The "S" word: Single-payor, Obama and the Wall Street Journal

Even when denying that he plans to institute a single-payor model, Obama gets raked over the coals by most of the readers who commented on today's WSJ Health Blog post regarding his health plan. 

Obama says that if we were starting with a clean sheet of paper, a single-payor system would make sense.  So far, so good: all industrialized democracies other than our own have taken the leap into this "monolithic" approach — and their systems work better than ours, as recent reports have borne out. We in the US of A spend far more per capita for health care than other nations, and we fare more poorly on a number of key quality indicators.  Obama also says, wisely, that since we aren't starting with a clean sheet of paper, we shouldn't destroy the existing system.  Rather, we should work on improvements around the edges. As I've written in posts over the past year or so: "Incrementalism, baby." It's the only way to go.

Otherwise, as Obama recognizes, we risk seeing dislocations that are too great. It should also be clear to any observer of our health care system that serious change must get underway in order to address the three-headed monster of cost, access (both in terms of coverage and availability of providers) and quality.  Since it seems an insurmountable obstacle, the all-too-human reaction is to shrug and think about something else.

Clearly, we need to attack one or another of these issues head-on. We can't realistically address all of them at once. Obama's plan makes one rational choice; other choices could be equally rational. The key is that we need to start somewhere, and soon.

Denying that a problem exists or that any potential solution brought forward, however imperfect, might advance the ball a bit, is a bit unrealistic at this stage of the game. Ultimately, the solution will involve — and benefit — all of us.

— David Harlow