Former Democratic Vermont governor and practicing physician and presidential candidate Howard Dean tells The New York Times Magazine that going to a single-payer, government-run health care system "is crazy":
You've got to start from where you are, not from where you wish you were. The Europeans have much more comprehensive and cheaper health care plans than we have, but they got there because their health care systems were essentially destroyed during World War II. We grew our private health care system around World War II—the only way that American employers could give their employees a raise was to enhance health-insurance benefits—so to change it to a totally public plan is crazy.
Dean remains convinced that the so-called public option is the cornerstone of any reform worthy of the term. Whether he believes that the public option will lead inexorably to a single-payer plan is not clear. More here.
It's not fully clear to me what Dean means by "much more comprehensive" plans in Europe, given the vast array of subsidized and free services available in these United States. There's no question that European countries pay less overall for health care, but that's mostly because of rationing of one form or another. Indeed, it's not self-evident why spending more for health care is a bad thing, any more than higher spending on restaurant meals or cars is a bad thing, in and of itself.
I think it's great that Dean points to the post-World War II wage-and-price controls as the origin of our current stupid and inefficient employer-based health-care system. What I'm curious about is precisely which existing, large-scale government system would he point to as a model for the public option: Medicare? Medicaid? the Veterans Administration? The simple fact is that every large-scale public system in the U.S. is riddled with waste, fraud, abuse, and more. Why should anyone believe that the next reform would somehow solve any or even address any of those problems?
Here's a Reason.tv video that explains how to cover half of the uninsured in America. Go here for embed code, downloadable versions, and more.