So the consensus, even among liberals, is that Obamacare did not have a good week at the Supreme Court. It was so bad, in fact, that I heard people speculating that the Solictor General deliberately did a bad job to get it struck down.
The thinking is that if Obamacare is struck down, this will pave the way for … a single payer system. Seriously:
In the face of a total strike down, single payer probably becomes the best option. But it’s not an easy one. The hurdles to passing Obamacare were that Democrats needed to have a majority in the House, the presidency, and 60 senators. The good news to passing single payer is that they probably would only need 50 senators. (Single-payer could be done simply by expanding Medicare, a pure fiscal change that could be accomplished through a budget bill that can pass the Senate with a majority vote.)
I tweeted about the absurdity of the other night, but I thought I’d expand on that thought. The idea that striking Obamacare will pave the way for single payer is ludicrous. It is based on two bogus schools of thought that run through liberal thinking.
First, liberals are big believers in political determinism. They believe that their idea are so wonderful and fabulous that it is only a matter of time before everyone realizes it and we finally evolve into a liberal utopia. This line of thinking can be traced to Marxism, which posited that the forces of history were leading to the inevitable collapse of capitalism and the inevitable rise of communism. Just as the communists predicted that labor relations would get worse and worse until we had the inevitable worker revolution, liberals are now predicting (hoping) that our healthcare system will get worse and worse until we have the inevitable single payer revolution. All they had to do was stand back and let it happen.
But they are just as deluded as Trotsky was. First, it is not inevitable that our system will get worse without Obamacare. It is possible, if we allow competition across state lines and move people toward more consumer-controlled system, that we could turn the tide. And even it our system does continue to get worse, why would this lead to a surge in support for single payer? Why would people who have vehemently opposed single payer suddenly favor it in the wake of an Obamacare defeat? Liberals want single payer. Indeed, their biggest problem with Obamacare was that it was not single payer. But conservatives and libertarians opposed Obamacare because we saw it as leading to single payer.
The second problem with this line of thinking is that it completely misreads the political situation. To listen to the Left, Obamacare was passed over the fierce opposition of the health insurance companies, pharmaceutical companies and physicians. This is complete bullshit. The insurance industry favored Obamacare. Big Pharma was bought off with promises of no price controls. The doctors and hospitals were bought with promises of a permanent stay of the SGR cuts. All kinds of special interests favored Obamacare because they knew precisely what would happen: healthcare would become even more politicized. More money would flow to companies that were politically connected. Do you think Big Pharma is mad that HHS is mandating that their most expensive birth control pills be covered? Do you think the insurance companies hate it that people are being force to buy insurance? Give me a break.
Obamacare was a product of industry, a distillation of what they wanted out of healthcare reform. And they supported it heavily. They will not, however, have such a love affair with a single-payer system. Such a system will put private insurers out of business, set the stage for price fixing in all branches of healthcare and, given Medicare’s horrific finances, necessitate massive cuts in physician and hospital reimbursement. The special interests will unite against single payer just as they united for Obamacare.
At most, striking down Obamacare may set the stage for an Australian-type system where the government provides basic insurance and everything else is private. Or it may set the stage for the Ryan plan of breaking the federal monopsony that already controls half the healthcare system. But the idea that this sets the stage for single payer is pure Left Wing fantasy.
(And since we’re on this, it’s always worth pointing out that the contention that Medicare is more efficient than the private sector is bullshit.)