Posted on December 31, 2007

Where are we on reform?


Associated Press-Yahoo Poll
Interview dates: December 14 - 20, 2007

14. Which comes closest to your view?

34% - The United States should continue the current health insurance system in which most people get their health insurance from private employers, but some people have no insurance

65% - The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers

2% - Refused / Not Answered

15. Do you consider yourself a supporter of a single-payer health care system, that is a national health plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?

54% - Yes

44% - No

2% - Refused / Not Answered

Full poll results available through link at:


Candidates split along party lines on health

By Tony Leys
The Des Moines Register
December 29, 2007

State Sen. Jack Hatch, a Des Moines Democrat, said his party’s health reformers used to talk more about implementing a “single-payer” system, in which the government would directly insure everyone. But the only presidential candidate still backing that idea is Ohio Congressman Dennis Kucinich, whose campaign is gaining little traction. “The candidates are moving away from that, which shows they’re being realistic,” he said.

Hatch, who is leading a health reform effort in the Legislature, describes himself as one of the most liberal legislators at the Statehouse. But he said that even many lefties like him have decided to back off single-payer proposals and to look for more pragmatic approaches.

Top Democratic presidential candidates all are talking about ways to improve and expand the country’s current mixed system of public and private insurance plans, Hatch said. Their more moderate stances demonstrate their belief that major health care changes can pass if they’re not too extreme.


By Don McCanne, MD

We have a disconnect on reform.

From a policy perspective, the nation now believes that “the United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.” The majority also supports the concept framed as “single payer,” though the Medicare framing elicits stronger support.

From a political perspective, both the elected and self-anointed elites of the progressive community have chosen to ignore the input of the public at large, and, instead, reframe reform as a model that they believe is a political winner. The words of Iowa State Sen. Jack Hatch (above) express the prevailing framing.

And what is their political goal? They want to create a critical mass of support by including conservatives who believe that everyone should have health care. The problem is that these conservatives still insist that we use the private markets to bring everyone under the umbrella. These are the same people who insist that Social Security is bankrupt and that it can be saved only by privatizing it. These self-appointed progressive elites have to understand that no amount of smooth talking will ever change the DNA of the conservative ideologues.

Although these progressive elites agree that we should establish an optional Medicare-like public program that anyone can purchase, they have narrowly focused their politics by crafting their policies around one single phenomenon that they believe they have discovered. That is that most of us want to keep the coverage we now have.

In all honesty, there are still some private plans that do provide good coverage - good enough that many individuals may not want to deal with the hassles and uncertainties of change. But they also don’t want to even think about potential future insecurities that they might face by hanging on to their current coverage.

Well, they do need to start thinking about it. They need to think about the fact that rules regarding coverage for retirees have just been relaxed, exposing them in the future to the potential of underinsurance or uninsurance. They need to think about the fact that their employer-sponsored coverage is only as secure as their employment, in this age of frequent job changes. They need to think about the fact that the rising costs of health care are impacting their employers causing many to convert to underinsurance, and some to drop coverage altogether. They need to think about the fact that the lack of control over rising health care costs is making coverage unaffordable - a serious challenge should they be thrust into the individual insurance market. They need to think about the fact that the insurance industry continues to expand the market of innovative products - code language for a tradeoff of making premiums affordable by paring down benefits to a level that financial hardships are created for individuals who actually need health care.

OK. So you say go ahead and cover everyone with government programs and subsidies, but still just leave my coverage alone. I’m happy with it, and I don’t want the government messing with it (and I refuse to think about the potential insecurity of the future should any of those frequent events listed take place). Cover everyone? But the costs of adequate coverage now exceed the capability of median-income households to pay for that coverage. Who is going to make up the difference? Doesn’t “government programs and subsidies” mean the taxpayers will? Aren’t you a taxpayer? Do you really want to pay the high costs of your current coverage (even if indirectly through salary reduction) plus pay the taxes to support coverage for the majority of us? Wouldn’t it be far better to have a transparent, equitable process for funding health care for all of us?

The Democrats are placing a bet that politics designed to meet the let-me-keep-my-health-care framing is the key to finally achieving success in reform. It is a bet that will leave us with a choice between unaffordable private plans with inadequate benefits, or a bankrupt public program that is a victim of the death spiral of adverse selection. If we don’t want to place that bet, then we have to tell the self-anointed elite to get out of the way so we can fix our health care system ourselves - in 2008 - by electing politicians who really do represent our views.