It goes without saying that in history the most moral solution to a problem has not always been the most politically popular. Even more seldom, it seems, has morality coincided with economic convenience. Yet in the case of the health care crisis, a single-payer or "Medicare For All" system in which the government replaces private insurers while leaving patients with their choice of doctors meets all three criteria: not only is it the only morally acceptable solution, but it enjoys overwhelming support among the general population and would also give a significant boost to the US economy. Just causes that do not meet the criteria of popularity and economic pragmatism are no less urgent or legitimate, but when they do, as in this case, there is even less excuse for opposing them.
First, the moral dimension. According to data collected by the CDC and analyzed in the upcoming December 2009 issue of the American Journal of Public Health, around 45,000 people die each year in this country because they have no health insurance. The 46 million uninsured people in this country have a 40 percent higher risk of death than the insured, as many reputable studies have demonstrated [1]. For many of those who are insured the picture is often only slightly less grim, with insurance companies charging astronomical premiums and regularly denying coverage for necessary medications and procedures. An August 2009 study published in the American Journal of Medicine found that at least 62 percent of all bankruptcies in this country result from medical bills [2]. An industrialized society that fails to provide its people with adequate health care is profoundly sick in a moral as well as physical sense. The ONLY way to fulfill the moral imperative of universal health coverage, as all other industrialized nations do, is through a single-payer, Medicare-For-All system.
Public opinion is likewise unambiguous. Though often dismissed by Democrats as "politically impossible," Medicare For All has long had the support of the US public. In dozens of major opinion polls in recent decades, between 55 and 65 percent of respondents have consistently expressed support for a system of national, universal health care (for a partial list of polls check out the website of the Western PA Coalition for Single-Payer Health Care).
Finally, Medicare for All would bring enormous economic benefits. While administrative overhead consumes about 12 percent of private insurance costs and 31 percent of total health care spending, Medicare’s overhead costs are less than 4 percent [3]. As the organization Physicians for a National Health Program reports, "the US could save enough money on administrative costs (more than $350 billion annually) with a single-payer system to cover all of the uninsured" [4]. According to a recent study by the National Nurses Organizing Committee and California Nurses Association, expanding Medicare to cover the whole population would create over 2.6 million new jobs and would increase public and business revenues by $317 billion, providing a huge stimulus to the economy [5].
This economic stimulus will be many times greater if single payer is implemented within the context of a more general budgetary shift away from military spending and toward social programs, education, and public infrastructure. As economists inside and outside of government have demonstrated, these types of spending are far more effective in creating jobs and stimulating an economy than is military spending. A 1992 study by the Congressional Budget Office estimated that local and state governments are twice as efficient as military spending at creating jobs. Economists Robert Pollin and Heidi Garrett-Peltier echo this basic conclusion in a March 2008 Nation article, finding that "[e]very $1 billion spent on a combination of education, healthcare, energy conservation and infrastructure investments creates between 50 and 100 percent more jobs than the same money going to Iraq" and other military expenditures [6]. As in the case of single payer itself, there is broad public support for this shift. Polls have found that ordinary people identifying as both Democrats and Republicans—as opposed to their elected leaders—overwhelmingly favor sharp reductions in the bloated Pentagon budget; in an October 2006 PIPA poll, for example, Democratic respondents said they would cut military spending by 48 percent, Republican respondents by 20 percent [7].
The only interests that would be hurt by a shift to Medicare For All are the insurance companies, and, to a lesser extent, the pharmaceuticals and private health care providers that would be forced to cut down on overhead and abide a reduction in their often-astronomical profit levels. Yet these interests have shaped the debate thus far. One of their major accomplishments has been keeping the single-payer solution out of view and limiting the debate to whether or not a "public option" will be included in the reform bill. Obama’s public option proposal, though still ambiguous and ill-defined, would fall short on all three counts: the moral, the political, and the economic. It would, as Obama himself has admitted, fail to cover everyone [8]. It would likely force most of the uninsured to purchase expensive health insurance plans from private companies, effectively channeling even more of the public’s money into corporate hands [9]. And by leaving the insurance companies intact, it would do little to reduce the enormous economic waste and astronomical prices of the current system [10]. And, ultimately, it would also leave voters even more dissatisfied with the Democrats in the same way that the Clintons’ failure to promote single-payer health care in 1993-94 helped bring about the Democrats’ defeat in the 1994 Congressional elections [11]. A bill with a robust public option might represent a small improvement, but that improvement would pale in comparison with the myriad benefits of single payer.
The infestation of US government with corporate lobbyists and donors, the personnel overlap connecting government and corporations, and the general shared interests between wealthy politicians and economic elites have helped obscure the arguments in favor of single payer. But on the other hand, single-payer activists have the support of overwhelming moral, political, and economic evidence, making the atmosphere riper than ever for genuine change. We could hardly wish for a better opportunity.
Notes:
[1] Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser, Danny McCormick, David H. Bor, and David U. Himmelstein, "Health Insurance and Mortality in US Adults," American Journal of Public Health 99, no. 12 (December 2009). Earlier studies had put the mortality figure at between 18,000 and 20,000: the figure of 18,000 is from a 2004 study by the Institute of Medicine at the National Academy of Sciences, "Insuring America’s Health: Principles and Recommendations," January 14, 2004, available on the IOM website; see also, on the same webpage, the series of reports issued by the Committee on the Consequences of Uninsurance at the IOM; in addition, see the Frontline documentary "Sick Around America" (transcript available here), which cites another IOM study giving the figure of 20,000.
[2] David U. Himmelstein, Deborah Thorne, Elizabeth Warren, and Steffie Woolhandler, "Medical Bankruptcy in the United States, 2007: Results of a National Study," American Journal of Medicine 122, no. 8 (August 2009): 741-46.
[3] Steffie Woolhandler, Terry Campbell, and David U. Himmelstein, "Costs of Health Care Administration in the United States and Canada," New England Journal of Medicine 349, no. 8 (August 21, 2003): 768-75.
[5] Cited and analyzed in John Nichols, "Single-Payer Health Care Would Stimulate Economy" (blog), The Nation (online), January 14, 2009.
[6] Congressional Budget Office estimates in "Why We Overfeed the Sacred Cow," Defense Monitor 25, no. 2 (February 1996): 1-7; Pollin and Garrett-Peltier, "The Wages of Peace," The Nation (March 31, 2008).
[7] Program on International Policy Attitudes, "Opportunities for Bipartisan Consensus—2007: What Both Republicans and Democrats Want in US Foreign Policy," January 2007, 13-14.
[8] "Promoting Healthcare Reform, Obama Admits US Can’t Insure All Americans Without Single Payer," Democracy Now! July 23, 2009.
[9] Drs. Steffie Woolhandler and David Himmelstein, "Why Obama’s Public Option Is Defective, and Why We Need Single-Payer," The Progressive (online), July 22, 2009.
[10] See the list of studies from between 1991 and 2008 collected on the website of Physicians for a National Health Program.
[11] A similar point is made by Leonard Rodberg, "Is There Any Way Out for Obama?" (blog on PNHP website), October 9, 2009. I am no campaign strategist—nor would I ever be for a corporate-beholden party that has always sought to co-opt and defuse progressive movements—but considering public opinion polls and the massive public disillusionment with the two-party system expressed in low voter turn-outs on election days, it’s reasonable to assume that a strong Democratic push for single payer—clearly framed as "Medicare For All"—would work to the political advantage of the Democratic Party. Democrats would lose future campaign funding from the health care industry, but would gain and galvanize millions of working-class supporters. And if the Democrats were to cast off their allegiances to corporate power more generally, the result would be amplified many times over. Expecting Democratic leaders to do so is highly unrealistic at this point, however.
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