The discussion of national health insurance during the current presidential campaign seems quite familiar. The public, in polls – for decades, in fact – support single-payer systems in one form or another – notwithstanding many disingenuous arguments that all single-payer systems are (1) ineffective (2) too expensive (3) immoral, as they are a form of “handout” which weakens family and individual resolve. The phrase “socialized medicine” – my initial research suggests that this term first gained currency as an epithet during the Johnson-Goldwater race of 1964 – has been re-introduced by former Mayor Giluiani. This phrase seems to be shorthand for points (1) – (3) above.

At least three of the leading Democratic candidates are for a system which will improve on the current system – and might be a bridge to single-payer, or a hybrid.

How we get from here to there is a political question beyond my sophistication. For one thing – it seems unlikely that private insurance companies – and their owners and shareholders – are going to be passive about such a transition.

We here propose a point of consensus: that the President be given the explicit power to declare public health emergencies – with the following terms of reference:

• Irrespective of apparent cause (terrorism, accident, other cause); like an arson investigation, determining whether a disease outbreak has an intentional or negligent causal origin is a matter for careful and slow investigation. This power should be without limitation as to preconditions;
• Having declared such an emergency, the President may, in his capacity as Commander-in-Chief, use any and all resources and funds, including but not limited to the Veteran’s Administration, Medicaid, Medicare, and active and reserve elements of the Department of Defense, to combat the declared emergency;
• the President may, in anticipation

of a public health emergency, or in planning for such a contingency, direct any and all elements of the government – notwithstanding the limitations of the posse comitatus and similar restrictions -to put in place infrastructure to prepare for emergencies. (In other words – have the infrastructure in place for a rapid expansion in an emergency; plan it, run the drills, be ready). Based on Paul Krugman’s columns on this subject – and recent reports about the excellence of the Veterans’ Administration’s infrastructure and its open-source patient management software – they’re a good candidate for this responsibility. But that’s a detail not necessary for this proposal.

The advocates of the “unitary executive” theory – that Presidential powers trump all restrictions, including the Geneva Conventions – must surely assume that the President already has these powers. Those opposed so socialized medicine are no less concerned about bioterrorism than its advocates.

So – I put it to the supporters and surrogates of each of the candidates – should or should not the President have the power to declare public health emergencies, and use federal resources to combat them?

[NB: This is not my idea – it’s Irwin Redlener’s rather elegant proposal; he had the good sense to come up with it, but apparently didn’t think much of it, because it’s nearly hidden in an appendix to his book Americans At Risk. There’s a lesson or two here: good books are worth re-reading (this one is); sometimes the best stuff is in the back of the book].

Thanks to Karina Ron for inspiring the conceptual frame.