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Obama And The Single-Payer Menace

By James Rothenberg

24 June, 2009

President Obama used to be a proponent of single-payer health care (government pays directly, eliminating middlemen insurance companies). He doesn’t like to make a big deal out of it now, but here is what he said in a speech to the Illinois AFL-CIO when running for the U.S. Senate on June 30, 2003:

I happen to be a proponent of a single-payer health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, is spending 14 percent, 14 percent, of its gross national product on health care, cannot provide basic health insurance to everybody...A single-payer health care plan, a universal health care plan. And that's what I would like to see. As all of us know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, we have to take back the House.

Then something changed. He decided to become more practical.

This from a profile of the Senator in the New Yorker on May 7, 2007:

A single-payer system would probably make sense. But we've got all these legacy systems in place, and managing the transition, as well as adjusting the culture to a different system, would be difficult to pull off. So we may need a system that's not so disruptive that people feel like suddenly what they've known for most of their lives is thrown by the wayside.

Now that Obama’s people (the Democratic Party) have pulled off the triple play of taking back the White House, and the Senate, and the House, here is how Obama responded to two questions posed at a Rio Rancho Town Hall on May 14, 2009. The first question was, “Why have they taken single-payer off the plate?” (Applause).

For those of you who don't know, a single-payer system is like --Medicare is sort of a single-payer system, but it's only for people over 65, and the way it works is, the idea is that you don't have insurance companies as middlemen. The government goes directly – (applause) – and pays doctors or nurses.

If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense. That's the kind of system that you have in most industrialized countries around the world.

The only problem is that we're not starting from scratch. We have historically a tradition of employer-based health care. And although there are a lot of people who are not satisfied with their health care, the truth is, is that the vast majority of people currently get health care from their employers and you've got this system that's already in place. We don't want a huge disruption as we go into health care reform where suddenly we're trying to completely reinvent one-sixth of the economy.

The second question (actually two) was, “And why is Senator Baucus on the Finance Committee discussing health care when he has received so much money from the pharmaceutical companies? Isn’t it a conflict of interest? (Applause).

Obama’s didn’t answer this part. He ignored it. It should be noted that this exchange, including the applause annotations, is taken directly off the White House transcript.

Polls consistently show overwhelming support for single-payer by the American people. When physicians are polled, the results are the same. Health cost pressures on big business are pushing even it away from the “legacy” of providing health care to employees under the current system. But Congress and the President want no part of it.

Summing up the excuses for why single-payer is not on the table, we have:

Not starting from scratch, legacy systems in place, managing the transition, adjusting the culture, and the huge disruption that people will feel when the health system they’ve known is thrown by the wayside.

And yet millions of Americans go through this “transition” and adjust to the “culture” without the slightest trouble when they reach 65 and become eligible for Medicare. If the Medicare users are not disrupted by this transition, perhaps the disruptive force that Obama alludes to would be felt elsewhere, by the culture of profit in the industries that have the most to lose, that will, in effect, be thrown by the wayside.

According to the Center for Responsive Politics, the pharmaceutical and insurance industries spent $1.2 billion and $949 million, respectively, on all lobbying efforts since 1998. In the 2008 election cycle, the total health sector gave $90.7 million to Democratic candidates and party committees and $76.6 million to Republicans, a turnaround but unsurprising in that the Democrats gained control of Congress in 2006. Also unsurprising is that Max Baucus, chair of the Senate Finance Committee and as such the Senate’s main man on healthcare, received more campaign money from health and insurance industry interests than any other member of Congress.

Obama is keenly aware of the hold that the pharmaceutical and insurance companies have over the Congress through the power of the dollar.

From a Democratic primary debate, Sept. 9, 2007:

…we’ve also got to overcome the drug & insurance company lobbies, that spent $1 billion over the last 10 years to block reform. As president, I am going to take them on.

Is that what’s happening when single-payer is thrown by the wayside?

James Rothenberg


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