Obama Endorses State Flexibility (to Implement Single-Payer Health Care Systems)


President Obama may have a reputation as being somewhat cool and detached, but he seems to work fairly hard to come across as a good listener. And he wants the heads of America's state governments to know that when it comes to his health health care overhaul, well, maybe he hasn't felt their pain, but he has heard about it. At a speech to a gathering of state governors today, Obama said that he's aware that there's some antipathy toward the Patient Protection and Affordable Care Act. Via Marc Ambinder:

"I agree with Mitt Romney, who recently said he's proud of what he accomplished on health care in Massachusetts and supports giving states the power to determine their own health care solutions."

First, a word of advice: When talking about health policy, it's usually advisable to avoid starting any sentence with the words "I agree with Mitt Romney." (Granted, in this case we probably shouldn't be surprised; the White House has made no secret about its affinity for the health care overhaul signed into law by Romney during his tenure as governor of Massachusetts.)


But lets move on. What is this newfound state "power" Obama speaks of? Why it's the power to request permission (how kind! how generous!) to opt out of the health care overhaul's individual mandate and federally-mandated insurance requirements…by proposing slightly different ways to meet those same federally imposed coverage and benefit standards. Apparently, if states can find different ways to screw up their health systems in roughly the same way that the PPACA already outlines, Obama will be happy to let them try.  

Which is to say that the proposal endorsed by the president, originally put forward by Senators Ron Wyden and Scott Brown, leaves very few plausible options for state governments seeking to experiment. Perhaps some states could find alternative ways to achieve a similar effect to the individual mandate, but those states would still be in the position of having to find some way to coerce individuals into purchasing health insurance that met the law's minimum requirements. That's not much of a change.

Indeed, if you're looking for potential changes, you should look elsewhere. There's no option to opt out of the budget-busting Medicaid expansion, no option to ditch the exchanges or many of their minimum coverage requirements, no option to fold multiple existing state-level health care programs into the permission request. About the only significant choice it seems to open up is whether to ditch the PPACA's government-run insurance exchanges and go directly to a state-run single payer plan—which is exactly why Vermont's fun-lubbin' socialist senator Bernie Sanders is so fond of the idea.

Arguably, it doesn't even add anything new to the law; all it does is back up the date at which states can ask for waivers. The law already allowed states to look for these alternatives starting in 2017. Under the Wyden-Brown proposal that Obama endorsed today, that date would change to 2014.

So my criticism of the proposal now remains the same as when it was first announced last November: It provides a curious form of flexibility: the kind that only bends one way. Obama, in other words, wants state governors to know that he's heard their complaints about the lack of state-level flexibility. But he doesn't seem interested in actually doing much to help them.

NEXT: Total Tax Burdens: Rising on the Richer, Falling on the Poorer

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  1. First, a word of advice: When talking about health policy, it’s usually advisable to avoid starting any sentence with the words “I agree with Mitt Romney.”

    In fairness, at some point in time, everyone has agreed with Mitt Romney on every issue. That guy has taken more positions than the Kama Sutra.

    1. If I were planning to run in the Republican Primary and I was NOT former Gov. Goodhair, I’d just put that Obama comment in a loop and buy ad space on rightwing blogs.

  2. I’m still confused about how the PPACA (or whatever it’s called) passed in the first place.

    1. It involved “deeming”, as I recall.

      Beyond that, it’s all a hazy, horrible, terrible memory of generalized angst, fear and loathing.

  3. Perhaps some states could find alternative ways to achieve a similar effect to the individual mandate, but those states would still be in the position of having to find some way to coerce individuals into purchasing health insurance that met the law’s minimum requirements.

    And if they don’t or choose not to, one can just bet that the Federal government can find any number of “non-coercive” ways to punish encourage them – aka – witholding of various kinds of Federal funding for example.

  4. I’m starting to wonder how any reform is going to reduce costs if our primary focus remains on acute, tertiary care.

  5. Don’t trust Obama, he’s a trickster, a con artist, he’ll pretend to be anything and anyone to get his way.

    Obamacare is 100% unconstitutional and un-American, this entire filthy bill must be repealed.

    Want healthcare? Get a job, go to a charity, but don’t ask me to pay for your medical bills.

    This is the land of the free, not the land of the freeloader!

    Shariah4America: The Muslim Extremist Extravaganza coming to DC.

    1. You are already paying for all the uninsured emergency room visits and malpractice cases. Open our eyes.

      1. Then we should repeal the unconstitutional law requiring emergency rooms to treat all comers.

        To address the malpractice situation we need to work on tort reform.

        Let me know when the Dems are willing to work on those.

        1. Then we should repeal the unconstitutional law requiring emergency rooms to treat all comers.

          Finally! The risible faux-libertarian is honest about his position on health-care reform. All of us who are fiscal realists and think that health care is a right already knew your position, but it’s so rare to have it stated openly.

          This is a great development. Allow states to adopt single-payer (like Vermont is on track towards). That way all of us in civilized states will start paying per-capita rates similar to Canada and get everyone covered, and all the right-wing morons can just deal with it.

        2. To address the malpractice situation, we need to address not malpractice itself, not compensation for malpractice. Over the last 20 years only about 2 percent of physicians were responsible for over half of all the money paid for malpractice, and most of them had multiple payments in their records. But only about 11 percent of these few physicians who cause the bulk of the problem had any action at all against their licenses.

          Wouldn’t it be better to stop the physicians causing the problem rather than keeping the people they hurt from being compensated for their injury (or death).

  6. Mitt Romney peed his pants, so now the rest of us are all supposed to pee in our pants too?

    Someday this Obama nightmare will be over.

    It may take a generation to fix all the damage, but someday–Obama won’t be able to do any more damage.

  7. Obama’s really not gonna let anyone forget about Romneycare. They seem to have been banking on a Romney nomination for a long time.

    1. Romneycare was confined to one state, popular with the people of that state, and fully in line with the constitution of the jurisdiction which made it into law.

      Obamacare is none of those things.

      1. Let’s see if GOP primary voters appreciate the distinction.

        1. I bet they don’t, mainly because there really isn’t one. Both have a mandate and impose similar cost restructuring.

          So far only The Failure of RomneyCare is the big difference. Hopefully we don’t have to see this repeated on a federal level.

  8. I work in the health policy sphere in DC myself. I heard these new rumblings starting a couple weeks ago through the grapevine. Apparently, Vermont wants to institute a single-payer system and the administration has been falling all over themselves to help make that happen as well as trying to buy some more time for the transition for the rest of the states (the current medicaid situation was just plain impossible, so something had to give).

    1. That’s Vermont’s business. I think it’s a terrible idea but I don’t live there.

      1. They haven’t managed to drive away enough business/educated youth yet.

        1. Except by transitioning to single-payer, the educated youth will have a safety net to take the risks they want in business and education. And the large businesses will find their marginal labor expense reduced dramatically.

  9. Ya know, states as labs for new ideas have a pretty good record. Don’t be afraid of a little experimentation, or a lot of small “d” democracy. Vermont may just turn out to be the Tunisia of health care reform.

  10. Wow, OK man now that really does make a LOT of sense.


  11. If the good Lord wanted every American to have health insurance, he would have made them all rich.

    Leave civilized health care to all the other developed countries.

    1. Yeah, because healthcare totally has got to cost shitloads upon shitloads of money, and the government has not been involved in healthcare at all for the past fifty years, and has done nothing to distort the market and help drive prices ever upward.

      The good Lord clearly did want every ignorant shit to have a voice, because He provided the Internet.

    2. I’m not sure why the good Lord would care more about how health care is paid for than whether people have it, but the ways of progressives are mysterious to me too, probably because I’m not a dumbass (usually).

  12. , you should look elsewhere. There’s no option to opt out of the budget-busting Medicaid expansion

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