Why isn't single-payer "uniquely American"?

By Timothy Noah

On July 30, single-payer advocates staged a rally on Capitol Hill to demand why Congress wasn't even considering enacting a single-payer health system. The usual answer you hear from Sen. Max Baucus, D-Mont., and others is that the United States requires a solution to its health care crisis that's "uniquely American."

This smug cliché, as I have complained before, encapsulates the American political establishment's hubristic refusal to consider how other industrialized countries tackle the problem at the practical level. Health care reform, it is said, must reflect distinctly American values, and that's why Congress resolutely ignores the single-payer model favored in Canada; the Bismarckian nonprofit model favored in France, Germany, and Japan; and the socialized model favored in the U.K., Spain, and much of Scandinavia.

Under a single-payer system, the government doesn't care which doctor or hospital you use because none is going to be more expensive than the others. Granted, the government may deny choice in tests and treatments, but Brett judges that reality as no more restrictive than with market-based medicine; the only difference is whether the gatekeeper is public or private.

By definition, a single-payer system would deny consumers (or, more typically, their employers) the opportunity to choose a health insurer. But choosing an insurer, Brett says, is "not an end in itself." Rather, it's a means to "efficient, cost-effective health care." And single-payer has shown itself superior to private insurance in this respect as well, "[b]ecause administrative costs are consistently lower in single-payer systems than in private-based systems." (Brett might also have pointed out that a single-payer system can set hospital and doctor fees at whatever it deems reasonable.)

Why, then, is Congress so resistant not only to creating a single-payer system but even to creating a robust "public option" government health-insurance plan as one option among many? In the Aug. 3 New Yorker, Hendrik Hertzberg correctly identifies the obstacle not as culture but as the structure of U.S. government itself:

Other industrialized democracies typically favor a more streamlined parliamentary approach. Hertzberg goes on to point out that in one of our legislatures (the Senate), "one member may represent as little as one-seventieth as many people as the member in the next seat," and a minority of members may block any action through the filibuster. (These are two hobbyhorses I happen to share with Hertzberg. See "Abolish the Senate!" and "Abolish the Filibuster!") Harold Pollock, faculty chair of the University of Chicago's Center for Health Administration Studies, noted last month that the small, bipartisan "coalition of the willing" writing the Senate finance committee's health-reform bill while it munched on chocolate-covered potato chips represented a combined population of fewer than 11.2 million, which was less than that of greater Los Angeles. Since Pollock wrote, Sen. Orrin Hatch, R-Utah, has dropped out, reducing the coalition's membership from seven to six and lowering its collective constituency to 8.5 million souls, or less than that of the Chicago metropolitan area.

Read it all at Slate Magazine