A Single-Payer Solution?
(Photo by Robin Holland)
In this week's JOURNAL, Bill Moyers sat down with physician and activist Dr. Margaret Flowers, who was recently arrested for an act of civil disobedience - trespassing - as she attempted to deliver to President Obama a letter urging him to resuscitate the stalled effort at health reform and consider a Medicare-for-all plan, known colloquially as "single-payer."
"I went into medicine because I really do care about taking care of my patients... I really thought that medicine was going to be about taking care of patients, and I learned otherwise - that it was more about fighting with insurance companies and being pushed to see more and more patients. When I looked at what was going on and looked at what works in other places and what models have worked here, I saw that if we have a Medicare-for-all system, then really doctors can practice medicine again... [The White House was] concerned that if we let the single-payer voice in, or if it was associated in any way with [their] legislation, that it would hurt their ability to pass that legislation, so they kind of put the kibosh on it... Why is [Obama] excluding us? Why isn't he letting us be at the table when this makes complete sense from a public policy, public health policy, and economic health policy standpoint?"
Former Secretary of Labor Robert Reich, who appeared on the JOURNAL last June, argued that single-payer is the best possible health reform but that it is not politically achievable in Congress:
"The single-payer system would be the best of all... Because a single-payer actually would have huge bargaining leverage, be able to tell the providers what they can do and what they can't do without it being 'socialized medicine.' A single-payer would actually have the reins... But a President, to some extent, has got to be politically realistic. There is no real political option in Congress now for a single-payer... I'm a big single-payer fan. Unfortunately, we cannot get there from here because the political forces are just too strong against single-payer."
On the other hand, columnist John Steele Gordon of the WALL STREET JOURNAL has argued that, historically, self-interested politicians have proven unable to run large enterprises sensibly. Gordon wrote:
"It might be a good idea to look at the government's track record in running economic enterprises. It is terrible... Because of the need to be re-elected, politicians are always likely to have a short-term bias. What looks good now is more important to politicians than long-term consequences even when those consequences can be easily foreseen... And politicians tend to favor parochial interests over sound economic sense.... The inescapable fact is that only the profit motive and competition keep enterprises lean, efficient, innovative and customer-oriented."
What do you think?