Single Payer

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Every time I write a story about the state of the health reform debate –like this one–commenters here want to know why I don’t include an extensive discussion of a single-payer option, which essentially would be a government-financed program like Medicare for everyone. The reason is that it is not going to pass. The House is not going to pass one; the Senate is not going to pass one; President Obama is not pushing for one.

The most die-hard single-payer advocates insist this means that health care reform is already a failure, and no improvement on the status quo in their eyes. But is that really true? Ezra Klein has an interesting interview with the leading supporter of single-payer in the Senate, Vermont’s Bernie Sanders. He sees some paths where it might happen–eventually–within the context of the kind of health reform effort that has a more realistic chance of reaching Obama’s desk:

You’ve implied here that single payer may be the long-term goal. In the shorter-term, what should single payer advocates be looking to get out of the health care process Baucus is running? Are there any concessions that could make that a win?

I am sure that there are some single payer advocates who think the only thing worth fighting for is single payer. What I have also introduced, which we will be fighting for, is a five-state option. That would mean five states would have the option of running pilot programs in universal health care but one would have to be single payer.

I think it’s possible this will never happen in DC, but that this country will join the rest of the industrialized world when a state, maybe like Vermont, implements single payer and does it well. And then New Hampshire will be looking over our shoulders, and they will adopt that, and so on through the country. That’s in fact how national health care came to Canada, it started in the Saskatchewan province.

The second area of less importance, but important nonetheless, is the fight for a strong public option. In my view, if you had a level playing field and a pubic program and a private insurance program providing the same level of benefits, people would come into the public program because the public program would be substantially more efficient. I think we can make that case, and I will advocate for it in the legislation.

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