Mandate Single-Payer

The Clinton and Obama campaigns have been tossing brickbats at each other over the details of their attempts to make health insurance affordable for the 47 million Americans -- mainly the working poor -- who do not have coverage. In brief, Hillary Clinton would mandate individuals and employers to buy insurance while Barack Obama would mandate employers to contribute to insurance coverage.

Both Democrats are better than John McCain, who only recently put up a health policy page on his Web site that basically parroted the Bush administration's proposal of tax credits to help individuals buy insurance with high deductibles, which would cover catastrophic illness but would discourage people from seeing a doctor for routine ailments.

The US spends about twice as much for health care as the average among industrialized nations, said Dr. Steffi Woolhandler, an associate professor at Harvard Medical School. But those other developed countries provide comprehensive coverage for their entire populations, while the US leaves more than 47 million uninsured and millions more inadequately covered. The US performs poorly on major health indicators such as life expectancy, infant mortality and immunization rates, in comparison.

Woolhandler is a co-founder of Physicians for a National Health Program (, which advocates a single-payer universal health-care plan such as HR 676, the "Medicare For All Act" proposed by Rep. John Conyers (D-Mich.). In a Web conference hosted by, Woolhandler noted that a study by the Harvard Law School and the Harvard Medical School found that half of all bankruptcies are due to medical bills. That is virtually unknown in Canada, which has single-payer coverage that takes care of major medical expenses. And 76% of those medical-based bankruptcies in the US were families who had health insurance at the onset of their illness, Woolhandler noted. People either lost their jobs and their insurance as a result of their illness or, if they held onto their insurance, they were undone by required co-payments, deductibles and gaps in coverage.

We're already paying enough to cover everybody, she noted. One-third of health care dollars are eaten up in administrative costs, she said, as resources are squandered on paperwork and accounting. A single-payer plan that expands Medicare would result in savings estimated at $350 billion a year -- which would pay for the coverage of the uninsured as well as fill in the gaps for the underinsured and those at risk of being put out of a job in the coming recession.

HR 676, which has 78 co-sponsors (including former presidential candidate Rep. Dennis Kucinich, D-Ohio), has yet to get a hearing in the health subcommittee, despite polls that show that two-thirds of Americans support the idea of universal health care paid through taxes. The reason is that, in the absence of a grassroots pressure, Congress members listen to insurance and pharmaceutical industry lobbyists who are willing to pay to keep the system just the way it is. When Republicans controlled Congress, they got two-thirds of the $31.2 million the insurance industry donated in 2006. Democrats are just now getting their share and they hate to alienate those donors.

While the American Medical Association has tended to support the status quo, Woolhandler said many physicians support single-payer as a way to simplify their practices. "We have excellent technology, but if folks can't afford to get into our offices or, if they get into our offices, can't afford to pay for the treatments, we can't do our jobs," she said.

As we've said before, instead of trying to patch our substandard private-insurance dominated health system, the best thing Democrats could do for working people as well as businesses in the US would be to expand Medicare to provide full-service health care for every American regardless of employment.

Any serious reform of health care will require a public groundswell to prod Congress to go to war with the health insurance and pharmaceutical industries that are determined to protect the status quo. If we're heading into that fight, we might as well push for real reform.

"When the public gets mobilized, we're able to beat back the lobbyists and the private interests," Woolhandler said, "but if this is a backroom deal, the insurance industry and the pharmaceutical industry will have a field day."

Massachusetts passed a state mandate in 2006, ordering individuals to buy coverage, but without effective cost controls insurance is still too expensive and provides too little coverage. Woolhandler said the cheapest policy in Massachusetts costs $4,100 a year with $2,000 deductible.

The good news is that both Clinton and Obama have said they are not opposed to a single-payer program -- they just think it is not feasible to get such a program through Congress. "It's important to have someone in the White House who's not ideologically opposed to single-payer)," she added.

So progressives should turn their attention to getting things moving in Congress. "It's election season and that's a tremendous opportunity to get active and bird-dog all the candidates -- particularly congressional candidates," she said. She recommended going to debates and town-hall meetings and asking candidates for the House and Senate variations of this question: "Since decades of experience have shown that private health insurance can't control health costs or assure universal coverage, are you ready to support the single-payer bill, HR 676, Medicare for All?"

Woolhandler added that Obama's mobilization of youth and independent voters might help move the Democrats to more progressive positions. "He's getting people's hopes up and when that happens it's hard to get that genie back in the bottle," she said.

(See the entire editorial at [The Progressive Populist. See health-care links at . Cross Posted at

Tags: Barack Obama, Congress, Democrats, Health care, Hillary Clinton, Single Payer, tip jar (all tags)


1 Comment

Re: Mandate Single-Payer

Clinton is the last hope for any reform that might become a single payer program, because she has a mandate that everyone must opt into the insurance system, and offering a public Medicare like nonprofit program for people to join if they choose. It is a progressive proposal, with very generous subsidies to help those who cannot afford insurance and a low cap on he percentage of income that an individual or family would have to pay for their coverage.

There are no known mechanisms to reduce the cost of insurance that work other than getting everyone into the system. Obama
s plan cannot work to lower costs, unless there is drastic rationing of services.

Single payer is essentially a mandated national insurance system, with everyone contributing their share to pay for it, but through taxes, not premiums, however progressive.

The only health care reform bill positioned to pass Congress at this time is the bipartisan Senate Wyden/Bennett Healthy Americans bill, which will force everyone into the private insurance market, the least affordable option in the industry.

by 07rescue 2008-03-02 12:50PM | 0 recs


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