Little Single Payer

by digby

Obama had a town hall meeting and a very sharp woman in the audience asked him why we can’t have single payer health care. Here’s is his answer:

Obama replied……. so this touches on your point, and that is, why not do a single-payer system. (Applause.) Got the little single-payer advocates up here. (Applause.) All right. For those of you who don’t know, a single-payer system is like — Medicare is sort of a single-payer system, but it’s only for people over 65, and the way it works is, the idea is that you don’t have insurance companies as middlemen. The government goes directly — (applause) — and pays doctors or nurses.

If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense. That’s the kind of system that you have in most industrialized countries around the world.

The only problem is that we’re not starting from scratch. We have historically a tradition of employer-based health care. And although there are a lot of people who are not satisfied with their health care, the truth is, is that the vast majority of people currently get health care from their employers and you’ve got this system that’s already in place. We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy.

So what I’ve said is, let’s set up a system where if you already have health care through your employer and you’re happy with it, you don’t have to change doctors, you don’t have to change plans — nothing changes. If you don’t have health care or you’re highly unsatisfied with your health care, then let’s give you choices, let’s give you options, including a public plan that you could enroll in and sign up for. That’s been my proposal. (Applause.)

Now, obviously as President I’ve got to work with Congress to get this done and — (laughter.) There are folks in Congress who are doing terrific work, they’re working hard. They’ve been having a series of hearings. I’m confident that both the House and the Senate are going to produce a bill before the August recess. And it may not have everything I want in there or everything you want in there, but it will be a vast improvement over what we currently have.

We’ll then have to reconcile the two bills, but I’m confident that we are going to get health care reform this year and start putting us on a path that’s sustainable over the long term. (Applause.) That’s a commitment I made during the campaign; I intend to keep it.

I understand the political problem with single payer — that is that the majority of politicians are bought and paid for by the insurance and pharmaceutical industries and it’s very difficult to ask people to give up something they have for something new. Let’s not kid ourselves about that. It’s just another symptom of a dysfunctional political system that isn’t going to be solved by one party or the other coming into power.

However, what this underscores is the absolute, bottom line necessity of the public plan option. Without it we will have at best a lightly regulated insurance industry and some kind of mandate,which is a recipe for disaster. Under the current dysfunctional system, the only way to get to a system that truly makes sense — which the president himself acknowledges is single payer — is for there to be a public option which will have all the advantages of the economy of scale the government can offer. Eventually most people will move to that system as it becomes known as the least expensive and most efficient. And that is why the health industry is going to put its full weight behind stopping it.

There are many moving parts in the health care debate, and nobody knows where it’s going to end up. But that woman asked a great question today and it got a nice round of applause from the audience. Even though Obama called them the “little single-payer” advocates, it’s important the people keep asking it or this debate is going to be a full production of the health industrial complex. (She also asked why members of congress should be allowed to work on health care when they have such conflicts of interest with the health industry, and the President didn’t address it.)

Meanwhile, in case anyone is under the impression that this is a simple process, note that the circus is in town:

Lobbying may be the one remaining recession-proof industry, and as Washington prepares for a summer-long debate over how to reform health care, lobbyists for every conceivable interest group have camped out in congressional anterooms to press their case. There are advocates for doctors, insurance companies, patients, nurses, pharmaceutical companies, big business and small business. And for faith healers too. Of course, they wouldn’t call themselves “faith healers.” They argue that the term dismisses what they do as simple wishful thinking. But practitioners of Christian Science as well as other alternative therapies — including acupuncture, biofeedback, herbal medicine, holistic medicine and Reiki, a Japanese healing and relaxation technique — are intent on influencing the coming health-care-reform process. “We’re advocates for people who want access to spiritual treatment,” says Phil Davis, a Christian Science practitioner and his church’s chief lobbyist. Their goal is to encourage Congress to think of health care as more than just medical care — and to allow insurance companies to provide coverage for their holistic treatments. The Christian Scientists have had some success in this area in the past. Founded in 1866 by Mary Baker Eddy, the Church of Christ, Scientist has worked for nearly a century with state licensing boards and legislatures to obtain recognition or acceptance for its practitioners, who treat injured or ill individuals by praying for them. Contrary to popular belief, Christian Scientists are not prevented from seeking medical treatment; the church just wants to make sure that both members and nonmembers are also able to afford visits to practitioners, which typically cost from $20 to $30 per session, and longer-term services of private nurses (who provide nonmedical care such as bathing, dressing wounds and feeding) and nursing facilities. TRICARE, the military health plan, already covers these services. And the Federal Employee Health Benefits program provides partial reimbursement for stays in Christian Science nursing facilities. More recently, Christian Scientists were able to obtain a special provision in the universal health-care plan enacted in Massachusetts, where the church is headquartered. In addition to exempting Christian Scientists from the requirement that all Massachusetts residents carry health insurance, the state allowed private insurer Tufts Health Plan to cover both medical and spiritual care, including stays at church nursing facilities.

Oy.

Update: Here’s an interesting piece on the current state of play in the senate. It doesn’t exactly fill one with optimism.
.