I guess I may be one of those stuck in the past. I'm so old-fashioned. I still think a single-payer universal health coverage is essential. I'm moved only a little by the urgency of this essay because I'm concerned that the fix proposed by the coalition may not fix things.

Now, I'm completely ready to be shown I'm wrong; that "Medicare for all" isn't a better, more cost-effective, better-for -business, better-for-labor policy than the one this group is proposing. But, unless I've missed it, this post doesn't even notice the existence of the issue.

Daniel -- This is one of the hard questions, of course. You might be right about single payer being the "better" idea on the points you note, but I don't think that's the most important issue. At this point, the issue is, and should be, what idea or set of ideas will move the ball farther down the field sooner. What I consider to be reliable market research, plus my own relatively long experience trying to win health coverage expansions and reforms, tells me that the country is not ready for single payer next year or anytime soon and won't pass it. If it is possible to achieve significant cost controls and much wider coverage -- millions more people with insurance -- then I think that's a worthy and, for the time being, more important task. I know single payer advocates have heard this before and do not necessarily buy it, but I think that a big leap forward not only helps millions of insured and uninsured people sooner, but also brings the whole process closer to whatever final resolution, single payer or otherwise, more completely solves the problem. We have a chance to get that done, and we should go for it.

John

Hmmm - you wrote "...tells me that the country is not ready for single payer next year or anytime soon and won't pass it."

I believe this statement to be that our government (that which is more of puppets on the strings of larger corporations like giant insurance companies) is not ready to pass it. I don't know that I agree that our "country" isn't ready.

I am not looking to hi-jack your healthcare entry, but I want to see legislation passed that is really for the majority, and not just what little bit we think we can get past the large companies that run everything.

Here is my idea for doing so, and believe it applies to the process and not one single topic. John, please give this a look. http://www.buybackamericanow.com

Thanks,

-Jason

Meh. Medicare is expensive. It's hard to compare Medicare data directly because Medicare covers a population that uses health care a lot to begin with; however, Medicaid, which uses the same model, costs about $6,900 per person as of 2004. That's significantly worse than private insurance, and a world apart from the various single-payer health care schemes, which spend about 3,000 as of 2007. I'm pretty sure a difference of 4,000 dollars per American - that's $1.2 trillion a year - is important enough to fight for.

As for the point about top-down versus bottom-up health care, do you know any public health advance that emerged bottom-up? The British NHS came about because dissatisfaction with the private system was so high that Clement Attlee could implement single-payer. Canada's Medicare began from Tommy Douglas, the Premier of Saskatchewan, whose system's success led to its adoption in the other provinces (In Canada, health and education are left entirely to the provinces). Bill Clinton's problem wasn't that he was trying to impose universal health care from above; it was that he put his wife in charge of the operation, and refused to compromise with Newt Gingrich.

2008 isn't 1993. In 1993, HMOs seemed to be successful in curbing health costs, and the US wasn't spending that much more than the rest of the first world or getting much worse results. Since then, the cost of American health care has exploded, so that corporations find it easier to open factories in Canada and pay Canadian taxes than to open them in the US and pay American health insurance. You used to have to be a leftist to support this; now you can read pro-business arguments for single-payer from Paul Krugman. If Michael Moore were less knee-jerk, he could get GM to endorse whatever universal health care scheme he cared to tout ("Roger, I know there's bad blood between us, but you need this to compete with Toyota just as I need this to fight poverty").

The one thing that occasionally trumps money and influence is strong evidence of voter interest and demand. Its a bad idea to try to do "bottom-up" health care reform, if what you're talking about is designing and fighting through the complex policy specifics. But its a good idea to do "bottom up" health care reform if what you're talking about is increasing the political importance of getting the job done. You need enough policy specifics to attract a critical mass of angry voters, and then you need to keep the heat on. That's what the Health Care for America Now campaign is designed to do, and ditto with several others, like Divided We Fail (AARP and SEIU and allies). There's a good chance that significant healthcare reform can happen if people work on it.

John

If the point is to keep the issue alive, then the last thing you should do is start an organization called Health Care for America. Such interest groups are good for lobbying, not for "increasing the political importance" (whatever that means to a group that doesn't even try selling universal health care to business).

The best way of building up demand is having a major politician who campaigns on it. Hillary Clinton would be good for it. But the Democratic primary voters chose to nominate someone who prefers to campaign on government reform. There are other ways of getting people on board, none of which involves writing articles that use language like "Think about almost 50 million Americans who are uninsured, and how none of them can afford to responsibly seek preventive care."

OK -- what are the "other ways"? That's the point -- not whether you're right or I'm right, but what works. What I mean by "political importance" is a significant measure of voter activism so that politicians think they might lose (or win) elections over it. If you've got something that works to activate people on this, bring it on. I think that was my original point -- if you don't like the tack I'm suggesting, that's fine. The point is to be active -- put those "other ways" in action. Go for it.

John

The important thing to note is that many Democrats have been using the same language you promote for decades, to no avail. Bob Shrum has been doing this in every election campaign since 1972; he's yet to win a single Presidential election. The Democratic Party has used up every gram of political capital to be gotten from an empathy-based call for universal health care.

Better ways of controlling the issue involve talking about costs. For example, running an ad pointing to Obama's promise to reduce premiums by $2,500 by the end of his first term, you might say, "If your taxes are up $1,000, and your premiums are down $2,500, aren't you better off now?" For another example, cosponsoring panels with major chambers of commerce about how skyrocketing health costs are hurting American competitiveness. The idea is to turn universal health care from a purely empathy-based issue to an economic growth issue, which will appeal to the middle class better. This is good both for the cause of universal health care, by drawing more people, and for general election purposes, by reducing the influence of anti-tax conservatives.

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Does it matter to any of you that this healthcare legislation will bankrupt the country? Not to mention reduce the quality of healthcare and fail to cover everyone?

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