Are We Headed for Single Payer Health Care?

It’s been interesting to listen to the debate rage over what will happen to the individual health insurance mandate in President Obama’s health care reform bill as the issue moves its way up through federal courts. The mandate was recently ruled unconstitutional by one (Bush-appointed) federal judge in Virginia, but was ruled constitutional by a couple of other federal judges. It seems that most pundits agree that this issue is headed for the Supreme Court.

Ezra Klein of the Washington Post noted that Republicans may be doing some long-term damage to their cause by focusing on the individual mandate, which as my last post explained, was originally a Republican idea. To be certain, the mandate is essential to have a health-care system where everyone has coverage but private insurers dominate (Obama’s plan). If the Supreme Court ultimately rules the mandate unconstitutional, the only other options for universal coverage will be the single-payer system, as found in Canada, or the fully nationalized system, as found in the United Kingdom. The mandate, as Klein states, is a very “common device” used in several other industrialized countries (including Switzerland and the Netherlands) that ensure universal coverage while relying on private insurers.

Klein makes a convincing argument when he states, “if Republicans get [the insurance mandate] ruled unconstitutional in America, they’d be wise to ask themselves what other options they have: After all, the constitutionality of Medicare is not in question, and that’s really the other model we could eventually trend toward.”

Another columnist argues:

By fighting the mandate needed to make private insurance solutions work, and doing nothing to ease the health cost burden on everyday Americans, you’ll hasten the day when the public throws up its hands and says, “Just give us single-payer and price controls.” Don’t think the anti-government wave this fall won’t reverse itself on health care if the most private sector-oriented health care system on earth keeps delivering the world’s costliest, most inefficient care.

The current unrealistic threats by the new Republican-controlled House of Representatives to repeal the 2010 health care reform bill are good political theater, but will likely backfire. Anyone with a rudimentary understanding of how our federal government works, knows that Republicans do not have the numbers they need to repeal. They don’t have a veto-proof majority in the House and are in the minority in the Senate. Additionally, the non-partisan Congressional Budget Office, which typically acts as a referee in the partisan atmosphere of Congress, has indicated that a repeal of the health care bill would increase the national deficit by $230 billion.

What is ironic about the last election, which was supposedly about run-away government deficits, is that Republicans have supported positions that drastically increase the national debt. The extension of the Bush-era tax cuts for the rich have added far more to the long-term debt of our nation than Obama’s 2009 stimulus plan. The CBO estimated that the health care reform bill would actually decrease the deficit by $143 billion in its first 10 years and $1.2 trillion in the second 10 years. In an upcoming post, I’ll go into some of the details of the new law, including its cost savings, but the fact of the matter is that repeal would drive us further into debt, notwithstanding doing nothing to improve our antiquated health care system including helping the tens of millions of uninsured working-class Americans and their families.

Isn’t it ironic that the new House majority voted against a measure this week that would have required all Representatives to disclose whether they would accept their government-provided health insurance? As Rep Steve Israel (D-N.Y), stated, “every Republican voted to hide their own government health care, while many of them are pledging to repeal health care for everyone else.” Don’t we think it is relevant for constituents to know whether their representative is accepting government-sponsored health care? Nonetheless, repeal isn’t going to happen. The Supreme Court is really the only mechanism by which the Obama heath care reform bill (and Romneycare) can be annulled at this point. And in the remote chance that occurs, it will probably lead us to something that is actually closer to what conservatives label as “socialized medicine.”


  1. "you'll hasten the day when the public throws up its hands and says, "Just give us single-payer and price controls." "
    This is a good point, and seems logical, but will it really happen, and if so, how long will it take? It seems that any idea of "socialized medicine" people treat like the plague, no matter how bad their health insurance currently is.

  2. The socialized medicine attack on single payer really frustrates me to no end. Is it better to deny sick people care unless they can pay. When ever I see John Boehner or any of the other talking heads of the right say, “We have the best health care system in the world, don’t tamper with it.” It’s what they AREN’T saying that makes me livid. “We have one of the WORST health care delivery systems on Earth, especially for a so called industrial democracy, that children can go without care because their family can’t afford insurance is disgraceful, and the people who are comfortable with sending people away should be ashamed. For a balanced intelligent view of health care around the world I urge everyone to view this: by T.R. Reid

    1. Andy- thanks for reading and commenting. You’ve perfectly captured the problem with our health care system prior to ACA- that it isn’t so much a matter of quality as it is with the delivery. It is incredibly irritating to hear Republicans like Boehner make deliberately misleading statements about us having the “best” health care in the world. I watched that Frontline program a few years ago when it came out- it was great.

  3. The problem with most people who say “the US has the worst health care delivery systems on earth” is that they confuse “health care” with “health insurance.”
    The US does indeed have the BEST “health CARE” system on earth. Why else do you have kings, queens, sultans, foreign diplomats, foreign stars, etc., coming to the US for surgery and medical treatment? Because it is THE BEST.
    What may not be the best, is the “health INSURANCE” system. Yes, it IS quite pricey, and DOES need reforming – but NOT to be taken over by the federal government. However, we do have insurance coverage available for most everyone who needs it. Medicaid for adults, and we have CHIP for children. Admittedly, I don’t know the details of the CHIP program, as many people do not, because the government does not promote this particular program as much as they should. No child should be without health care or health insurance, and this program was designed with that in mind.
    But again, there is a distinct difference between “health care” and “health insurance” – and the US does indeed have the best health care.
    P.S. Please don’t bore me with any “study” that says we are such-and-such number below other nations, bottom-line is, people of wealth come HERE for surgery and treatment, they do NOT go to those other countries on the list.

    1. Cmm912- thanks for reading and commenting. I agree that some of the world’s best health care is available in the U.S. We’ve got some great hospitals and doctors. It’s also worth noting that we also have some pretty lousy ones. But overall, excellent health care is available to those who can pay for it or have insurance. You may not be aware, however, that foreign dignitaries also frequently travel to European countries to receive medical care. London is a popular place for third-world dignitaries to travel to receive world-class health care. And I think you are correct in saying the “health insurance system” is not the best. I think this statement should be expanded to say that our health care delivery system is not the best. That’s why the U.S. fares so poorly on those rankings. So while those rankings may bore you, they are important to the discussion about our health care system because they show the areas where our health care system is failing- the area that you pointed out. And while you are technically correct that most people (meaning more than 50%) have insurance coverage, a huge portion of Americans, namely about 40 million (including many children), did not have insurance prior to the passage of ACA. SCHIP was not broad enough in scope to cover all uninsured children. If you think ACA is a big government takeover of our health care system, you are grossly mistaken. ACA does not involve government managing day-to-day decisions of health care providers. Doctors, nurses, and other health care professionals do not become employees of the government under ACA. At it’s core, ACA, whose model received wide support from politicians on both sides of the aisle, helps expand insurance coverage and ends some of the health insurance industry’s worst practices, including denial of coverage to those with pre-existing conditions. The existence of 40 million uninsured Americans was truly a travesty and ACA helps ensure near universal coverage with mostly private health insurance providers.

  4. How about a real socialist program like single payer.  Want an example of it working?  Look to North Dakota.  They have a true monopilistic Workers Comp program.  No Insurance Carriers.  The cost of having the state run the Workers Comp program = Comp Premiums in some of the higher risk  employer catigories such as Hot Tar Roofing can save employers over 2/3rds of what the same employer would pay in Florida.  Websites for injured workers show the system is not perfect, but it is one of the better examples of premium = provided care in the US.  So, Give us a good old socialist program that eliminates another wasteful administrative layer with insurance carriers, and then the trial attorneys needed to get benefits, or the carriers legal rep to protect them from policy holders seeing the Chiropactor 5 times a week.   

    Time to do this and work with those who will sit at the table with us. If they wont sit down, shut the door.

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