The ACP Advocate Blog

by Bob Doherty

Friday, November 7, 2008

Will single payer advocates get behind Obama-style health reform?

One reason why President Bill Clinton was unsuccessful in his effort to reform health care is that although the opposition was unified, the advocates for universal coverage were split. One reform camp was willing to support a pluralistic model, as proposed by President Clinton, as long as it included guaranteed (mandated) coverage. The other insisted that a single payer plan - often described as Medicare for all - was the only acceptable outcome.

Jacob Hacker, professor of political science and resident fellow of the Institution for Social and Policy Studies, had this to say in the May-June issue of Health Affairs:

"Born in a policy hothouse, the Clinton plan wilted in the cold winds of politics."

He argues that a successful effort this time "will require updated strategies including a greater willingness to compromise on means, yet greater clarity on ends" and "serious efforts to bring on board ... reformers who support a universal Medicare plan, to provide them with the guarantees and arguments they need to embrace a less inspiring but more politically palatable approach."

President-elect Obama's health care reform proposal builds upon existing employer-based coverage provided principally by private insurers, instead of a "Medicare for All" approach. (Click on ACP's election tool for more information about the Obama plan and how it compares to ACP policies)

ACP understands why a single payer approach is appealing to some. Based on an evidence-based review of the experiences of other countries' health systems, ACP recommended that policymakers consider one or the other of two pathways to achieve universal coverage: a single payer financing model or a pluralistic model with coverage guaranteed by law. The paper notes that either have significant advantages and disadvantages that would need to be considered, but both are preferable to status quo of pluralism without universality.

The political reality, though, is that President Obama will not ask Congress to enact a single payer plan.

Today's questions: Will the "Medicare for all" camp be behind the Obama approach, even though it may be the "less inspiring but more politically palatable approach?" Or, will they hold out for a day when the political environment might allow for a single payer plan - at the risk of losing any chance for reform now?

2 Comments :

Blogger Kathy said...

My experience with those who advocate single payer is that they will not accept compromise on this issue. I agree with them that it would be the most efficient and comprehensive system we could have. But it's hard to imagine an entire industry, the health insurance companies, would go down without a fight. However, my take on the Obama reform plan is that it is a back door way of getting to single payer, by including a government-sponsored health plan as one of the options. There is no way a for-profit health plan would be able to compete in the long run. That's my hope, anyway.

November 7, 2008 at 1:34 PM  
Blogger Discover What You Think said...

Facts that are believed to exist regarding the present U.S. Health Care System-
This may be why about 80 percent of U.S. citizens want our health care system overhauled:
The U.S. is ranked number 42 related to life expectancy and infant mortality, which is rather low.
U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses. Health Care cost presently is over 2 trillion dollars of our gross domestic product. One third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.
We have around 50 million citizens without any health insurance, which causes about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children that covers about 7 million kids.
Our children
Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits.
About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported. Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system. The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than a third of all physicians are members of the AMA.
Our health care we offer citizens is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.
Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported. It is estimated that we need about 60 thousand more primary care physicians to satisfy the medical needs of the public health in the United States. And we have some greedy corporations that take advantage of our health care system. Over a billion dollars was recovered for medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations ripped off taxpayers. These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy.
Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up the U.S. Health Care System, which is why the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens. We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals. It should be and likely will be funded by a combination of payroll taxes and general tax revenue:
Access- citizens do not have the right or ability to make use of this system as we should.
Efficiency- this system strives on creating much waste and expense as it possibly can.
Quality- the standard of excellence we deserve as citizens with our health care is missing in action.
Sustainability- We as citizens cannot continue to keep our health care system in existence , or tolerate it as it exists today any longer,

Dan Abshear

December 14, 2008 at 9:41 PM  

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About the Author

Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog

Email Bob Doherty: TheACPAdvocateblog@acponline.org.

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