Obama once supported a single-payer health care system. (Photo: AP)
Back in 2003, an Illinois state senator named Barack Obama spoke to an AFL-CIO group and what he told them is now making headlines across the Internet. "I happen to be a proponent of a single-payer universal health-care plan," he said to applause. "I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care, cannot provide basic health insurance to everybody."
As Obama understood at the time, single-payer offers enormous advantages. Everyone's in, nobody's out. Patients pick their own doctors, who remain in the private sector. The government pays the bills, while private insurance companies and health maintenance organizations (HMOs) no longer act as gate-keepers, excluding pre-existing conditions from coverage and telling doctors and patients what is "medically necessary" and what is not.
Equally important, the insurers and HMOs no longer burden the system with their profits, high executive salaries, marketing expenses and administrative costs, which amount to as much as 31 percent of our national health care spending. Instead, the Social Security Administration handles the payments and paperwork, as they now do with Medicare, and the overhead comes down to an estimated 3-5 percent, or probably less with a healthy dose of advanced computer technology.
Who could be against such a straightforward, cost-saving system? The answer is obvious - private insurance companies, HMOs and the lawmakers they so generously support. Which, I suppose, is why Obama rather clumsily backed away in his campaign for president. "I never said that we should try to go ahead and get single-payer," he announced in January. "What I said was that if we were starting from scratch … I would probably go with a single-payer system."
"A lot of people work for insurance companies; a lot of people work for HMOs," he added in August. "You've got a whole system of institutions that have been set up."
"People don't have time to wait," he went on. "They need relief now. So my attitude is let's build up the system we got, let's make it more efficient, we maybe over time - as we make the system more efficient and everybody's covered - decide that there are other ways for us to provide care more effectively."
Much of his caution came from former Senate Majority Leader Tom Daschle, an early supporter whom Obama has now named to be secretary of health and human Services and head of the White House Office of Health Care Reform. Daschle spelled out his thinking in his book "Critical: What We Can Do About the Health-Care Crisis."
"Most of the world's highest-ranking health-care systems employ some kind of "single-payer" strategy - that is, the government, directly or through insurers, is responsible for paying doctors, hospitals and other health-care providers," he wrote.
"Supporters say single-payer is brilliantly simple, ensures equity by providing all people with the same benefits, and saves billions of dollars by creating economies of scale and streamlining administration. But pure single-payer system is politically problematic in the United States, at least right now. Even though polls show that seniors are happier with Medicare than younger people are with their private insurance, opponents of reform have demonized government-run systems as 'socialized medicine.'
"I have strong views on what an 'ideal' system would look like," Daschle added. "But I'm not willing to sacrifice worthy improvements on the altar of perfection. I find it encouraging that the leading Democratic presidential contenders appear to share this attitude. The proposals that Obama, Clinton and Edwards put forward would improve our current system rather than scrapping it, using the Massachusetts reform plan as a model."
The argument is classic: "Don't let the best become the enemy of the better." Or, perhaps more to the point: "Don't pick a fight we have no chance of winning."
Daschle and Obama are two of America's brightest political minds, and they could well be right. But the best way to find out is to fight for single-payer and then, if we must, negotiate a compromise. If there was ever a time to go for the whole loaf, it is now, when the insurance companies are despised for their high-handed gate-keeping and their role in creating the current financial crisis.
How, then, do we convince Obama, Daschle and the Democrats in Congress to give up the old politics and join us in a fight for the Change We Need? Here's what I'm doing. I went to www.change.gov, clicked on "Lead a Health Care Discussion," and arranged to host a house party for other Democrats abroad here in France. If enough of us did this in our own communities, we might well remove the veto from single-payer health care.