As we get into the nitty-gritty of subsidies, health insurance exchanges, and Medicaid income caps, it's helpful to remember that many health-care experts still support single-payer -- a government-run health system. Some, like Our Bodies Ourselves executive director Judy Norsigian, are ignoring congressional politics to take a stance right now in favor of single-payer, while the country is focused on the topics of health-care outcomes and cost. Here is my interview with Norsigian on why she believes anything less than single-payer is "un-doable" and "not sustainable" -- and why public education is key to health reform.
Why are you coming out for single-payer right now, when it's not on the table politically?
One of the things that's clear is that those who are opponents of single-payer, pretty much all of them are opponents of any meaningful public health insurance option. I have not seen much wiggle room. You know, there might be a few legislators we missed, but in general it looks like the opposition is just as stiff for both. So going down the path of planning for a public health insurance option is, in my mind, a recipe for following [what] the Clintons [tried], which is to do something that is un-doable. In the end it just wouldn't work for a variety of reasons.
It's true that a lot of legislators who supported single-payer in the past are now pushing a public option instead. But politically, the issue is that in poll after poll, Americans who are happy with their employer-based coverage say they don't want any change. Single-payer would be a big change! And that's the fear that politicians have. After all, insured people vote at much higher rates than uninsured people.
Well this is where I would hope legislators would go to the mat in educating their constituencies. And if they don't, and if the public interest groups don't, we're not going to succeed. I credit Arnold Relman's book, Second Opinion, with changing the minds of physicians in favor of single-payer. When you really understand nothing else can work, then you say, OK, we’re just going to simply take the time it takes, because the economy, too, is at risk here. And a piece of why the economy is at risk is, of course, the way health care has cost businesses so much. The other thing is that businesses are going to be able to dump people if there is a public health insurance option. ...
You know, this isn't a five-minute conversation. But I think educating the public is absolutely vital. In some cases, we need somebody who is a charismatic leader, who basically was willing to go to the mat and say, "Nothing else really could work, we've got to marry best practices with more primary care and a single-payer model."
Read the rest of the interview after the jump.
--Dana Goldstein
