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    The title of this diary should actually read "Yes, we can lead you back to single-payer", as in the January 2009 issue of "The Progressive", John Nichols writes:

The point won’t be to teach Obama about single-payer. Less than six years ago, he told the Illinois AFLCIO: "I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care, cannot provide basic health insurance to everybody . . . a singlepayer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House."

    Yes, we did that, thank you all very much.  Now what, President (Yay!) Obama?

    As the Obama team seizes the reins of power, it is becoming increasingly clear that the best system for financing healthcare is getting short shrift.  HHS nominee Tom Daschle devoted all of one paragraph to single-payer in his recent book on healthcare reform, "Critical", in which he states:

Most of the world’s highest ranking healthcare systems employ some kind of a ’single payer’ strategy...that is, the government, directly or through insurer’s, is responsible for paying doctors, hospitals, and other healthcare providers. Supporters say single payer is brilliantly simple, ensures equity by providing all people with the same benefits, and saves billions of dollars by creating economies of scale and streamlining administration.

    I would edit this particular passage to say that not only do supporters say this, but so do detractors (maybe without the "brilliantly"), because there is no debate that single-payer is the most fiscally responsible way to ensure fair, comprehensive, and universal healthcare coverage for a population.  If this were debatable, someone would have by now proposed a better system.  Nobody has.

   So what's the problem?  Is Obama not progressive enough?  Nichols* goes on to write:

After he secured the delegates required to claim the Democratic nomination, Obama found himself at a town hall meeting in suburban Atlanta, where he was grilled about whether—having run as a primary-season progressive—he was now shifting to the center.

The Senator was clearly offended by the suggestion. "Let me talk about the broader issue, this whole notion that I am shifting to the center or that I’m flip-flopping or this or that or the other," he began. "You know, the people who say this apparently haven’t been listening to me."

Obama continued: "I am somebody who is no doubt progressive. I believe in a tax code that we need to make more fair. I believe in universal health care. I believe in making college affordable. I believe in paying our teachers more money. I believe in early childhood education. I believe in a whole lot of things that make me progressive."

    Clearly not according to Obama.  I think the legitimate disconnect is that our voices are not being heard loud and clear enough on this issue.**

    In the words of Meteor Blades:

[Obama]’s touted a "bottom-up politics" of renewal. That’s a message we needed to hear years ago. Some of us progressives, especially us left-progressives, are determined to make sure that these words don’t calcify into nothing more than a campaign slogan. We seek to give them life. To never let the new guy forget that we’re on his side as long as he’s on ours.

   This is what we hear from the Obama camp:

"Change starts from the ground up, and we believe that's true on critical issues like Healthcare reform as well."
Stephanie Cutter, Obama Transition Team Spokesperson

   If this the case, then we'd best try to find out just how loud and clear our voices are.

    Polling data is rather iffy on issues.  Are you going to trust Kaiser's polls, the third largest private insurer in the country (OK, it's not the for-profit part of Kaiser that is doing the polls, but...)?  The wording of poll questions is absolutely critical, but perhaps there is something to be culled from what is out there.  I have made an appeal for my fellow Kossacks to fund a "definitive" - or at at the very least better - poll regarding this issue, although I understand that Kos is more interested in political contests and not policy issues.  What about the polling that's been done, such as it is?

    Let's take a look.

    If you cruise over to and look at the 3700+ posts*** in the healthcare discussion you will see very diverse opinions, most of which have to do with the delivery end of healthcare, not the financing end.  Those that speak primarily to the financing end are largely in the single-payer camp, not surprisingly.  (See my "analysis" of the related healthcare questions here.)

    From, I have lifted some relevant surveys.

    At the very top, Quinnipiac University Poll. Nov. 6-10, 2008. N=2,210 registered voters nationwide. MoE ± 2.1 (for all registered voters):  


    This would seem to indicate that a government role is acceptable to a majority of people.

     ABC News/Washington Post Poll. Oct. 9-13, 2003. N=1,000 adults nationwide. MoE ± 3:


    Here we see ample support for universal coverage even if it raises taxes!

    And from a CBS News Poll. Sept. 14-16, 2007. N=706 adults nationwide. MoE ± 4 (for all adults):


    Now that is clear support.  It even has the word "taxpayer" in the question!

    Then there is the much ballyhooed - and perhaps less scientific, AP poll which indicated a very large (65%) support for single-payer.

    Physicians for a National Health Program offers up this:


    What about less rosy pictures?  Kaiser did a very recent poll (pdf) which would seem to indicate a scant 28% support (46% if you include the "somewhats") for a single-payer option (h).  This is more or less in line with a previous poll.


    Option (h) seems to me to be a rather slanted way to phrase single-payer that insinuates that the "single government plan" is some sort of limitation.  Nothing could be further from the truth.  You cannot find a private insurance plan with benefits that even come close to those of a well-designed single-payer plan, at least not without spending most of your income on premiums.  As Don McCanne comments on this poll:

They need to ask, "Would you support a government-administered insurance program that covered everyone and was financed through the tax system if that meant that most Americans would pay somewhat less than they are now paying for health care and only the wealthy would pay more?" Until now, polls asking only about government and taxes in health reform usually have provided about a 60 percent positive response.

    What about the progressive organizations?  PDA is on board with single-payer, although you gotta dig a little to find the words "single-payer".

    MoveOn is the biggest disappointment to me as a member.  Last July they made an executive decision to jump on the Health Care for America Now! campaign with $500 grand of their members' money.****  There is no doubt that HCAN does valuable work in raising the visibility of the issue, but they are clearly not supporters of single-payer, as evidenced by the happy horseshit contained in their "statement of common purpose":


A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.

    That's not only an impossibility, it's a complete pander to those fearing loss of coverage due to healthcare reform.  They can't possibly be serious, really.  The bitter irony is that HCAN spends the bulk of it's efforts beating up private insurers, and then includes them in the "solution".  But that is a whole other discussion.

    TrueMajority is also in the HCAN camp, but I'm not too sure how relevant they are these days.  League of Women Voters, yes, Planned Parenthood, no (another HCAN supporter).  Many labor unions support it on a chapter by chapter basis, some leaders, most notably Andy Stern, don't.

    I certainly don't have the run-down on all of the organizations out there.  Please add your thoughts in the comments!  I offer these up only as examples.

    A final poignant observation from Nichols' article:

Franklin Roosevelt’s example is useful here. After his election in 1932, FDR met with Sidney Hillman and other labor leaders, many of them active Socialists with whom he had worked over the past decade or more. Hillman and his allies arrived with plans they wanted the new President to implement. Roosevelt told them: "I agree with you, I want to do it, now make me do it."

and in a similar vein from Miles Mogulescu:

I have written before about FDR's Secretary of Labor Francis Perkins (the only woman in his cabinet) who, soon after his election, went to FDR and asked him to do more for America's workers. FDR's response was "go out and make me".

    I suppose if I were a politician looking at these numbers, and knowing the monumental financial strength of the vested interests that would like to see them go down, I would probably also say "you need to make me do it".  By the same token, as an individual, I would also say doing it is the right thing and I apparently already have the support of a majority of my compatriots.

Bottom line: Let's get out there and "make him do it"!

And now for something completely statistically meaningless (the poll, not the footnotes)!

* John Nichols is associate editor of The Capital Times in Madison, Wisconsin, and Washington correspondent for The Nation

** Part of the problem lies in the purposeful conflation of healthcare financing with healthcare delivery.  This muddies the waters enough for proponents of non single-payer plans to claim they are saving money, when actually they are only saving money on the delivery end and spending more money on the financing end.  Single-payer financing enables all of the proposed savings on the delivery end that have nothing to do with private insurance.  Hence, it remains, overall, the best system.

*** Apparently the comments are no longer available for viewing.  I don't understand the purpose of this (unless they're short on server space) and have emailed asking for an explanation.  So far no response...

****  They then tried to cover their tracks with a "poll" of their members which putatively indicated weak support for single-payer.  Read Eli Pariser's lame attempt to defend this poll, and this response that takes him to task.

Originally posted to tegrat on Fri Jan 23, 2009 at 01:25 PM PST.


As far as the financing of our healthcare system goes, I

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Comment Preferences

  •  Excellent diary! RECOMMEND THIS! (3+ / 0-)
    Recommended by:
    sarakandel, tegrat, Youffraita
  •  That's sure not what Obama put (2+ / 0-)
    Recommended by:
    tegrat, VClib

    on his campaign website, however.  

    Here's what he said: incrementalist mods to the status quo.

    Barack Obama and Joe Biden's Plan

    On health care reform, the American people are too often offered two extremes - government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

    The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors and plans to implement the plan. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

    Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year.

    If you don’t have health insurance, you will have a choice of new, affordable health insurance options.

    "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

    by lgmcp on Fri Jan 23, 2009 at 01:34:16 PM PST

    •  Obama ran against single payer (2+ / 0-)
      Recommended by:
      Silverbird, lgmcp

      As lgmcp shows above Obama ran against a single payer plan. Personally I think that we will get to a single payer plan quicker if we let those who would like to keep their private plans keep them and provide a tax-supported Medicare-for-all option for everyone. It would be like public and private schools. Everyone helps pay for public schools, but some choose to also pay for private schools. Both Canada and England, two single payer systems often discussed as models, allow private pay insurance plans where people can opt out of the national plan, although they still pay taxes to support it. The political capital spent trying to kill private insurance would be much better spent expanding Medicare-for-all.

      "let's talk about that"

      by VClib on Fri Jan 23, 2009 at 01:53:20 PM PST

      [ Parent ]

      •  two points: (1+ / 0-)
        Recommended by:

        You can buy private insurance in some single-payer systems, usually to supplement what is not included in the single-payer menu.  This is not a good thing, as it divides the risk pool, invites adverse selection, and lessens the benefits of single-payer.  The only reason this type of privatization happens in the first place is because the single-payer system is underfunded (demonstrably true for both the UK and Canada).  The single-payer menu should be absolutely comprehensive, to the degree that it isn't it is a failure.

        Private insurers in this country will never allow a public option to compete with their products, any more than they will stand for being removed from the system entirely with a single-payer replacement.  Words included in plans like Obama's to the effect that "you can keep you current plan if you like it", are, as I pointed out, pure horseshit intended to lessen people's fears about reform.

        •  Here is the problem (0+ / 0-)

          The percentage of people who do not want to give up their private plans, which may be as many as 25%, have a hugh amount of political capital. They will use all of their political capital, and other resources, to delay a single payer plan that does not have a private pay option. However, most of them will agree to higher Medicare taxes to fund a Medicare-for-all program. So we have a choice, a blended plan now, or no national plan for several more years. You will be amazed at how tenacious a portion of both the patient community and the physicians will be if they face being forced into a one-size-fits all single payer plan. My view is let's take the wind out of their sails, let the people and physicians who want to be part of a private pay plan have their own sandbox and get coverage for everyone.

          "let's talk about that"

          by VClib on Fri Jan 23, 2009 at 02:37:07 PM PST

          [ Parent ]

          •  they are simply uninformed if they believe the (0+ / 0-)

            private option gets them something, is some sort of value added, then it is simply a matter of demolishing that myth.  In a well-designed single-payer system, one size does indeed fit all.  The only reason one might want a private plan is to engage in adverse selection, that is, I buy cheapo insurance because right now I'm healthy.  If I get sick then I can always get on that public option.  Great for private insurance companies, bad for everybody.

            •  Another reason (0+ / 0-)

              There are physicians who do not want to be part of a single payer plan. These include some of the best in each field of medicine. They want to provide a small number of patients a very high level of personalized care. There are people who are happy to pay well above market prices, out of pocket or through a premium insurance plan, to access these physicians. These are patients who do not want to wait for access and want the very best care. Now this is a small group, but there is a larger group who want the next level of service and don't want to be in a national plan. In fact, many physicians do not want to be part of a national single payer plan and would like to make an arrangement with their patients outside of a single payer system. One size does not fit all and adverse selection is not the issue. Some people who want a high level of service have life long health problems. Single payer is not going to happen any time soon. Obama ran against it. I say let's take what's on the table and let folks who can afford it cut their own private deals while we have quality health care for all.

              "let's talk about that"

              by VClib on Fri Jan 23, 2009 at 07:36:35 PM PST

              [ Parent ]

              •  these physicians would not be affected (0+ / 0-)

                in SB840, for example, providers do not have to use the single-payer system, it's their choice.  And patients can always pay out of pocket, should they choose to do so.  What cannot be allowed is for private insurance to "compete" with the single-payer plan.
                Almost 60% of doctors support single-payer.  The ones who don't are mostly older or ill-informed.  You would be amazed at how many doctors know absolutely nothing about single-payer.

                •  ill-informed? (1+ / 0-)
                  Recommended by:

                  While I am sure that there are many physicians who aren't experts in single payer programs to suggest that the 40% who do not support a single payer program are ill-informed is presumptuous. Physicians see single payer programs in Canada, England and other parts of Europe that are underfunded, and where physicians earn about half of what they do in the US. Canada started allowing private insurance and private practice medicine just a few years ago and it is growing rapidly because people want personal service, and better care, and physicians want to earn more money. I am all for Medicare-for-all, but the single payer advocates have a choice. Obama ran agains a single payer plan. No single payer program will be implemented in his first term. There is momentum to provide care for everyone in a Medicare-for-all type system. The comprimise is that patients and physicians will have the choice not to be part of the system and patients will be able to manage their health care risks using private insurance. If that comprimise is unacceptable then four years from now we will have 50-60 million uninsured.

                  "let's talk about that"

                  by VClib on Sat Jan 24, 2009 at 07:13:30 AM PST

                  [ Parent ]

                  •  I don't think it's 40% uninformed (0+ / 0-)

                    and yes, I have no idea what the exact number is, I'm only going by my own experience of talking to actual doctors about single-payer and being quite astounded by the relative lack of knowledge about this alternative to financing healthcare.  Certainly there is some percentage of doctors who are dead set against it (like the 22% that still support Bush) and will never change their minds.

                    The momentum you mention is for a system that simply cannot exist with the compromise you mention.  I repeat, private insurers will never allow a public plan to compete with their plans.  And the term "managing risk" can only be translated as adverse selection, there is no other point to having multiple plans to choose from (unless the premium and out of pocket expenses for all of them is exactly the same).

          •  Do Those People Include Senators and... (1+ / 0-)
            Recommended by:

            Congressman?  As long Senators, Congressman, Justices and their families are covered under the plan I have, I will be confident we will like it.  

            Unfortunately these groups are "outside" the mainstream most of the time.

        •  Medicare (1+ / 0-)
          Recommended by:

          is clearly an enormous example of a public funded insurance program that reduced the availability of persons who would be buying commercial health policies.  Of course they then developed supplemental policies to cover the gaps.

  •  And there is no going back (5+ / 0-)

    Once people have it, paying for health care will seem like paying for elementary schools or firefighters. They will wonder why they didn't do it decades ago.

    And they will remember who kept them from achieving it.

    No one is winning this game any more. Not even the insurance companies, who can no longer extract usurious premiums from bankrupt US businesses and workers.

    It's time. It's really time.

  •  I was glad to read that old quote from Obama. (2+ / 0-)
    Recommended by:
    Silverbird, tegrat

    He has not been that out there on health care recently.  It will likely fall to whoever has the balls to say to the insurance industry, "Fuck off."  I happen to believe that once someone does, others will do it, too.  Everyone is waiting for Congress to tell the insurance industry to fuck off except those who cash insurance industry checks -- Congress.  Lawrence Lessig's idea to pass campaign finance reform for Congress only should be getting more play...  Once Congress members do not have to rely on lobbyists to finance their re-election, they will be free to vote as they wish.  Absent that, we will have more of the same.  But this concept may be too complex to get sound bite coverage any media, even though it's pretty damn simple.  

    It's such a shame -- eliminate the insurance biz and have health care for all -- not insurance, CARE.  But the insurance industry lurks offstage, and no one wants to be first... well, no one except Michael Moore...

    Kick apart the structures.

    by ceebee7 on Fri Jan 23, 2009 at 01:48:41 PM PST

  •  I agree that this should be the ultimate goal... (0+ / 0-)

    But I don't think that's going to happen on Obama's first term.  I think we'll get to his middle ground on the issue.  But you guys don't see what that would do?  It puts us half way to the goal of having single payer.  It seems a lot more feasible from that perspective.  Obama sees this health care plan as a LONG TERM project.  Not a bill and then we're done.  That's not the way it works.  Eventually you keep adding addendums to the bill and small supplements, and we'll get to single payer.  It's not going to be possible to get it done at once with the right wing screaming constantly about it.  

    •  if you can lay out that plan for me (0+ / 0-)

      I would be happy and eager to examine it because I agree that this may be a very long road.  All of the plans I see, and admittedly, they are only "plans" with no legislative meat on them, are recipes for disaster similar to what has happened in every state that has tried "reform" so far.  The danger in all of this is missed opportunity.  If the politicians can say "see we did something" then the momentum is lost, regardless of the merits of what they did.  If it is a failure, which seems most likely to me at this point, then our side's political strength will go down the toilet.

  •  We need a government that works. (1+ / 0-)
    Recommended by:

    We need helthcare that works and every other modern industrial nation manages to have that.  God, what I would not give to sleep at night without fearing that illness in my aging years will wipe out all my savings.

    Actually it won't, because I would die before I would spend a hunk of my savings on modern medicine. If I can't keep going under my own steam, I would rather die. (I am 65; other people hold differing opinions.) the elites...actually believe that society can be destroyed by anyone except those who lead them? - John Ralston Saul -

    by Silverbird on Fri Jan 23, 2009 at 01:59:52 PM PST

  •  I think that it will be easier to get single (0+ / 0-)

    payer done once people understand a few things.  Many here forget that 5/6th of Americans already have health insurance.  They are worried that the new taxes collected from them will cost them more then the portion of there premium they pay (most employers pay most if not all of the premium), plus deductibles, and copays.

    I have looked into this situation and have concluded that Single Payer health care needs to reduce the price of healthcare per person down to roughly $4,000 per person to make this work.  I don't hear alot about the costs however and this is why many are suspect of this program.

    We need to prove and garuntee to the 5/6th of Americans that the income tax increase for single payer health care will be less then the fee's they pay now.

    The other group of people that I am worried about are those that think single payer will be free somehow.  Everyone in America will get the same benefit for this program so obviously everyone will pay.  The Bill, H.R. 676 suggests a flat percentage payroll tax increase for every single America which I think is an ok idea.  It should be expanded so those that are retired and living off of retirement income also pay their fair share as well.  I think everyone can agree that a benefit every person in America uses equally means that every person in America should share the burden of the cost equally.

    These are things that haven't been addressed very well at all.  These "nuts and bolts" are extremely important and they need to be spelled out much more clearly.

  •  Just a reminder (1+ / 0-)
    Recommended by:

    He did say that he would go with single payer if that's what Congress sends him.

  •  thank gods we are even having this conversation (1+ / 0-)
    Recommended by:

    two years ago I wouldn't have dreamed of it.

  •  Dialogue on universal health care approaches (1+ / 0-)
    Recommended by:

    by leading proponents of pure single payer and a hybrid public/private system, discussing the political, economic and health dimensions:

    Steffi Woolhandler of Physicians for a National Health Plan (PNHP)  
    and Richard Kirsch of Health Care for America Now (HCAN).  

    There is no such thing as a free market.

    by Albanius on Fri Jan 23, 2009 at 03:47:59 PM PST

    •  good link, I had heard comments about that (0+ / 0-)

      exchange but hadn't seen the whole thing.  I think the bottom line remains pretty much the same, Kirsch (who also used to advocate for single-payer) and of course Woolhandler both agree that single-payer is the most efficient way to go, but Kirsch has abandoned embracing it because he believes it is more politically expedient to get something.  I just have to disagree with that kind of thinking.

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