'Single-Payer' left out of health care debate, but many doctors want it in

By Mike Rose
Austin (Minn.) Daily Herald, Jan. 23, 2010

When the current health care debate began in earnest last year, one potential topic of discussion was largely left out — “single-payer” insurance.

Perhaps most indicative of the exclusion were remarks early in the debate from Sen. Max Baucus, D-Mont., who chairs the Senate Finance Committee and has been an influential player in the health care reform process. On several occasions, the senator said everything was on the table, except for the possibility of establishing a national health insurance plan that would supplant private insurers.

Leaving single-payer off the table, said Dr. Quentin Young, has been a great injustice.

“The health care system is going to hell rapidly,” the retired Chicago physician said. “(And single-payer) is mentioned only in passing.”

Young is working to change that. He is currently the national coordinator for Physicians for a National Health Program, a 23-year-old non-profit that counts 17,000 doctors as its members.

The organization is not alone in pushing for single-payer health insurance, but PNHP is among a number of groups focusing on the issue through the lens of the medical profession.

“Physician support (of single-payer) is getting stronger every day,” Young claims. “We’re doing a good job of publicizing.”

Numbers seem to support Young’s claim. According to a survey done by the Indiana University School of Medicine in 2007, 59 percent of physicians in the country supported legislation to establish national health insurance — up 10 percent from five years earlier. In Minnesota, 64 percent of doctors polled in 2007 said they favored a single-payer plan, according to an article in the journal Minnesota Medicine.

The doctor said the reason for moving toward national health insurance is simple — it would expand coverage to more people and reduce administrative costs that come from a complex private insurance industry.

But Young said his organization is willing to accept options short of a full-fledged single-payer plan, as long as coverage increases and prices decrease.

“We’re not single-payer or nothing,” he said. “We certainly welcome other reforms.”

However, that doesn’t include reforms in front of Congress now, Young said — the doctor believes the proposed legislation would do more harm than good.

“They’re both bad,” he said of the House and Senate health care bills. “They’re not tiny steps forward, (but rather) important steps backward.”

Dr. Ann Settgast, a St. Paul-based physician who is also in PNHP, said perhaps proposed legislation making its way through committees in the Minnesota Legislature could pave the way for national health insurance.

The state House and Senate health care reform bills, known collectively as the Minnesota Health Plan, would make Minnesota a single-payer state.

With 71 co-authors in the Legislature, Settgast said it is clear the plan has initial support. Now, she wants to see it move forward and see Minnesota become a pioneer by instituting a single-payer system.

If it does pass, Settgast said it could start a ripple effect, leading other states and perhaps the country as a whole to adopt similar measures.

Like the Chicago-based Dr. Young, Settgast said she sees more and more support along these lines, though she acknowledges true change will come slowly.

“Single-payer is very well supported,” Settgast said, though adding that “it was needed years ago. The sooner the better.”

Both Settgast and Young say the main obstacle to a single-payer plan is the health insurance industry. Settgast for one said groups like PNHP simply can’t compete with insurance lobbyists in Washington.

“Certainly, if your campaign contributions are resting on (insurance industry) money” that makes it hard to listen to other sides, she said. “The single-payer voice is largely underrepresented in the debate.”

But Robert Zirkelbach, strategic communications director for America's Health Insurance Plans, the country’s largest health insurance trade association, said the industry has not been a “bully” during the reform debate.

Instead, he said AHIP represents the majority of Americans who don’t believe in a single-payer plan.

“The American people do not support a government takeover of the health insurance system,” Zirkelbach said.

The spokesman said the private insurance industry has pioneered a number of innovative health care ideas, adding that a vast majority of Americans were satisfied with their current plans.

A single-payer insurance system, Zirkelbach said, would not lower costs and would only reduce services.

“Moving toward an entirely government-run system would turn back the clock on health care,” he said.

Editor’s note: This is the last in a three-part series examining the health care debate from the perspectives of different social groups.