The Rise of Single-Payer Health Care

Health care reform plans are being drafted and passed around on both sides of Capitol Hill, but the plan with the greatest number of Congress members behind it was first introduced as a bill six years ago. With two new co-sponsors having just signed on, Congressman John Conyers's single-payer health care plan, HR 676, now has 80 Congress members supporting it.

A House committee held a hearing on single-payer health coverage on Wednesday, and a Senate committee included single payer in a hearing on Thursday. Many opponents of single payer, including President Barack Obama and House Speaker Nancy Pelosi, say it would be the ideal solution if it were possible.

A single-payer or "Medicare for all" system that eliminates for-profit health insurance and simply pays for everyone's treatment by private doctors and hospitals of their choosing is also the only solution consistently favored by a majority of Americans in polls. The proposal, already in place in most of the world's wealthy nations, is raised at every health care town-hall forum that Congress members or President Obama speak at, including the one Obama held on Thursday in Green Bay, Wisconsin.

The president always rejects single payer on the grounds that some Americans are too fond of their health insurance companies to part with them. A report by Fairness and Accuracy in Reporting last week found that the corporate media still virtually bans coverage of single payer. A Senate bill being championed by Sen. Chris Dodd in place of ailing Sen. Edward Kennedy, does not include single payer (which is supported by only one US senator, Bernie Sanders). The Kennedy-Dodd bill, at least in its initial draft, does not even include a "public option," that is a Medicare-like program to exist alongside the private insurance companies. The House bill is being drafted by one current and two former co-sponsors of HR 676, Congressmen George Miller, Henry Waxman and Charles Rangel, but it avoids single payer, championing a public option instead. Other competing Senate bills are expected to complicate things further.

The approach taken by the Kennedy-Dodd bill and considered for the House bill is, rather than eliminating health insurance companies, expanding them by making insurance mandatory and subsidizing its purchase. While this approach is favored by the insurance companies, which have been among the primary participants in White House and Congressional health care forums this year, it is not supported by other corporations that would rather not be required to provide health insurance to employees. If anything has emerged on Capitol Hill this week, it is a chaotic lack of consensus except around the idea that something must be done to address a health care system that is damaging Americans' health and economy. Whether the growing chaos opens the door to single payer remains to be seen, and that possibility appears much more real in the House than in the Senate.

In the House, the progressive Caucus has declared that, while it would prefer single payer, it will back no bill without a public option; the Black, Hispanic and Asian caucuses have also backed a public option; and Speaker Nancy Pelosi has said that no bill without a public option will pass. This should mean that, as the debate advances, the House will be more likely to back single payer than any other solution. Or, rather, it would be if it could create laws without having to get them through the Senate as well.

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