Could Single-Payer Health Care Proposals Arise from the Current Health Care Reform Debate Impasse?

As women’s health educators and advocates for nearly 4 decades (we are best known for the landmark book Our Bodies, Ourselves, which now appears in 24 foreign editions), Our Bodies Ourselves urges everyone to contact colleagues and friends whose Congressional representatives are Blue Dog Democrats currently blocking any meaningful health care reform legislation, including proposals that include a robust public health insurance option.

Our Bodies Ourselves has taken a strong stand in favor of single payer health care and continues to believe in the importance of educating the American public about this superior approach to our current health and medical care crisis. Media distortions continue to be a major obstacle, but repeated polls that use clear, lay language consistently show public support for the single payer approach. In addition, the same forces that oppose single payer plans also vigorously oppose the robust public health insurance option, so there is really little political advantage to pushing for a public health insurance option rather than single payer (see more details from Physicians for a National Health Program).

Numerous journalists have written eloquently about this issue (see, for example, the recent column by Robert Kuttner). Now we need to make sure that members of Congress hear from their constituents in larger enough numbers to offset the lobbying of the health insurance and pharmaceutical industries. PLEASE CONTACT YOUR FRIENDS TO MAKE THEIR VIEWS KNOWN TO THEIR CONGRESSIONAL REPRENTATIVES, ESPECIALLY THOSE IN DISTRICTS REPRESENTED BY “BLUE DOG DEMOCRATS.” There is a list of Blue Dog Democrats at the end of this piece.*

Although not sufficient by itself to reduce waste that results from failure to use best practices in medicine, the single payer approach best aligns itself with mechanisms to contain costs while at the same time improving outcomes. As Atul Gawande so eloquently pointed out in his June 1 article in The New Yorker, cost savings AND improved medical care outcomes can go hand in hand. This is particularly clear in the arena of maternity care, where hospital costs alone for maternity care services were more than $86 billion in 2006, and we did not have especially good outcomes to show for this expenditure in comparison with all other industrialized countries.

Couple single payer with measures to ensure that comparative effectiveness research would be encouraged through appropriate incentives, and we would achieve significant savings on top of the $400-500 billion dollars in savings from eliminating wasteful administrative overhead costs. This approach – unlike almost all others – would clearly be sustainable. (For more discussion of comparative effectiveness, click here).

New legislation must also address the enormous need for more primary care practitioners in the U.S.: family practice physicians, general internists, physician assistants, nurse practitioners, and midwives. For example, greater access to nurse-midwives in communities across the country would significantly reduce cesarean section rates and thus both improve outcomes and reduce costs. (It is worth noting that many people now employed by the private health insurance industry might be interested in retraining to become primary care providers.)

We are already 60% of the way to a single payer health care system, if we include Medicare, Medicaid, the VA system and other publicly-run programs. The majority of physicians, other health care providers, and the general public now support single payer health care. It is critical to keep a focus on this approach, even if its prospects for passage are dim. Because it offers the best means to help stabilize the economy while providing health and medical care for all, it should not be dropped from the public discourse. And as many leading economists have emphasized, the obstacles to adopting single payer are largely political, not economic.

An activated citizenry on this issue just might make a difference.

Judy Norsigian is Executive Director of Our Bodies Ourselves

*BLUE DOG DEMOCRATS (July 2009)

California
Rep. Mike Thompson – 1st District
Rep. Dennis Cardoza – 18th District
Rep. Jim Costa – 20th District
Rep. Loretta Sanchez – 29th District
Rep. Jane Harman – 36th District
Rep. Joe Baca – 43rd District

Colorado
Rep. John Salazar – 3rd District

Florida
Rep. Allen Boyd – 2nd District

Georgia
Rep. Sanford Bishop – 2nd District
Rep. Jim Marshall – 3rd District
Rep. John Barrow – 12th District
Rep. David Scott– 13th District

Iowa
Rep. Leonard Boswell – 3rd District

Idaho
Rep. Walt Minnick – 1st District

Indiana
Rep. Joe Donnelly – 2nd District
Rep. Brad Ellsworth – 8th District
Rep. Baron Hill (Co-Chair for Policy) – 9th District

Kansas
Rep. Dennis Moore – 3rd District

Kentucky
Rep. Ben Chandler – 6th District

Louisiana
Rep. Charlie Melancon (Co-Chair for Communications) – 3rd District
Maryland
Rep. Frank Jr. Kratovil – 1st District

Maine
Rep. Mike Michaud – 2nd District

Minnesota
Rep. Collin Peterson – 7th District

Mississippi
Rep. Travis Childers – 1st Districts
Rep. Gene Taylor – 4th District

North Carolina
Rep. Mike McIntyre – 7th District
Rep. Heath Shuler (Whip) – 11th District

North Dakota
Rep. Earl Pomeroy

New York
Rep. Mike Arcuri – 24th District

Ohio
Rep. Charles Wilson – 6th District
Rep. Zack Space – 18th District

Oklahoma
Rep. Dan Boren – 2nd District

Pennsylvania
Rep. Jason Altmire – 4th District
Rep. Patrick Murphy – 8th District
Rep. Christopher Carney – 10th District
Rep. Tim Holden – 17th District

Tennessee
Rep. Lincoln Davis – 4th District
Rep. Jim Cooper – 5th District
Rep. Bart Gordon – 6th District
Rep. John Tanner – 8th District

Texas
Rep. Henry Cuellar – 28th District

Utah
Rep. Jim Matheson – 2nd District

Virginia
Rep. Glenn Nye – 2nd District