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Single-payer option just barely stays alive


WASHINGTON -- With all the public confusion over the various health care reform proposals that have come out of House and Senate committees, voters can't be blamed if they yearn for one relatively simple plan that they can understand.

There happens to be one, and it has in fact been reported out by the House Education and Labor Committee, though almost as an academic exercise, because even its strongest supporters acknowledge it has no chance of enactment. It is the so-called single-payer plan modeled on the Canadian system in which the federal government pays all the medical bills.

Contrary to the misinformation of critics, including the insurance industry that would be bypassed by this approach, the government would not operate the health care system. Instead, it would leave it in the hands of existing providers and pay them directly for the services rendered, rather than going through a middle man by buying premiums from profit-making insurance companies.

Patients would use the doctors and other health care providers of their choice and could buy supplemental coverage if they chose from insurance companies for additional benefits or such things as cosmetic surgery not provided by the government plan. Every American would be covered, as President Clinton has proposed, and savings would be substantial -- another Clinton goal. The General Accounting Office, run by Congress, has estimated savings in administrative costs of $67 billion a year.

So why hasn't this approach been embraced by the president and Congress? One key reason is that conservatives, chiefly but not exclusively in the Republican Party, have done a masterful job of spooking Clinton, Congress and Democrats generally with two longtime political bugaboos.

The first is that creating another huge governmental bureaucracy will result in more waste, inefficiency and corruption, and the second is that this approach is just another example of the old liberal Democratic philosophy of tax-and-spend. Good arguments can be made against both allegations regarding a single-payer plan, but most Democrats simply shy away from making them.

Among the most desired programs run by the federal government are Social Security and Medicare, and while stories of inefficiency in the delivery of checks often are heard, there is very little public pressure to undo either of these programs, once defiled as "socialized medicine." And while it is true that a single-payer plan would be financed by new taxes, all the other approaches require some financing scheme, such as the much-criticized "employer mandates." The virtue of using a progressive tax is that it is straightforward and doesn't try to kid the voters that they will be getting something for nothing.

But the Democrats, including Clinton, have been socked for so long with the two bugaboos that they duck by reflex, especially as the policies and philosophy of the New Deal that gave rise to these allegations have lost their appeal and luster. It is much like the way Republicans have been demonized by Democrats as wanting to kill Social Security. Defensively, Republicans, whose party once deplored the idea as a socialist plot, now fall all over each other championing the sanctity of the payments to the elderly.

Clinton may wish, after all he and the first lady have gone through in trying to craft an acceptable health care reform package, that he had risked being labeled another bureaucracy-crazy, tax-and-spend liberal and proposed a single-payer plan himself.

Instead, advocates of that approach -- 92 House co-sponsors and about five in the Senate -- are reduced to using whatever clout they have to salvage a provision that would enable states to use single-payer if they choose. Opponents like the insurance industry, however, want to exempt from such coverage workers of employers operating in more than one state -- an exemption that advocates of single-payer say would gut their approach. So single-payer, which sounds and looks like the simplest answer, remains a long shot, except as a state-by-state option.

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