Thursday, January 08, 2009


I married into a family of single-payer fans. When I was with my in-laws over the holidays, the talk, when it turned political, often turned to HR 676 ("Medicare for All").

I'm in favor of single-payer, too -- but I don't talk it up very much because I simply can't imagine it coming to America -- certainly not all at once. Maybe gradually, over years or decades -- but that's a big maybe.

I think we forget that when we talk about single-payer, we're talking about the elimination of an entire very large industry segment. For the business community and corpocrats in government, this is an existential threat -- it's like an invasion of the homeland. They'll fight this with ever fiber of their being, and they have the resources to win.

An article in today's New York Times about Tom Daschle's upcoming confirmation hearings confirms my pessimism. Note the reaction to what would merely be a partial incursion onto the private sector's turf:

.... Lawmakers will most likely question him sharply about one of the most contentious aspects of President-elect Barack Obama’s domestic agenda: his call for a new public health insurance plan to compete with private insurers.

... the proposal is anathema to many insurers, employers and Republicans. They say the government plan would have unfair advantages, like the ability to impose lower fees, and could eventually attract so many customers that private insurers would be driven from the market.

"The public plan option is a terrible idea -- one of our top concerns in the health reform debate," said James P. Gelfand, senior manager of health policy at the United States Chamber of Commerce.

... "Forcing private plans to compete with a public program like Medicare, with its price controls and ability to shift costs to private payers, will inevitably doom true competition and could ultimately lead to a single-payer, government-run health care program," said Senator Michael B. Enzi of Wyoming, the senior Republican on the Health, Education, Labor and Pensions Committee, before which Mr. Daschle will testify on Thursday.

Senator Olympia J. Snowe of Maine, a moderate Republican, shares some of that concern. "Creation of a government plan is no panacea,” she said, and “could disproportionately shift costs from private plans to the public." ...

We're regularly told that Social Security is the third rail of American politics. I think health care is just as much of a third rail. Or not a third rail exactly -- rather, it's an electrified fence topped with razor wire and surrounded by towers where guards have shoot-to-kill orders and packs of vicious dogs at their disposal. Do not -- do not -- believe for a moment that you will be allowed the escape the perimeter.

I know the counterargument: Would-be reformers aren't bold enough, and if someone (Clinton in the '90s, Obama now) had the guts to put the single-payer option on the table, doing so would redefine "the center" and change the terms of the debate, and single-payer might pass.

I don't see it. Clinton didn't propose "socialized medicine," but what he proposed was defeated with arguments that it was socialized medicine. (And here come precisely the same arguments again: I noticed ex-Bush speechwriter Michael Gerson in yesterday's Washington Post warning ominously of "government control of 16 percent of the economy.")

I wish the public were in the streets demanding a real overhaul of health care. As it is, the gradualist reform Obama seeks is the change I'm most pessimistic about ever seeing.

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