In health care reform, even the supporters are divided
by Bob Braun
Columnist
New Jersey Star-Ledger
May 17, 2009 10:16PM
WASHINGTON — The debate over health care already has turned ugly — and it hasn’t formally begun. Long before Republicans and other opponents of big government involvement in health care even have a chance to denounce it as “socialized medicine,” supporters of bigger involvement are clawing away at each other.
Proponents of a single-payer system feel they were ignored in the congressional debate. That’s hard to refute — activists have been arrested at Senate hearings when they protested the failure of Democrats to take their cause seriously.
Proponents have lashed back, reminding Democrats of inconvenient campaign promises last fall and raising questions about the amount of campaign contributions key Democrats receive from insurance companies and drug firms that oppose single-payer.
“The best solution would be a single-payer system, similar to what all other developed countries have,” says Bill Armbruster of Jersey City, who is active in the group Health Care Now. “Yet single-payer isn’t even on the table in all the discussions about health care reform. That’s because of the power of the insurance lobby.”
Supporters of the bill likely to emerge from the Democrats argue single-payer proponents jeopardize any chance for reform. Says U.S. Rep. Rob Andrews (D-1st Dist.), one of the authors of the impending legislation:
“The country needs a law that will reduce the health care cost explosion for insured people while extending coverage to uninsured people. Single-payer does not have majority support in either house and cannot pass, largely because insured people are understandably reluctant to give up coverage that they have negotiated for and earned.
“We are trying to build a coalition broad and strong enough to deliver the change in health care that Americans voted for.”
U.S. Rep. Frank Pallone (D-6th Dist.), another author of the administration-backed bill, warns that division among reform supporters will endanger a key provision — a government insurance plan competing with private insurers in a so-called “marketplace.”
“It represents a clear compromise between those on the right who want competition only among private plans and those on the left who might prefer a sole public option or even a single-payer system,” says Pallone.
So that’s the stark choice, as painted by congressional Democrats — get on board the compromise train or health care reform will never leave the station.
Only one New Jersey congressmen, Donald Payne (D-10th Dist.), is supporting a single-payer bill. He is one of 75 co-sponsors of legislation — HR 676 — creating a system that would provide every American with government-backed health insurance.
One of the state’s chief supporters of single-payer is Winthrop Dilliway, a faculty member at the University of Medicine and Dentistry of New Jersey and a member of the Physicians for a National Health Program.
He called such a system “the most humane, most efficient, and most democratic” way of providing health care. It would not be “socialized medicine,” he says, because, unlike the British system, there would be no national health service that actually provides the doctors. The payment would come from the government — not the service.
All doctors would be paid by the same system so issues of choice would not come up. It would, in effect, extend the Medicare system for retirees to all Americans.
“It is the most efficient provider in the nation right now,” he says.
The Canadian single-payer system, he says, has reduced health care costs so that they are now one-half of those in the United States.
“There are complaints, sure, but Canadians would never give up their system for the non-system we have — who would? They do not have inferior quality of care.”
Dilliway argues that costs for private insurance companies are twice those of Medicare “because they have dividends to pay and all those clerks to hire.”
The issue at the heart of the debate is the risk pool. Medicare covers the elderly, the people most likely to need health care. If Medicare were extended to everyone, the pool would be expanded to include young as well as old, sick as well as healthy. Insurance can be efficient to the extent it can spread the risk.
Keeping private insurers — even in a “marketplace” approach with a public option — would not allow for a large risk pool with low-risk insured, Dilliway says.
“The government is already paying for costly programs — it needs the rest of the population on board to keep per-capita costs down,” he says.
Dilliway cites polls suggesting majorities of both the general population and of physicians themselves favor a national insurance system.
He knows, however, that, without Obama’s support, single-payer doesn’t have much of a chance — at least this time around.
“The president doesn’t want to have that fight now.”