Town hall results: Single-payer on the outs

EVERETT — The yelling at town-hall meetings makes more sense if you think of it as being about a single-payer health-care system. Universal government health insurance is not what Congress is considering, but it was on the mind of the nearly 3,000 people who attended Rep. Rick Larsen's town hall in Everett a week ago. Consider some of the hand-lettered signs:

"No Gov't Run, 'Take a Number' Healthcare"

"My Life, My Death, My Business"

"Health Care Is Not a Right"

A woman asked Larsen, a Democrat, whether he thought health care was a right — a position that leads directly to single-payer. "I don't know the answer to that," he said.

Ninety-three Democrats to the left of Larsen, including Seattle's Jim McDermott, are sponsoring a single-payer bill, House Resolution 676. Larsen said it would ban deductibles and co-pays, which he believes are necessary, and that it would create extremely rich benefits. It's too radical for him.

"I don't support a single-payer system," he said.

In the current system, the federal government protects the old (Medicare), the poor (Medicaid), children (SCHIP) and its own employees, leaving the rest to be insured in the market as groups or individuals. It's a hybrid system. "I want to change our hybrid system," Larsen said. "I don't think we need to throw it out."

That line won almost no applause. It was too moderate.

Speaking of House Bill 3200 — the main House bill — Larsen said, "People believe the premise of the bill is a government takeover of health care." A section of the crowd hooted. "Others think that the bill doesn't go far enough," and the other side cheered and waved signs such as:

"Private Insurance Companies ARE Death Panels"

"Put Single Payer on the Table"

"It's evenly split," Larsen said.

The woman behind me said softly, "It's not an even split." She was right. The noes had it.

Opponents worried what it would cost them to insure the 15 percent of Americans without coverage. Larsen told them that under the House bill, half the money would come from taxing million-dollar incomes and half from squeezing waste from Medicare. This implied that most of them would pay nothing — a thing they were not inclined to believe.

Medicare is in long-term deficit, and underpays doctors and hospitals already. And this plan is going to cost more than advertised. Medicare has. So has Medicaid.

Who pays? One group that's going to pay under the House bill is the twentysomethings. Larsen says he is against "age discrimination" in the individual insurance market. What this means is that young people won't get a break on rates. They will be required to buy coverage and pay the same as old people. This is called community rating, and in Massachusetts and New York it has made premiums high. It helps the old, but is not in the interest of the young.

The Everett crowd didn't catch that. They did ask Larsen whether the bill would cover illegal immigrants and abortions. No and no, he said. But if this is passed, there will be pressure to include them.

The opponents' biggest fear is that they will lose the health coverage they have, and be stuck with some inferior thing foisted on them by the government. They had heard on talk radio that if their plan changed in any way, this would happen. Larsen denied this, and cited the section in the bill that protects them.

I assume he's right. This is not single-payer. Not yet.

Bruce Ramsey's column appears regularly on editorial pages of The Times. His e-mail address is bramsey@seattletimes.com