How To Sell Single Payer: Lie About Other Policies

One tried and true way to win political debates is to vigorously misrepresent the facts. Health care, full of genuinely knotty public policy tangles, particularly lends itself to this. Everybody remembers the contribution of the insurance industry's "Harry and Louise" ads to the failure of the Clinton health plan. Just don't imagine that the dishonesty is confined to the right wing.

The Times last week ran one of their "room for debate" online roundtables, about health insurance mandates. In it, Marcia Angell, the former editor of the New England Journal of Medicine and a supporter of single payer, tries to paint any other system as a giveaway to insurance companies. Says Angell of the mandate to buy insurance:

I live in Massachusetts, where we have one. It requires people to buy private insurance at whatever price the companies choose to charge. As might be expected, this is a windfall for the insurance industry. Premiums are rising much faster than income, benefit packages are getting skimpier, and deductibles and co-payments are going up.

The idea that people in Massachusetts are buying insurance at "whatever price companies choose to charge" is absolute nonsense. You'd imagine from this that every insurance company in the country is rushing in to squeeze the poor citizens of Massachusetts. But in fact the only insurers that offer individual plans that satisfy the state mandate are non-profit. And while they offer many plans, including very expensive ones, the price of the most basic plans is not "whatever the companies choose" to charge, but fixed by the state. As for this premiums going up: you bet they are. That's because the reality of the "mandate" is that it has plenty of holes, and the first people to sign up have been, as you'd expect, the ones who need the most services.

At least Angell is honest enough to admit that one reason she doesn't like mandates is that she doesn't like any health plan that's not a government run single payer system. I don't think that misrepresenting the alternatives is the way to make that happen--then again, I don't like single payer and don't think it's politically viable anyway, so, like Angell, I'm biased here. I don't love mandates either, but if I had to choose between that and single payer, I'd go for the mandate. The biggest problem in health care isn't figuring out who should pay for it. It's changing how care is delivered so it does more and costs less (you can see some of the problems with the current system on display in Atul Gawande's fantastic article about McAllen, Texas). Neither mandates nor single payer will help on that score, but single payer will just bring us universal Medicare: ever rising costs for over-aggressive, under-effective medicine.