Today’s message is in honor of Sen. Edward M. Kennedy who told us,
“For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”
Special Issue: Exploring the Concept of Single Payer
Single Payers, Multiple Systems: The Scope and Limits of Subnational Variation under a Federal Health Policy Framework
By Carolyn Hughes Tuohy, University of Toronto
Journal of Health Politics, Policy and Law
August 2009
Neither Obama nor any other major contender for the presidency in 2008 proposed a universal single-payer (“Medicare for All”) model. The Obama proposal for a new public plan, to be offered in parallel with regulated private plans through a National Health Insurance Exchange modeled on the Federal Employees Health Benefits Program (FEHBP), would indeed represent a distinctive American hybrid, but it would not be a single-payer system. By definition, a government plan is not “single payer” if it competes with other insurers in offering comprehensive coverage. This is not merely a definitional issue, however: it has critically important implications for the economic and political dynamics of the system. Economically, competition between public and private insurers raises potentially crippling problems of risk selection requiring a regulatory framework that has so far eluded even those European jurisdictions with much longer experience with the regulation of social and private insurance. Politically, such a competitive framework renders the arena much more pluralistic and volatile — and effective regulation therefore much more difficult — than does a pure single-payer model with its central axis of profession-state accommodation.
In 2009, the colliding waves of hope, generated by the election of Barack Obama, and fear, generated by global financial turmoil, may produce (a paradigm shift in U.S. health care policy and a paradigm shift in the political landscape). At the very least, it seems inevitable that they will yield a larger governmental role in the health care arena. The shape of the resulting hybrid, and whether that hybrid has any room for a single-payer element, is much less clear.
http://jhppl.dukejournals.org/cgi/reprint/34/4/453
The fact that the entire August issue of the Journal of Health Politics, Policy and Law is devoted to exploring single payer certainly indicates that the concept has not died within the policy community.
Although a majority (but by no means all) of the political community dismisses single payer as not being politically feasible, much of the policy community accepts it as a feasible policy approach that would bring affordable health care to everyone. Even those opposed based on ideology understand clearly the feasibility of single payer from the policy perspective. Otherwise why would the opponents of reform keep insisting that policies that improve our health care financing would inevitably lead to a single payer system?