Monday, June 08, 2009

Letter From the Editor: Why a 'Single-Payer' Health-Care System Will Never Become a Reality in the U.S.

Establishing a 'Single-Payer' System Would Require Completely Doing Away With All Private Health Care -- and That Would Violate the Constitution; Direct Competition Between Public and Private Health-Care Systems Is the Best Health-Care Reform That Advocates For a 'Single-Payer' System Can Realistically Expect to Pass in Congress

Senators Tom Harkin (D-Iowa) (left) and Max Baucus (D-Montana) listen to President Obama at a White House meeting last week on health-care reform, just before the president took off on his historic trip to the Mideast and Europe. Progressives pushing for a government-run "single-payer" health care system are sure to be disappointed: Not only is there no chance that a "single-payer" system has the votes to pass in either house of Congress, but for such a system to work would require the government to nationalize all privately-run health care firms or put them out of business -- and that would violate the Constitution. (Photo: Brendan Smialowski/Getty Images)

(Posted 5:00 a.m. EDT Monday, June 8, 2009)


A funny thing happened on the road toward a government-run "single-payer" health-care system modeled after those in Canada and Europe.

It got derailed. Not by the Republicans, but by President Obama and the Democrats.

In a decision that has angered their supporters on the left, the president and congressional Democrats have ruled out "single-payer" as a means toward much-needed health care reform, and instead have settled on direct competition between public and private health care plans.

The White House and Democratic congressional leaders made it clear that a "single-payer" system has no chance of passage in either house of Congress, and not just because of a solid wall of Republican opposition. Many Democrats also oppose "single-payer," because such a changeover from the present private system would be "too radical."


Make no mistake. The United States is one of the few industrialized nations in the world that do not have a single, government-run, universal health-care system. The privately-run health-care system we have now is broken, leaving over 45 million Americans without health-care coverage.

Millions of Americans who do have health insurance are nonetheless facing bankruptcy because of skyrocketing costs that their health insurance does not cover.

"So many people go bankrupt using their credit cards to pay for health care," President Obama was asked at a town-hall meeting in Rio Rancho, New Mexico in May. "Why have they taken single-payer off the plate?"

Advocates for a single-payer health-care system have proven themselves to be determined. For months, they've doggedly pressured congressional Democrats with hard lobbying and with noisy protests, including one at a Senate hearing in May in which 13 single-payer advocates were arrested by Capitol Hill police.

Over the weekend, single-payer advocates made their presence felt at a series of "house parties" on health care reform hosted by Organizing for America, an Obama-backed project at the Democratic National Committee.


The status quo on health care simply cannot be allowed to continue. It threatens to undermine the nation's economy. But replacing our broken private health-care system with a single, government-run public health-care system will never become a reality in this country.

Why? Because the U.S. Constitution will not allow it.

For all of their efforts, supporters of a single-payer health care system are in for a big disappointment. Not only does such a system have no chance of passage in Congress, but even if the votes were there and Obama signed a single-payer bill into law, it would not survive a constitutional challenge in court.

The problem with establishing a government-run single-payer health care system in the United States is that to do so would require the government to nationalize every private health-care firm in the country -- or put them out of business.

That would violate the Takings Clause of the Fifth Amendment, which bars the government from taking private property for public use -- unless the government pays compensation to the owners of the private firms it nationalizes. And such compensation would run into the trillions of dollars.


The president made clear that a single-payer health care system was unworkable in this country. "If I were starting a [health care] system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense," Obama said in his answer to the unidentified questioner at the New Mexico town-hall meeting.

"The only problem is that we're not starting from scratch," Obama continued, noting that America's existing private health-care system is over 150 years old and makes up 14 percent of the nation's gross domestic product. "We don't want a huge disruption as we go into health-care reform where suddenly we're trying to completely reinvent one-sixth of the economy."

Instead, Obama and congressional Democrats are pushing for a "hybrid" system of competition between public and private health care plans that would impose tough cost controls and provide coverage to the more than 45 million Americans now without it.

The president also hinted that he might consider a requirement that all Americans have health care coverage, whether public or private -- a requirement already in place in Massachusetts.


To say that a single-payer system is fiercely opposed by insurance companies and congressional Republicans would be an understatement. Already, opponents have embarked on a massive advertising blitz against single-payer, which many Republicans see as a "government-run health care monopoly."

Conservatives for Patients' Rights, an advocacy group bankrolled by Rick Scott, former CEO of the for-profit Hospitals Corporation of America (HCA), last week launched a $1.2 million TV advertising campaign branding the Democrats' proposal for direct public-private competition in health care as a "bulldozer" that would put private health-insurance companies out of business.

"It's just one step removed from a single-payer system," Scott told The Washington Post. "The goal is to get rid of the insurance companies, and then the government makes all the decisions."


That a wholesale nationalization of the private health-care industry would be declared unconstitutional has its precedent set in 1952, when the U.S. Supreme Court overruled President Harry S. Truman's seizure of the nation's steel mills amid a strike by the United Steelworkers of America.

The strike, which came about in the middle of the Korean War, led Truman to fear that a strike of any length would cause severe dislocations for defense contractors and for the domestic economy as a whole.

Unable to mediate the differences between the union and the industry, Truman decided to seize their production facilities, while keeping the current operating management of the companies in place to run the plants under federal direction.

The steel firms, led by the Youngstown Sheet & Tube Co., immediately sued in federal court, accusing Truman of violating the Takings Clause of the Fifth Amendment. The case went all the way to the Supreme Court, which ruled 6-3 against Truman.


As much as this correspondent despises the private health insurance industry -- particularly for-profit health-care firms, as I believe very strongly that health care for profit is immoral -- we cannot get rid of them completely. Nonetheless, the hyperbole by Scott and other opponents of a single-payer system is misplaced and unnecessary.

Let me be clear: Single-payer will not pass and its supporters and opponents both know it. Single-payer is unconstitutional and its opponents know it -- although I seriously doubt that its supporters do (And I expect to receive a lot of flak from them for saying so).

So why are opponents of health-care reform screaming bloody murder against it? Simply put, they represent the existing private system and they don't want any competition from a public system. They're afraid that a public health-care system that directly competes with the private system will cover more people and provide better-quality health care.

More importantly, competition from a public health-care system would force the private system to do away with the two biggest complaints of patients: high out-of-pocket costs to patients, known as deductibles; and exclusion of coverage due to pre-existing medical conditions.

Competition in health care between the public and private sectors would be healthy (no pun intended). It would make for better-quality service. Competition in health care would also expand the number of Americans covered by it.

Most importantly, a public health care system in direct competition with the private system would provide a vital safety net for Americans who otherwise cannot afford private health insurance.

And with the profit motive removed, a public health care system in competition with the private system would be a magnet for health care workers much more concerned with serving patients than with the bottom line.

Skeeter Sanders
Editor & Publisher
The 'Skeeter Bites Report

# # #

Volume IV, Number 45
Copyright 2009, Skeeter Sanders, All rights reserved.


Sphere: Related Content


David Brick said...

A government "alternative" to private health insurance will have only minimal impact on cost reduction, as every health care provider will still have to maintain extensive staff to deal with the claims of their privately insured patients.

If the public was given a full explanation of the advantages of single pay, the support would be so great, that a constitutional ammendment would easliy pass if needed to accommodate the legal issues.

jacksmith said...


Howard Dean and the Democrats are correct.

"a" (Toothy, Robust, Affordable, Immediate, Triggerless, Medicare-Like ) "public health insurance option" (For All Who Want It) "is more important than bipartisanship, and Democrats should pass health-care legislation that includes the option with 51 votes if necessary."

"Democrats should have "no intention" of working with Republicans if it's not the strongest possible legislation that could be passed with a simple majority." (Howard Dean)

CONTACT CONGRESS and your representatives Now! And tell them you demand ALL of the minimum requirements above. This is the time for maximal, toothy, sustained pressure on Congress to get this done. Be creative. But be relentless.

This is what WE THE PEOPLE gave the Democrats all that power to do for ALL of us.

In medicine and healthcare there is only one acceptable standard. And that standard is the HIGHEST level of EXCELLENCE! you can provide for everyone. Nothing less is acceptable for a precious human life.

And the White House is right. "Good health care reform is essentially good economic policy." (Christina Romer)

BUT HEAR ME WELL! Just as I warned you before 911. Before the wars in Iraq and Afghanistan. And before the US and Global economic crisis.

I must tell you now that healthcare reform is now a critical matter of NATIONAL SECURITY. A-H1N1 (Swine Flu) was yet another loud WAKE-UP! call. And there is MUCH! worse lurking, and poised to strike at any moment. Working against the clock, many of us have known this for a long time now. And this is why we have been pushing so hard for so long without fully saying why. But Congress and the American people are literally running out of time.

I'll tell you more later. But get healthcare reform done NOW!.


God Bless All Of You

jacksmith -- WORKING CLASS