Health ReformPolicy & LawPublic Health

If ObamaCare Fails, Are We On to Single Payer?

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Is Obamacare just a trap set to lead the country toward a single payer system? The answer is no, but opponents of the law might want to think twice before gloating about the rocky rollout. I’ve said before that if Obamacare fails we are more likely to move toward single payer than back to whatever you want to call the status quo ante.

Noam Schreiber has a much more detailed argument to the same effect in the New Republic (How Obamacare actually paves the way toward single payer). To summarize:

  • Loosening of Medicaid eligibility will expand the constituency for the program to include white working-class voters who often vote Republican
  • Relatively low income individuals who get skimpy private plans through the health insurance exchanges will be jealous of their slightly less well-off brethren on Medicaid and will push for bigger subsidies for private insurance or for further expansion of Medicaid
  • Same thing for Medicare. Those who are a little younger than Medicare age will long for Medicare to replace their inferior exchange plans and may end up getting Medicare expanded or their exchange plans improved
  • Overall, once more people have insurance there will be a push for better insurance, and that will be hard for politicians to resist. Remember, one of candidate Romney’s big –and not very fair– points of emphasis was that the Affordable Care Act would make cuts to Medicare. In a few years we may see supposedly conservative Republicans fighting to keep or expand Obamacare

The Wall Street Journal’s letter section had a few interesting submissions from writers commenting on an earlier piece What to Do When ObamaCare unravels, by John H. Cochrane. I had read the original piece but ignored it since it seemed so detached from reality. A couple of the letter writers are in my camp but the other two (both from Connecticut for whatever reason) are not.

What I found funny about the original piece was that the proposed solution “A much freer market in health care and health insurance” was defined as health insurance that is “individual, portable across jobs, states and providers; lifelong and guaranteed-renewable, meaning you have the right to continue with no unexpected increase in premiums if you get sick.” That’s a funny definition of a “free” market.

As one writer points out “such a… plan would require its own detailed set of regulations.” Another seems to take Cochrane at his word and asks why premiums aren’t going to go up after policyholders file a claim, just like how it works for other insurance markets like auto. This writer’s simpler solution: Medicare for all.

The last couple letters are pure WSJ fantasy land stuff. The writer from Denver says, “All federal government involvement in health care should be eliminated.” Reason #1? The 10th Amendment, “black letter law” forbidding the federal government from getting involved.

The final writer bemoans the fact that, “Intelligent solutions, market-based calculations, and actuarially sound arguments by Prof. Cochrane cannot compete with the socialist myth system of promises.” Why is it that some on the right are so convinced that there are so many socialists out there in America? Is this the 47 percent in another guise?

In any case, if this is the best Obamacare’s opponents can come up with, the President can rest easy.

(photo credit: Public Citizen via photopin cc)

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