Baucus Regrets Not Including Single-Payer in the Health Care Mix

Regrets? He's got a few.

Regrets? He's got a few.

I think you rarely see a sitting Senator be as reflective about the legislative process as Max Baucus is here when he says he regrets that the idea of a single-payer health care system was left out of the mix:

He conceded that it was a mistake to rule out a fully government-run health system, or a “single-payer plan,” not because he supports it but because doing so alienated a large, vocal constituency and left Mr. Obama’s proposal of a public health plan to compete with private insurers as the most liberal position.

I thin that’s right. Framing effects are important in politics. The public-private competition is supposed to be a compromise between the pristine vision of single-payer and the desire of private insurers not to be put out of business. It creates a situation in which insurers are challenged to prove that single-payer advocates are wrong, rather than simply assert it. But with no single-payer plan in the mix, this gets lost, and the compromise becomes the leftmost anchor of the debate. A single-payer plan couldn’t possibly have passed, but I think having hearings on single-payer and having one committee draft a serious single-payer bill that gets a serious CBO score would have been a useful exercise. In particular, it would have focused the mind on the costs involved in rejecting this option.

Meanwhile, it would be nice if David Herszenhorn, who wrote the article, understood the difference between a “single-payer plan” for health insurance and “a fully government-run health system.” The concepts are quite distinct and correspond to the difference between a health-insurance company and a hospital. Single-payer means the government is the insurance company, government-run health system means that the government would actually run the health system. Both exist abroad (Canada is single-payer, the UK is government-run) and at home (Medicare is single-payer, the VHA is government-run) and they’re very different.