Boy the people over at MyDD are hysterical by the so called revelation that Obama "lied" about supporting single payer. The conversation here seems almost civil. So I thought I would revise and repost my diary here to see what happens.
The issue is about a statement Obama made in the past that he supports single payer, and his statement that he never proposed it. Frankly, I don't understand what the stink is all about. Thinking that single payer is the best way to get to universal coverage and never having actually proposed it do not seem like contradictory statements to me.
The reality is that both Hillary and Barack understand that single payer is the best way to guarantee access to health care for All Americans. And both understand that it is not politically feasible to just dump the current system and go wholesale into single payer. It is possible to hold these two thoughts at the same time and there is nothing contradictory about doing so.
Both of these candidates are very smart people. They both understand that single payer is THE best system for affordable, comprehensive, equitable, secure, efficient health care for all Americans. This is good news.
But the realities of our current system and how it has evolved over time, make it difficult, if not impossible, to move from where we are now to 100% single payer system over night.
Hillary Clinton understood that single payer was the best path to universal coverage in the 1990s but she and Bill didn't actually propose single payer in the plan they submitted to the Congress, because they judged it to be politically unfeasible.
Barack Obama understood as a Senator in Illinois that single payer is the best plan (he also supports the idea) but he did not actually propose a single payer plan in Illinois, he proposed an expansion reform for 150,000 people. He understood that proposing a single payer plan in the form of legislation was not politically feasible.
And now both Senators Obama and Clinton are running for President and have included the OPTION of a single payer plan in their proposals that would enable the US to voluntarily transition to single payer. They have BOTH now proposed it as a central element in their plans. It is just that no one is talking much about it. It seems that everyone is too busy throwing stones.
Supporting single payer but not proposing legislation that is single payer are not contradictory thoughts. They represent the understanding that what you know is the "best" policy is not often a "successful" policy. And in politics we often go for something less than what we want because of the political realities. This is the case with single payer.
Everyone should be rejoicing to know that Senator Obama, like Senator Clinton, knows that single payer is the best model for universal coverage. They should also be rejoicing that both Senators Clinton and Obama give Americans the options of a single payer plan in their proposals.
I actually proposed this idea of giving Americans the choice of a single payer plan that competes along side the existing system in 2002. I first developed the idea for the state of California as part of the State's HRSA grant for Health Care Options. I will provide links below to both the original proposal as it was developed for California and the a link to the ESRI report (funded by RWJ) on Covering America, which includes the federal model I developed for CHOICE as a plan that would voluntarily transition the entire US health cares system to a single payer system, with private plan options for those who do not want single payer.
link to CHOICE OPTION for California:
http://chpps.berkeley.edu/...
link to National Proposal:Getting to a Single-Payer System Using Market Forces: The CHOICE Program
http://www.esresearch.org/...
The federal plan speaks specifically to the point of having a single payer plan compete with the existing system and allow people to choose which they want. And guess what? Our current inefficient, inequitable, ineffective system cannot compete with a single payer plan. The Lewin Group, using their Health Benefits Simulation Model, modeled the CHOICE proposal and found that within one year of adoption a plan with the option of single payer, 70% of Californians would chose to enroll in the single payer plan and 94.4% of the Californians have health insurance coverage, all without a mandate.
link for The Lewin Group Analysis of the CHOICE option: he Lewin Group, Inc. The CHOICE Coverage Expansion Program for California: Summary and Estimated Cost and Coverage Impacts. Final Third Round Estimates. Prepared for the California State Planning Grant, California Health and Human Services Agency (CHHS). Health Benefits Simulation Model (HBSM) March 25, 2002.
http://www.health-access.org/...
Yes, it left out about 5-6% of the population. This is the group that has been the intense subject of the debate regarding the need for a mandate. But who are these people? I call them the "people who live in the shadows."
The people who live in the shadows are those who are eligible for SCHIP but have not signed up. They are the people who are eligible for Medicaid but have not enrolled. They are the homeless, seriously mentally ill, and addicts. They may not speak any English. They are the unemployed who have given up looking for work. They are the people who are paid in cash under the table. They are the people who have an undocumented family member and who are too afraid to sign up for government programs for fear of deportation. These are the people who have no wages to garner and no income to pay taxes on. These are people who are very hard to find and would be even harder to get to pay a fine for being uninsured. A mandate won't work on these people.
Perhaps a better model for them is one SF recently adopted, where the medically indigent can get free care at city and county health facilities, guaranteeing them access to medical care. An insurance model wont work for the people who live in the shadows.
Yes, there are some young people in their 20's who may not feel like they need health insurance and won't buy it. But rather than mandate that they buy it, Obama is the only one to offer them the option of staying on their parent's policy until they are 25. This would solve a big part of the problem. And for those whose parents aren't insured and who also refuse to buy affordable insurance when offered, I expect their numbers to be small - certainly small enough not to affect the nearly 300 million Americans who will have coverage. And when these "kids" get in an accident or get sick and go to the ER or clinic or hospital, we can sign them up.
Claims that Barack Obama does not support universal coverage are just wrong. And claims that he somehow has lied about single payer aren't true. He states very clearly on his website that he supports universal coverage. And his plan, like Hillary's and Edwards', would get us about 95% of the way there. But getting to 100% coverage will be very hard.
Again, we should all be rejoicing in the knowledge that all three Democratic candidates want to move the system towards a single payer system by offering Americans this choice and enabling a voluntary transition.
But first we have to elect a Democrat. And if we keep up this nasty business of smear and innuendo, when we are all on the same side, it may hurt us all in the end.
I think we have an extraordinary opportunity to come together as members of the DEMOCRATIC PARTY and say to the country, these three Democratic candidates all want to get to universal coverage and all of them will give you the option of moving into a single payer system.
Since there is so much consensus, we should be positioning ourselves against the Republicans, not against each other.
For the sake of the health of the American people let's agree to agree. The goal of health care reform for the Democrats is universal coverage and they all support a plan that will enable the US to voluntarily transition to a single payer system.
We should all be singing Hallelujah, not throwing stones.