The partisan shouting match in Washington about health system reform has ended with no resolution. The problem of health system reform, none-the-less, remains. It is arguably the single most important unresolved domestic issue in America. Without real and sustainable health system reform the United States will continue to waste a trillion or more dollars per year on health care that is poor quality delivered inefficiently. The opportunity cost of the status quo or business as usual in American health care is huge and will ultimately cost us our leadership position in the world. Doing nothing is not an option. Continuing to argue about Obamacare is useless. Defending it ignores the real problems of the status quo. Repealing, however, depends upon finding a replacement that receives support across the political spectrum. Ultimately, the Republican proposals were not really much different from Obamacare, which means that both parties were ignoring the real problems with the status quo.
Isn’t it time to actually look at the reform proposal that has yet to be taken seriously in Congress? Single payer health system reform, anathema to members of both parties thus far, has never had even a hearing in Congress. Can’t we at least talk about it?
Republican support for single payer will not arise out of discussions concerning coverage. The coverage approach to health system reform always has been a failure. Whether a health policy proposal leaves 30 million or 50 million uncovered ‘lives’ is meaningless. It is the kind of hair splitting policy argument between partisans that obscures the real issues of American health care business as usual. To villify one group of partisans (extremist Republicans) over another group of partisans (lying Democrats) is to join in with the nonsense that has become the American health policy debate over the past quarter century. Ds and Rs are both to blame for this mess. Single payer advocates must change the way health system reform is framed. Both major parties make the mistake of invoking market forces to fix health care. Single payer advocates must relentlessly reject the market as the model for understanding efficiency in health care delivery.I am not a progressive. I will leave to those of you who are the task of pointing out how to get people with a progressive mindset to embrace and vote for candidates who will legislate single payer health system reform.
I am a conservative. Here is how I see the pathway forward to get people who consider themselves to be conservative to first open their minds to single payer and then support candidates who will legislate sustainable health system reform.
1) Single payer health system reform is the most fiscally conservative approach to American health care problems. Most people who are conservative do not know the facts about the cost of American health care. Conservatives frequently talk about federal debt and sometimes actually mean to do something about it. The federal debt on into the foreseeable future is due to unfunded obligations for health care. Discretionary spending, other than health spending, is flat relative to federal revenues, at least as projected. Health spending (i.e., for Medicare, Medicaid, and other federal health programs) is projected to be upwards of $30 trillion in the red during my lifetime. Conservative health system reform will reduce the federal debt. The only health system reform proposal with any chance to really reduce the federal debt is single payer.
2) Single payer health system reform is Constitutionally conservative, if it is approached on a state by state basis. The most conservative members of Congress would like to see states given the freedom to attempt health system reform. They will vote for single payer enabling legislation at the state level because that is how they understand the 10th Amendment.
3) Corollary to #2-Conservatives do not understand health care in terms of ‘rights’. The argument, frequently made by progressives, that health care is a human right, is counterproductive to recruiting conservatives to the single payer cause. Rather than invoking human rights, when I speak about health system reform in Utah (where I live and where every audience is conservative) I point out that there is no constitutional right to asphalt, but none-the-less I can drive from my house to the White House on publicly paid roads and highways. Asphalt is infrastructure for the 21st C American economy. By analogy, I argue that health care is also infrastructure, making 21st C American life, liberty, and the pursuit of happiness possible.
4) Health care does not fit the market model: I point this out in many ways. The inverse relationship between price and demand does not fit health care. Positive externalities exist for health care transactions. High quality health care does not cost more, it costs less. Patients are not shoppers, or buyers who can beware. Doctors and nurses are not self-interested sellers. Markets are not principally funded by taxes, unlike American health care. etc. etc.
5) Single Payer health system reform is the most morally conservative approach to changing US health care delivery. Conservatives often approach many public policies from a religious perspective. They feel a calling to care for the unborn, for instance, because it is the morally ‘right’ thing to do. By analogy, I attempt to persuade them that caring for the ill and the injured, all of them, with optimum quality and efficiency, is the ‘right’ thing to do.
I have years of experience speaking to conservative audiences and know that my talking points resonate with many. I am doing my best to spread these messages on Facebook (Dr Joe Jarvis) and twitter (@DrJoeQJarvis). I believe this is how to win more conservatives to the single payer cause.