Over the last six years I’ve evaluated and treated hundreds of patients who have very little access to health care. These patients qualified for mental health care, but a great many didn’t qualify for access to Medicare or Medicaid (which Californians know as Medi-Cal). For these folks, I’ve been able to diagnose severe medical illnesses simply using lab results and clinical history – and for most of them, I could offer no treatment. We all need health care – and folks with serious psychiatric disorders, the need is even greater: as a group, they have far more physical illness and die far earlier than those without such burdens. This year’s fight for public health care could solve this problem – if the fight succeeds. If the fight fails, the patients I’ve served will keep suffering and dying from avoidable causes. Should progressives continue a circular firing squad over the mechanism for universal public access, I fear that’s exactly what will happen.

Do I want single-payer? Hell, yes. After over a decade spent in high tech health care, I’m one of thousands of physicians with horror stories about the patients who lost capacity, lost organs, and even lost lives because they were denied health care. Single payer would bankrupt the insurance megacorps who’ve colluded and lobbied to keep that deadly "system" in place. As hideous as Al Qaeda’s attacks were, they killed slightly more than 3,000 Americans. Once. Every year, nearly 20,000 Americans die because of the deadly system our insurance megacorps now spend over one million per day to maintain. The megacorps executives don’t deserve mere corporate bankruptcy: they’ve killed and maimed so many of us to deserve a fate worse than Gitmo. In a world free of human rights concerns, I’d cheerfully nominate them all – and their in house / outside legal counsel and lobbyists – for mandatory total organ donation. Though these heartless bastards don’t have anything to offer those awaiting cardiac transplant, the rest of the transplant lists could use the relief.

Fortunately, we live in a world (though not a nation) that offically upholds human rights and forbids execution and crimes against humanity – like involuntary organ donation. Unfortunately, in the part of the world called America, the megacorps own our political process. The guy who sits in the Oval Office came to bend his knee when the finance/insurance megacorps hatched out their own megafunded lobbyist group, the Hamilton Project.

So no surprise that when the guy in the Oval Office picked his OMB director, he picked another megacorp servant. Before he was OMB director, Obama’s pick Orszag not only directed the Hamilton Project, he’d actually co-founded it…with Robert Rubin. This will be good news for anyone who thinks Robert Rubin helped our economy when he took time out from helping loot America as Goldman Sachs’ co-CEO, and continued the task as Clinton’s Treasury Secretary…and then continued the looting when he rejoined our socialized finance sector as Citibank’s CEO. Hey – nothing succeeds like success, right?

For those of us blessedly free of psychosis, the idea that anyone from Bob Rubin’s baby the Hamilton Project will put our lives ahead of the megacorps’ greed would be hilarious – if the result weren’t so deadly.

So WTF does this have to do with health care and single payer? Plenty. Obama’s Hamilton Society pick Orszag has apparently wormed into position as Obama’s de facto health care czar. A corporatist errand boy as de facto health care czar? Why, it’s just what the doctor ordered – if we’re talking Dr. Kervorkian.

The indigent patients I’ve seen over the last six years by and large don’t have the luxury to focus on these issues. They are certainly every bit as clever as the rest of us, but they’re obliged to use that cleverness in their daily struggle to remain alive. In a very real sense, when progressive lobby groups and think tanks use my indigent patients urgent needs to justify one position for another, they act as proxies for the disempowered.

I’m very concerned that single payer advocates may vote their proxies against my patients’ survival. The folks I’ve diagnosed with Type II diabetes who can’t get effective treatment don’t care if access comes from a public option, from single payer, or from a coupon on a cereal box: they just need care. The delightful woman whose kidneys were already being damaged by the lupus I diagnosed just needed care – not an infinite debate over ideal mechanisms. We’ve had that debate here in San Francisco, and our uber-ambtious mayor has a "solution" to trot out for his resume: Healthy San Francisco. Which is great for his career, but not so great for the delightful woman on the way to needing dialysis: Healthy SF never got the funding to cover unmet need, and after months of trying to have patients enrolled, I learned our vaunted solution is little more than a Potemkin clinic.

President Hope and Rahm the Deal invested too much of their own prestige to be seen to fail on health care – so we’ll likely get something this year. I know my patients need universal and equal access to health care. Yet I’m very fearful that folks I respect and admire who demand single payer this year have put their own agenda ahead of my patients’ desperate needs.

Here’s the dirty fact: we have a corporatist servant as Prez. His de facto health care czar is a corporatist servant. Dozens of our corrupt House of Lords Senators are paid corporatist servants, as are hundreds of our corrupt "Represenatives". And single payer – a frontal assault on the insurance megacorps – directly attacks the corporatists’ paymasters. The "I" part of the FIRE sector – insurance – is one of the biggest paymasters. Sadly, we just don’t have the strength to directly destroy the health "insurance" megacorps.

And that’s why I’m so worried about how the quest for single payer will kill my patients. The single payer goal is worthy, but to the extent single payer advocates refuse to support other routes to universal coverage – like the robust public option – they are using their proxy vote to kill off the very indigent patients they desire to help.

For employees of Beltway think tanks who already have insurance, I believe this is immoral. For all the rest of us – especially the many folks in the FDL community who lack insurance and tirelessly advocate for single payer, my only criticism is that my indigent patients don’t have the luxury of sacrificing coverage in quest of an ideal solution. For many of them, that abstract poltical quest will bring nothing but disease, blindness, amputation, organ failure, and death.

Though I completely support single payer, I don’t support jettisoning other mechanisms that bring univeral coverage, provide equal access, and starve the megacorps. The most robust public option plans I’ve seen do exactly that, and I’ll be grateful to see any of them succeed. So will my increasingly ailing patients. We activists have years to defeat corporatism: single payer is one front in that very long war. Many of the indigent patients I’ve seen these last years – like many of the other 40 million uninsured Americans – will perish during that long war. With a robust public option this year, most of these patients will survive. Hell, some of them will find the health and energy to help us defeat the megacorps.

They can’t help us if they’re dead – and a future single payer triumph will ring hollow at gravesides and funeral urns. That’s why I hope progressives who share my long term hope for single payer will wholly support this year’s fight for full access, equal access, and a robust option. The megacorps won’t stop killing people what ever we do. But our choices this year can very literally save hundreds of thousands of lives: if we fight the megacorps, rather than one another.

Let’s get to work – together.