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OpEdNews Op Eds    H2'ed 4/4/09

Why "chocolate or vanilla"? Put Single Payer on the table!

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Message Claudia Chaufan

With 100,000 monthly foreclosures, 700, 000 jobs lost every month, and the number of uninsured, underinsured, and deaths for lack of health insurance not getting any smaller, if the time for healthcare reform is not now, when then? And private health insurers know this too well, which is why they claim to have become “team players”, and to support "change". But the question remains: which change?

 

As New York Times reporter Robert Pear recently noted, the only two options receiving any serious consideration in the halls of power of Washington D.C. are a “public option” (Medicare-like plan) or no public option, both within a “tightly-regulated-healthcare-marketplace”. In other words, our house is burning, and Washington, once again, gives us two options, “vanilla or chocolate”, both of which involve “comparative-shopping” (as if with health insurance, much like with Ipods, we could increase our market power if we wait for the next sale!).  

 

That private insurers are fighting the public option on the grounds that competing with government is “unfair” should come to nobody’s surprise: clearly, they are in the business for the money, not to provide a social service to the American people. And they win when they collect premiums and deny payments for health care, and when they dump “bad customers” (sick, old, poor, or “not-wealthy-enough-to-pay-for-our-products”) on taxpayers.

 

And from their point of view of course, a government-financed, privately-delivered, healthcare plan is “unfair competition”: who can compete against a publicly financed option -- whose goal is to eliminate financial barriers to health care -- with its demonstrable administrative efficiency, capacity to set high quality standards, and huge market power that could dramatically reduce the absurd prices Americans pay for services and goods (e.g. pharmaceuticals) that cost a fraction elsewhere?

 

And defenders of the public option, the “other side” of the “chocolate-or-vanilla” equation, are also very familiar with the strengths of publicly-financed systems, such as single payer. Indeed, renowned Berkeley professor Jacob Hacker has extolled the virtues of a Medicare-like plan, and argued that including it is critical to successful healthcare reform.

 

What is less clear is why Hacker, who clearly understands the advantages of social insurance (what his Medicare-type “option” is) -- advantage, that is, from the point of view of prospective patients -- when compared to for-profit liability insurance (what private for-profit plans are), would suggest a Medicare-like plan only as an “option”, and in so doing undermine its critical strengths – by chipping away its administrative efficiency, weakening its market leverage, and forcing it to compete against folks whose ultimate goal is not to meet a social need, but to make a buck, the bigger the better.

 

Why would Hacker not recommend extending the benefits of Medicare to all Americans (what Congressman John Conyers’ HR676 bill proposes for the nation and Senator Mark Leno’s SB 810 proposes for California), while extricating the profit motive, which created the current mess, from health insurance altogether?

 

To this, Hacker replies that Americans are “deeply divided” when it comes to health insurance -- after all, have we not been struggling with this while the rest of the world moved on? -- and that “polls” (two exactly, one of them conducted by himself) indicate that Americans prefer “choice”, not only of doctors but also of insurance plans (hmm...does it follow that pushing single payer off the table represents “the people’s will”?). And that anyway, Americans don’t trust government (very well...does it follow that we trust insurance CEOs more than our elected officials?).

 

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Claudia Chaufan, M.D., Ph.D., is Associate Professor at the University of California, San Francisco. She is also a member of Physicians for a National Health Program-California (http://pnhpcalifornia.org/).

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