Socialized medicine is different from a single-payer plan. Now, the way a single-payer plan works is that you still have private doctors, private hospitals, providers, et cetera, but everything is reimbursed through a single payer; usually, the government. So Medicare would be an example of a single-payer plan. Doctors don’t work for Medicare, but Medicare reimburses for services that are provided to seniors who are on Medicare.
There have been proposals to have, essentially, Medicare for all, a single-payer plan for all Americans, and — that person likes it. (Laughter.) And there are some appealing things to a single-payer plan, and there are some countries where that’s worked very well.
Here is the thing: We’re not starting from scratch. We’ve already got — because of all kinds of historical reasons, we have primarily an employer-based system that uses private insurers alongside a Medicare plan for people above a certain age; and then you’ve got Medicaid for folks who are very poor and don’t have access to health care. So we’ve got sort of a patchwork system. And it was my belief and continues to be my belief that whatever we might do if we were just starting from scratch, that it was important in order to get it done politically, but also to minimize disruptions to families that we start with what we have, as opposed to try to completely scrap the system and start all over again.
And so what my attitude was if you’ve got an employer-based system — and a lot of people still get their health insurance through their jobs — obviously, you’re self-employed, so there’s a different category, but the majority of people still get their health insurance through their employer. Rather than completely disrupt things for them, my attitude is let them keep the health insurance that they’ve got, the doctors that they have — there’s still a role for private insurance — but number one, let’s have insurance reform so that you can’t eliminate people for preexisting conditions — (applause) — so that there’s none of the cherry picking that’s going on to try to just get the healthiest people insured and get rid of the sick people. So you’ve got to set up some rules for how insurance companies operate.
Number two, that for people who are self-employed, for small businesses, for others, they should have an option that they can go to if they can’t get insurance through the private marketplace. That’s why I’ve said that I think a public option would make sense. What that then does is it gives people a choice. If they’re happy with what they’ve got, if they’re employed by somebody who provides them with good health care, you can keep it, you don’t have to do anything. But if you don’t have health insurance, then you have an option available to you.