Why is it so hard for President Obama and the Congress to even discuss a single-payer system for health care?
I don’t always agree with Michael Moore, but his 2007 movie “Sicko” was, I thought, a brilliant cocktail of journalism and satire. And it served an important purpose. Ever since the Clinton health care reform initiative was beaten to death in 1993, the very subject of national health care reform had been kept in a steel cage in some Potomac policy dungeon. Americans were free to complain about the increasingly dysfunctional national health care system. But we couldn’t propose ways to fix it because, well, that had been tried and resolved as though it had been scientifically proven to be a worthless herbal remedy for colds.
It’s hard for me to forget “Harry & Louise,” the actors Harry Johnson and Louise Caire Clark, who so smoothly acted out the Health Insurance Association of America’s script. This may have been the most perniciously effective political ad of all time in the way that it worked, so well, to persuade viewers that, with federal intervention in health care, bureaucrats were going to bungle medicine by getting hopelessly between patients and doctors.
No, we couldn’t have that. We’d just be better off with the status quo. You know, where private insurers would so compassionately work to provide innovative, state of the art care for everybody. Or at least everybody who could afford soaring health insurance premiums. Or at least everybody who worked for an employer willing to subsidize employee premium payments.
Suffice to say, we now know how that worked out. Health care costs soared. Even before 
Moore pointed his camera at the shameful, mounting problems, Americans were increasingly sharing horror stories in which even people who thought they were paying for first-rate health insurance were being denied coverage for life-threatening ailments. Notwithstanding the state-of-the-art care available to the wealthy, our for-profit health care system prefers to insure healthy people and limit or deny care for those who become unhealthy. We pay nearly twice as much per capita for health care as other industrialized nations and still there are more than 45 million who don’t have insurance and millions more who, though insured, still can’t access the care they need.
“It’s a shameful system, especially when I’m dealing with some of my patients,” says neurosurgeon and chief CNN medical correspondent Dr. Sanjay Gupta.
The reason I’m quoting Dr. Gupta is that he emerged as the fact-checker in chief for the mainstream media, soon after “Sicko” hit theaters. It was Dr. Gupta’s view that Moore had “fudged” facts in “Sicko” and this led to widely viewed confrontations on CNN where Moore first took on senior correspondent Wolf Blitzer and then Dr. Gupta himself.
It was good television only in the sense that Dr. Gupta and Moore argued vehemently over facts that–in hindsight–were substantively irrelevant to the argument Moore was making with his movie. What was relevant is that Dr. Gupta thought he was doing the country and his network a big favor by trying to discredit Moore and Moore, understandably, was not going to stand for it. When even Dr. Gupta wound up admitting that the U.S. system was “broken,” Moore had won the debate.
There are a pile of worthwhile arguments about how the U.S. system became broken and what it will take to fix it. But I don’t see how any of these avoid the basic question raised by Michael Moore.
If, as President Obama has said, health care is a right and not a privilege, then we need to have an honest and meaningful debate about how we deliver on that right. Are we going to continue with a private system that is organized for the primary benefit of stockholders and hope to legislate and manage the inequities out of it? Or are we going to move toward a single-payer system, like Canada, where universal access is the objective and the people who run and manage the system are directly or indirectly accountable to we the people?
This is the debate we should be having. But, mostly, we’re not. Why? Because Obama, for all his other gifts, has only shown, thus far, that the change we can believe in will be doled out in very small coins. And so it has been with health care, where the suspense is not whether he will endorse (let alone seriously consider) a single-payer option, but whether he will include, and really fight for, a public option for those who cannot get adequate insurance through their employers. There’s a serious argument about whether a public option choice makes sense alongside private insurance options, but we’ll dig into that another time.
What struck me is how the single-payer option essentially got banished right out of the box, with Republicans and many influential Democrats (most notably Sen. Max Baucus, the Chairman of the Senate Finance Committee) putting it off the table for legislative discussion. The reason, in Baucus’s words: “because it cannot pass. It just cannot pass.”
Baucus has been hammered, even in his home state of Montana, for holding this position while taking large sums of money from health insurers and the pharmaceutical industry. No doubt the money talks, but as it talks I think what it is bankrolling is a fundamentally hardened attitude of American conservatives. That attitude is, as they say in Wyoming, to “cowboy up.” Put another way: “you’re on your own.” “If you can’t afford health care, if you can’t manage to get a job where you enjoy decent health insurance, tough, that’s your problem, not mine.”
This is the movie we appear to be stuck in because of how well conservatives and industry groups have limited our choices before we even get around to discussing them. Talk of a “uniquely American” solution to the health care crisis is, to my ears, simply an excuse not to consider a single-payer system, even though it obviously works well enough in other countries to warrant serious consideration in ours.
Which is not to say the Canadian system or the other nationalized systems are perfect. You can find flaws with them, whether it is longer waiting times or the unavailability of advanced procedures that are available in the U.S. And, of course, it’s those flaws that get highlighted by those who, quite honestly, don’t want reform, or reform that actually delivers on making health care a right rather than a privilege. For them what we have is a bucket of cynicism and a new list of Frank Luntz talking points, which you can read here.
I probably had better things I could have been doing very late Friday night but I saw on one of the blogs I regularly read an item reporting on a hearing before a House Subcommittee on the single-payer idea. The hearing had taken place a month ago. The lead off witness was Rep. John Conyers who has sponsored H.R. 676, the single-payer proposal that is off Sen. Baucus’s table and nowhere to be found in President Obama’s reform proposals.
The hearing is an hour and a half long. I know you’re busy.
But look closely at a few things if you have time. The first is the introductory statement of Rep. John Kline of Minnesota about four and a half minutes into the session. Rep. Kline not only expresses contempt that the committee has taken time to hear testimony on single-payer but he references the President, himself, as one who has “been very clear in rejecting single-payer health care.”
Perhaps because I have a dark, crusty sense of humor, I actually laughed out loud at this part. I mean, think of it, perhaps the most important domestic policy decision that faces the country, and the first time it rears its head in a subcommittee hearing it’s denounced as an egregious waste of time. Unbelievable.
Then go to 1 hour and 13 minutes into the hearing and listen to the statement by Illinois Rep. Phil Hare, and hear his account of how recent public meetings in Hare’s very conservative district have been energized by constituents calling on him to endorse a single payer system for health care. You may also want to watch Rep. Dennis Kucinich’s clash with Dr. David Gratzer, a Canadian-raised physician who is now a senior fellow at the conservative Manhattan Institute. You can find this at 1 hour and 22 minutes into the hearing. The C-SPAN video allows you to jump around to different parts of the hearing, so that’s a bonus.
Oh, and if you think of it, share the video link of the hearing with a friend. It’s important. At the rate things are going, your children or grandchildren will ask you, in a decade or so, why our national health care system still doesn’t work. This hearing may help you answer their question. Or it may make you and others mad enough so that we actually get this done right, and then you’ll have other questions from your grandchildren, like how did you get them to listen?
–Tim Connor
No comments yet.