Taxing Our Health - Can NPR Say "Single Payer?"

In The Risks and Rewards of Taxing Health Benefits this morning, Scott Horsley discusses ways of paying for health care reform without mentioning Single Payer.

Horsely lays out the arguments in favor of a new tax on health benefits pretty much as they are described by the Center for Budget and Policy Priorities who argue that

(1) the exclusion provides the greatest benefit to those with the highest income.

(2) the exclusion encourages costlier coverage

(3) "the White House has announced that it will insist that health reform legislation be fully paid for. Congress will likely find it difficult to meet this objective unless the bill includes a cap on the exclusion as a significant source of financing. As a result, attaining universal coverage may depend on including a cap in the legislation."

The CPBB claim that the health insurance tax exclusion is "the nation's most costly tax subsidy," estimating it at about $145B/yr. But elsewhere, the CPBB estimates that the tax subsidy affected by lowering taxes on capital gains and dividends costs $148B/yr, thus contradicting themselves?

During the presidential campaign, Obama derided the tax on benefits claiming that

John McCain’s health plan would tax health benefits for the first time ever — imposing a trillion [$] tax increase on working families and leaving millions without heath [sic] care.

We didn't hear about that in Horsley's report - nor the comparable benefits of letting the dividends and capital gains tax cut expire. Instead we get a lame comparison with crass consumerism:

"Just like for anything else, if you got 30 percent off on your next car purchase, you'd probably buy a bigger car," said Leonard Burman, director of the Tax Policy Center in Washington, D.C.

Coincidentally, 30% are the estimated savings were we to go to Single Payer.

Now Leonard Burman is, no doubt, very intelligent and knowledgeable in these matters, but health insurance is not a commodity like a car and the analogy does a disservice to listeners. Without going into the arcana of the health care debate, suffice it to say that the words "Single Payer" did not pass through NPR's Horsley's lips, nor any of those he chose to interview.

According the GAO (as cited here) a Single-Payer type plan would save $150B/yr (2002 dollars) in administrative costs and you'd have "everybody in/nobody out."

The American Federation of State, County and Municipal Employees, AFL–CIO has weighed in on this recently, and to his credit, Horsley does bring in Gerald Shea from AFL-CIO, but Horsley undercuts Shea with a swift boat slash saying, "academic arguments [aren't] very persuasive to union leaders." As if you wouldn't expect union leaders to be well-educated (Shea is a graduate of Boston College.)

Of course, Shea doesn't much support single payer either. He is quoted here commenting on the health benefit tax exclusion:

That would be a radical change. If you’re going to go that far, you might as well go to a single payer system. I’m flabbergasted that you would even consider it.

So what was really excluded was the option that about 60% of Americans favor: Single Payer. It's interesting to note that a NPR search for "Single Payer" yields 157 hits over the last 13 years, but a review of the last 10 or so shows that most hits are from reader's comments, not the article itself.