Currently viewing the tag: "Single-payer"

Will Conservatives Ensure That Single-Payer Becomes America’s Healthcare System?

by Lev on 27 March 2012

Who could have predicted that the conservative bloc of the Supreme Court doesn’t like the individual mandate? Not me, I never expected any different. Of course, whether they want to overturn it is still up in the air. In my opinion it is not a question of whether they want to do it, it is not a question of whether they think the law supports it (they don’t, regardless of what the experts say), it’s a matter of if they have the guts to do it. Of course, I remind you that this is one of those short-term smart/long-term dumb kind of things that characterizes nearly everything they’ve done post-Bush. For example, stirring up xenophobia is brilliant during tough economic times, as people naturally look for scapegoats when money is tight, but the long-term implications are just awful for the GOP. Similarly, if a mandate-subsidize model gets struck down by SCOTUS, the only position left for healthcare reform folks is single-payer. Absent the mandate, the ACA’s effectiveness will be sharply curtailed. A significant Court decision against the bill could be a real body blow in terms of public opinion of the Act and Obama personally, likely discrediting the Romney/Gruber/Obama healthcare approach within the Democratic Party.

But contrary to what some pundits say, it won’t take another two decades for the issue to come up again, due to the decreasing number of people on employer-based plans. Part of the reason we don’t have universal care is because in spite of not having a true system, most people do actually have insurance. It’s a hacked together, piecemeal thing, not to mention wildly inefficient but most people can’t gauge the mediocrity as they have nothing to compare it to. But this is the kicker: if your typical person has something that they value highly, like life-saving insurance, even if it is actually worthless they will never give it up. On the other hand, if they have nothing, then almost anything starts to look darn appealing. So here it is: as costs continue to mount, as they have since the mid-1990s, more workplaces will drop these plans. This will remove the primary obstacle to aggressive healthcare reform, which is that people who are insured don’t want to lose what they have. Clinton’s plan was (falsely) believed to do this thanks to a falsehood campaign, and it was doomed after this became widely believed. But if people have nothing, the main obstacle will not exist. And with mandate-subsidize out of the question, the only remaining approach with any sort of organized support will be single-payer (which will undoubtedly and accurately be sold as Medicare-for-All). I suppose the key determinant here could wind up being how Vermont’s pending single-payer reforms work out.

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Finally, A State Legislature NOT Doing Something Horribly Monstrous*

by Lev on 27 April 2011

(It makes sense if you listen to it…)

Vermont’s legislature is poised to adopt single-payer healthcare for the state. Even if you don’t like single-payer, it’s the sort of thing that at least ought to be tried on a state level, just to show whether it can work on that scale. I would say that I’d love to see a right-wing state take a shot at implementing conservative healthcare ideas, but I thought that’s what this was (admittedly not in a right-wing state though), and Erik Kain explains why the right’s new idea–block grants for Medicaid–isn’t so great:

Block grants do very little to give states any more flexibility to experiment with healthcare delivery systems. Instead, they incentivize state governments to cut corners even where corner-cutting is against the interests of the greater good.

This is what bothers me about so much of the debate about spending–as though it’s more important to hit some arbitrary number than to fund our commitments efficiently and fully. It’s letting the accountants set your vision, instead of the leaders. It’s a sign that you view these programs as just pure waste, that any amount is as good as any other, with no amount being best. Republicans have elided this for years by insisting that they believe in these popular programs but that they also believe that the government is much, much too large. There are a lot of people out there who are angry at the government for any number of reasons, but who like Social Security and the like. In fact, I wager they outnumber committed libertarians by several factors. Pandering to that anger while not really, you know, doing anything has served the Party very well over the past few decades. With the Ryan budget, though, it appears we just might be headed into a new era.

Anyway, it’s certainly an interesting time to be observing politics. For the conservative movement to have been on the rise again after that little Iraq blip–while the movement for single-payer care is simultaneously gathering steam, and winning actual victories on the state level–just makes for a very strange an interesting present we’re living in. Talk about topsy-turvy. I suspect we’ll have to wait a few years until we get some level of equilibrium.

Oh, and also, John Boehner has made two more big message mistakes in the last two days than Nancy did during her entire tenure as Speaker. There are certainly similarities between Obamacare and Paul Ryan’s stingier Medicare replacement program, but exactly who is this comparison for? Thanks to Boehner’s Party’s misleading and deceptive attacks (remember death panels?), the only people who really like Obamacare at this point are the Democratic base minus the single-payer absolutists and some portion of Dem-leaning indies. Is he really trying to win them over? And by pissing off his own base in the process? I’ve said before that the Republicans’ initial thought–backing national Romneycare to forestall single-payer–remains the smart approach. Their preferred approach–doing nothing and undermining the ACA–only increases the odds of actual socialized medicine getting enacted here. Not now, but in ten years when upwards of one-third of the public has no insurance at all? You won’t be able to scare people with the loss of what they already have if they have nothing. I’d just rather it didn’t come to that.

* Well, from my perspective anyway. Yours may vary.

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