By Chris Frates Politico December 2, 2008
A new fault line is forming in the health care reform debate that could prove to be just as bruising as the conservative-vs.-progressive battles: the schism between single-payer and public-private advocates.
Both sides are pushing for universal health care, but the more purist single-payer advocates believe that any approach that retains the insurance industry is doomed to fail.
"Private health insurance is no longer a workable model for health care reform, because the insurance companies sell a defective product and health care costs are so high that even moderate-income families can no longer afford the premiums, co-pays and deductibles," said Ida Hellander, executive director of Physicians for a National Health Program, a group of 15,000 doctors who support a single-payer system.
So far, though, groups working to create a public insurance plan that exists alongside tightly regulated private plans have grabbed the political high ground - largely because many deem a single-payer system too easy to demonize as socialized medicine.
Many of the progressives charting a course for the public-private mix were single-payer advocates who emerged from the health care battles of the early 1990s. They realized that "we need to focus on the goal of quality, affordable health care and make that goal paramount instead of any particular solution in getting there," said Richard Kirsch, national campaign manager for Health Care for America Now.
Kirsch's group is a large progressive force pushing for a public-private scheme. HCAN claims 530 organizations as members - including a number of unions, a fact not lost on its single-payer detractors.
"These guys have unions as part of their coalition, but apparently they don't understand collective bargaining. If you don't ask for something, you'll never get it," said Chuck Idelson, spokesman for the California Nurses Association/National Nurses Organizing Committee, the nation's largest nurses union.
The nurses union believes that by not pushing for a single-payer system, HCAN and its allies are setting Americans up for failure.
"President Obama, we believe, seriously wants to reform our health care system in a way that solves a problem," Idelson said. "He's not going to be helped by those people who are advocating health care reform that won't work but would leave people looking for real change disillusioned."
HCAN argues that its plan will work and that single-payer advocates need to realize that their approach is politically untenable - a notion that Idelson dismissed. "Every significant reform in American history has been mocked ... as out of the political mainstream," he said.
"There are well-meaning players within HCAN who have made a tragic decision to settle for what is politically practical, regardless of whether it works," Idelson said. "Then there's the service employees union that has elevated expediency to the point of principle and will sign anything with anyone to benefit themselves at the expense of the public interest."
Said Service Employees International Union President Andy Stern: "The one thing we know is that the longer we wait, the worse it gets. SEIU is on the ground, ready to help President-elect Obama fix our health care system so that it provides quality, affordable health care for every man, woman and child in America."
Kirsch added that the attacks by single-payer advocates are aimed in the wrong direction and "are more of a distraction than anything else."
"It's great for them to go out and advocate for single-payer, but we think they're misplacing their energies by attacking us," Kirsch said. "They should be focusing their energies on those that don't want to see any public health insurance plan and don't want to see stringent regulations of the private insurance industry."
The upside to having single-payer advocates in the fight, Kirsch said, is that they help "keep pressure on Congress and the president to support a public health choice."
"How nice of them to be so condescending," Idelson said.
And for the moment, it seems, not even the shared adversaries of insurance companies and conservatives who would kill any kind of public plan, single-payer or otherwise, can bring the two progressive factions together.
http://www.politico.com/news/stories/1208/16092.html
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