This is the question at the center of a blog post by Health Care for America Now campaign director Richard Hirsch that's making the rounds at DailyKos, the Huffington Post, and of course, the HCAN! blog. The answer, essentially, is that single-payer is but one way to reform the health care system so that it complies with the HCAN! statement of common purpose, and that although single-payer may be the simplest or best solution (depending upon one's opinion) we are more likely to succeed if we are open to solutions that are consistent with our principles that may more closely resemble our current system. Flawed and broken though it is, completely removing and replacing it with a single-payer system is not the only way to ensure that our goal of securing quality, affordable health care for every one is achieved.

In his post, Hirsch elaborates on why the HCAN! Campaign is not advocating single-payer to the exclusion of all other possibilities:

One point of this approach was not to scare people away from reform or to make it easier for the opponents of reform to panic the public. I realized we could reassure people about change by building on what people are familiar with - both private insurance and Medicare's public insurance plan.

A lot of what I wrote at the time also had to do with the need to reaffirm the positive role of government in America. To do that, we need to demonstrate that government can better people's lives in real ways. Even though it might make us feel good, stating our ideological position in the hope that people will eventually come around is not effective. We need to win real changes that show government can work in positive ways.

Our goal is to have the United States provide a guarantee of good, affordable health coverage to all its residents. That's the bottom line. A national health insurance plan (single-payer) is one way to accomplish the goal, but it's not the only way. In fact, one of the myths about health care around the world is that "everyone but us has single-payer." In fact, single-payer is the way Canadians provide a government guarantee of good health coverage. Other countries - including the European countries usually held up as models - do it differently, with all sorts of variations of public, private, and non-profit insurance and socialized medicine. But what's true in all these countries is that health care is guaranteed and regulated as a public good.

It is more important that we move toward a health care system that is consistent with our principles than it is to hold out for single-payer, accepting nothing less. At the state level here in Connecticut, we have seen and taken multiple approaches to improve the health care system; in 2008 alone we have the Health Care Partnership Bill that would have enabled small businesses, non-profits, and municipalities to join the state health insurance pool and negotiate lower rates (were it not vetoed), and the Charter Oak Health Plan which aims to provide affordable health insurance to uninsured adults (although that plan has its flaws). These are not perfect solutions, and neither are they single-payer solutions.

But we are better off with them than without them.

This is an excerpt from the statement of common purpose for the HCAN! Campaign:

Our government’s responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing:

• A truly inclusive and accessible health care system in which no one is left out.
• A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.
• A standard for health benefits that covers what people need to keep healthy and to be treated when they are ill. Health care benefits should cover all necessary care including preventative services and treatment needed by those with serious and chronic diseases and conditions.
• Health care coverage with out-of-pocket costs including premiums, co-pays and deductibles that are based on a family’s ability to pay for health care and without limits on payments for covered services.
• Equity in health care access, treatment, research and resources to people and communities of color, resulting in the elimination of racial disparities in health outcomes and real improvement in health and life expectancy for all.
• Health coverage through the largest possible pools in order to achieve affordable, quality coverage for the entire population and to share risk fairly.
• A watchdog role on all plans, to assure that risk is fairly spread among all health care payers and that insurers do not turn people away, raise rates or drop coverage based on a person’s health history or wrongly delay or deny care.
• A choice of doctors, health providers and public and private plans, without gaps in coverage or access and a delivery system that meets the needs of at-risk populations.
• Affordable and predictable health costs to businesses and employers. To the extent that employers contribute to the cost of health coverage, those payments should be related to employee wages rather than on a per-employee basis.
• Effective cost controls that promote quality, lower administrative costs and long term financial sustainability, including: standard claims forms, secure electronic medical records, using the public’s purchasing power to instill greater reliance on evidence-based protocols and lower drug and device prices, better management and treatment of chronic diseases and a public role in deciding where money is invested in health care.

If federal legislation is passed that meets all of these principles, our work will not be done, but we will have taken a great leap in the right direction. These principles provide a way for every single person to receive health care in theory, but we will need to improve the health care delivery system to ensure that every single person can receive quality, affordable health care in practice.