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Written by Richard Davis

Pubilshed by Bennington Banner

It is the curse that has carried into a new century. Just mention the term "single payer" and there is either the silence of non-registering comprehension or the sneer that tries to fend off the threat of a socialist plot. Most reactions of this nature are based on a lack of information and a knee jerk reaction to the sound-byte mentality that has taken over our society.

There is no escaping the fact that the term "single payer" carries a lot of baggage. For years, single payer proponents have recognized the negativity that the words engender. They understand the need to change the name, but nothing ever happens. That is why there are references to National Health Insurance (NHI) or Medicare for All. They are often substitutes for the dreaded words.

Here’s my best definition of single payer. It refers to health insurance, not health care and that is an important distinction. Under a single payer health insurance system there would be one "single" entity that pays for health insurance. That could be the state or federal government.

In essence, a government body issues the rules for insurance and they set the rates and assume the risk. They could then hire an insurance company to administer the government insurance plan. That is how Medicare operates at an administrative cost of two to three percent. Private insurance company administrative costs run from 18-31
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percent.

The political problem with establishing a single payer system is that it requires the elimination of all other insurance companies. Imagine how difficult it is to force out the some of the most lucrative industries in America from the world of mega-profiteering.

If you want more details about single payer and the details of reform from differing perspectives I suggest reading T. R. Reid’s, The Healing of America, as well as checking out the Physicians for a National Health Plan (PNHP) web site at www.pnhp.org. Back to the stigma. A lot of the problem with educating the public about why single payer is the best option from an economic and human perspective has to do with the fact that once the dreaded words are mentioned the discussion is often over. Over the years, I have learned to avoid mentioning the term single payer whenever possible. A few years ago I went around to a number of local business owners to push the single payer option and to try to get their support for a legislative initiative.

When I spoke to these people I described how a reformed system would work in terms of costs to business owners and their employees. I had spreadsheets to show them how much money they would save and how much their employees would benefit from this plan that I was asking them to sign on to.

Every one of those business owners quickly understood that the plan I was presenting to them was the best option for them and their employees that they had ever seen. Some even said, "How come we’re not hearing about this? This is what we need." Once I had reached that point in the conversation where they were sold on the concept I would then tell them that this idea has been around for years, that is commonly called "single payer." Most business owners were quite surprised when I revealed the name of this plan. They had assumed that single payer was something that would hurt them and that it was bad for business. Once they actually had the facts, they were sold.

Then there were the many home health patients I talked with during my years as a visiting nurse. I would never bring up politics while I was providing care, but if people brought up the subject of health care reform, we would talk.

Many of the people I visited were clearly far right Republicans. What they all had in common was that they had serious chronic health care problems and they all knew that the current health care system was in serious need of fixing.

When they talked of reform they would describe, without the baggage of labels, either a single payer system or a purely socialized model such as the Veterans Administration as the best solution. These were people who used the "system" on a nearly daily basis and, despite their right wing politics, they had a clear idea of the direction reform should take.

They didn’t care what it was called. They just wanted it fixed yesterday so that systemic problems didn’t kill them before their chronic health care problems did.

Richard Davis is the head of a grass-roots group called Vermont citizen Campaign for Health. He lives in Brattleboro and is a registered nurse.