The New York Times devoted some rare space on September 20 to discussing single-payer (or Medicare-for-all) health reform. The result? A one-sided account of why such a system couldn't work.
With a headline like "Medicare for All? 'Crazy,' 'Socialized' and Unlikely," readers probably had a sense of what the Times had in mind with the piece, which was the latest in a series titled "Prescriptions: Making Sense of the Healthcare Debate." Reporter Katharine Seelye wrote: "Extending Medicare to all has seemed like a good idea to many--except to those who call it 'socialized medicine.' Or crazy."
The Times seemed to want to express single-payer opposition in more gentle tones, explaining that the idea is, from the start, politically impractical: "Beyond a liberal base in the House, there is little support for expanding Medicare." And outside of Congress, wise minds seem to agree: "But even experts of diverse ideological views say expanding Medicare would be far more complicated and politically difficult than it might appear."
That led to the first claim: "For one thing, they say, Medicare reimburses doctors and hospitals at much lower rates than private insurance companies do. So, in general, healthcare providers oppose extending Medicare because they fear being driven out of business." It's not clear how serious this fear might be, since most doctors participate in the Medicare system without going bankrupt. Any attempts to reduce the skyrocketing costs of the healthcare system involve cuts of one form or another; most single-payer proposals discuss how to do this without shortchanging physicians. (U.S. doctors make, on average, almost three times the median physician salary in other wealthy industrial countries--Ezra Klein, 4/19/06.)
It's worth noting that thousands of doctors have voiced support for a single-payer system (see, for example, Physicians for a National Health Program's letter to Barack Obama), in part because they believe they spend too much on the administrative costs associated with private insurance companies. A survey of physicians published in the Annals of Internal Medicine (4/1/08) found that 59 percent supported government-sponsored national health insurance.
Seelye also wrote that Medicare for all "would almost certainly mean a big tax increase on the middle class," before noting in parentheses: "Supporters argue that a tax increase would be somewhat neutralized by the elimination of premiums that people pay now to insurance companies." Actually, single-payer advocates argue that a payroll tax on businesses (many of which currently pay for private insurance for their employees) and a small income tax increase that would likely amount to less than what most citizens currently pay out of pocket could fund a single-payer program. By calling a "big tax increase" a near-certainty and treating the savings on insurance premiums as a claim made by advocates, the Times told readers which side it was on.
Seelye cited Stuart Altman--identified as "a Brandeis economist who specializes in health care and who advised Barack Obama in his presidential campaign," but not as a director of a managed-care company that offers health insurance plans (WhoRunsGov.com)--to make a similar point about potential tax increases, and then went to "the other end of the political spectrum" to quote Robert Moffit of the conservative Heritage Foundation: "I don't see popular support for it beyond liberals.... It's a philosophical question: Do you want to give the government that kind of power?"
Of course, one might point out that public polling for years has demonstrated that support for single-payer is much broader than merely a liberal sliver of the population (FAIR Action Alert, 3/12/09); a July 2009 tracking poll from the Kaiser Family Foundation found 58 percent support for Medicare for all. But a piece detailing the deficiencies of a "crazy" single-payer system is an unlikely venue for that.
Seelye quoted Moffit saying that single-payer "would not save taxpayers money," while another academic suggested it would "require a tripling in payroll taxes just to pay hospitals alone." These are stark claims that are at odds with the research of single-payer advocates and experts. Physicians for a National Health Program, for example, calculate the annual savings on administrative paperwork under a single-payer system at more than $350 billion. International surveys of health systems generally show that nations that have adopted public plans spend far less than the U.S., and achieve better results (BMJ, 5/26/07).
So why couldn't the Times quote sources who would take issue with these claims? From the looks of it, balance wasn't the point here. The Times collected a litany of criticisms of single-payer healthcare--in effect rebutting claims that the paper rarely allows its advocates to make in the first place.
Ask New York Times public editor Clark Hoyt why the Times ran a piece devoted to undermining the case for single-payer healthcare without allowing advocates to make the case in support of Medicare for all.
New York Times
Clark Hoyt, Public Editor