By Don McCanne, M.D.
As the author of a PNHP blog entry in November 2010 on the limitations of the Wyden-Brown amendment, which would move up the date when states could obtain waivers from the federal government to introduce their own state-based health reforms, I’d like to clarify my position.
It is true that moving up the date by three years alone is not enough to ensure that states like Vermont can enact a “pure” single payer model of reform. There would be more work to do. But that is not a reason to not move forward with enacting a system that is as close to single payer as is possible under current law, and to continue efforts to enact measures that would give states more flexibility in designing a comprehensive financing system.
What we really need is a national single-payer program, but, considering the national political scene, that is highly improbable in the near future — not that we shouldn’t continue to advocate for it in the strongest terms. But it would be wrong to say that we must have a national program or nothing. Too many will face financial hardship, or worse, suffer physically and perhaps even die, if we do nothing.
In parallel to our national efforts, the states should move forward toward accomplishing as much reform as is possible in the face of our current politics. If the states can provide some temporary relief from suffering and hardship before we are able to enact a national program, then, by all means, we should make those efforts. We should apply for all waivers currently allowable at the same time that we seek to change the law to allow the granting of other waivers that could further improve the state legislation.
At the same time, above all, we must continue the parallel effort to enact a national single payer program — an improved Medicare for all. If some states get there before the federal government does, then the relief from suffering will have been well worth the state level efforts.
Don McCanne, M.D., is senior health policy fellow at Physicians for a National Health Program (www.pnhp.org). You can subscribe to his āQuote of the Dayā here or read them at the PNHP blog.