Do voters exist? In the United States, that is–do we still have voters? All available evidence points to yes, we have millions upon millions of them who vote in national elections. But maybe I’m getting too caught up in the numbers. Recent anecdotal evidence challenges my theory. I’m referring, of course, to the obvious consequences if the Supreme Court strikes down Obamacare. The result, everyone says, will be single-payer, government-run health care for all.
The problem, though, is that this was suggested and polled repeatedly during the health care debates in 2009-10. As the debates dragged on, a single-payer health care program repeatedly polled as the least popular path to universal coverage, and its poll numbers dropped over time. So I’ll pose a simple question: If the entire Obamacare law is struck down, will President Obama campaign on a single-payer system? No, he won’t. And the reason is because it will hurt him with voters, who in the end really do exist. Ezra Klein has, however, proposed a feasible way for the Democrats to move toward a default single-payer system:
I think that path would look something like this: With health-care reform either repealed or overturned, both Democrats and Republicans shy away from proposing any big changes to the health-care system for the next decade or so. But with continued increases in the cost of health insurance and a steady erosion in employer-based coverage, Democrats begin dipping their toes in the water with a strategy based around incremental expansions of Medicare, Medicaid, and the Children’s Health Insurance Program. They move these policies through budget reconciliation, where they can be passed with 51 votes in the Senate, and, over time, this leads to more and more Americans being covered through public insurance. Eventually, we end up with something close to a single-payer system, as a majority of Americans — and particularly a majority of Americans who have significant health risks — are covered by the government.
It certainly could happen. Klein isn’t in love with the idea, to say the least. But yes, it’s a possibility. But the part I take issue with is the first sentence, in which Klein says everybody walks away from the health insurance issue for a decade. I don’t think Obama would do that, and I don’t think the election could pass by without health care thrust right back in the debate, only this time centered on the question of how to replace Obamacare.
So in that case, politically, what does Obama do? Like I said, I don’t think he runs as an advocate for single-payer. Klein’s suggestion is probably workable in the long run, but Obama can’t run on it. He cannot stage a re-election campaign on the idea that he’ll give up the reform game and that it’s now up to Harry Reid to slowly and quietly bring us to the cusp of single-payer while everyone else is distracted watching “Mad Men” and arguing over Tim Tebow.
Again, I don’t doubt the feasibility of this incremental Medicare-for-all approach. But elections include voters, and voters will want to know what the candidates are going to do about health care if Obamacare disappears entirely. The president cannot say “nothing.” He cannot say “trust us, we’ll take care of it in a way that requires no public discussion and no voter input.” And he cannot say: “We’ll do what Canada and Britain have done.” So what will he say?
Kind of depends on whether the whole law goes, portions of if or just the mandate. If it's just the mandate, Dems will want to rejigger the rest to reduce the overall costs and pass some set of tax incentives for the young and healthy, plus almost certainly added taxes to cover the inevitable remaining revenue need. If it's the mandate plus the guaranteed coverage and community rating, the Dems can probably give it a rest through November, with Obama taking credit for the more popular provisions. If the whole law goes, the Dem's liberal base will launch a jihad against the court and Obama will have little flexibility to stay out of that. The left will also surely put single payer back on the table — even reintroducing one of the earlier unsuccessful plans — putting Obama on the spot.
Leave no authority existing not responsible to the people. – Thomas Jefferson
Perhaps the Republicans won't move away from the subject either. All projections for Medicare point to economic failure under current conditions. Voters are not likely to be complacent as in the past given the annual deficits and national debt issues becoming greater threats to future prosperity. The current budget proposal submitted by Rep Ryan proposes dramatic changes to Medicare. Not what historical strategy would suggest to be politically prudent. The same may happen with health care reform – Republicans know that it is a concern of the public and if the election results allow them the opportunity to introduce market-based reforms, they might be brave enough to make the premptive move.
Of course, with Medicare going bankrupt it would be problematic to expand this program even incrementally without precipitating its crash and burn. The real immediate crisis is Medicare and its reform must be addressed before any other health care insurance reform for the rest of the population.
Obamacare and Single-Payer are permanent rigid systems. Health care has been changing and fluid before Obamacare (hospitalization evolved into HMO's and then into today's half-Obamacare and in-between what people had). The point is, a lot of what the lib justices questions pertained to all assumed a rigid unchanging forever after health care system. That got me thinking that if Obamacare is overturned, anything (but hopefully starting with Ryan's Medicare plan) can happen to fix health care system problems.
Frankly, I wish the US would go to "VA Health Care For All." All the money we pay to insurance companies now would just about pay for it. I have VA Health Care, and it is excellent–very well organized, patient centered.
The expansion is exactly what has been going on for over 40 years, accelerated in the last 20 by Clinton's admin. How did that happen? Conservatives won the battle against Hillary care, but allowed incremental increase of Medicare, Medicaid, and CHIPS.
Universal healthcare is long overdue in our country. Single-payer is (by far) the most efficient and effective way to manage it. Zero dollars are wasted on advertising, lobbying, and shareholder dividends. Every dollar goes to treatment. n nOurs is the only advanced industrial nation on the planet that has not moved to this system. n nWhy? In our country, we treat cancer as a profit center. In the advanced nations, they treat it as a disease. n nWhy should be so lucky as to have the Canadian system. Their average life expectancy is FOUR YEARS longer than ours. They have universal health care. We do not. n nFour years. n
The life expectancy number, which comes from a WHO study conducted about a decade ago, was manipulated to make a capitalist country without universal health care look bad. In short the life expectancy number was calculated including deaths from traffic accidents and gunshots. Obviously that "cooks the books" on the life expectancy number. Take a look at "The Worst Study Ever," by Scott Atlas, published in Commentary in 2011. It will open your eyes about so-called "definitive studies" and the alleged failures of the U.S. health care system.
Any study that include gun shot deaths will have high mortality rate. And the U.S. has the mot gun shot deaths of all, especially after all those "Stand Your Ground" state. I think America let this law sneak up on us.
Medicare is going bankrupt and the notion of incremental expansion is a recipe for accelerating the precipitous crash and burn of this program in crisis. Reform of Medicare is a must do prior to any other new government sponsored health care insurance.
If the entire Act is swept-out, it may pave the way for a return to more market-based and patient-centered programs such as the ones created or envisioned by Jim DeMint or Mitch Daniels. n nThe real problems besetting the U.S. healthcare ssytem arise from the interposition of a third-party gatekeeper/payor between the customer and the vendor. nWhile there wioll always be a need for catastrophic and chronic illness/accident insurance, those risks can be shared among the rlevant populations at market rates. nOrdinary preventive care and health maintenance can be returned to a realistic marketplace where services and prices reflect the needs of the consumers and the resourcefulness of the providers. nAlrady, we see a proliferation of "wellness" centers as stand-alones or sharing space with stores and pharmacies. Some doctors are offering packages of services and programs for set rates, despite State objections and interference with their rights to practice. nThe elimination of the "one size fits all" regime and the replacement of the present adminstration maty see a return of the control of healthcare to those to whom it is most important: the customer and the provider.
Who would trust anything Jim Demint or Mitch Daniels would recommend??
You obviously haven't looked at the success and reduced costs of Daniels' programs, or your "spread the wealth," anti-market bias has blinded you. nThe facts speak for themselves. Ignorance is no excuse.
Single payer is impossible without substantial across the board tax increases. Obama locked himself into no middle class tax increases during his campaign and has never backed down from this promise (much like his equally asinine campaign position of "Iraq bad war, Afghanistan good war" meme leading to spending billions on a needless loss of American lives with an ineffectual surge). And that's part of the entire problem with Obama. He has all these grandiose proposals that he never wants to pay for. All the class warfare tax increases he proposes don't even pay for the new programs he wants. He is not a serious president, just another political hack. n nBTW, the notion that single payer administered by a bloated government not based on a competitive market will reduce costs is beyond ridiculous
America is unique: every single one of us wants what we want, now. Patients ignore guidelines, doctors give in, and we all remember the abuses and lawsuits of the HMO days. 350 million citizens demanding royal treatment is uncontrollable and unsustainable. nWe need to go back to the major medical days of insurance that was insurance and not health care coverage. We certainly need to find a way to make the patient own and responsible for his own healthcare dollars. nIf the Federal government is going to be involved at all, I liked the tax credit scheme that Bush proposed: family tax credits for buying their own insurance. At the least, the Feds should encourage, rather than limit and increase taxes on health savings accounts.
The next administration will drop health care reform like a hot rock and concentrate on three issues of far greater and immediate importance for the American people, unemployment, housing foreclosures, and the price of gasoline. These are the three issues that Barack Obama has studiously avoided for almost his entire Presidency and they are what are going to cost him the election. And any GOP President who also avoids them risks the same fate. Health care reform is important, it's just not that immediate.
Gasoline is more important than health care? Somebody's priorities are not straight.
I certainly can see this happening. Especially when, after the next Republican administration, Hillary, the true winner of the 2008 Democratic primary (re:Florida and Michigan), is finally elected and begins government for and by the people.