14 January 2008

What the hell is single-payer?

On Saturday I was cold-calling in person at a conference, approaching people and asking them if they were for single-payer universal health care. It's a bruising thing to do, because you're not insulated from people who are annoyed by your invading their space and people who disagree with your message.

But it's also instructive.

One guy was impatient. "What's single-payer?" he asked. "What is that?"

I began to explain and he cut me off after less than 10 words, saying his life was too short. "You mean socialized medicine," he informed me. "Why don't you just say 'socialized medicine'?"

He went on to say that to him, single-payer is what we already have. He's the single-payer for his health care.

He was so arrogant, dismissive and nasty that I was left reeling -- and wondering what he was doing at a "Faith in Action" conference. I suppose this is why the "heartland" feels the way it does towards academics, because that's all I could imagine that he was. But trying to put it into perspective, his observation was a good one. It's not something that we didn't already know, but it's a confirmation, once again, that the term "single-payer" is a head scratcher.

Guaranteed health care might be better. How would we describe the police or fire departments? Guaranteed police or fire? Universal police protection... with single-payer financing? State police protection? Municipal fire protection? Government-sponsored health insurance?

George Lakoff likes "doctor- and patient-run health care" -- like citizen- and police -run policing?

Or, back full circle, universal health care with single-payer financing?

I'm reminded of the Family Research Council employee who got a month sabbatical to go work for Huckabee. He said that among the things he learned were that the mainstream media were far more fair and balanced than the right-wing media, and that whenever people asked for real information, not just a soundbite, their attention would be gone after 30 seconds. And those were people who wanted to pay attention.

People want things to be easy. We want someone else to have to make the changes, to do things differently, in order to better the system. Mandates are just the ticket for that in many politicians' eyes. Since the majority of Americans do already have Medicare or employer-sponsored insurance, it's a siren call for them to hear that if we just force the uninsured to buy insurance out out-of-control costs will be solved.

They won't be.

Cost-shifting (providers charging insurance companies more to make up from losses elsewhere) is only part of the problem, and only a small percentage of cost-shifting is due to the uninsured. The rest is from Medicare and Medicaid. But even if it were mostly from the uninsured, who really thinks that companies and families would reap the benefits of forcing everyone to buy insurance -- who really thinks the insurance companies would turn around and lower their costs? This is one of the most profitable industries in the world -- has that led them to step back and reconsider their profit margins?

But from what I heard Saturday, a number of people, especially elderly women, are enthusiastic about forcing poor single moms to buy insurance. These seniors were also outraged about their personal out-of-pocket costs.

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