PERSPECTIVE FROM THE 19^TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon, as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.

Here’s the reality for a single payer system.

If the United States moves to such a system, the cost will be a huge, defining issue. Depending on your point of view, it may be a cost worth paying or one too high to contemplate.

There are essentially three options:

1. Impose higher taxes to pay for the multiple trillion-dollar price tag.
2. Allow the federal budget deficit, already at record levels, to go even higher.
3. Divert money from other programs to pay for health care.

Add to this the possibility, also difficult to achieve, that it might be possible to cut the cost of health care at a time when many citizens believe access is a right.

Analyzing these costs issues is incredibly difficult, as illustrated by a piece by economist Richard Rubin in the Wall Street Journal.

Rubin wrote: “The Democrat presidential hopeful from Massachusetts (Elizabeth Warren) could propose a plan to partly pay for a single-payer system by finding ways to reduce health-care costs, expanding budget deficits or adding new levies on the richest Americans. But replacing insurance premiums would likely require taxes on individuals and businesses.

“And she has to find a way to explain the shifts in payments and coverage to voters. If her plan works as advertised, many Americans would pay less for health care but owe more to the government, trade-offs that wouldn’t be easy for individuals to estimate or calculate.”

Rubin’s point strikes me as exactly right. Which is one reason why Warren is taking so long to announce her plan for how to fund her preoposed single payer health care system. I am not defending her silence on costs to this point, but arriving at a conclusion is difficult for her, both in terms of substance and politics.

Meanwhile, Time Magazine – yes, it still exists –- showed up with an interesting story on how many physicians are becoming pointedly more active on health care reform, often in favor of a single payer system, rather than sitting on the sidelines or, as the magazine remembers, adopting a conservative approach.

Here is how the article started:

“Miriam Callahan remembers the patient who clarified her decision to become a political activist. He was homeless, suffered from severe arthritis in his hip and was self-medicating with fistfuls of Advil. That gave him a bleeding gastric ulcer that landed him in the emergency room at a public hospital.

‘Callahan, who is a medical student at Columbia University, and her colleagues patched him up and sent him back to the shelter, where he began self–medicating once again. He was stuck in a horrific cycle. Arthritis isn’t a disease that should kill people, Callahan says, but in this case, it was becoming a real possibility. ‘It’s immoral,’ she says, ‘the way that we treat people in this country.’

“In the months since seeing that patient, Callahan has channeled her frustration into political organizing—and she’s hardly alone among her fellow medical professionals.

“With roughly 27.5 million Americans uninsured and nearly 80 million struggling with medical bills, doctors, nurses, medical students and other patient-facing professionals are finding themselves on the front lines of a broken system.

“Like Callahan, many are looking for ways to fix it. The result is that the medical field, which was once one of the most conservative professions, is becoming an unlikely hotbed of progressive political activity. One of these advocates’ top goals? Single-payer health care, now known most often by its politically charged nickname: Medicare for All.”

Immoral, as Callahan contends?

Perhaps.

But it also would be immoral for this country to embark on a trillion dollar health care system – some credible estimates put the cost at more than $32 trillion — without knowing how to pay for it.

Back to Warren.

Rubin, the WSJ columnist, suggests that Warren “has to find a way to explain the shifts in payments and coverage to voters. If her plan works as advertised, many Americans would pay less for health care but owe more to the government, trade-offs that wouldn’t be easy for individuals to estimate or calculate.

“Financing is just one piece of the proposed shift to a single-payer system that would expand coverage, upend health-industry jobs, and put the government more firmly in charge of cost control and access to care.

One key question for Warren relates to how much money she needs to generate to fund her proposal.

Single-payer advocates argue that such a system could reduce health-care costs by removing insurance-company profits and administrative inefficiencies. Skeptics say it would increase total costs by covering more people and encouraging the use of free services that now cost money.

Rubin reports that, according to the Urban Institute, a non-profit economic and social-policy research organization, increased costs would outweigh savings in any single payer approach. The Institute says the most generous single-payer plan would require between $29 trillion and $34.8 trillion in additional federal revenue over a decade.

A “single payer lite” plan, excluding undocumented immigrants and imposing cost-sharing on individuals, would need between $13.3 trillion and $17.3 trillion.

My wife asked a very good question this week. How, she asked, did countries with socialized medicine reach political consensus to embark on such a system – and she asked this question after “our” recent experience with socialized medicine in England, a good experience.

I don’t know how the consensus was reached, but, for me, the question prompted thoughts of the political dislocation in this country – dislocation that ignores potential middle-ground solutions in favor of extremes.

The left-wing wants a full and complete federal government entitlement on the apparent theory that federal employees should control health care access for you and for me.

The right-wing, for its part, wants nothing to do with any larger government role, so ritually opposes everything, even better health care.

Never the twain shall meet.

Too bad, because this country deserves better on one of the most momentous issues of our time – health care.