The Limits of the Debate on Single-payer Healthcare

New York Times' columnists Gail Collins and David Brooks did something that almost never happens: they discussed why single-payer is never even considered by mainstream media and Washington politicians. The absence of even occasional debate over the merits of single-payer is especially disheartening given the fact that is the most obvious cure for what Republicans and Democrats alike agree at the two most fundamental problems with US healthcare today: the skyrocketing costs and the fact that so many are left without insurance at all.

But the debate, held as part of a recurring online feature, was incredibly problematic. While Collins rightfully acknowledges that since "a third of the cost of health care is in administration, and the problem with reorganizing health care has to do with all the multitudinous plans and policies, a single-payer system would be far and away the most cost effective answer."

"We don't talk much about it because it isn't politically possible. But it isn't politically possible because we don't talk about it," she said.

Brooks response, however, is very short-sighted.

"Democratic politicians throw around statistics claiming that Medicare has much, much lower administrative costs than private insurers. I've been told by various economists that this claim is three-quarters trickery. It's a lot cheaper to administer a targeted population that uses a lot of care than it is to administer a large population that uses little care per capita. Plus you can save a lot of administrative costs if you don't actually regulate treatments that much," he said.

But what about every other industrialized nation in the world? Many of them -- Canada, the UK, Tawain (which is based on Medicare) -- have a single-payer system, while all other developed countries essentially share the basic idea of single-payer: a centralized funding mechanism that guarantees coverage to all while controlling costs.

In each of these instances, the countries pay significantly less than the United States on healthcare as a percentage of GDP and on administrative costs. The United States spends now about 16 percent of GDP on healthcare, while the average expenditure for a country in the countries in the Organization for Economic Co-operation and Development, is about half of that.

Brooks claims that the sheer size of the US makes single-payer non-viable, but he doesn't explain why, only claiming that, "There is no way something that big and complex and dynamic can be run out of Washington."

Why not? He does not say. Having a large population is a factor in healthcare spending, and healthcare needs -- although when pooled together it also provides leverage that smaller countries do not have -- and it obviously isn't working to have for-profit private insurers run the show. But he seems not only willing, but adamant, that this system must be preserved. This is despite the fact that government-run systems within the US - Medicare and the Military healthcare system - are the most efficient and have the highest satisfaction levels.

A national Commonwealth Fund survey, for example, found "Medicare beneficiaries reported greater overall satisfaction with their health coverage, better access to care, and fewer problems paying medical bills than people covered by employer-sponsored plans. The findings bolster the argument that offering a public insurance plan similar to Medicare to the under-65 population has the potential to improve access and reduce costs."

It is sad that Brooks is perpetuating this myth that preserving for-profit private insurance companies -- bound by law to put the bottom line for shareholders above all else, including the public good -- to be the primary vehicle for health insurance is vital, without providing any evidence. Given how infrequently this topic is discussed in the US media, even though the public supports single-payer in virtually every public poll taken on the subject, that the concept was dismissed so fallaciously by a columnist for an elite national paper is rather troubling.


As a report done by Fairness and Accuracy Reporting showed in a survey of articles about healthcare for a week in March:

Over the past week, hundreds of stories in major newspapers and on NBC News, ABC News, CBS News, Fox News, CNN, MSNBC, NPR and PBS's NewsHour With Jim Lehrer mentioned healthcare reform, according to a search of the Nexis database (2/25/09-3/4/09). Yet all but 18 of these stories made no mention of "single-payer" (or synonyms commonly used by its proponents, such as "Medicare for all," or the proposed single-payer bill, H.R. 676), and only five included the views of advocates of single-payer--none of which appeared on television.

Of a total of 10 newspaper columns FAIR found that mentioned single-payer, Krauthammer's syndicated column critical of the concept, published in the Washington Post (2/27/09) and reprinted in four other daily newspapers, accounted for five instances. Only three columns in the study period advocated for a single-payer system (San Diego Union-Tribune, 2/26/09; Boston Globe, 3/1/09; St. Petersburg Times, 3/3/09)."

Why the media is so complicit in narrowing the debate so it favors the interest of insurance companies is worthy of examination. The fact that the public supports single-payer -- even in the face of this media blackout -- is also rather telling of how persuasive the argument for single-payer truly is.