Some in Sacramento still want a single-payer system
Nathan Dietrich, left, holds the mic as Eric Vega chides Sacramento Rep. Doris Matsui at her town hall meeting Saturday for backing a public option in lieu of a single-payer plan to cover the nation's 46 million uninsured. "If we started all over again," Matsui said, "I'd go single payer."
Some critics of the Obama administration's plan to remake health care call it a government takeover of medicine. But Kathy Dennis doesn't think it goes far enough.
Dennis, 49, a registered nurse from Woodland, wants the government to dismantle the private health insurance industry and replace it with a single, government-run insurer.
"I believe we need universal health care, and I believe in a single-payer system," said Dennis, 49. "Insurance companies are out to make money, and the way they make money is to deny you health care."
At a May rally in Washington, D.C., Dennis marched in her red scrubs alongside hundreds of other nurses, chanting slogans backing a single-payer plan.
They might as well have been shouting into a howling wind for all the impact they had. On Capitol Hill this year, single payer is a non-starter. Even a much more limited "public plan" option for health care faces a major fight.
"People aren't really fighting for what would be the best reform," said Deborah Burger, a registered nurse at Kaiser Permanente in Santa Rosa and co-president of the California Nurses Association. "Is it a lack of personal will or lack of political will? There's a whole bunch of people who say they support it but aren't moving it along."
"We get lectured about what's politically feasible," she said. "Of course it won't be politically feasible if you don't push for it."
Democratic Rep. Doris Matsui of Sacramento was sharply questioned on single payer by constituents at the health care town hall she hosted Saturday.
Eric Vega, a single-payer supporter, chided Matsui for endorsing the more limited public option that he said would not be enough to provide access to the country's estimated 46 million uninsured.
"If we started all over again," Matsui responded, "I'd go single payer."
A single-payer system would seem simple enough one insurance entity that would cover the entire population but establishing it would require a herculean effort.
As envisioned by supporters, a single-payer system would extend Medicare, a federally run insurance program for country's elderly, to every U.S. resident.
It would mean the end of the commercial insurance industry, which would fight back accordingly.
A single-payer system "would require a massive conversion to a different health care system," said Patrick Johnston, president of the California Association of Health Plans.
"The history of the United States suggests that we are a nation that values the free enterprise system and entrepreneurship, and uses the government system for things that the private system cannot provide," Johnston added.
The California Legislature has twice passed single-payer legislation, but both bills were promptly vetoed by Gov. Arnold Schwarzenegger. A third bill never got out of committee.
Health care advocates have been tantalized by the prospect of nationalizing health insurance, which a single-payer system would do, "but politically it's never developed serious traction," said Daniel Zingale, senior vice president of policy for the California Endowment, a health philanthropy.
Zingale was a key adviser in Schwarzenegger's failed attempt to overhaul the state's health care system two years ago.
The governor's plan would have required every state resident to obtain health coverage and required insurers to spend at least 85 percent of premiums on patient care and to issue policies to anyone, regardless of health status.
In his veto of single-payer legislation in 2006, the governor said he could not support a government-run health care system.
"Socialized medicine is not the solution to our state's health care problems," the governor wrote in his veto message.
"I want to see a new paradigm that addresses affordability, shared responsibility and the promotion of healthy living," he said. "Single payer, government-run health care does none of this."
In theory, single payer is not dead. There are proposals floating in the Senate and House Senate Bill 703 and House Resolution 676 but both may end up as mostly symbolic in the health care debate.
"They don't have the votes," said professor John Ellwood, who directs a health policy research program at the University of California, Berkeley.
"Single payer is a great dream of my liberal academic colleagues, but I just don't think it will happen in the foreseeable future in the United States," Ellwood said.
"I think it's a mistake for people on the left to just focus in on single payer and be locked into it. There are other options," he added.
House Speaker Nancy Pelosi, whose San Francisco district is among the most liberal in the country, may personally support a single-payer system, but she has to walk a delicate political line to placate the spectrum of ideologies within her party, Ellwood said.
At her health care forum, Matsui, too, acknowledged a political reality in which even the public option is a stretch. She said her focus is to "build on and improve on the system we have today. Having a public option is the way to do this."
A government-run health plan the so-called public option that would provide a presumably lower-cost alternative to commercial health plans remains a topic of hot debate in Congress. Critics call the proposal for a federally run health plan a back door to an eventual conversion to single payer.
At this point, even a public option is "highly uncertain," said William Dow, a professor of health economics at UC Berkeley. "There would still be a lot of politics necessary."
Despite pressure from the progressive wing of the Democratic Party, a public option is not expected to be part of the bill that's scheduled for a vote today by the Senate Finance Committee.
The dueling proposals in the Senate and House fall short, said Henry Abrons, a retired doctor of internal medicine and spokesman for the California Physicians Alliance, which advocates a single-payer system.
"The bills currently being discussed in Washington are not going to provide universal coverage, because 15 million to 25 million still would not receive health insurance," Abrons said. "Single payer is truly universal everybody would be covered."
Supporters of the single-payer concept are disappointed that the idea was ruled out so early in the health care debate this year. But they hope that in time their arguments will still win out.
"It's our job to better explain single payer and why it, among our other options, is our best option," said Bob Vizard, a Stockton doctor employed by Valley Emergency Physicians and a member of the physicians alliance.
While conservatives have cited the public option as the scary first step toward single payer, Vizard and other supporters of a government-run system hope it is a baby step in that direction.
"This is a missed opportunity, but we look forward to tomorrow," Vizard said. "There's been a great advance in people's understanding about the health care financing crisis. Ultimately, we want single payer. But at this point, we want a strong, robust public option."
Kathy Dennis, a registered nurse at Mercy General Hospital, favors a single-payer system. "Insurance companies are out to make money," she says, "and the way they make money is to deny you health care."
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