landscape, however, seems to be begging for progressives to start making the case for drastic reforms. Especially given the folly of President Bush's latest proposal, which, unlike the state plans, does not even pretend to provide universal coverage. "Bush's reform plan - fiddling with the tax system and peddling skimpy private health plans - will fail miserably," said Dr. Oliver Fein, Professor of Medicine at Cornell University in a statement released in response to Bush's State of The Union speech. He also noted that, like Massachusetts and California proposals that rely on private insurers, "it would leave millions without coverage."
Consider that in September, an ABC News/Kaiser Family Foundation/USA Today survey found that 56 percent of Americans preferred a government-run universal health system "like Medicare" to our current system-a development that Marcia Angell called the unsung development of 2006 in an op-ed for The Boston Globe. "They want a single-payer system," she wrote. "We are the only advanced country with market-driven private health care. Other countries spend about half as much per person, cover everyone, and get better health results. Shouldn't this option be on the table?"
The recent elections have placed some well-known single-payer advocates in positions of prominence, and with enough pressure from constituents they could help to advance the debate. Rep. John Conyers, (D-MI), for example, is has reintroduced key single-payer legislation to Congress.
One of the bill's cosponsors, Rep. Barney Frank, (D-MA) is now the chair of the House Finance Committee and has been a longtime supporter of the single-payer model. On Jan. 3, in a speech in front of The National Press Club he said, "If we were to have a universal single-payer health care system, which took health care out of the wage system ... we would begin to reverse the inequality."
While the two leading 2008 presidential candidates, Barack Obama and Hillary Clinton, do not advocate a single-payer system, there are some candidates (and potential candidates) who have shown an enthusiasm for it, such as Rep. Dennis Kucinich (D-Ohio) and General Wesley Clark.
"No child in America should grow up without regular medical check-ups and care," said Clark in a 2006 speech to The New America Foundation. "And inevitably this will mean transitioning over time from a work place centered, private payer system toward greater reliance on some form of single-payer system to ease administrative burdens and reduce costs."
(John Edwards is touting "universal" coverage but has been noticeably short on details.)
There have also been encouraging signs on the state level. The AFL-CIO of Connecticut recently started lobbying for a single-payer system, and called it "the cornerstone" of their 2007 legislative agenda.
Actually implementing such a system it is indeed a tall order due to staunch opposition from the private health insurance industry and the pharmaceutical manufacturers. "Both Democrats and Republicans get oodles of money from these industries, and are understandably loathe to take them on," Woolhandler said. "However, a growing number of middle-class, insured Americans are profoundly dissatisfied with the health care finance system."
With health care reform in the news cycle and at the center of policy debate it is vital that progressives use this opportunity to push for real universal coverage. This is not merely a fight for the health of our citizens, but also for the health of our national debate.