Single-Payer National Health Insurance

Tom Lehman TLEHMAN at
Tue Aug 24 18:14:31 PDT 1999

Wojtek, The Blue Cross/Blue Shield system of fairly inexpensive semi-public health insurance doesn't exist anymore. It was based on economies of scale and regulated by the interaction of physicans, hospitals and large scale employers. Where it still exists it doesn't have the monopoly that it once had or has changed into more of an HMO style package. Not cheap anymore either.

Corporate downsizing and runways to low wage no benefit areas have diminished the amount of dollars available--that's where Steve Perry's comment on Lee Iacocco comes in--fewer employers paying more dollars to maintain a shrinking health insurance pool. And Lee Iacocco isn't the only one to realize this! National single payer health insurance makes good business sense. And as I have pointed out before no matter what the economic system people are still going to do business.

Tom Lehman

Wojtek Sokolowski wrote:

> 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.
> wojtek

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