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The Single-Payer Taboo


Among the giant taboos afflicting Congress these days is the proposal to create a single payer health insurance system (often called full Medicare for everyone).

How can this be?  Don’t the elected politicians represent the people?  Don’t they always have their finger to the wind?

Well, single payer is only supported by a majority of the American people, physicians and nurses.  They like the idea of public funding and private delivery.  They like the free choice of doctors and hospitals that many are now denied by the HMOs.

There are also great administrative efficiencies when single payer displaces the health insurance industry and its claims-denying, benefit-restricting, bureaucratically-heavy profiteering.  According to leading researchers in this area, Dr. David Himmelstein and Dr. Stephanie Woolhandler, single payer will save $350 billion annually.

Yet, on Capitol Hill and at the White House there are no meetings, briefings, hearings, and consultations about kinds of health care reforms that reform the basic price inflation, indifference to prevention, and discrimination by health insurers.

There is no place at the table for single payer advocates in the view of the Congressional leaders who set the agenda and muzzle dissenters.

Last month at a breakfast meeting with reporters, House Speaker Nancy Pelosi (D-CA) responded to a question about health care with these revealing and exasperating words: “Over and over again, we hear single payer, single payer, single payer.  Well, it’s not going to be a single payer.”

Thus spake Speaker Pelosi, the Representative from Aetna?  Never mind that 75 members of her party have signed onto H.R. 676-the Conyers single payer legislation.  Never mind that in her San Francisco district, probably three out of four people want single payer.  And never mind that over 20,000 people die every year, according to the Institute of Medicine, because they cannot afford health insurance.

What is more remarkable is that many more than the 75 members of the House privately believe single payer is the best option.  Hillary Clinton, Barack Obama, Ted Kennedy, and Nancy Pelosi are among them.  But they all say, single payer “is not practical” so it’s off the table.

What gives here?  The Democrats have the numbers and procedures to pass any kind of health reform this year, including single payer.  President Obama could sign it into law.

But “it’s not practical” because these politicians fear the insurance and pharmaceutical industries-and seek their campaign contributions-more than they fear the American people.  It comes down to the corporations, who have no votes, are organized to the teeth and the people are not.

So, when Senator Baucus, chairman of the Senate Finance Committee and a large recipient of health insurance and drug company donations, held a public roundtable discussion on May 5, fifteen witnesses were preparing to deliver their statements.  Not one of them was championing single payer.

As Senator Baucus started his introductory remarks, something happened.  One by one, eight people in the audience, most of them physicians and lawyers, stood up to politely but insistently protest the absence of a single payer presentation.

One by one, the police came, took them out of the hearing room, arrested and handcuffed them.  The charge was “disruption of Congress”–a misdemeanor.

They call themselves the “Baucus Eight”.  Immediately, over the internet and on C-Span, public radio, and the Associated Press, the news spread around the country.  You can see the video on

To the many groups and individuals who have labored for single payer for decades, the Baucus Eight’s protest seemed like an epiphany.

Dr. Quentin Young, a veteran leader for single payer and a founder of Physicians for a National Health Program (PNHP) e-mailed his reaction: “For our part, when the history of this period is written, we believe your action may well be noted as the turning point from a painful, defensive position to a more appropriate offensive position vis-à-vis Senator Baucus and his health industry co-conspirators.”

Webster’s dictionary defines “taboo” as “a prohibition against touching, saying, or doing something for fear of a mysterious superhuman force.”  For both Democrats and Republicans in Congress it is a fear of a very omnipresent super-corporate force.

However, moral and evidential courage is coming.  On May 12, 2009, Senator Baucus is having another roundtable discussion with thirteen more witnesses, including those from the business lobbies and their consultants.  Word has it that the Senator is about to invite a leading single payer advocate to sit at the table.

Here come the people!  Join this historic drive to have our country join the community of western, and some third-world, nations by adopting a state of the art single payer system.

Visit and break the taboo in your Congressional District.

RALPH NADER is the author of The Seventeen Traditions.


Ralph Nader is a consumer advocate, lawyer and author of Only the Super-Rich Can Save Us! 

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