“If I were designing a system from scratch, I would probably go ahead with a single-payer system,” Obama told some 1,800 people at a town-hall style meeting on the economy.
A single-payer system would eliminate private insurance companies and put a Medicare-like system into place where the government pays all health-care bills with tax dollars.
Obama’s health-care plan aims for universal coverage by offering a new government-run marketplace where Americans could buy insurance, mostly from private plans. He would offer subsidies to individuals and to small business owners that offer their workers coverage. His plan also would require that parents get insurance for their kids. And he aims to lower health-care costs to make coverage more affordable. His plan includes one small step toward single payer. His new marketplace would create a new government-run plan, like Medicare, to compete against the private plans.
But Obama repeated that he rejects an immediate shift to a single-payer system. “Given that a lot of people work for insurance companies, a lot of people work for HMOs. You’ve got a whole system of institutions that have been set up,” he said at a roundtable discussion with women Monday morning after a voter asked, “Why not single payer?”
“People don’t have time to wait,” Obama said. “They need relief now. So my attitude is let’s build up the system we got, let’s make it more efficient, we may be over time—as we make the system more efficient and everybody’s covered—decide that there are other ways for us to provide care more effectively.”
Obama's said things like this before about single-payer health care as an ideal system (witness this January 2008 dust-up between him and the Clinton campaign). While Obama isn't saying that he wants to immediately implement a single-payer system, he also seems to be indicating that he doesn't mind working towards that end; short-term political changes pave the way for other changes.
This focus on incremental change is a key theme of the Obama campaign, perhaps as a legacy of his community organizing. It also allows him to keep his options open for longer-term planning. Will he ultimately work to implement single-payer health care? Maybe. Would he work to ban handguns? Well, he thinks that banning them now is "not politically practicable." Circumstances can change, and, when you have the power of the presidency, you can change a lot of circumstances.