Just getting my sea legs in attempting to keep up with the health policy comingssingle_payer_sam  and goings, so this one is a little late getting up on the blog.

I will be attending the meeting of “United for Single Payer” in Seattle on Wednesday 1/6/10. While my health reform manifesto didn’t make it crystal clear, I am a very vocal skeptic of the entire single payer idea. A recent private correspondence pretty well sums it up:

When I speak to supporters of ‘single payer’ approaches, I don’t find their arguments persuasive because they are rarely able to successfully contrast single payer with other options for universal coverage (a la Switzerland, Denmark, etc.). In speaking with many proponents of single-payer, I have yet to get an answer to my crucial question: we’ve seen the firepower the for-profit insurers pulled out against proposals that were not direct, existential threats to them. How would any practical approach for single payer be able to survive the political and economic onslaught that would inevitably ensue?

Seems to me the best approach is to focus on goals that are (mostly) shared: universal coverage, radically greater transparency (on several dimensions), much more tightly regulated medical insurance, a sensible ‘floor’ of medical coverage, etc. Only then can the appropriate pressure be placed against for-profit insurers to meet the new bar. That’s the way to equitable universal coverage – long-term strategic approach.

My other problem with ‘single-payer’ is more ethereal and probably less defensible. I just have an aversion to mono-culture. That’s not the way nature works – and it seems to me that we need an approach that is not just functional for now, but also sustainable and adaptable over the long term. A diversity of approaches is needed in order to achieve that end. I just have a gut reaction to the idea that a single approach to funding the entire system would give us that adaptability. We will still need to innovate as time moves forward.

That said, I’ll be going to the meeting tomorrow to learn and be open to new ideas. Stay tuned, if you will.