June 9, 2017


The Health Care Debate Is Moving Left : How single-payer went from a pipe dream to mainstream. (Reihan Salam, 6/09/17, Slate)

[M]y guess is that support for single-payer will keep increasing in the months and years to come. This is despite the fact that I believe creating a single-payer system would be a costly mistake, for reasons ably outlined by Chris Pope in National Review and Megan McArdle in Bloomberg View.

Why do I think single-payer health care will keep growing more popular? Part of it is the availability heuristic. The more familiar the idea of a single-payer health care system becomes, and the more mainstream Democratic politicians embrace it, the "safer" it will be for people to support the idea. A single-payer system is no longer seen as a crazily socialistic idea relegated to the fringes of the political debate. It's an idea that is taken seriously by serious people.

Indeed, a key part of the new push for single-payer health care is branding it "Medicare for all." Medicare is a single-payer system that offers coverage to every American over the age of 65. Though no one would describe Medicare as perfect, it's pretty popular. So naturally the idea of opening Medicare to everyone has a lot of appeal. Of course, there's a case to be made that Medicare has in some ways made America's health system worse by serving the interests of politically powerful hospitals over those of patients, but I digress.

The single-payer cause also benefits from the fact that Obamacare has been a mixed bag. While coverage expansion via Medicaid appears to have gone fairly smoothly in the states that have signed up for it, the move to expand coverage via Obamacare's new state-based insurance exchanges has been far rockier. If the exchanges represent the best managed competition can do, it's no wonder many have concluded that the smarter move is to further expand public insurance programs, as we've been doing for decades under Democratic and Republican administrations alike. Medicare for all is, according to this line of thinking, simply the next logical step. Here too there is another way of looking at things: Had Obamacare used the exchanges more narrowly as a vehicle for insuring the uninsurable, not as a means of transforming the entire individual insurance market, it might have proven more popular and effective.

But the most important reason behind the single-payer boomlet, I believe, is the health policy failures of Republicans. While the GOP has spent years attacking Obamacare, it has proven utterly incapable of offering an attractive alternative. If the GOP had such an alternative, it would nudge centrist Democrats in its direction. But as long as the right doesn't have a workable plan for fixing America's health system, it should come as no surprise that the center of gravity on health policy is shifting left.

Americans, like the citizens of every developed democracy, consider health care a right, so it is one.  The argument is over how universal health care will be delivered, but the GOP is still stuck on whether.

Posted by at June 9, 2017 12:27 PM