No, the Fall of ObamaCare Won't Lead to Single Payer Health Care


So the Supreme Court arguments over the 2010 health law didn't go quite the way that liberals expected. In response, a number of them seem to be attempting to console themselves with the notion that in the long run, a loss would actually be a win: If the Court overturns all or part of ObamaCare now, the argument goes, it will build support for true single-payer health care. Here's UCLA law professor Adam Winkler making a strong version of the case in article by TPM's Sahil Kapur:

"Conservatives may find that they weren't careful about what they wished for in opposing 'Obamacare,'" Adam Winkler, a constitutional law professor at UCLA School of Law, told TPM. "The economic, social and political pressure for health care reform aren't going to just disappear. There's a reason every major industrialized country has national health care. If the Supreme Court invalidates the Affordable Care Act, we are likely to see a government takeover of health care in the next decade."

…"The defenders of federalism will be rewarded with an even bigger federal government," Winkler said. "Wouldn't that be ironic?"

If it's really the case that liberals stand to win if the law goes down, then shouldn't ObamaCare's backers be hoping that the Supreme Court rules against the law? I suspect I don't see them rooting for the law to be overturned for a reason. 

Still, Winkler isn't the only one making some version of this case. The Nation's George Zornick declared last week that "if the mandate falls, single payer awaits." Columnist Eugene Robinson similarly predicted that if the mandate falls, "a much more far-reaching overhaul of the health care system will be inevitable." The "only alternative" Robinson sees to ObamaCare? A single-payer system.

If only there were alternatives to columnists (and presidents) who can't believe that there are health policy alternatives to increasing the government's control over the system. The United States has been steadily ratcheting up regulation of the health sector for nearly 50 years. At this point, the government is responsible for almost half of all health spending. Isn't it at least possible that the problems with the health system are not caused by too little government interference but by too much? Liberal health wonks frequently insist that they mostly want to make the system smarter and more effective, but they and their predecessors have been saying the same thing about every reform for decades—and yet it always seems that yet another fix, another tweak, another technocratic reform is necessary to finally rationalize the system.

The good news is that single payer isn't the lineup should any part of ObamaCare fall—at least not in the foreseeable future. The critics Kapur quotes, both supporters of the 2010 health law, do a good job explaining why:

That's far from certain, because the political obstacles to single-payer — vehement opposition from conservatives, the might of insurance and other health care industries and the difficulty of selling bigger government to the American public — may yet be too great to overcome.

"Not in my lifetime. There just isn't the political support," Tim Jost, a law professor at Washington and Lee University and a supporter of the Affordable Care Act, told TPM. "We could not even get a public option when the Democrats had 60 Senate votes. The alternative is to limp along with an ever larger share of Americans receiving ever less care. This doesn't seem to bother a lot of Americans, at least those who pay for political advertising."

"I think that is naive," Jonathan Gruber, an MIT professor and health policy expert, told TPM. "If you look at the history of health care reform, every time we come back to it the proposals are more conservative than the last time."

I don't know if I would use the word "conservative," though Gruber is correct to argue that ObamaCare's mandate/subsdize/regulate design was built partly out of a desire to appease Republican policymakers. But at least for the forseeable future, it's unlikely that if the health law is struck down its backers will have much success passing something even more ambitious, like single payer, in its place. 

Jost, meanwhile, is right to note public opposition to single payer as a major obstacle. If Democrats made a major push for single payer, Republicans would immediately trot out the familiar line about the plan being a "government takeover of health care." And this time it wouldn't be an exaggeration with elements of truth, it would just be the truth: The government would essentially be nationalizing the health insurance industry, and, by taking over the payment side of the business, centralizing control over the nation's health providers as well. 

Public opposition isn't all that single payer pushers in Congress would have to contend with. The health care industry would wage a lobbying World War III to prevent it from happening. Anyone who thinks that doesn't matter should remember that the White House made a massive effort to court the support of the major health industry groups— insurers, drug makers, doctors, and device makers. All would be adamantly opposed to a single-payer system, and would use every asset—from the public trust in doctors to the massive P.R. war chest of the pharmaceutical industry—to attempt to stop it. The White House was convinced that it couldn't pass the law without industry support, and plentiful handouts, last time around. During a single payer push, the handouts wouldn't exist—and neither would the support. 

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  1. Single-payer had 8-10 supporters in the Senate according to Bernie Sanders.

    Its dead as a doornail.

  2. That is some serious wishful thinking. The whole reason Obamacare exists in its present form is because single payer is a political no-go.

  3. I tend to think we’ll end up with single-payer regardless of what happens with Obamacare.

    The bottom line is that too many Americans think that (1) health care is a right, and (2) they are entitled to as much of it as they want, at no direct cost to themselves.

    We’ll end up with a dual-tier system. The “free” system will work about as well as Britain’s National Health or Canada’s system, only at astronomically higher costs and at health care centers that make your local DMV look like Don Draper’s apartment.

    The more affluent and desperate will go to cash-only medical practices for more immediate and advanced care. In the USA if allowed, and off-shore if the feds ban private care like the Canadians have.

    1. However, I recognize that this may take awhile to happen. Probably not within the next decade. There will be several more silly attempts to make the current Frankenstein system work.

      On the brighter side, single-payer will bankrupt this country even faster, so if you’re rooting for a crash and a do-over, well…

  4. Eyyyyyyyyyyy!

  5. All they need is 61 senators and a majority in the house. It’s a slam dunk!

    1. And the White House.

  6. ObamaCare’s mandate/subsdize/regulate design was built partly out of a desire to appease Republican policymakers.

    Why don’t we abandon the whole charade and start calling Blue Dog democrats Nazis.

  7. Suderman, you’re going to burn in a very special level of Hell. A level they reserve for child molesters and people who talk at the theater.

    1. They didn’t even have theaters in that show, so it was odd that Book said that.

      Also, how the heck were there so many wild animals native to Earth living on all those planets and moons? I could maybe see the rabbits in “Safe” as being escaped livestock but the vultures in the pilot episode I’m having a hard time figuring out. How did they manage to keep vultures alive and maintain their wild instincts aboard generational spaceships?

      1. Terraforming ships that came before the generational ships made them whole from genetic materials.

        As you said generational ships.. meaning that the terraformed planets had plenty of time for ecological balancing before man ever stepped foot on them.

        1. The opening monologue to Serenity says the people were already there during the terraforming process. Plus, how would the terraforming ships arrive there earlier unless they were (a) much faster or (b) launched much earlier, probably both.

          If it’s (a) why didn’t they make the people-ships faster too? If (b) that means they made everyone wait on Earth a few hundred years which is probably the minimum for ecological balancing.

      2. They didn’t have theaters on the crappy backwaters the Serenity crew went to. We barely saw life on the Central Planets.

        I presume if they were planning on terraforming they either brought some ships that were just big ecosystems, or they cloned things like vultures once they arrived.

        1. But Mal had presumably been living in the non-central planets all his life; it’s odd that Book would bring up that example, particularly since Book himself had been in a monastery for decades.

          1. It’s not a good idea to assume much about Book’s past.

          2. Exactly how do you arrive at the idea that Mal or Book would utterly ignorant of the rudeness of talking in one, even if they had never been in a theater?

            Furthermore, despite not seeing one, i would be surprised if the planet they visited in “Shindig” did not have some kind of theater.

  8. So they think Obamacare is all that’s standing in the way of single payer?

    That means if you support single prayer you should oppose Obamacare. Don’t recall them doing that back in 2009-10 (or now in the courts).

    1. single prayer

      Praise be to RCz law!

  9. I am more interested in the immediate political fall out from the supreme court overturning Obamacare.

    Without a repeal Obamacare movement the republicans could lose momentum.

    Of course Romney is already tagged as the midwife of Obamacare so the repeal Obamacare push may have never entered the equation.

    Anyway i have been predicting Obama would lose a second term no matter who runs against him. (been predicting that since 2008)

    I am still holding to that prediction…still the fall out to an overturning of Obamacare needs to be watched as it could be a game changer.

    1. dont worry, there are plenty of other things to hit Obama with and with gas prices this high, and his insistance on raising taxes, there will be plenty for the Tea Party to continue to rail against.

    2. In an alternative universe, the Supreme Court actually does its job and shits on the other two branches with regularity (see what I did there?). An expansive definition of the Commerce Cause is the fool dream of technocrats made to live like lice ridden homeless bums for they have no useful skills. Most goodiest of all, no one gives a rat’s ass who is president, so there is also no concern about ‘electability’, and keeping the other Team from making court appointments because professional jurist are almost to a man Constitutionalists and not the feeble minded Stare Decisisist we are so plagued. Even the I of that world had to ask who was president, and it so happened to be Paul.

      1. Commerce Cause — note I took out the ‘l’ to avoid barbaric alliteration that otherwise would have occurred.

  10. I don’t think they will ever get their single payer for one reason: WE ARE OUT OF FUCKING MONEY.

    Look how hard The Obama and Pelosi and Reid had to work to get a number without a capital ‘T’ in it to pass Obamacare. The ‘T’s are piling up till the the crash of it all. Single Payer will need a bigger check and we’re running out of checks these days.

    1. Cuba has been out of money since 1991 and they still have single payer.

      1. Which of course means zero payer most of the time…

    2. No, um, see, there’s plenty of money. You just have to confiscate the trillions currently spent on healthcare via taxation. It’s like free money!

  11. If only there were alternatives to columnists (and presidents) who can’t believe that there are health policy alternatives to increasing the government’s control over the system.

    This is a naturalism fallacy. Single payer healthcare can be a terrible idea and still be politically inevitable.

  12. Gotta love those bought and paid for politicians! Best politics money can buy lol.


  13. Black is beautiful

  14. “If the Supreme Court invalidates the Affordable Care Act, we are likely to see a government takeover of health care in the next decade.”

    …”The defenders of federalism will be rewarded with an even bigger federal government.”

    Evey time some big government scheme from the Left is in legal or political trouble we get this weird sort of reverse B’rer Rabbit and the Briar Patch warning from the Left. That we would consider Single Payer worse than Obamacare does not mean Obamacare is something we should just live with, especially with the choice destroying regulatory diktats coming from the administration this ill considered monstrosity enables.

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