"Hold out for single payer" by Nick Skala, sr. researcher at PNHP

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Fri Jun-12-09 11:35 AM
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"Hold out for single payer" by Nick Skala, sr. researcher at PNHP

Here, first, is my reason for posting this article:
Single-payer advocates have found that some of our friends at DU are quite upset with us for not joining them in fighting for a "public option" which would reliably cover all the uninsured. Some who have done inspiring work in providing the rest of us at DU with excellent information on many issues including on the current state of the debate in Congress on healthcare, and whose opinions have often clarified many other issues for us are saying that we are disrespecting them by not dropping the single payer fight. For myself, at least, I know nothing could be further from the truth, and it's likely that most single payer advocates feel that way as well. Where we differ is that we believe that the fight for a truly viable public option is no easier than the fight for single payer because the health insurance industry sees a workable public option as equal to single payer in the threat it would be to their continued existence, so would fight just as hard, w/ just as much money, just as many promises of high-paying jobs for Congressmembers when they retire, and just as much farflung disinformation. And though we believe it is possible to craft a public option that covers all the uninsured including those dumped off the rolls of private insurers when they become too expensive, we do not think it is possible for that public option not to need huge taxpayer subsidies from people who will also be paying premiums to their private insurers. We don't believe it is possible to create a public option that will stimulate the economy in these difficult times by removing the burdensome cost of healthcare from businesses, large and small. We don't believe it is possible to create a public option that controls costs. We don't believe it is possible to create a worthy public option with costs that wouldn't rapidly wear out its welcome, drain rather than help the economy, and alienate the public from gov't health plans entirely. Our beliefs come from reading the research and conclusions of those who have been researching the issue for years, like the author of the article quoted here.

from remarks presented to the Congressional Progressive Caucus on June 4:

The “public option” preserves all of the systemic defects inherent in reliance on a patchwork of private insurance companies to finance health care, a system which has been a miserable failure both in providing health coverage and controlling costs.

Elimination of U.S.-style private insurance has been a prerequisite to the achievement of universal health care in every other industrialized country in the world. In contrast, public program expansions coupled with mandates have failed everywhere they’ve been tried, both domestically and internationally.

First, because the “public option” is built around the retention of private insurance companies, it is unable - in contrast to single-payer - to recapture the $400 billion in administrative waste that private insurers currently generate in their drive to fight claims, issue denials and screen out the sick. A single-payer system would redirect these huge savings back into the system, requiring no net increase in health spending.

In contrast, the “public option” will require huge new sources of revenue, currently estimated at around $1 trillion over the next decade. Rather than cutting this bloat, the public option adds yet another layer of useless and complicated bureaucracy in the form of an “exchange,” which serves no useful function other than to police and broker private insurance companies.

Second, because the “public option” fails to contain the cost control mechanism inherent in single-payer, such as global budgeting, bulk purchasing and planned capital expenditures, any gains in coverage will quickly be erased as costs skyrocket and government is forced to choose between raising revenue and cutting benefits.

Third, because of this inability to control costs or realize administrative savings, the coverage and benefits that can be offered will be of the same type currently offered by private carriers, which cause millions of insured Americans to go without needed care due to costs and have led to an epidemic of medical bankruptcies.

Virtually all of the reforms being floated...have been tried, and have failed repeatedly. Plans that combined mandates to purchase coverage with Medicaid expansions fell apart in Massachusetts (1988), Oregon (1992), and Washington state (1993); the latest iteration (Massachusetts, 2006) is already stumbling, with uninsurance again rising and costs soaring. Tennessee’s experiment with a massive Medicaid expansion and a public plan option worked - for one year, until rising costs sank it.

The Federal Employee Health Benefit Program (the model for a health insurance exchange) leaves hundreds of thousands of federal workers uninsured, and has proven unable to contain costs....A quarter-century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry-picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan - which started as a single-payer system for seniors and have now become a funding mechanism for HMOs - and a place to dump the unprofitably ill.

When we read careful, thorough and exhaustive research like this, we know that much as we might want to support our fellow DUers, we can't get behind what has failed in the past and can be expected to fail in the future. We feel as the brave nurses and doctors who made themselves vulnerable by engaging in civil disobedience before the Senate, in the current inhospitable atmosphere for such activities, that single-payer healthcare is the only option that will lead reliably to treatment of health care as a right for all in this country.