By Steffie Woolhandler and David Himmelstein
Room for Debate Blog, New York Times
January 28, 2010
Having surrendered in advance to the private insurers and drug companies who profit from our dysfunctional health financing system, President Obama and the Democrats who lead Congress couldn’t rally the American people to support their woeful plan against Republican attacks.
In the end, the Democrats’ back room deals produced a scheme reminiscent of the ones crafted by Mitt Romney (in Massachusetts, 2006) and Richard Nixon (Washington, 1972) – but even less effective than those.
A simple single payer program could save $400 billion annually on insurance-related bureaucracy and profits, and tens of billions more by driving down drug prices. That’s more than enough to cover the uninsured and to upgrade coverage for insured Americans, without increasing health spending.
But the Democrats’ efforts to appease insurers and pay off the pharmaceutical industry made covering the uninsured unaffordable. Once they’d rejected single payer (and its savings on useless bureaucracy), the Democrats could only offer unpalatable funding options; stick consumers with ever-higher health costs, raise taxes, or drain money from care. In the end, the Democrats chose all three.
Their individual mandate would force millions to pay private insurers’ outrageous premiums for coverage so skimpy that a major illness would still lead to bankruptcy. (And if you currently have coverage you don’t like, they’d force you to keep it). They added a steep excise tax on workers lucky enough to still have good coverage. And their massive Medicare cuts included a plan to take billions from already-strapped public hospitals (and other safety net providers) and give it to private insurers. In sum, the Democrats asked middle class Americans to pay more, and get little in return.
The president can regain his footing by reconnecting with the hopes of Americans who elected him and rejecting the sordid corporate compromises that signify Washington politics as usual. A single-payer, Medicare-for-All reform would lower costs, cover the uninsured, and upgrade coverage for most insured Americans. Leading a crusade for such a plan, he’d mobilize vast popular support; enough to overwhelm Republican obstructionism. But instead, he seems intent on looking for light at the end of the same old tunnel.
During his campaign, President Obama declaimed that he’d back single payer – if we were starting from scratch. One thing’s clear from the recent Massachusetts election upset: it’s time to start from scratch.
Steffie Woolhandler is a professor of medicine and David Himmelstein is an associate professor of medicine, both at Harvard Medical School. They are co-founders of Physicians for a National Health Program.
http://roomfordebate.blogs.nytimes.com/2010/01/28/did-obama-move-health-care-forward/#steffie
