July 9, 2001
A roundtable discussion
Moderator: “What about the proposal that Medicare be used as a model for a new American system?”
George D. Lundberg, M.D., Editor-in-chief of Medscape and former editor of JAMA:
“Medicare could certainly serve as part of our model. It’s not a new idea. Some people have said that it should be extended to cover the whole population. Then they made the terrible mistake of calling that a ‘single-payer system.’ There will never be a single-payer system in this country, because that presupposes people can’t or won’t use their own money to buy whatever they want outside the system.”
Comment: All health care systems, including single payer, allow people to use their own money to buy whatever they want outside of the system. It is long past time to end fighting against reform based on semantic or rhetorical issues, and to begin supporting reform based on sound policy. The words, “single payer,” are not the enemy, but reflexive, stilted thinking is. The issues are straight forward. We all agree on the goals of universal access and coverage, free choice, quality, and value in health care. The structural changes required to achieve those goals are simple. Even Dr. Lundberg recognizes that publicly administered insurance, such as Medicare, will provide the reform we need. Call reform single payer or don’t call it single payer, just do it!