I'm in In These Times this month moderating a debate between Steffie Woolhandler, co-director of Physicians for a National Health Program and a single-payer supporter, and Richard Kirsch, the national director for Health Care for America Now and an advocate of a hybrid approach. In some ways, the conversation goes rather like you'd expect: Woolhandler makes a lot of sharp points on the policy questions but has no real answers on the politics. Pressed on how single payer becomes a reality, she says things like, "If you’d asked me five years ago, what was more likely, passing single-payer or electing a black president, I probably would’ve said single-payer and you probably would’ve, too." It's a fair argument, but it doesn't light the way forward. Indeed, likening single payer to exceedingly unlikely political events that require an almost unique alignment of personalities and demographic forces and technological advances is actually an argument to do something else in the meantime. After all, Democrats didn't refuse to support candidates until they could elect a black president. And people need health care coverage now.Kirsch, by contrast, makes a lot of sharp points on the politics but gets a little fuzzier on the policy. In particular, he heavily emphasizes the need for a public insurance option to keep costs down. That, in fact, seems to be much of the cost control theory behind his plan. But he doesn't have much of an answer for what happens if the public option fails for the same reason single payer would fail. And I'm not convinced that a public plan, on its own, will do much to restrain cost growth at all. Medicare is not exactly a model of restrained spending. THE GREAT DEBATE.
I'm in In These Times this month moderating a debate between Steffie Woolhandler, co-director of Physicians for a National Health Program and a single-payer supporter, and Richard Kirsch, the national director for Health Care for America Now and an advocate of a hybrid approach. In some ways, the conversation goes rather like you'd expect: Woolhandler makes a lot of sharp points on the policy questions but has no real answers on the politics. Pressed on how single payer becomes a reality, she says things like, "If you’d asked me five years ago, what was more likely, passing single-payer or electing a black president, I probably would’ve said single-payer and you probably would’ve, too." It's a fair argument, but it doesn't light the way forward. Indeed, likening single payer to exceedingly unlikely political events that require an almost unique alignment of personalities and demographic forces and technological advances is actually an argument to do something else in the meantime. After all, Democrats didn't refuse to support candidates until they could elect a black president. And people need health care coverage now.Kirsch, by contrast, makes a lot of sharp points on the politics but gets a little fuzzier on the policy. In particular, he heavily emphasizes the need for a public insurance option to keep costs down. That, in fact, seems to be much of the cost control theory behind his plan. But he doesn't have much of an answer for what happens if the public option fails for the same reason single payer would fail. And I'm not convinced that a public plan, on its own, will do much to restrain cost growth at all. Medicare is not exactly a model of restrained spending. 
