The top-tier Dems have all unveiled pretty good healthcare plans, but none are willing to consider a single-payer system. (To his credit, Kucinich has a single-payer proposal, but his position has not yet influenced the larger policy debate.)
Barack Obama told a YearlyKos audience that if he were starting a healthcare system from scratch right now, he’d gladly support a single-payer system, but given the healthcare structure that currently exists, he doesn’t see that kind of overhaul as feasible. It’s not the ideal answer for proponents of such a plan, but at least he acknowledged the merit of the idea. John Edwards, in perhaps the most disappointing remark he’s made all year, dismissed single-payer, telling Rolling Stone, “Do you think the American people want the same people who responded to Hurricane Katrina to run their health-care system?”
And yet, Obama, Edwards, and Hillary Clinton all offer reasonably good alternatives. Are they good enough? Or should Dems hold out for a real single-payer system? Paul Krugman makes the case for the prior, arguing that the basic Democratic plan “looks like something that could actually happen early in the next administration, while enacting a single-payer plan like the Conyers plan or the PNHP plan, excellent though those plans are, might take a very long time.”
First, because most health insurance costs will continue to be paid out of premiums, the Demoplan doesn’t require a big tax increase — in fact, it can be financed simply by letting the high-end Bush tax cuts expire. I know, I know, the taxes that would support single-payer aren’t a true cost, because they would simply replace premiums and in most cases be lower than those premiums. But we’re talking about legislation, not reality.
Second, the Demoplans offer choice — so that people won’t feel that they’re being forced into a government plan. Over time, I suspect, many people will choose the government plan or plans — but they’ll have the option of staying with those wonderful people from the private insurance industry.
In an ideal world, I’d be a single-payer guy. But I see the chance of getting universal care, imperfect but fixable, just a couple of years from now. And I want to grab that chance.
Sounds good to me — just so long as Dems realize Republicans, Fox News, and the rest of the reflexive right will call their plan(s) “socialized medicine” whether it’s accurate or not.
And speaking of socialized medicine, Dr. Ezekiel Emanuel, an oncologist and chairman of the Department of Bioethics at the National Institutes of Health, explained in a terrific WaPo piece today that conservatives keep throwing the canard around, but — surprise, surprise — they don’t know what they’re talking about.
The U.S. health-care system has two distinct parts — financing and delivery. The financing system is how we pay for health-care services. It is composed of employer-based insurance, the individual insurance market, Medicare, Medicaid, SCHIP, the veterans health system and other programs. Today, the private part — employer-based coverage and individual insurance — accounts for just under 55 percent of all payments for health care, while government contributes about 45 percent.
The delivery system consists of about 850,000 doctors, 5,000 acute-care hospitals, 39,000 pharmacies and 8,100 home health agencies, as well as hospices, surgical centers, radiological centers, laboratories and other outlets that provide the actual health-care services Americans need.
To the extent that any health insurance scheme involves spreading among members of society the financial risk of getting sick, all insurance “socializes” the risk. This is, of course, not what people mean when they level charges of “socialized medicine.” This term is never used in reference to police protection, fire departments or highways — all of which are provided by government.
Properly speaking, socialism is when the state owns or controls the means of production. Thus “socialized medicine” is when the doctors are state employees; when the hospitals, drugstores, home health agencies and other facilities are owned and controlled by the government.
Only one part of the U.S. system really is socialized medicine: the veterans’ health-care system, which is wholly owned and operated by the federal government. Veterans love the system and vigorously oppose any suggestions of dismantling it and integrating them into civilian health care. By many measures, this bastion of socialized medicine may constitute the highest-quality and most efficient part of American health care.
Socialized medicine cannot mean that the government pays for part or all of health care while it is provided by doctors in their private practices and at private and (frequently) for-profit hospitals, commercial drugstores and the rest. If that were the case, Medicare would be socialized medicine. Maybe the people throwing around that epithet believe Medicare is “socialized medicine,” but they certainly have not told the elderly — who are well satisfied by Medicare. Most do not have the courage to openly oppose — and seek to end — Medicare because it is “socialized medicine.” Indeed, some of those who invoke the epithet have praised, as Novak put it, the “popular private Medicare program.”
None of the proposals by the three major Democratic presidential candidates can be characterized as socialized medicine. None calls for government ownership or control over U.S. hospitals, drugstores or home health agencies, or for making doctors employees of the federal or state governments. Indeed, the proposals by Hillary Clinton, John Edwards and Barack Obama retain and even include measures to expand the private employer-based insurance system.
If Republicans were worried about whether their talking points reflected reality, they might even find this troublesome.