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Thursday, July 23, 2009


"I want to cover everybody. Now, the truth is unless you have what’s called a single-payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual." -Obama at his recent presser.

I was a bit surprised to hear him admit this. Not that he (and Pelosi, etc.) refuse to consider it.

"And never mind that over 20,000 people die every year, according to the Institute of Medicine, because they cannot afford health insurance."

Well at least this figure is up from the 18,000 I keep seeing, but don't you think this has to be very, very low? I mean, look, there are 40 + million uninsured, and another many millions underinsured - does 20,000 really represent all the folks who die because of this fact? Fewer than smoking, car accidents, etc?

I'd love to know who came up with this figure.

Thanks for your site. I check it every day.

I agree that single-payer is not "practical," because I define "practical" as "not achievable under our current political system."

What the advocates of single-payer want (and what I want) is to take one of the most powerful economic and political interests in the country, and eliminate that interest with one stroke. I really can't think of another example where reform advocates have proposed anything remotely similar. It's as if the advocates of banking reform proposed to eliminate banks (come to think of it, that's not a bad idea...)

Not that I'm on Pelosi's side, but I get a bit frustrated with liberal single-payer advocates who take the attitude that, "This is a good idea, why can't we just explain to everyone why it's a good idea and have it enacted into law?"

The insurance companies are fighting for their very existence, and nobody in that position is going to leave any weapon unused.

Sorry, an extra "not" in that first sentence.

Conyers' single-payer bill, HR 676, has 85 co-sponsors as of this morning.

Rojo: Obama's statement is actually what made me think of the Nader analogy, because it's similar to 2000, when so many people recognized Nader was the best candidate and yet they wouldn't vote for him. The analogy breaks down when applied to the actual Democrats blocking reform, though, which is why I didn't mention Obama.

Catherine: Good question. Apparently the 18,000 figure comes from here; I'd guess Ralph's using an updated version of that number. I'd agree, it seems like the actual number must be higher (and I don't see how an accurate number can be found, since many people who die without insurance are likely off the radar in other ways also).

And thanks for the thanks—glad you like what you're reading.

SteveB: I agree that single-payer is not "practical," because I define "practical" as "achievable under our current political system."

I know where you're coming from, but I don't agree with the way you've expressed it, because it echoes the language of many liberals who use words like "practical" and "pragmatic" to pretend that the vested interests that run our society are immutable forces of nature. They're not. They're just groups of people with a shared interest, no different from the hundreds of millions of us who'd like to see a sane health care system in this country. Yes, they have enormous economic and political power, but that's because they've been assisted in their rise by the very political forces who are now telling us single payer is impractical. Using "practical" in this way reinforces the notion that single payer is something Democrats in general would like to establish, but they're thwarted by forces outside themselves—when the reality is that for decades most Democrats have bent over backwards to help foster the establishment of the corporate-run health care system in this country, and there's no way they're going to bite the hand that feeds them now.

So while I understand and largely agree with your point, I think it's a bad idea to use a weasel word like "impractical" to get it across, because it masks the deep rot of corruption that underlies the refusal of the vast majority of Democrats to consider real health care reform. There's nothing inherent in our political system itself that makes single payer impractical; it's just that the people in power are dedicated, first and foremost, to the maintenance of corporate power, and enacting single payer is (as you observe) antithetical to that overarching goal.

Practical? Who was it that said "That which is politically feasible will not solve the problem, and that which will solve the problem is not politically feasible" ? My office web filters seem to block me from citations of that quote.


The Institute of Medicine has done a number of studies on mortality rates for people with and without insurance. They focus on people from the ages of 25-64. Therefore, something like a higher rate of infant mortality among the uninsured is not part of the number. John Caruso is probably right that the "18,000" number captured the public's imagination as a result of the USA Today story in 2002. Subsequent studies have gotten a higher number.

BTW, does anyone know how the polls break down on single payer by age group? I know a majority supports it overall but I wonder how the issue polls among seniors who already have it with Medicare. It might be very popular with people 18-25 who don't vote in high numbers but unpopular with seniors who do. I'm just speculating on that but just because a majority of Americans something does not mea a majority of the ones who vote support it.

That quote is definitely appropriate here, Thomas. More generally, that's why Democrats like Obama are incapable of fixing the fundamental problems in our system—because they're too invested in it (figuratively and literally), and so they refuse to consider the only approaches which actually have a chance of succeeding.

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