"Don't make the perfect the enemy of the better" is a favorite slogan in Washington because compromise is necessary to get anything done. But the way things are going with health care, a better admonition would be: "Don't give away the store."
Many experts have long agreed that a so-called single-payer plan is the ideal, because competition among private insurers who pay health-care bills inevitably causes them to spend big bucks trying to find and market policies to healthy and younger people at relatively low risk of health problems while avoiding sicker and older people with higher risks (and rejecting those with pre-existing conditions altogether). Competition also causes them to contest and litigate many claims. A single-payer saves all this money and focuses on caring for sick people and preventing the healthy from becoming sick. The other advantage of a single-payer is it can use its vast bargaining power to negotiate lower prices from pharmaceutical companies, hospitals, and suppliers.
Unsurprisingly, insurance and drug companies have been dead-set against a single-payer for years. And they've so frightened the public into thinking that "single payer" means loss of choice of doctor (that's wrong -- many single-payer plans in other nations allow choices of medical deliverers) that politicians no longer even mention it.
On the campaign trail, Barack Obama pushed a compromise -- a universal health plan that would include a "public insurance option" resembling Medicare, which individual members of the public and their families could choose if they wished. This Medicare-like option would at least be able to negotiate low rates and impose some discipline on private insurers.
But now the Medicare-like option is being taken off the table. Insurance and drug companies have thrown their weight around the Senate. And, sadly, the White House -- eager to get a bill enacted in 2009 rather than risk it during the mid-term election year of 2010 -- is signaling it's open to other approaches.
More on the other approaches (and their efficacy) after the jump.
--Robert Reich