Single-Payer National Health Insurance

Wojtek Sokolowski sokol at
Tue Aug 24 15:40:05 PDT 1999

At 04:31 PM 8/25/99 -0500, Steve Perry wrote:
>Out here in Minnesota--whose gift to the world was the HMO system--
>there have been quite a few interesting folks involved with the single-
>payer question. Early in his first term, Paul Wellstone was seriously
>interested in pushing single-payer initiatives--not that he thought it
>was practical to attempt it nationally at that point; his notion was to
>pursue measures that would make it easier for states to do single-payer
>experiments and thus try for a groundswell that way. But he was
>seduced by Hillary Clinton during her '93 March to the Sea, and
>he's never made a noise about it since, to my knowledge. (By the way--
>why does everyone persist in claiming that the Clinton plan failed,
>just because it wasn't passed into law? It's quite obvious that the
>administration's move in the direction of HMOs touched off a merger
>mania that made her plan--minus some of its rube goldberg
>convolutions--into reality.)

-- snip

Two points. First, Christopeher Hitchens argues that Hillary's "reform" was, in fact, a move designed by big insurance firms and received a relatively mild oppsotion from smaller guys in the insurance biz. So it was hardly a propaganda blitz that "killed" that initiative. Au contraire, the whole "initiative" was a scham never intented to be implemented as advertised.

Second, health reform involves two conceptually different issues - the cost-effectiveness and the universal coverage. "Single payer" or more generally - public insurance schemes are designes primarily to address the cost-effectiveness issue by reducing transaction costs that are significant in this business. It does not automatically lead to universal coverage - in fact the acclaimed public health care systems under state socialism were NOT truly universal - for example, self-employed were not covered. Moreover, not every procedure was covered - only those available in public health care facilities.

Universal coverage does not require a single payer solution - it is possible to attain by means-tested public subsidies of insurance premiums. That is, you buy your insurance from a market vendor, and if you cannot afford one - government subsidies will make up the difference between what it costs and what you can afford.

So it makes a lot of sense, from the Left's point of view, to make that conceptual distinction clear. As katha p. & others pointed out, changing the status in the insurance biz will be extremely difficult politically, and the left should focus their energies on issues that really matter to its constituents, i.e. working class.

I do not think that cost-efficiency should be of primary concern to the Left for a number of good reasons, chief among them being that insurance companies can take of that. Moreover, "government health care" has become one of the buzz-words that provoke a knee jerk reaction on the right - so fighting for a single payer system is not the best strategy for the left, except perhaps for scoring symbolic points in a kulturkampf.

A much better strategy is to focus on universal coverage - which as I have argued - can be achieved by institutional arrangements that are not limited to a single payer public insurance scheme.


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