(M)ost reform proposals out there - even proposals from liberal groups like the Century Foundation and the Center for American Progress - reject a simple single-payer approach. Instead, they call for some combination of mandates and subsidies to help everyone buy insurance from private insurers.
Some people, not all of them right-wingers, fear that a single-payer system would hurt innovation. But the main reason these proposals give private insurers a big role is the belief that the insurers must be appeased...
But I think that's the wrong lesson. The Clinton plan actually preserved a big role for private insurers; the industry attacked it all the same. And the plan's complexity, which was largely a result of attempts to placate interest groups, made it hard to sell to the public. So I would argue that good economics is also good politics: reformers will do best with a straightforward single-payer plan, which offers maximum savings and, unlike the Clinton plan, can easily be explained.
From our standpoint, this column highlights the need for immediate action. Right now, the status quo is an almost entirely publicly-funded system. The more insurers that are able to set up shop before any action is taken, however, the more vested interests there will be in the privatized elements of the system.
Krugman notes that even with 70+% support both in the 1940s and now, the U.S. has never been able to put a universal health-care system into effect. We have that system now - but if we let it slip away, it'll be nearly impossible to regain it.
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