We Can’t Settle for Less Than Single Payer

In 1994, America was in the throes of healthcare reform. First Lady Hillary Rodham Clinton was leading the Clinton administration’s grand effort to implement a system of ​“managed competition,” a proposal that would expand healthcare coverage by putting big insurance companies in the driver’s seat but regulate how that care was administered. Her failed proposal, while not perfect, was not that far off from the Obamacare we got 16 years later.

Here at In These Times, the office was divided. Some supported Clinton’s plan on the grounds that it was an improvement, while others thought it folly to settle for less than single payer.

John Judis, a founding editor at In These Times, wrote in March 1994:

I am [not convinced] that a Canadian-style plan could pass Congress … .

As Congress strips away the ungainly features of Clinton’s plan … the real danger is that what remains will more closely resemble the prim [Rep. Jim] Cooper [D-Tenn.] plan [known as Clinton Lite] … . Given that danger, liberals’ priority will probably be defending what the Clinton plan, for all its deficiencies, has in common with the Canadian system: a commitment to universal coverage and control of costs.

What will I do? I’ll have to demonstrate my altruism by defending the Clinton plan against its conservative rivals, even as I anticipate the prospect of my health insurance fees doubling.

Vicente Navarro, a professor of health policy at Johns Hopkins and author of Dangerous to Your Health: Capitalism in Health Care, took the opposite tack in January 1994:

The implementation of the Clinton ​“managed competition” proposal will put large insurance companies in command of the health care system. … The profitability of the insurance industry is based not only on selecting and screening patients, but on favoring those providers who consume the fewest resources, a strategy that frequently interferes with the quality of care. …

And this is why managed competition is favored by large insurance companies. None other than Bill Link, vice president of Prudential Insurance, has indicated that ​“for Prudential, the best-case scenario for reform — preferable even to the status quo — would be enactment of a managed-competition proposal.”

What we need is a single-payer system that, as in Canada, provides comprehensive and universal coverage without co-payments and deductibles, and also allows people to choose their providers. …

There is an urgent need to mobilize support for the single-payer proposal, both to move the debate to the left and to expand and strengthen the single-payer elements in the legislation that Congress may finally approve.

Now, 25 years later, we are faced with a field of Democratic primary candidates who run the gamut from Bernie Sanders’ wholehearted push for Medicare for All to Joe Biden’s dismissal of it. God willing, in another 25 years, we will be having a different discussion. Of course, the nature of that debate will depend on the results of the 2020 election.