Doug Henwood:
> The SEIU's health care project, Americans for
> Healthcare, says nothing about single-payer.
> They're now pushing Maryland-style legislation,
> which is a pretty half-assed approach.
If you want to talk about stuff that's half-assed, let's talk about single-payor, which in this country would socialize insurance but leave in place all the ripoff artists on the provider side of the ledger -- and I'm referring not just to the big for-profits like HCA or Tenet, which probably have whole departments of people who specialize in ripping off the government, but also the non-profits (including very large chains, especially religious and academic ones) who are almost as bad save that they do not pay taxes.
Presumably a single-payor system would have to have a prospective payment system similar to the DRG system we have now, and with what the Whiskered One would have called "the anarchy of production" still reigning on the provider side, that would still mean not only graft but systemic inequities, as rural hospitals continue to lose out, for example. We don't need "Medicare for all," we need the VA for all -- with better funding, of course! Nationalize the whole thing from soup to nuts, with every hospital and clinic and nursing home owned by the government and a rational and fair process for planning and capital spending, and everyone from the doctor to the janitor an employee of the state. Single-payor is a cringeing social-democratic half-measure.
My tone may be facetious, but in principle I am quite serious. Only in a desperate health care situation like our own can single-payor look radical.
All of that said, once we've accepted the need for fundamental change in principle, there is still the matter of how to get there. We should have the luxury of debating single-payor vs. a National Health Service. We don't. Instead, we have a battle over ballooning state Medicaid budgets in an atmosphere of austerity. When the federal government is supremely hostile, and when many legislatures too are controlled by the Republicans, it is almost impossible to talk about raising real revenue -- in just about every state, it's all about "sin taxes" on cigarettes or on legalized gambling. In this atmosphere, it's a step forward to talk about taxing large employers and/or requiring them to pay for their employees' health care. That is the sad but unavoidable reality.
- - - - - - - - - - John Lacny http://www.johnlacny.com
Tell no lies, claim no easy victories