By Dan Eggen
Washington Post Staff Writer
Saturday, June 6, 2009

When President Obama convened a town-hall meeting in Rio Rancho, N.M., last month, he wanted to talk about credit card reform. But many in the crowd had a different agenda.

"So many people go bankrupt using their credit cards to pay for health care," the first questioner said to applause. "Why have they taken single-payer off the plate?"

The "single-payer" activists had struck again. As Obama and congressional Democrats work to hammer out landmark health-care legislation, they face increasingly noisy protests from those on the left who complain that a national program like those in Europe has been excluded from the debate.

The White House and Democratic leaders have made clear there is no chance that Congress will adopt a single-payer approach -- named for the idea that a single government-backed insurance plan would pay for all Americans' medical costs -- because it is too radical a change.

That has not dissuaded single-payer activists, who have spent months hounding Democratic lawmakers and organizing demonstrations, including one that resulted in 13 arrests at a Senate hearing last month. The offensive continues this weekend with plans to swamp a series of "house parties" on health care hosted by Organizing for America, an Obama-backed project at the Democratic National Committee.

The movement poses both an opportunity and a challenge for Obama, who is able to position himself as a centrist by opposing a single-payer plan but who risks angering a vocal part of the Democratic base.

"Obama is really the one who is puzzling to us," said Rose Ann DeMoro, executive director of the California Nurses Association, a union that has been leading many of the single-payer protests. "We were all supporters of him. . . . It's hard to understand how he can expect to rally support around a plan that will leave the big insurance companies in charge and keep hurting patients."

Many Republicans see the movement as evidence that Democrats are setting the country on the path to "government-run health care," as they describe it. Conservatives for Patients' Rights, an advocacy group bankrolled by ousted Columbia/HCA chief Rick Scott, unveiled a $1.2 million ad campaign Thursday that portrays Democratic plans as a "bulldozer" aimed at eliminating private insurance companies.

"It's just one step removed from a single-payer system," Scott said in an interview, referring to current Democratic proposals. "The goal is to get rid of the insurance companies, and then the government makes all the decisions."

Obama and other Democrats dispute such characterizations, saying they favor a plan that would marry private and public resources to control costs and expand coverage for 46 million uninsured Americans. Obama wrote in a letter to Democrats this week that he "strongly" backs creating a public insurance option to compete with private carriers, and also signaled that he is open to the idea of requiring coverage for all Americans.

Obama has rejected the idea of establishing a single government insurance program, however, saying the U.S. tradition of providing health care through employers would make such a shift politically and practically impossible.

"If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense," Obama said in response to the questioner in New Mexico, echoing comments he made during his presidential campaign. "The only problem is that we're not starting from scratch. . . . We don't want a huge disruption as we go into health-care reform where suddenly we're trying to completely reinvent one-sixth of the economy."

Advocates of a single national program argue that its benefits would far outweigh the drawbacks, noting that most other industrialized nations guarantee coverage for all at far lower costs with generally better health outcomes. They also dispute allegations by Scott and other conservatives that such a system would lead to rationing and waiting lists, saying that Americans face the same problems and worse now.

"Single-payer on its merits can win," said Tim Carpenter, national director of Progressive Democrats of America. "But we've been cut out by the doctors, the insurance companies and other special interests."

The single-payer activists won a small victory this week when Sen. Max Baucus (D-Mont.), who is leading health-care negotiations as chairman of the Senate Finance Committee, agreed to meet with them after months of tension. Those in attendance said Baucus apologized for not including single-payer advocates more prominently in earlier hearings, but he also said it is too late to change direction.

Polling on single-payer insurance varies widely, based largely on how the issue is framed. In an April Kaiser Family Foundation poll about ways to increase the number of Americans covered by health insurance, the option finished last on an eight-item list, with 49 percent in favor and 47 percent opposed. Moreover, about a third of those who support a public insurance option would turn against the idea if it were an initial step toward single-payer care, the poll found.

Most mainstream progressive groups, including some that have previously advocated a single-payer approach, think Obama's strategy has the best hope for success. Many groups draw lessons from the Clinton administration, which buckled under attacks from Republicans and the medical lobby when it proposed a more centralized approach.

This time around, unions and groups such as Health Care for America Now plan to spend more than $80 million on ad buys, outreach and other efforts to support Obama and the Democrats. The DNC, using Obama's campaign e-mail list of 13 million names, kicks off its effort today with thousands of "house parties" focused on "the urgency of passing health care reform this year," according to a news release.

In an e-mail this week, Progressive Democrats of America urged its supporters to "take the single-payer message" to the meetings.

DNC spokesman Brad Woodhouse said the gatherings are open to all. "Their voices, energy and passion are welcome, and no one is looking at them as the enemy," he said. "It's just that with the system we have, single-payer is not something that's likely to happen."

Polling director Jon Cohen contributed to this report.