Tuesday, October 27, 2009

Unrecognized Issue in Health Care Reform

One of the things I find interesting about the current health care reform debate is the number of issues that are going unrecognized and undiscussed.

One is the issue of national health insurance or, as it is more euphemistically known, single payer.

There is a sizeable group of people, including much of the left wing of the Democratic Party and almost all of the health policy people in academia, who are strongly committed to the idea of national health insurance. Their commitment is so strong that no other ideas have been forthcoming as to the shape of the reformed health care system of the future.

The problem they have had is that there is little support for it among the public at large and among political leaders.

While President Obama denies that he is in favor of national health insurance, its advocates comprise his political base and he needs their support for his health care reform initiative. It appears that his gesture to them has been the so-called public option – a federal health insurance program that would operate in competition with private health insurance companies.

One version of that proposal has the public option program paying providers the same rates as Medicare, and requiring providers to accept those payments as a condition of participation in Medicare. The final version may tone that down some but still with the potential of underpricing private health insurance companies and of eventually getting all of the health insurance business. At that point we would effectively have national health insurance.

For the advocates of national health insurance, the public option is not only the best chance of achieving their goal that they have ever had, it is probably the last one of their lifetimes. If the public option is defeated with a liberal Democratic president and sizeable Democratic majorities in both houses of congress, national health insurance is probably dead for decades. That undoubtedly accounts for the strength and persistence of their support for it.

The issue is worthy of debate and it is too bad there isn’t any.

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