Friday, July 24, 2009

Not pushing Single Payer is hurting Obama's health care reform agenda

By Dave Hornstein

As President Barack Obama seeks to reform the broken American health care system, his failure to push Single Payer as the solution has made achieving reform a more difficult process.

That is because Single Payer makes the issue far more clear-cut. As president, Obama should have been using the bully pulpit of the White House to educate Americans on how the insurance industry piles up huge profits from a dysfunctional system. When an average of 30 percent of the health care money going to private insurers goes to overhead, compared to four percent for Medicare, and when every other industrialized country has achieved universal health care coverage when spending far less per capita than the U.S., the facts are already there. Single Payer offers the best coverage at the least cost.

But instead Obama wants a public health insurance option to compete with private insurers, while tightening regulations on insurance companies to produce such reforms as limiting a person's out of pocket costs and banning denial of coverage for pre-existing conditions. This has resulted in bills in Congress that are at times complicated and confusing. Under such circumstances, it can be difficult for the public to make head or tail out of what's going on, and support for reform can erode.

To a good extent, Obama has failed to learn the lessons from what happened to former President Bill Clinton's health care reform effort in 1993. Like Obama, Clinton didn't go for Single Payer, instead proposing a system of managed competition for private insurers. Then, as now, the insurance companies had no intention of changing the way they do business, and the complicated and confusing managed competition proposal died.

Republicans often get their way politically by demonizing their opponents, but Democrats are usually reluctant to do so. Probably no one likes insurance companies other than the politicians of both parties who have been bribed by them with campaign contributions.

While failing to demonize the insurance companies, Obama is right to want health care reform enacted as soon as possible. Delay only means defeat, and there is no point in waiting until after the 2010 midterm elections, as some have suggested. In the 1994 midterm elections, Republicans took over both houses of Congress, and health care reform was killed for the next decade.

Whatever happens, the public health insurance option must remain non-negotiable. It could well evolve into Single Payer if private insurers can't compete profitably against it. Another part of the health care reform proposal that should remain intact is progressively funding it through increased taxes on those making more than $350,000 a year.


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