Monday, July 6, 2009

Christian Science Monitor: The Missing Piece of the Health Care Debate

What is keeping single payer health care out of the ongoing debate in Washington? Advocates, is civil disobedience the only way to get the single payer message out to the public?
by David R. Francis. Posted at the Christian Science Monitor, July 1

If no one is paying any attention, create a fuss.

Maybe that explains why 13 doctors and nurses got arrested last month when they disrupted a Senate hearing. Their protest: The committee wasn’t considering a single-payer solution to fix America’s healthcare system.

In fact, as healthcare reform works its way through Congress, the idea of a government-paid national health-insurance system hasn’t gotten very far in the Washington debate.

Perhaps it’s too politically radioactive. Or too difficult to pass. For whatever reason, neither the most Democratic Congress in decades nor the most liberal president since Jimmy Carter have opted for a sweeping national health-insurance system, as exists in Europe and Canada, where private insurers disappear and government pays the tab.

“There are countries where a single-payer system works pretty well,” President Obama, a onetime single-payer supporter, told the American Medical Association June 15. “But I believe … that it’s important for our reform efforts to build on our traditions here in the United States.”

That stance leaves single-payer advocates in a political quandary.

“We haven’t yet applied enough pressure to get done what has to be done,” says David Himmelstein, cofounder of Physicians for a National Health Program (PNHP). Maybe, he added, “we will have to give strong consideration to civil disobedience.”

Why are single-payer advocates so passionate? For one thing, many of them see medical healthcare as a civil right for all Americans.

Call up the Internet home page of Rep. John Conyers (D) of Michigan and immediately, without further clicking, a video shows the congressman talking on the House floor about one of “the biggest challenges of the 21st century” – healthcare reform. His bill would provide national health insurance to every person with no deductibles or copayments for medical treatment. Uncle Sam – via citizens – would pay the bill.

Prospects for his bill in Congress don’t appear strong, although 80 House members have signed on to his bill and 59 percent of physicians back national health insurance, according to a new poll.

Public support has also grown over the years. In 1979, 40 percent of Americans thought the federal government should provide national insurance; last month, 72 percent supported the idea, according to CBS News/New York Times polls.

“Things have gone very well for us,” says Quentin Young, PHNP’s national coordinator. “There has been a new surge of support in the last few months.”

Economic stress may explain some of that shift. In 2007, even before the recession, medical bills were the cause for more than 60 percent of bankruptcies, a new Harvard study finds. More than 75 percent of these bankrupt families had health insurance, but it wasn’t enough, Dr. Young points out.

Reformers of every stripe figure that today’s system is unsustainable in the long run. The Congressional Budget Office projects national healthcare costs to rise from today’s 18 percent of gross domestic product, the total output of goods and services in the nation, to more than 30 percent in 2030 and 50 percent by 2080. That assumes modest cost-cutting measures are imposed. Without them, healthcare costs would consume nearly the entire economy by 2080, an impossibility.

Compromise reforms under consideration in Congress are economically “not feasible,” Dr. Himmelstein says, “The likelihood we can afford what they are offering is nil.”

So he figures a single-payer plan is essential. Just cutting the system’s bureaucratic overhead from today’s 31 percent of total expenditures to Canada’s level (1 percent) would save nearly $400 billion annually, more than enough to cover the 48 million now uninsured, he argues.

So why hasn’t Congress moved toward a single-payer system? The financial and political clout of health industries, charges Himmelstein.

And who was the top recipient of their largess in the 2008 election cycle? Mr. Obama.

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