Single payer is the only way.

It’s the only way to control costs and cover everyone.

That’s the take of Dr. Marcia Angell.

She’s a senior lecturer at Harvard Medical School.

And the former editor-in-chief at the New England Journal of Medicine.

“Single payer is the only way because it’s the only way to do two things at the same time — provide comprehensive universal health care and control costs,” Angell told Single Payer Action last week. “You can do one or the other of those things — as members of Congress and the President now want to do. You can expand coverage. But if you do it will increase costs and the country can’t afford that now. Or you can control costs but if you do then you’ll decrease coverage. They have to move in parallel. So when I say it’s the only way, I mean that literally.”

If it’s the only way, then why isn’t it becoming law?

“We have a special interest Congress,” Angell says matter of factly. “The insurance industry and pharmaceutical industry have enormous lobbies and they get what they pay for. The only answer is for the public to mobilize. And we’re beginning to see that. We’re beginning to see the public come out strong for single payer even while Congress says it’s unrealistic. And people begin to see that gulf. There’s a gulf between what Congress says can be done and what the public wants.”

So, will we ever see single payer?

“I’m afraid not,” Angell says. “The lobbies are so powerful that the Congress will come up with small little expansions and they’ll celebrate it as though it’s a big deal. They’ll arrange for some more people to get coverage, costs will go up, it’ll be said to be a big deal.”

“As costs go up they’ll have to shrink benefits. They’ll have to shred it. Then people will draw the wrong lesson. They’ll say — Oh, it’ll cost too much provide universal care. That’s the lesson they’ll draw and that’s the wrong lesson. The lesson should be — You can’t do it the wrong way. You have to do it the right way.”

What about next time around?

“Well there may be another 15 years during which it’s the third rail,” Angell says. “My fear is what we’re going to see is an extension of the market-based systems so that wealthy people can get their health needs taken care of and the rest of us really don’t. We get something like stripped down manage care or even worse. That’s my fear.”

(For the complete interview with Dr. Marcia Angell, see video clip here.)