Time to Play the Single Payer Card

Rob Stone MD  March 30,2009

“First they ignore you, then they ridicule you, then they fight you, then you win.”  – Ghandi


A health care reform bill out of Congress by the end of the summer?  An end to our national nightmare within five months?  The health insurance industry is banking on an Obama-Kennedy-Baucus bailout – “universal” health care, with taxpayer subsidies for those who can’t afford the unaffordable premiums.

Right now the insurance gang is controlling the debate, with big headlines about how they will give up a few of their most egregious behaviors and accept a modicum more government oversight as long as we mandate that everyone become their customer.  And, most importantly, don’t let the Socialists have their way and allow a Medicare-like “public option.”  They cry that it would be unfair competition to ask the for-profit insurance companies to go up against a government run plan. 

If they think the government can do so much better than they can, why don’t we listen to them?  Let’s go ahead and put everyone in a government plan!

The strategy from the industry and their Republican allies is obvious – appear to offer a series of compromises, but draw the line to prevent any government plan.  Wrap it all up in a big package and proclaim that we’ve got a uniquely American solution to our problem: a huge system of taxpayer subsidies to the insurance industry, with no mechanism to control costs, because there are too many big money interests who don’t want to see real cost control.  They are happy to expand access to insurance because it makes good business sense to create more customers.

The strategy of Obama, the Democrats, many labor leaders, and “progressive” groups like Healthcare For America Now is equally clear.  Let’s offer a compromise plan with many complex features, all of which need to be clarified and debated, and hope that we can get the whole thing through Congress intact, including the public option.  This is a strategy for failure.  The public option will be the part that gets compromised out.

Many prominent progressives like Paul Krugman and Jacob Hacker have argued that the public option is the key to the whole reform process.  The public option will constrain the rapacious insurance companies.  The public option will be popular and efficient.  The public option will be, at its best, a slippery slope to a single payer plan.  Never mind that critics have pointed out that if the public plan is enacted, the insurance companies will find ways to game the system again.  Never mind that the Right has recognized the slippery slope argument, and that is why they are so adamantly against it.

This calls for an obvious change in the Democrats’ strategy.  Up to now they have tried hard to keep the voices for single payer out of the debate. They have reassured the Republicans that single payer isn’t even “on the table.”  If they want to have a chance to get the public option through Congress, it‘s time for a new strategy.  Time to play the single payer card. 

Purely from a strategic perspective, the President should put single payer back on the table and start explaining to the people all the advantages of Medicare for All.  Then, when the going gets tough in the trenches of Congress, they can compromise and  settle for the public option, and a muscular enough public option that it could serve as a model (a slippery slope) for an eventual single payer system. 

Of course, maybe once the single payer cat is out of the bag, the weight of logic and public support will just push the insurance gang right out of the way.