WASHINGTON -- While the Clinton administration advocates "managed competition" as the bedrock approach to its health-care reform package, many liberal groups and some liberal legislators are continuing to push for a single-payer approach modeled on the Canadian plan that has been widely disparaged by conservatives.
These liberals insist that far from the huge government bureaucracy that many conservatives say will be required under the approach that calls for Uncle Sam to pick up the tab for all health insurance, single-payer will eliminate from the equation another costly bureaucracy -- the private insurance industry and its premiums -- and actually save money for most insured Americans.
A single-payer alternative to the Clinton package has been introduced by Democrats Paul Wellstone of Minnesota in the Senate and Jim McDermott of Washington, with five co-sponsors in the Senate and 89 in the House. It predictably will encounter the old conservative complaints of "socialized medicine," a big new bureaucracy and new taxes, and for that reason among others it is probably politically unfeasible right now as the formula for national health-insurance legislation.
But the advocates of single-payer -- government paying for medical services but not dictating the choice or nature of hospital or physician care -- see one feature of the Clinton plan as an open door to demonstrating that the old bugaboos about it are invalid, and that there is growing public interest in the approach.
Under the Clinton plan as laid out in general, health insurance would be administered through the states, with any state having the option of choosing the managed competition approach of regional health-care alliances favored by the White House, or a single-payer plan. Under both approaches, the federal government would set basic standards for benefits, require that all Americans be covered and that the insurance be portable -- that is, assured in the event an employee changes jobs.
Cathy Hurwit, legislative director for Citizen Action, the national coalition of self-styled citizen lobbies, cites a General Accounting Office study indicating the single-payer approach would save $60 billion, largely in administrative costs. She notes that Canada spends only 11 percent of its health-care dollar on such costs compared with 25 percent spent now in the United States through private insurance companies. And she emphasizes the argument that the government under single-payer would not run the system, but merely provide the financing mechanism.
At the same time, Hurwit and Mike Podhorzer, director of Citizen Action's campaign for the single-payer approach, acknowledge that the cries of socialized medicine and a new big government bureaucracy, plus the prospect of a broad-based new tax (or "public premiums"), have been important inhibitions to White House support for it. They insist that once voters have the facts they will favor that approach, and they see the states as laboratories where the economy and feasibility of single-payer can be demonstrated. So if the option to the states is retained in any federal health-care legislation that passes, their efforts will be focused on state legislatures to adopt single-payer.
For now, though, the single-payer advocates say they will continue to press for that approach nationally, recognizing that Clinton is still flexible on what the health-care package should be. "Clinton is out there selling security right now," Podhorzer says. "He's not selling his plan at all, he's selling his card" -- a reference to the "health security card" the pres- ident flashes to audiences as their prospective ticket to universal, com-prehensive care.
Wellstone says it should be an easy sell. "Health care is the kind of issue that has walked into [Ameri-cans'] living rooms and smacked them in the face," he says. "People want to know if they will be covered, have their choice of doctors, and whether it will be a good package and affordable." He is hoping to pro- mote a "Health Care Day" across the country this fall or winter at which all members of Congress go home one weekend to hear directly from the voters on what they want -- clearly hoping that single-payer will be what they hear.