ObamaCare, the Prequel


Before ObamaCare, there was HillaryCare, the universal coverage overhaul proposed under Bill Clinton in 1993 and overseen by his wife, Hillary. Unlike President Barack Obama, our last Democratic president never managed to pass a health care law. Indeed, HillaryCare never even came to a floor vote in Congress. One reason the proposal failed was its sheer complexity: Republican critics famously created a chart showing the impenetrable maze of bureaucratic administration the law would require. 

In the wake of the bill's failure, supporters looked for ways to streamline the system. As Rick Henderson wrote in "Canadian Club," an article in the January 1994 issue of reason, "The mind-numbing complexity of Bill Clinton's Health Security Act has revived interest in simpler alternatives." The most popular option? "A government-run, single-payer medical system," according to Henderson. Advocates for universal government insurance, he wrote, "maintain that such plans will cut bureaucracy, enhance choice, and preserve quality."

But on issues of cost, quality, choice, and simplicity, Henderson argued, those advocates were wrong. In a Canadian-style single-payer system, lines are longer, cost controls delay adoption of new technologies, and heart patients report lower satisfaction. As for the alleged simplicity of a federal single-payer system, Henderson argued that it was a myth. "It's ludicrous to assume that any government-run system, no matter how lean its initial design, would remain bureaucracy-free," he wrote. 

Many liberal health care reformers still believe this myth, however. Several prominent progressives argue that if ObamaCare is overturned by the Supreme Court, a single-payer system will be inevitable. And even if the law is upheld, many are holding out hope that states will pursue the policy on their own. 

The latest in a string of single-payer efforts recently stalled in California, while activists in Ohio have been unsuccessfully pushing a similar bill since 2008. But at least one state, Vermont, is already moving forward with a single-payer approach.

ObamaCare gives states the right to pursue alternative health policy reforms starting in 2017, as long as they meet or beat ObamaCare's projected levels of coverage and subsidies. That limits potential experimentation to essentially one option: a total state takeover of the insurance market. Vermont plans to run a single-payer system starting in 2017, or, if the state can secure an early federal exemption, perhaps even earlier. One thing the state does not have in place, however, is any mechanism to finance the program.