The wrong answer on single-payer healthcare

August 18, 2007

When it comes to Democratic presidential candidates, I more or less look at single-payer healthcare the same way I look at gay marriage — it’s something the top-tier candidates probably want to support, but hold back for political reasons. The unstated position seems to be, “I like the idea, but the country’s just not there yet.”

At YearlyKos, Barack Obama went a little further than his most competitive rivals, acknowledging that if we 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, who, by some indications, has offered perhaps of the best healthcare plan of any candidate, has decided to take a far different approach.

Edwards is also careful to temper his progressivism with more centrist positions. Speaking to Rolling Stone, Edwards … even demonized single-payer health care: “Do you think the American people want the same people who responded to Hurricane Katrina to run their health-care system?”

I can hope Edwards was misquoted, because that’s a remarkably bad answer to an important question.

For one thing, Edwards is parroting Mitt Romney’s position, almost word for word. Romney, in the midst of blasting Democratic healthcare reform measures, told a New Hampshire audience a few weeks ago, “I don’t want the guys who ran the Katrina cleanup running my health care system.” Edwards, apparently, agrees.

This is breathtakingly foolish; I’d assumed Edwards knew better.

This should be obvious by now, but the problem with a breakdown like Katrina is not with government; it’s with incompetent government. P. J. O’Rourke once joked, “The Republicans are the party that says government doesn’t work — and then they get elected and prove it.”

The point isn’t that FEMA is incapable of responding to a natural disaster. Bush helped turn the agency into a joke, but FEMA used to be extremely well run and fully capable of helping areas in need of disaster assistance. To hear Edwards and Romney tell it, government can’t respond to a hurricane, so it certainly can’t bring access to quality healthcare to Americans. In reality, it can do both with competent, quality leadership in positions of power.

Indeed, I wonder how far Edwards and Romney are prepared to take this little comparison. Do they want the same people who responded to Katrina running Medicare and providing healthcare to seniors? How about S-CHIP and providing access for children? How about Social Security? Should all of them be privatized because the Bush administration is incapable of governing?

Politically, Edwards’ comments don’t make a lot of sense, either. A lot of liberal voters just saw “Sicko,” and are inclined to see the merit of a single-payer system. By dismissing it with a nonsensical comparison, Edwards risks turning off people who might otherwise find his campaign pitch appealing.

Maybe Edwards was misquoted. Maybe he was kidding and was taken out of context. I’d love to hear an explanation. In the meantime, when leading Democratic candidates repeat misguided Republican talking points on healthcare reform, it’s a problem.

“Do you think the American people want the same people who responded to Hurricane Katrina to run their health-care system?”

Counter-question: “If elected, do you intend to leave incompetent people in power?”

And am I the only one who thinks Katrina jokes will continue to be fucked up until the damage is repaired?

  • Perhaps the most complicated and condequential thing a government does is wage modern warfare in a far-off foreign land. Someone needs to ask Mitt wy he is ok with the same people who mishandled Katrina taking responsibility for the sons and daughters of others in Iraq. And maybe ask Edwards if that means he is willing to relinquish the title Commander in Chief and let a private entity have that one?

  • What is so scary about single payer health insurance? Are people unhappy with medicare. My dad was hospitalized for several months and medicare worked fine for him. Why not take major steps in that direction by expending medicare with affordable policies and tax credits for the uninsured of any age? I don’t get it, What’s the objection other than finding a way to pay for this subsidy?

  • Government can competently provide services. But a president that is determined to undermine government provided services or is indifferent to providing those services can severely compromise their delivery. That is the take away lesson from BushCo.

    Before we institute single-payer healthcare, and I strongly think we should, we must make sure that a structure is in place so that it can not be easily undermined whenever the next corporate crony sits in the White House.

  • Universal Healthcaret has to do with the common good which is beneficial and vital for all of us. (just like education) Why is this such a difficult concept?

    The only candidate I think is in favor of universal healthcare is… Kucinich. Isn’t he?

    not sure where Gravel stands in all of this…but will see him on ABC/Stephanopoulos tomorrow, Sunday AM.

  • Kucinich did state this properly as well–Medicare for All.

    Medicare works for most. And its overhead is what, 2% compared to 38% for our current system?

  • I think it’s either misquoted or taken out of context. It makes no sense to me unless he meant single payer as run by the Bush administration, and I would agree with him on that.

    Edwards’ health care plan is the surest way to single payer because it has the best chance of overcoming objections from the health care industry. I think he’s the only one who’s found a way to shepherd it into fruition without it getting shot down.

    From Paul Krugman’s op-ed in Feb.:
    “This would offer a crucial degree of competition. The public insurance plan would almost certainly be cheaper than anything the private sector offers right now – after all, Medicare has very low overhead. Private insurers would either have to match the public plan’s low premiums, or lose the competition.

    “And Mr. Edwards is O.K. with that. ‘Over time,’ the press release says, ‘the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan.'”

    Honestly, how else would we get single payer unless it’s backdoored? The reason Bush said he would veto the SCHIP health care plan for kids was that he was afraid that if people had a chance to try it they would demand more and it would end the insurance industry. This is exactly what Edwards’ health care proposal does.

    I think that’s why any plan that directly challenges the very existence of HMOs is doomed. they need to be left in place… at first, if only to quell their objections.

    However, when other options are allowed, as Edwards proposes, demand from individuals and businesses for the medicare type of option can overtake the lobbying efforts of the insurance companies. the key here is to demonstrate that single payer is a low cost, viable, and preferable option in the real world.

    I just don’t buy that Rolling Stone quote as it stands.

  • I can’t believe Edwards said that. If he did I will have to take another look at him. My wife and I are both on Medicare and it works very well. We have to pay for a Supplemental which costs a little over $300 per month, but it’s certainly worth it. The HMO Medicare programs suck and are more costly. Conservatism also sucks and is destroying the social contract in our society, meager as it is. Harry Truman tried to get universal health care coverage back in 1949 and was defeated by conservatives, the AMA and racist Southern Senators (mostly democrats) angry with his civil rights policies. Conservatives all. Had universal health care been in effect since 1950 it would have long ago been folded into our economy and an enormous benefit to all of us. Conservatives have also tried to kill off Social Security as we all know. I don’t know why these conservatives hate the rest of us. Many even depend on Social Security and Medicare yet keep voting for politicians who are trying to kill the very programs they depend on. During his run for the Presidency against Nixon, George McGovern encountered two elderly women entering a supermarket. He noticed they had food stamps, which they both said they depended on. McGovern pointed out to them that he authored the food stamp program that Nixon opposed. But they didn’t care, McGovern was just “too liberal” and they were voting for Nixon. Can anyone explain that phenomena? “What’s the matter with Kansas” tried to but I don’t think in the end that the book really did. Beats me.

  • DAMN IT CB You do it too. How can you mention this topic and not even mention Dennis Kucinich. Like most journalist for some reason they just pretend he isn’t there.

    Dennis Kucinich has already introduced legislation in the House for single payer not for profit health care insurance. Unlike Edwards and the others who just talk about “maybe”, Kucinich does it…everytime. Talks right , votes right and also DOES it. The other top tier candidates say they want to bring the ins. co. to the table to discuss…They have feasted at the table for years. They shouldn’t even be allowed in. Get another job. What do they have now …6 lobbyists for every member of congress…and they will get more…they’ve been bilking Americans for Billions on healthcare, and pharmaceuticals for decades. We already have a plan in place…Medicare/Medicaid and we could have this type of healthcare for all by next week. Kucinich is the ONLY candidate doing this for us and even the blogs just ignore him like he doesn’t esist.

    How could you write a piece on singlepayer healthcare…Edwards and top tier candidates…and not mention Dennis Kucinich?…He’s the one saying and doing it all.

  • ***sorry campari**comment #7 But that is a total cop out.
    “…Over time,’ the press release says, ‘the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan.’”

    That’s a laugh. These greedy corporations don’t evlove. Witness the success of single payer not for profit healthcare world wide except for the US. That’s why they have so many lobbyists and why they donate so much money to the Republican parties, why Bush has appointed so many lobbyists to run federal agencies who worked for the same corporations they are supposed to be protecting us from. The only way we will ever get a national health care plan is if we force one. It doesn’t have anything to do with what the corporations will allow, they are trying to destroy government plans rather than make them more efficient. We the people are the government and we the people can decide to have single payer not for profit healthcare with no co-pays and no deductibles if we decide we want to do it and corporations will always try to prevent that from happening because it cuts their profiteering out of the picture. The only reason the issue is even coming before us now is because of how many people our present system has either killed or financially destroyed, compared to how successful the healthcare systems in place in every other industrial nation has been successful. You obviously have not seen the movie “Sicko” and I wonder if Edwards has taken the time to watch either. Even the health care industry can find nothing to say after seeing this movie. The pharm/healthcare ins co have nothing to say over our healthcare plan choices and should not even be allowed into the discussion.

  • I can’t imagine how this quote came out of Edwards’ mouth. If you take a look at the text of his health care plan, it lists the following as one of its virtues:

    “over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan.”

    So I’m guessing that we don’t have the whole context here, or that something has gotten confused.

  • The only candidate I think is in favor of universal healthcare is… Kucinich. — Evergren, @5

    All of them are for universal healthcare, more or less. Where Kucinich differs is that he’s for universal *and* single-payer healthcare, straight off. Which is what all people in the US (except the insurance companies) should want. I’ve seen, first hand, state-provided healthcare at work in Poland, the Netherlands and UK and, warts and all, it beats the hell out of the health “plan” I now have — for efficiency, cost and convenience to the consumer.

  • I’m thinking maybe there was a subtlety missed in the interview. I hope Edwards meant NOT THIS BUNCH OF ASSCLOWNS. Not wanting a repeat of the Medicare Prescription Drug Bill.
    Maybe public funding of elections has to happen first. No one out there with the courage of Tommy Douglas…

  • Yeah–I have had the opportunity (rotten luck, really) of having to experience the healthcare systems in the UK, France, Holland and even Egypt (UK/France by participating in their systems, Holland/Egypt due to injury while on holiday). I have no complaints, and thought the care was just as good if not better than here. And whenever I (or a member of my family) had a health issue come up that needed attention, we received it promptly and the doctors and their support staffs were outstanding.

  • I asked my local contact at the Edwards campaign what was up with this, and this is his reply:

    What he was talking about there is what OTHER people think about single payer health care, and why it would be difficult to move to it directly. In fact, it states publicly in writing in our health care plan that John believes his plan will have the potential to moving our country towards a single-payer system.

    Thanks for catching that, and I hope this clears it up!

  • Put me amongst those above who doubt Edwards said that or that it was taken out of context. Living in Iowa now gives a bent political junkie like me a chance to see and hear the proposals from most of the candidates. Clinton still has no details on health care, won”t even answer questions from the audience. Obama says yes to the idea without specifics but wants to pay for it by letting the tax breaks for those earning >$250K EXPIRE in 2011 (which is close to the end of a first term), Richardson is on record as supporting Universal Health Care and access but needs to flesh it out a bit. Dodd-Simon said we need this type of program (but they all saaay that…)

    Only Edwards drills down into it at his candidate pitstops in ANY detail and he wants a dual insurer system: you could choose to stay with the private insurance company you have now OR you could enroll in “Medicare Plus” which is an extension of what current senators and representatives get now… your choice but he adds that over time the program could evolve into a single payer entity because he believes that a system like the VA and Medicare would be better for consumers and that is what they will migrate to.

    Edwards praises certain aspects of government programs… he points out what works well during his talks. But he did have a scathing analysis of the Bush administrations handling of Katrina so perhaps this supposed quote arises out of the conflation of fictions in the mud?

  • $%&*! I just wrote a long reply to you, bjobotts, and it somehow evaporated when I hit submit. Anyway, the short version is this: what I said is in no way a cop out.

    Kucinich’s plan would be lovely in a perfect world, but ours is not that. Only Edwards has a health care plan that pragmatically acknowledges and circumvents HMO power structure and the Bush-bot dead enders who think single payer is the first step towards communism.

    It’s incredibly naive to think that insurance companies will go gentle into that good night with the millions of lobbying dollars they spend. They won’t. Kucinich hasn’t come up with a way around them, but Edwards has.

  • The excuse that “ours is not a perfect world” may, in and of itself, be viewed as somewhat of a cop-out. One should not have to accept the status quo; one should see what is, and elect to reach for the higher standard.

    Should someone have to accept less than the best this country could produce for its citizenry, simply because the status quo is so distant from the best?

    No.

    Edwards’ health-care plan does with health-care policy what Cheney did with energy policy. America can no longer allow the fox to design the henhouse, build the henhouse, and serve as landlord, security staff, and maintenence crew for the henhouse. America certainly does not need to negotiate with the insurance industry—so why should America need a presidential candidate who supports doing such?

  • Steve, it’s not accepting the status quo, it’s being smart and bold enough to understand the weaknesses of status quo and to change it from as strong a position as possible. Many years ago I had the good fortune to be a student in Robert Dallek’s class on American political history. It was the first time I began to understand that the political landscape was more nuanced than it appeared to be to me at the time.

    “‘Successful leadership in a democracy must rest on a certain amount of illusion,’ says Dallek, a CAS professor of history. ‘Theodore Roosevelt was able to run a very aggressive realpolitik under the guise of being a pacifist, and Franklin Roosevelt was very effective in preaching Wilsonian universalism during World War II. At the same time, he had a hidden agenda, which was to advance America’s national interests through sphere-of-influence diplomacy.'”

    I am very afraid that a direct hit to the HMOs as proposed by Kucinich would be political folly — too easy to shoot down by the opposition. I want universal health care in the USA, very badly. I’m one of the uninsured and underemployed, and have been for most of Bush’s tenure as president. This is perhaps the most important issue for me, certainly it is the most important domestic issue, and I want to see it become a reality. I’ve suffered economically (and in many other ways) the past 7 years as so many Americans have. I do not want to see us lose real opportunities to fix this mess because they don’t appear on the surface to be perfect. Please look below the surface and carefully examine the health care plans proposed. Think about the real barriers they will face and consider the ways they can overcome them.

  • Go read about Haircut Boy and Fortress Investments and his half-million dollar paycheck for advising the pinstriped pimps he goes around the corner and “attacks.”

    John Edwards: just another typical Southern lying asshole politician, like his teacher Billy-boy Clinton. The Democratic Party needs to write off the region and most particularly its politicians. The whole place and everything in it is toxic.

    That simpering little hypocrite gets nothing more from me but the kick in the ass out the door he so thoroughly deserves.

  • Fortress Investment Group is a New York, NY-based asset management firm which manages private equity, hedge funds and real estate and railroad-related investments, with announced plans to move into casinos and horse racing. The company went public on February 9, 2007.

    Subprime is not its primary business. It’s not even its focus. It has a subsidiary that does it. Just like Bear-Stearns. And Merrill-Lynch. And Wells Fargo.

    Apparently, when Edwards found out about Fortress’s involvement in sub primes, he pulled out, an honorable thing to do.

    Now, would you like to discuss his support of universal health care or would you rather keep trashing him with Fox News talking points?

  • John Edward’s comment shows how out of touch he is with the American people on this. The polls clearly show more Americans (60%) do support a single-payer national health insurance plan (like Medicare for all). Single Payer is not socialized medicine but a financing system that would pay PRIVATE healthcare providers directly instead of the middleman whose profit motive can only seek to deny. It works by removing the waste of private insurance so we can properly fund Medicare to cover everyone for LESS than we currently pay now for private insurance company’s premiums, co-pays, etc. We would save billions with Single-Payer and control costs, which is not possible retaining the very problem – private insurance. The more Americans learn about it the more they want it but John Edwards is still pandering to the insurance industry and their huge contributions. Actually ALL of them are EXCEPT Dennis Kucinich. He is the only one who supports the solution and would deliver real reform with HR676. The rest of them are all talk and empty campaign slogans.

  • For anyone who thinks we can ever get meaningful reform while still retaining the very problem – private insurance companies, I would like to pose the following scenario.

    Imagine operating the fire department or police in the same fashion we do healthcare. If you live in a neighborhood that has had more fires you have to pay more for fire coverage than someone in another area that has had fewer fires. And private companies – middlemen who have nothing to do with providing fire protection – will be in charge of paying the fire department and their sole incentive, even by law, will not be ensuring fire protection but their profit. And this alone is the incentive to deny fire protection or not to pay for it. So, picture this. You have a fire and you call the fire department but rather than send out a truck pronto, they now have to worry about how THEY will be paid and need to run a check to see if you are covered before they can dispatch a fire truck. And they are told how many trucks they can dispatch. If they do show up and put out the fire they perhaps charge you a huge co-pay. Or if the private company decides they are not responsible for the cost based on some exclusion in their 1000 page finely printed policy (perhaps they investigate and learn you smoke and didn’t divulge there were pre-existing matches in the house) you are hit with the entire bill. This is how private insurance works in our healthcare! And we put up with it! But with our system now, you must understand, people will set more fires and be more careless because the fire department is FREE!

    The answer to our healthcare problem is HR-676 a SINGLE-PAYER National health insurance and would REMOVE the private insurance companies and their profit incentive that must put profit before care.

  • NO, Mr. Edwards—we want the same people who run MEDICARE to run our health care. Dummy!!!!! He talks like a Republican spinner. That’s because he has gotten too much money in contributions from the insurance industry. Hillary is even worse and Obama is right behind her. Sally is right – only Kucinich is backing up his words with real action. Kucinich gets my vote.

  • This is the not the first time someone has written about Gravel and Single-Payer. (from my health care blog here: Presidential Candidates and Universal Healthcare. And, NO, Gravel’s plan isn’t Single Payer.

    Gravel does NOT have a Single-Payer plan – far from it. He doesn’t even have a specific plan of action but more of a vague proposal that more resembles medical savings accounts and the Bush plan which would further privatize our healthcare system and leave even more people vulnerable. His use of the term Single-Payer is possibly an attempt to capitalize on its growing popularity as more Americans are becoming educated. It is very simple for everyone to remember this: ANY PLAN THAT RETAINS THE PRIVATE INSURANCE INDUSTRY IS NOT SINGLE-PAYER. Let’s all make it a habit to ask any candidate who claims to have a plan for universal healthcare one simple question. Does your plan include the private insurance industry and their profit motive? If they say yes, then they are not offering real reform and that is the bottom line.

    True Single-Payer is everyone contributes into ONE risk pool that covers everyone – period. It is not paid out based on projected “individual” needs, which is what Gravel indicates. Instead, people pay into the pool based on their income. But, because it is far more efficient, even those who pay the most (because they can afford it) will pay LESS than what they pay in our current system now where over 1/3 of the money goes to a middleman who provides no value to our healthcare (for-profit insurance.)

    Gravel is proposing vouchers and its unclear if they would be paid for by tax dollars or from the individuals because nothing has been thought out at all – lots of maybes and variables.

    Gravel also proposes a plan based on “projected individual needs” and maintaining health records to decide what each individual would get based on their “individual needs.” But who decides? Insurance companies? And just imagine someone miscalculates your individual needs, where does that leave you? And since private insurance would still be in control, you would be at their mercy. And there is no mechanism to control costs.

    Imagine operating the fire department or police in this fashion. If you live in a neighborhood that has had more fires you have to pay more for fire coverage than someone in another area that has had fewer fires. And private companies – middlemen who have nothing to do with providing fire protection – will be in charge of paying the fire department and their sole incentive, even by law, will not be ensuring fire protection but their profit. And this alone is the incentive to deny fire protection or not to pay for it. So, picture this. You have a fire and you call the fire department but rather than send out a truck pronto, they now have to worry about how THEY will be paid and need to run a check to see if you are covered before they can dispatch a fire truck. And they are told how many trucks they can dispatch. If they do show up and put out the fire they perhaps charge you a huge co-pay. Or if the private company decides they are not responsible for the cost based on some exclusion in their 1000 page finely printed policy (perhaps they investigate and learn you smoke and didn’t divulge there were pre-existing matches in the house) you are hit with the entire bill. This is how private insurance works in our healthcare! And we put up with it! But with our system now, you must understand, people will set more fires and be more careless because the fire department is FREE!

    Gravel also claims his vouchers would allow people to choose any doctor or hospital – how a Single-Payer plan would work. But, he never says the voucher would pay the medical provider directly (which would be an administrative nightmare beyond what we have now anyway) only that people will have a choice between 5 and 6 insurance companies. What the heck does this mean? Vouchers paid for with tax dollars will subsidize 5 or 6 private insurance plans? So, people can “choose” which middleman can deny them care when they need it? We don’t need any help with that! We want a system that removes the middleman and for a single payer to directly pay for HEALTH CARE – doctors, nurses, hospitals – not insurance companies so they can pay their executives millions of dollars, give to candidates and elected officials and run marketing campaigns to gain a bigger piece of the “health care market.” NO, NO, a thousand times NO.

    So far, Kucinich is the ONLY presidential candidate who supports the real solution – Single-Payer National Health Insurance – to our healthcare crisis. The other candidates say they are for universal healthcare but these are merely empty campaign slogans for they do NOT support the solution to make it happen.

    Why is this? The insurance lobby is so powerful that most candidates do not want to take them on or lose their contributions. This is why the only way we are going to get true healthcare reform is for citizens to actively engage and educate themselves and others to the details. The devil is in the details. We must be armed with the knowledge and the facts so we can demand the true reform of our candidates and other elected officials. With an informed pubic behind them, candidates will have the courage to stand up for us. But it’s up to U.S. to make this happen.

    WAKE UP EVERYONE AND DO YOUR HOMEWORK BECAUSE THE MAINSTREAM MEDIA SURE WON’T DO IT FOR YOU.

  • Healthcare should be one of the top three issues of this campaign and no one is stepping up to the plate. As a conservative physician I have long realized (as have many physicians) that our current system is unworkable and will lead to diasaster in the next 20 years. I recently spent a day running with some Canadian physicians and talking about our diffent systems and it was clear to us all that even though the Canadian system has problems (financing and rationing) these are minor compared with our uninsured population and the growing complexity of the multitude of insurance plans. Medicare and the VA system can form the core of a single healthcare system in the US with very low administrative costs.. The problem is that the insurance industry will fight tooth and nail to prevent this in order to continue extracting a fat margin for adminsitration out of the pockets of the patients and the providers.

    • Comments are closed.