Single-Payer’s Day in the Sun in the House

So that’s what we’ve been missing in the Senate.

Today, Health, Education, Labor and Pensions Subcommittee (a subdivision of the House Education and Labor Committee, one of the “Tri-Committee” structure working on health care reform) held an entire session of hearings on the single-payer vision of health care.  It may well be, the way the political winds are blowing, that Congress decides there are ways to cut costs, improve quality and increase access short of dismantling for-profit insurance and a fee-for-service system that, as Dr. Atul Gawande amply demonstrated in his New Yorker article, is set to make a lot of money but not necessarily a lot of Americans healthier.  But we’ll never know unless we get to have real debates about the choices before us.

Normally my motto is “I watch C-SPAN so you don’t have to,” but I’m breaking that pattern today by posting a clip of Dr. Marcia Angell.  As a former editor-in-chief of the New England Journal of Medicine (the first woman to hold that position) and a current lecturer at Harvard Medical School – well, let’s just say she knows what she’s talking about:

It’s not just that Dr. Angell is an articulate advocate against for-profit insurance and the excesses of fee-for-service – which she clearly is.  It’s that she’s willing to contest the points that we skip over too often.  The problem with the scary stories of Canada and Britain – aside from the fact that they’re a-typical and deliberately ignore how prevalent equivalent stories are here in America – is that you’re not comparing like to like, given how much more we spend per person.  Far from indicating an inherent inferiority in quality, “For them, it’s not the system, it’s the money.  For us, it’s not the money, it’s the system.”

We often get caught up thinking the system we have now is an OK foundation, and our job is merely to improve upon it to curb excesses and extend the benefits of quality, affordable health care to more of our citizens.  But that’s not particularly true, given our out-of-control spending for less than impressive results.  Instead, every incentive in the system now is rigged for, as Dr. Angell puts it “maximizing income, not maximizing health.”  The tough question is what are we going to do about it – is our goal to save an industry that’s been getting rich off cherry-picking some patients and denying care to others?  Or should we finally start focus on maximizing health, not maximizing income?

You may or may not think that single-payer is automatically the answer, but it’s hard to argue that it’s not worth asking the question.