Why is single-payer health reform not viable?

Reporter's notebook
Billings Gazette
Dec. 1, 2008

HELENA - When it comes to health care reform in America, there is a relatively simple solution that will cover everyone's basic health care, control costs and save businesses, most people and the country a lot of money.

It's called a single-payer health plan, where the government collects taxes to finance national health insurance. The government, which is the "single payer," covers all citizens and pays the bills when they visit private (or public) doctors, hospitals and other facilities for medical care.

All would have basic coverage, regardless of whether they have a job, or where they work. Nobody gets billed for basic care. No-body goes broke because of medical bills.

Yet this option has been declared "off the table" by Sen. Max Baucus, D-Mont., who's among those leading the charge for health care reform in America.

Top Democrats who will be deciding policy in America in 2009, including Baucus and President-elect Barack Obama, say single-payer is "not politically feasible," because the public won't strongly support it.

What they really mean is that when it comes to health care reform, they don't want a political fight with some of the nation's most powerful financial interests, which have the resources and the motivation to turn public opinion against meaningful reforms.

These interests include the health insurance industry, pharmaceutical drug companies, some hospitals, highly paid medical specialists, medical suppliers and others who now profit handsomely from our current system - and who could no longer command those profits under a single-payer system or an alternative form of a national health plan.

There's no doubt that it would be a huge political battle to attempt to install a single-payer or other national health system in the United States.

But single-payer is not without its prominent supporters.

HR676, which would create national health insurance and a single-payer system, was introduced last year by Rep. John Conyers Jr., D-Mich. and has 93 co-sponsors in the U.S. House. It has not even had a hearing.

Nearly 500 labor unions from across the country have endorsed the bill, as have AFL-CIO units in 39 states, including Montana. There is a national coalition supporting single-payer, led in part by the California Nurses Association (CNA), which has 85,000 members.

Michael Lightly, director of public policy for CNA, said single-payer is "the most fiscally conservative approach" to health care, because by having one payer/insurer (usually the government), you eliminate the profits of private health insurers, you negotiate bulk purchases of drugs, you negotiate reasonable fees with health care providers and you have global budgets for hospitals and large clinics.

Single-payer or a regimented national plan also is how nearly all other developed countries run health care and cover everyone - and at a lower price than we do, because it's more efficient.

Yet Democratic leaders in Congress, who want to reform health care, say single-payer won't be an option, because it doesn't "poll well."

They cite polls showing that the public thinks single-payer equates with "big government" and taking away what insurance they already have. A majority may like the idea, but that support erodes when asked if they'd pay higher taxes to support it.

This polling is testing the obvious lines of attack that single-payer's political opponents would employ: big government, higher taxes, less choice.

If single-payer is packaged in that context, of course it's a loser. But as any skilled politician knows, if you craft a better message and get it out there, you win.

Higher taxes? Not if single-payer all but eliminates the health insurance premiums that you and your employer currently pay.

Big government? In America, the government is the people, and you tell it what to do. It has to be more responsive than big insurance.

Less choice? With single-payer, no doctors or hospitals are out of the network, because there is no network. It's one system. Everyone gets the same basic care. You might have to wait for specialty care or some tests, but that's not exactly a deal-breaker.

"The only reason it's not on the table is because there is a belief that it's not politically viable," Lightly said. "That is a miscalculation in our view. We believe that a real policy debate means single-payer must be a part of that debate."

Lightly also said that even the mild reforms proposed by Baucus and Obama are going to face a political fight from insurers and other interests.

If you're going to have a fight, why not fight over something worth winning? he asks.

Finally, there's the simple question of morality: In America, an incredibly wealthy country, shouldn't we join the modern world and guarantee basic health care for all, regardless of the ability to pay?

As health care writer T.R. Reid told a Helena audience a week ago, our neighbors are suffering and dying because they don't have decent health coverage.

You don't believe that? Just open a newspaper or walk into your local grocery store. Every week, you're bound to see a flier or advertisement for a fundraiser for someone who's been horribly injured in an accident, or stricken with cancer or other debilitating disease, and can't pay thousands upon thousands of dollars of medical bills.

Under a single-payer system or other national health care plan, that wouldn't happen.

But unless citizens apply the pressure to our political leaders, it won't even be considered.

Gazette State Bureau reporter Mike Dennison can be reached at or at 800-525-4920 or 406-447-4068.