The ‘Public Option’ on Health Care Is a Poison Pill The ‘Public Option’ on Health Care Is a Poison Pill
Some Democratic candidates are pushing it as a free-choice version of Medicare for All. That’s good rhetoric but bad policy.
Exchange: ACA vs. Single-Payer—Bury the Hatchet? Exchange: ACA vs. Single-Payer—Bury the Hatchet?
Washington, D.C. As the attorney who filed the amicus brief on behalf of Single Payer Action, It’s Our Economy, and Fifty Medical Doctors Who Support Single Payer, all of which opposed the individual mandate but otherwise supported the Affordable Care Act, I agree with Wendell Potter that it’s time for progressives to bury the hatchet [“No Time for Infighting,” July 30/Aug. 6]. I invite Potter and other progressives supporting the ACA to join those who never wavered in supporting what we all know is the only solution to the healthcare crisis—single-payer, aka Medicare for All. I hope Potter will blow the whistle on the individual mandate, which he, more than anyone else, must recognize as a deal with the devil. If Potter won’t bury the hatchet by embracing single-payer, he should at least rescind his demand that single-payer advocates support a law entrenching the same for-profit health insurers he now renounces after a lucrative career as their PR man. Otherwise, he’s just perpetuating the same old misinformation. OLIVER HALL New York City Wendell Potter’s insightful critique of his former bosses in big health insurance was marred by his reprimand of his newfound friends in Physicians for a National Health Program and the rest of the single-payer movement for failing to adopt the political style of his erstwhile employer. Potter incorrectly implies that PNHP urged a no vote on President Obama’s health reform by the Supreme Court. Some PNHP members condemned the ACA for boosting private insurers’ financial (and future political) power with a trillion-dollar infusion of public subsidies and mandated premiums. Others welcomed its expansion of Medicaid. All agreed that the reform would leave at least 26 million Americans uninsured and most others underinsured; that it would accelerate the corporate takeover of medicine and increase costs; and that single-payer reform remains an urgent necessity. Potter derides PNHP as a group of strategy-less “die-hards” too “furious at the president and the Democrats” to vote in November or pursue rational alliances. How odd to see a group of 18,000 doctors—including a number of Republicans, conservatives and libertarians—caricatured as ultra-leftists! His call for diluting the single-payer message in defense of Obama’s reform mistakes the nature of the group and its role in society. Physicians are neither politicians nor corporate lobbyists. On health policy, as in our consultations with patients, we’re ethically bound to tell the truth, not a tale we only wish were true. Aspirin may ease the pain of cancer, but it must not be portrayed as a cure. In Massachusetts, five years into Obama/Romney reform, access to care has barely budged, medical bankruptcy is common and costs continue to spiral. Having lived with such reform, doctors in the state favor single-payer over it by two to one, according to a recent Massachusetts Medical Society survey. Love it or not, Obamacare is the new status quo. Private insurers—whose paperwork and profits siphon off nearly one-third of healthcare dollars—are still in charge. We and our PNHP colleagues remain determined to replace them with a humane, publicly controlled single-payer system. We invite others to join us. STEFFIE WOOLHANDLER, MD, MPH DAVID U. HIMMELSTEIN, MD, founders, Physicians for a National Health Program Potter Replies Philadelphia Our country owes Drs. Woolhandler and Himmelstein an enormous debt of gratitude for their untiring efforts over many years to see our uniquely dysfunctional and inefficient multipayer system of private insurance companies replaced with a more rational single-payer one. As I thought was evident, I’m on their side now. I agree with them and my other friends at PNHP that we must keep working for a more humane system in which private insurers are no longer in charge and can no longer siphon off our premium dollars to cover unnecessary administrative costs and to reward shareholders and executives. I hope Drs. Woolhandler and Himmelstein will take another look at my article. They’ll see I was suggesting that all reform advocates, not just PNHP members, might consider taking a more strategic approach to achieving their goals. In fact, I referred to PNHP only once, in the penultimate paragraph. I did not write or imply that the organization urged the Supreme Court to declare the ACA unconstitutional, only that many single-payer advocates (including some PNHP members I know personally) felt that way and expressed themselves very vocally. I also did not characterize PNHP as a group of “strategy-less ‘die-hards,’” and I did not reprimand advocates, single-payer or otherwise, “for failing to adopt the political style of my erstwhile employer.” Developing a comprehensive research-based strategy and forming alliances with other organizations to achieve a goal is not synonymous with adopting the insurance industry’s political style. Anyone who knows me and what I have written and said about the ACA knows that I always point out that the law falls far short of getting us to universal coverage and controlling costs. But I have indeed written that as flawed as the bill is, it is all we are going to get from the 111th Congress, and that starting over would mean that millions of Americans who now or soon will have better access to care would be out of luck for who knows how long if it hadn’t been enacted. I’ve often cited Drs. Woolhandler and Himmelstein’s 2009 study, which estimates that, as a PNHP news release put it, “nearly 45,000 annual deaths are associated with lack of health insurance.” When the ACA is fully implemented, that number will drop. This means that many friends and family members will not have to die prematurely. That number will not drop to zero, however, which is why we need to “get down to the business of developing a strategy to move forward.” That I did write, and I trust it is something all reform advocates can agree on. As well-written as Mr. Hall’s amicus brief was, it didn’t persuade Chief Justice Roberts to declare the ACA unconstitutional. And as sincere and hopeful as single-payer advocates were at the beginning of the debate on reform in 2009, they regrettably were not able to persuade Congressional leaders or the president to give single-payer even a hearing. So now that the ACA apparently will move forward, where is the strategy to persuade the public and lawmakers to even consider single-payer as a replacement for what we have now? Is it likely that a President Romney and Senate Majority Leader McConnell would be more receptive than Barack Obama and Harry Reid? Is the best strategy to wait until the special interests are no longer as powerful as they are on Capitol Hill and in statehouses or as able to manipulate public opinion? Is it best to wait for the revolution as millions more Americans fall into the ranks of the uninsured and die? No, thank you. My children and your children might be among those who die waiting for the revolution. Any one of us could be. We absolutely need those who have been unwavering in their support of Medicare for All—including the single-payer advocates I’m preparing to meet with as I write this—to stay unwavering and join us to begin the process of developing a strategy to win. I invite anyone interested in seeing a single-payer healthcare system established in this country to join in. WENDELL POTTER