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 change.gov 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 pollingreport.com, 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)!
** 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.