Jefferson was the principle writer of the Declaration of Independence.   Lincoln signed the Emancipation Proclamation.   Roosevelt instituted Social Security.  Each are great accomplishments and arguably the enduring legacies of these past presidential luminaries.  These achievements were not the product of misplaced prudence, excessive pragmatism, and half-measures.  They were the product of bold, deliberate, and courageous action.  If Obama's first 100 days in office are any measure of things to come, he is well on his way to a historically productive presidency.  But what will be his enduring legacy?  If he can temporarily put aside his instinctual caution and penchant for compromise, I believe it will be true single payer universal health care reform.  For any meaningful and lasting reform in the health care arena, prudence is not a virtue.


The case for single payer universal health care is strong, and the evidence pointing to the breakdown of our present for-profit private insurance model of health care delivery is irrefutable.  Yet in the upcoming debate, the multibillion dollar health insurance industry (where did those billions come from?) will do everything in its power to convince you that the facts don’t matter, that real Americans adore private health insurance, and that the only way to heal our poisoned health care system is even more poison.


So let’s cut through the hype.  Single payer universal health care is not socialism.  Doctors and hospitals are not owned by the government under a single payer insurer system, and all doctors are “in plan.”  Does your current private health insurance plan offer you that?  A single payer plan will not tie you to your present employer’s group health insurance benefit, and your health insurance will not disappear if you unexpectedly lose employment.  A single payer plan obviates the need for a redundant network of private payers, with their complex and capricious rules designed to maximize income while minimizing coverage.  A single payer plan removes the profit-taking middleman that now stands between the deliverer of health care and the recipient of health care.  A single payer plan eliminates the administrative nightmare faced by every health care provider that currently is forced to employ a staff of billing clerks with no other function than to extract payments for services-rendered from literally hundreds of intransigent private insurance companies.


We already have a working model for single payer health care right here in the United States.  It’s called Medicare.  It’s not universal health care because it is presently limited to the elderly, demographically the most prolific and costly consumers of health care services.  If it can work for the most infirmed members of our population, it can work for the population at large, and at a significantly reduced cost per capita.  Recipients of Medicare are largely satisfied with their coverage.  Few of the millions of participants in Medicare feel they have been victimized by “socialized” medicine.  They see the same doctors that those with private insurance see, and they get the same quality medical care.  What Medicare patients don't share with their private insurance counterparts is the constant sparring with the insurance company over eligibility, pre-existing illnesses, pre-authorizations, hidden exclusions, out-of-network surcharges, and sharply rising premiums. 


Medicare, like the United States Postal Service, is often castigated as an inefficient government bureaucracy.  Yet the administrative costs for Medicare is about 3% of total expenditures, while the administrative costs for private insurance – including advertising, lobbying, and executive compensation – runs in the 20% to 40% range.  So which operation is the fat and dysfunctional bureaucracy, and which operation is the efficiently run business?  If the critics who label Medicare as “socialized” medicine were ideologically consistent, they would also be calling for the closure of the “socialist” USPS, yet their silence on this front is deafening.  If we believe that government has a legitimate function in delivering our mail in a timely fashion, doesn’t if follow that government, in its constitutional mandate to “promote the general Welfare,” has a commitment to guarantee affordable health care for all its citizens?  Solving the health care crisis with publicly funded single payer universal health care isn’t an intrusion of big government; it is an obligation of government.


In truth, we actually need to solve two crises when it comes to health care reform, and any solution that solves one crisis without addressing the other is doomed to failure.  The first crisis is the growing number of uninsured and underinsured Americans.  The second is the ever-escalating and increasingly unsustainable cost of health care.  Universal health care seeks to fix the first crisis by guaranteeing access to health care for all Americans, regardless of the cost.  Unfortunately not all proposals to achieve universal health care are equal.  Forcing currently uninsured Americans to buy private health care insurance, or using taxpayer money to purchase private insurance for them, is the expensive way.  If we can’t currently afford a private health insurance system that leaves 50 million Americans without, and even more underinsured, then how can we afford to add these millions of people on to the national health care bill?  Yet this is precisely the solution proposed by the proponents of the present for-profit private health care insurance industry, and not surprisingly, this solution would be a short-term financial windfall to them.  Sadly it seems to be the overly cautious and fatally flawed incremental approach favored by the Obama administration.


And make no mistake:  It will work . . . until it doesn’t.  In other words, it will work until we run out of money, and with health care costs soaring while the economy at large is in a deep downturn, we will run out of money sooner rather than later.  It is a false step in the right direction, and if we take this step and allow our economic woes to compound, it may be our last.  Single payer universal health care reform addresses both crises by extending health care to all Americans while eliminating the waste and greed inherent in allowing private insurers to feed at the health care table.  Health care reform that achieves universal coverage without a single payer public plan will fail.  Likewise, universal coverage with a public plan in competition with private insurance will do nothing to cut administrative costs on the provider side (because it is not really single payer), and will also lead us to insolvency.  The only workable solution that saves enough through efficiency to extend health care to everyone is true single payer universal health care.


Returning to Obama’s lasting legacy, it is clear that fixing health care once and for all has the potential to become the signature accomplishment of his presidency.  The opportunity is his to seize.  Address both parts of health care reform with a single payer universal system that makes health care a right of all Americans, at a cost that America can afford – a Medicare for all solution – and Obama cements his place in history as one of this country’s greatest Presidents . . . even if he were to accomplish nothing else.  Address only one part of this reform by enacting an ad hoc patch to health care that provides universal coverage at a crushing and unsustainable expense, and he will become a tragic hero in the history books of future generations; a President who had true greatness in his reach, and then timidly fumbled the ball.