Democratic leaders stay cold on single-payer

Washington -- Advocates of a single-payer health system finally got their hearing in Congress, but they remain on the outside looking in as Democratic committee leaders seek to reform -- but not eliminate -- private health insurance.

Supporters of single-payer health care, in which the federal government would be the sole third-party payer, are frustrated. They cite national polls indicating that a majority of Americans support their proposal. They also say such a system would slow the growth of health spending by vastly improving preventive care and eliminating the administrative costs incurred by the roughly 1,300 health plans in the U.S.

"Attempting to reconcile the dual imperatives of universal coverage in cost control through alternative methods besides single-payer is an exercise in futility," said Walter Tsou, MD, MPH, a former Philadelphia health commissioner and a national board member of the Physicians for a National Health Program, a single-payer advocacy organization.

Democratic leaders favor creating a public health insurance plan to serve as competition to private health plans, rather than radically transforming the health system. Republicans staunchly oppose a single-payer system, and they say a public plan option eventually would lead that way by unfairly competing against private plans and luring away consumers.

"It amounts to a government takeover of health care, and it would force millions of Americans off their own plans and into a government-sponsored plan," House Minority Leader John Boehner (R, Ohio) said on June 11.

Long-time supporters of a single-payer health system, such as Rep. John Conyers (D, Mich.), are particularly frustrated by President Obama, who has said he does not support the idea because it would be too disruptive to the U.S. health system.

"There are countries where a single-payer system works pretty well," Obama told the American Medical Association House of Delegates June 15 during its Annual Meeting in Chicago. "But I believe -- and I've taken some flak from members of my own party for this belief -- that it's important for our reform efforts to build on our traditions here in the United States."

Single-payer advocates say they have plenty more flak to give Obama and key Democrats. Single Payer Action, an activist organization in Washington, D.C., is planning more than 100 protests in the coming months, said board member Russell Mokhiber.

Physician organizations have not embraced the single-payer concept. The AMA opposes such a system. Neither the American Academy of Pediatrics nor the American Academy of Family Physicians has a policy in this area. The American College of Physicians identified single-payer as one of two ways to achieve universal health coverage. The other is a public-private system that includes a legal guarantee that everyone has access to coverage and that offers health care subsidies to low-income residents.

Pleas and protests

Rep. Tom Price, MD (R, Ga.), said giving the federal government more responsibility over health care will not improve access, affordability, quality, innovation or choice.

"The right to health care in other nations that have a single-payer system is a right to get in line," Dr. Price said. He's a member of a House Education and Labor subcommittee that held a June 10 hearing on the single-payer idea -- the only such hearing this year.

But Rep. Robert Andrews (D, N.J.), the subcommittee's chair, said single-payer deserves more respect. "It is a solution that, unlike some in the Senate, I believe belongs on the table."

Andrews was responding to comments made by Senate Finance Committee Chair Max Baucus (D, Mont.). Baucus repeatedly said this spring that all possible health reform ideas were "on the table" but then said in late May that he was not considering single-payer because it cannot pass Congress. "We can't squander this opportunity. We can't waste capital on something that's just impossible," Baucus said.

Conyers said some programs the nation takes for granted today once seemed politically impossible. "Medicare was fought tooth and nail. I know because I was here," said Conyers, speaking at the June 10 subcommittee hearing. Conyers is the sponsor of the United States Health Care Act, a single-payer bill. The measure has 82 co-sponsors.

Baucus did not seat any single-payer advocates on any one of the three panels of witnesses -- 41 experts in all -- who testified during Finance Committee health reform discussions on April 21, May 5 and May 12. More than a dozen members of groups such as Physicians for a National Health Program and Single Payer Action disrupted the start of the first two discussions with a protest. They stood up one by one, demanded a seat at the table for a single-payer supporter, called Baucus corrupt or argued for their stance, and were removed.

Baucus had 13 protesters charged with disruption of Congress. If convicted of this misdemeanor, the protesters likely would face a community service requirement. Mokhiber said that during a meeting with single-payer supporters, Baucus promised to drop the charges; a Baucus spokesperson did not respond to questions about the arrests.

Judy Dasovich, MD, was one of the 13 who were arrested. The internist is the volunteer medical director at the Kitchen Clinic in Springfield, Mo., where she said staff routinely turn away sick people because they don't have the capacity to treat them all. "Working in the free clinic has highlighted for me more than anything that the so-called safety net is anything but."

Dr. Dasovich, who's been practicing since 1981, said other countries have demonstrated that single-payer works. "The problem is not with the proposed solution. The problem is with the congressional body that doesn't have the political will to make it happen."

Dr. Dasovich said physicians who worry about having their pay reduced by the government in a single-payer system should remember that the health system's first goal is not to provide them with a "fabulous living."

"If you are making $600,000 and you're only going to make $500,000 after ensuring the health of the community, maybe that's something we as physicians ought to suck up," she said.