HCAN! New York

Health Care Reform: Single Payer vs. Choice

Posted on March 26th, 2009 by David Vigoda

At first glance it may look like there are deep disagreements between those who support a single payer only plan and those who support a public health insurance plan as a choice alongside private insurance. I’m going to argue that the differences are mainly tactical.

Here’s my key point: As an organizer in the campaign for ‘choice,’ I have yet to meet anyone who wouldn’t prefer ‘single payer,’ that is, a single payer only system. We all want it. The question—the crucial question—is how do we get it?

Many believe that a single payer only plan can be achieved soon. Many others do not. These folks, including me, believe we have no choice but to compromise with a public option that competes with the private ones.

There are various claims to support both sides. What I want to emphasize here is that all of these claims concern one topic: the practical question of how we get from here to there.

If we acknowledge that, then a great opportunity presents itself. That is the opportunity to work together against our common adversary. If we don’t work together, we work against each other, and that is self-defeating.

I look at it this way: Moving up the field against the opponents of health care reform are three main groups. On the right flank we have the insurance industry, pretending to be for reform. In the center we have Health Care for America Now, the coalition I’m working in that supports a choice between private insurance and a single payer plan. On the left are coalitions supporting H.R. 676, a bill in Congress that would create a single payer only system.

With that array of forces, how do we win? If the left flank and center turn against each other, the battle is lost. If we advance side by side, we strengthen each other’s position. The left helps the center by pulling the reform debate away from the right. The center helps the left by making a single payer plan acceptable to those who oppose it as the only option.

We are not adversaries. We are allies.

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