by Brad Warthen

Can anyone among those with a chance of becoming president say "single-payer?" If not, forget about serious reform of the way we pay for health care.

It doesn't even necessarily have to be "single-payer." Any other words will do, as long as the plan they describe is equally bold, practical, understandable, and goes as far in uprooting our current impractical, wasteful and insanely complex "system."

And the operative word is "bold." Why? Because unless we start the conversation there, all we might hope for is that a few more of the one out of seven Americans who don't have insurance will be in the "system" with the rest of us - if that, after the inevitable watering-down by Congress. And that's not "reform." Actual reform would rescue all of us from a "system" that neither American workers nor American employers can afford to keep propping up.

But the operative word to describe the health care plans put forward by the major, viable candidates is "timid."

"Single-payer" is definitely not that - at least, not within an American context. Seen from the perspective of most advanced nations - which accept medical care as just another part of a nation's infrastructure, like roads and post offices - it's no big deal.

Not here, though - not by a long shot. Here, we have too many people preprogrammed to go ballistic at the mention of "single-payer." That's because of the identity of that payer.

It's... well, it's the government!

This column will now take a short break while libertarians run around shrieking until they turn blue and fall over... da-da-dum-dum, hmmm... readers might want to go look at the Sunday comics until we resume... da-dee-da-dahhh... Still screaming, so let's get another cup of coffee... Ah, that's good stuff...

OK, we're back, and they're still screaming, but we'll just have to accept that they're going to do that, and proceed.

"Government," in America, is a word that we use for a free people banding together to do something that we can do far better working together than working separately. Some people don't accept that fact. They seem to believe that "government" is some scary thing that intrudes on their lives from out there somewhere, like a spaceship full of aliens with ray guns that will turn us all into toads or something.

Those people are one of the two big reasons why you don't hear any presidential candidates saying "single-payer" except Dennis Kucinich. You may recall recent reports that Mr. Kucinich had a close encounter with a UFO, and it was a positive experience, so I guess he's just not scared of the aliens any more.

But the major candidates are. Or rather, they're scared of being labeled as extremists. Also, they don't want to offend the health insurance companies whose reason for being would disappear under "single-payer."

Last week, I got a press release from a labor union that complained "that no Republican candidate has a plan to ensure all Americans have access to health care." That's true. But the union, which represents blue- and pink-collar workers in health care, was missing the fact that the leading Democrats are little better.

"Sens. Hillary Clinton and Barack Obama have been engaged in a bitter back-and-forth over whose health plan covers more people," The Wall Street Journal reported last week. "Former Sen. John Edwards has jumped in, saying his plan is the best of all."

But what they're fighting over are plans that would pull varying numbers of the uninsured into the same overly expensive, wasteful, maddening system of private health insurance that the rest of us are caught in. Conveniently, they say their plans would be paid for by repealing the "Bush tax cuts for the wealthy."

Maybe you could pay for a health plan that way - as long as it doesn't provide real reform.

Make no mistake: A single-payer national health plan would cost a lot of money, and you would pay for it in new taxes. The good news is that most of us would probably still pay less than we currently pay in premiums.

According to the Web site of Physicians for a National Health Program, which promotes single-payer, "This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans."

But when not even touchy-feely liberal Democrats have the guts to say it's worth paying a new tax to make health care affordable for all, even when that's the hottest domestic issue among voters (which would not be the case if the insured majority were happy), we're in trouble.

Little wonder that Dow Jones' MarketWatch reported last week that "Those who hope the 2008 presidential election will finally bring about drastic health-care reform may well end up finding it's a case of politics and business as usual, experts say." The same article noted that Hillary Clinton has received $1.8 million in contributions from accident and health insurers, followed by Barack Obama with $1.45 million, Mitt Romney with $1.09 million and Rudy Giuliani with $1.08 million.

That, by the way, is money that you and I and the guy down the street paid for health care that didn't go to health care.
Given the odds against substantive reform - between the government haters, the insurance industry and Big Pharma, all of whom have a demonstrated willingness to outlast the rest of us in any protracted political fight - the only way we're going to see significant change is if a president is elected with a mandate for bold reform. Only a president is elected by the whole nation, so only a president would ever have that kind of juice.

Unfortunately, as previously noted, none of the viable candidates will say "single-payer."

But I will: Single-payer. Single-payer, single-payer! Now, do you have anything better to say?

--Brad Warthen
© 2007 The State.com