Conservatives have long worried that Obamacare is just a stalking horse for an eventual single-payer health system. Over the weekend, Sen. Majority Leader Harry Reid seemed to vindicate their fears.
On a Las Vegas PBS program, Reid said "he thinks the country has to 'work our way past' insurance-based health care," according to the Las Vegas Sun. "What we've done with Obamacare is have a step in the right direction, but we're far from having something that's going to work forever," the paper quotes Reid as saying.
I've long been skeptical of the idea that the Affordable Care Act was step one in some devious, far-reaching plan to take us to single payer. And for the most part I still am.
For one thing, a provision that was explicitly designed as a single-payer advance scout—the government-run insurance plan usually referred to as the "public option"—was removed from the final bill. And it's probably the case that the Obama administration was never particularly concerned with the public option anyway; it was floated mostly in order to be sacrificed so that President Obama could say he compromised on a big liberal goal.
For another thing, it assumes too much power to execute complex, long-term legislative planning on the part of Congress and the White House. The ten-year, multi-step plan to achieve single-payer is not in any sense a real thing. Legislators today cannot easily tie the hands of legislators down the road. Most can barely commit themselves to long-term legislative goals. That means it would be very difficult for even a large and motivated group of Democratic legislators to make a premeditated single-payer-in-steps plan work.
At best, some Democratic legislators, including perhaps Reid, believed that passing Obamacare would create conditions under which single-payer might easier to achieve at some unspecified point in the future. But that doesn't get you very far. If single-payer is seriously on the table in the next decade or so, it will almost certainly be because of problems, and public dissatisfaction, with Obamacare. Is it really plausible to think that the public, which has never been supportive of the health law, would once again turn to Democrats and support them in a plan that is even more far-reaching in terms of the influence it gives public officials over the health system, that adds far more to taxpayers' tab, and that would effectively wipe out an entire industry (or convert it into an arm of the government, depending on the transition details) along with numerous related ripple effects? Especially when the original vote for Obamacare was so close, and the public has never been fully behind the law? Maybe you can tell a story in which this happens, but it doesn't strike me as the most likely scenario.
No, the best way to understand Reid's comments is that he's a liberal, talking to liberals, and throwing progressives a bone while irking conservatives in a way that's essentially cost free.
But that doesn't mean there's no news here. The important bit isn't the single-payer innuendo, but the idea that Obamacare is only a "step in the right direction," and not "something that's going to last forever." Obamacare, in other words, isn't the be-all-end-all of health policy. It's an admission that Democrats believe the law is not enough, and a sign, arguably, that some now understand it won't entirely work. Reid isn't laying the groundwork for single payer—not really. But he's putting up cover for the law's potential failures, and warning, to anyone who will listen, that "fixes" will be coming down the line.