The agonizing road to single-payer

Monday, as President Obama argued the practical merits of a public-private heath-care system to a gathering of the American Medical Association in Chicago, back in Washington the Congressional Budget Office was unwittingly ratifying the superior wisdom of a single-payer system.

Observed the CBO of the Senate health committee's byzantine brew for a health-care fix, on which the gavel, it is reported, starts coming down today, "Once ... fully implemented, about 39 million individuals would obtain coverage through the new insurance exchanges. At the same time, the number of people who had coverage through an employer would decline by about 15 million ... and coverage from other sources would fall by about 8 million."

Or, as the New York Times summarized and simplified the CBO's mathematical mix, once some millions are added to, and other millions are stricken from, the Senate committee's health-coverage scheme, about "36 million people would remain uninsured in 2017."

Soon followed the reportorial understatements, the only amusement to be had. The NYT, for example, pronounced the CBO's eleventh-hour draft "a surprise" -- not to mention an enormous fiscal bump in the road, since Obama's $106 billion cost-saving plan of reduced subsidies to hospitals was based on eradicating America's untouchable class of the uninsured. Oops.

For its part, the Washington Post calmly muses this morning that the CBO's report is "likely to complicate" health-care reform's pre-existing condition of utter incomprehensibility and legislative crossfire.

What the Post did not say, nor did the CBO, is that the costly rococo patchwork of health-care reform being diabolically weaved would be rendered unnecessary by a single-payer system: All your medical bills go to one office, and that one office pays them; which, say, Medicare already does to the eminently frugal tune of 2-3 percent administrative costs versus 30 percent by private insurers.

Nevertheless, if you wish to remain encased in the profit-centric bureaucracy of privately insured care, that's your right as a rugged individualist. No one is saying you can't, excepting those elected propagandists from (mostly) Dixie.

Yet what never ceases to dishearten are the rhetorical games we all find ourselves forced to play in the gradual, incremental pursuit of intelligent policy. For instance Monday, in Chicago, as Obama defended the ambiguous construct of some manner of public plan -- which would, he said, "keep the insurance companies honest" -- he also banished as "illegitimate" the critical charge that such a plan would be tantamount to "a Trojan horse for a single-payer system."

Denial of that legitimacy is, of course, nonsense. And no one knows that better than Barack Obama.

A government-owned-and-operated insurance option would be stupendously popular, not to mention supremely efficacious in whacking away at exploding health-care costs. It wouldn't be long before private insurers found themselves squeezed, in time providing little but boutique coverage for aging aristocrats.

Fine. Who cares, as long as all Americans are covered, short of face lifts, tummy tucks and gluttonous ass-fat reductions.

Naturally it would be one hell of a lot simpler and far cheaper to merely impose -- yes, let's just call the act what it is, there's no need to be rhetorically faint of heart here -- a Medicare "option" on everyone now. But, as mentioned, we must first play these little games: Oh, no, my goodness, heaven forbid that the introduction of a semi-intelligent policy will lead inexorably to a wholly intelligent one, which is to say, a single-payer system for everyone, at birth, to grave, unless you opt out (contingent, perhaps, upon a psychiatric examination first).

However, I must add that I wax simplistic, because, simply, it's not that simple, which is the commonest of knowledge. Congress' chief goal is always to get itself reelected, which it accomplishes chiefly by pampering traditional special interests, like health insurance companies, who in turn heave efficient mountains of reelection cash onto Capitol Hill.

Intelligent policy has nothing to do with it, unless, of course, one recognizes the principle aim of that policy as the extenuation of a plutocratically kleptocratic kakistocracy.

Whew! But I do feel better, thank you.

At any rate, given the working parameters of the proximate paragraph above, we'll be lucky if Congress graciously deigns to grant us -- those who were suckered once again -- even some imitation-lite form of a public option. That, however -- and this is the undeniable upside -- would represent the proverbial camel's nose.

In the absence of single-payer, health care in America is just going to get sicker, and Congress will someday (sooner) be forced to concede that towering fact of political life and make the necessary fiscal, ideological, and reelection adjustments.