Were they really doctors? Who knows, and who cares. The protesters have a point. When nearly a hundred legislators in both houses of Congress have endorsed legislation calling for a single-payer health insurance system (Medicare for all?), it seems only proper that hearings held to discuss alternatives to the current mess include that point of view on the dais.

That said, most polls suggest Americans do not want to scrap their employer-based health insurance system and face the potential disruption of a transition to a single-payer plan. But how much disruption would there be?

What would happen to physician and hospital payment rates under a single-payer plan? What would be the tax incidence and employer costs incidence effects of scrapping the health insurance marketplace and moving to either a payroll tax or income tax system for supporting health care? What would happen to the tens of thousands of workers processing claims for insurance firms (and in provider offices) if the U.S. adopted single-payer?

All are fitting questions for a Congressional hearing that fleshed out the implications of all the alternatives on the table. But what is most remarkable about the health care reform debate as we head into the crucial month before legislation gets unveiled (at least, that is what Sen. Max Baucus, chair of the Senate Finance Committee, is promising) is that the only public debate about what will go into the final bill has revolved around creating a government-run insurance option to compete with private plans, with the insurance industry insisting national regulation can deliver the same improvements in quality, cost and access as being forced to compete with a public plan.

The grand compromise, already hinted at, will allow creation of a public plan, but one forced to act the same as any insurance company. If that comes to pass, what's the difference if there's a public plan or not? A public plan cut off from Medicare's administrative efficiencies and its pricing power will not generate substantial savings. 

While continuing to fight for a public plan alternative, progressives might consider throwing an additional option on the table: opening up Medicare to anyone 55 and over. Why not work on making the public plan we already have available to more people and simultaneously reform Medicare to deliver more effective and cost-effective care.

The rap on Hillary-care 15 years ago was that it was incubated behind closed doors and then dropped on Congress, making it an easy target for the special interest lobbyists who stood to lose from the bill. Now that Congress is in charge, its leaders appear intent on keeping the lobbyists inside the tent. That doesn't bode well for significant changes on the cost side in the short run. But, as more than one observer (including this one) has pointed out before, perhaps we need to get everyone insured -- you know, a level of social solidarity achieved in western Europe in 1948 -- before we can turn to the more difficult question of how to deliver health care in this country in a way that delivers good results at a price we can afford.