The Social Medicine Portal

It’s about objectives, not means: An analysis of the Obama Administration’s position on single payer

An analysis of the Administration’s position on single payer as reported by White House Chief of Staff Rahm Emanuel is suggestive about what blows the winds of Washington DC and what stands in the way of transparency in the political process, including, yet probably not limited to, health care reform (the handling of torture and eavesdropping in your inbox come to mind as well).

Emanuel argues that the president is now against single payer because what matters is “not the means but the objectives”, namely, cost control and universal coverage — or so we would assume. That you don’t see the relationship between controlling costs and covering everybody and opposing single payer, i.e., Emanuel’s argument? Don’t worry: you are not alone…

I include the critique of this argument in full because it is not only quite telling but also witty, and may elicit a chuckle or two. The gist of it is that Congress and the White House do not want to hear the truth: that a single payer health care system would save money, cover everybody, and set the right framework to control costs for years to come. Which is why the White House and most members of Congress are rather pleased that the Congressional Budget Office is not analyzing it as it did with other proposals (e.g. “public option choice”), and even getting in the way of this analysis. (After all, who would want to hear that?).

What the CBO has said about current proposals for reform is consistent with the assertion that none of the “traditional” explanations for our high costs work, really: the Japanese, among many others, have higher utilization rates than we do (visits to doctors, MRIs, etc), greater percentage of elderly in the population as we do, and to our knowledge do not eat more broccoli than we do. And yet, they pay 50% of our price tag (per person) when it comes to health care.

Why? Because they collectively foot their medical bills (social insurance in health policy jargon), and take shared responsibility seriously (that is, everybody pays into the system a proportion of their income). So do Germans,  Britons, Canadians, and so forth.

So, it looks like to achieve health care reform we cannot wait for the winds of Washington to blow favorably in the direction of the American people. Rather, the American people will have to make these winds blow all by themselves.

In the meantime, let’s take a peak into the winds of Washington. Click here to listen to Rahm Emanuel himself.

The analysis was published in Single Payer Action, a loose coalition of single payer supporters that informs about health care reform, gathers signatures for petitions, and organizes rallies. Those who want to be part of the growing grassroots movement for true health care reform can sign up here for their action alerts.

You can email the president or call the HHS Secretary Kathleen Sebelius at 1-877- 696-6775