To add a little more to David's post. Today's town hall meeting in New Hampshire gave Obama a chance to explain clearly his position on a single-payer national health care system. He didn't do it.
The opportunity came when a man brought up those old quotes in which Obama said he was a supporter of a single-payer health care system. (The man unfortunately referred to it as "universal," but the president picked up his meaning and addressed the question of single payer.) Here's the exchange:
QUESTION: Mr. President, you've been quoted over the years -- when you were a senator and perhaps even before then -- that you were essentially a supporter of a universal plan. I'm beginning to see that you're changing that. Do you honestly believe that? Because that is my concern. I'm on Medicare, but I still worry that if we go to a public option, period, that the private companies, the insurance companies, rather than competing -- because who can compete with the government; the answer is nobody. So my question is do you still -- as yourself, now -- support a universal plan? Or are you open to the private industry still being maintained?
OBAMA: Well, I think it's an excellent question, so I appreciate the chance to respond. First of all, I want to make a distinction between a universal plan versus a single-payer plan, because those are two different things.
A single-payer plan would be a plan like Medicare for all, or the kind of plan that they have in Canada, where basically government is the only person -- is the only entity that pays for all health care. Everybody has a government-paid-for plan, even though in, depending on which country, the doctors are still private or the hospitals might still be private. In some countries, the doctors work for the government and the hospitals are owned by the government. But the point is, is that government pays for everything, like Medicare for all. That is a single-payer plan.
I have not said that I was a single-payer supporter because, frankly, we historically have had a employer-based system in this country with private insurers, and for us to transition to a system like that I believe would be too disruptive. So what would end up happening would be, a lot of people who currently have employer-based health care would suddenly find themselves dropped, and they would have to go into an entirely new system that had not been fully set up yet. And I would be concerned about the potential destructiveness of that kind of transition. All right? So I'm not promoting a single-payer plan.
I have not said that I was a single-payer supporter. The problem for Obama is that, in 2003, as he was ramping up a run for the Senate, he told a union conference that "I happen to be a proponent of a single-payer universal health care plan." From that speech:
I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its gross national product on health care, cannot provide basic health insurance to everybody. And that's what Jim is talking about when he says everybody in, nobody out. A single-payer health care plan, a universal health care plan. That's what I’d like to see. But as all of you know, we may not get there immediately. Because first we've got to take back the White House, we've got to take back the Senate, and we've got to take back the House.
As Michael Barone has pointed out, the only impediment to single-payer that Obama mentioned was the fact that at that time Republicans controlled the House, Senate, and White House. That's now moot.
Also, in 2007, when starting his run for president, Obama said, "I don't think we're going to be able to eliminate employer coverage immediately. There's going to be potentially some transition process."
In 2008, Obama refined his position a bit, saying that his previous statements in support of single-payer were based on the supposition that if the U.S were building a health care system from scratch, then he would favor single-payer. But even then, he did not back down from his preference for single payer, at least in theory.