Obamacare

Harry Reid Says Obamacare Just A First Step Toward Single Payer

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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.

credit: Center for American Progress Action Fund / Foter / CC BY-ND

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. 

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  1. Who cares what that geriatric old fucker thinks. He needs to retire and go home and take the rest of the old prune faces in congress, with him.

    There is one thing I will agree to support with my taxes. Build a nursing home and put these old prune bags in it, now, and lock the fucking doors!

    1. There is one thing I will agree to support with my taxes. Build a nursing home and put these old prune bags in it, now, and lock the fucking doors!

      Fuck that….they can live in tents! I think it would be fitting if they raised those tents in Harrys boyhood home of Searchlight.

      1. But when you set fire to the tent some of the might be able to get out.

        Personally, I’m more of a bag of rocks and a river type guy myself.

  2. Kill it. Kill it with fire.

  3. Oops, just a little mask-slip. First we pass a horrendous 2,000 page bill designed to destroy the American Health-Insurance industry. Then they ignore the Constitution and come to the rescue with single-payer.

    Hardly anything that hasn’t been suspected for a couple of years.

    1. Mask slip indeed. What thinking clump of cells hasn’t know this for the past 5 years??

  4. just because you don’t think it’s a good plan or understand the meta plan doesn’t mean it’s not a plan. who knows, part of the plan might be getting the benefit of the doubt from journalists.

  5. Peter, I think you’re giving this administration more credit than is due. I don’t think that the chances of success actually factor into the policy making process here.

  6. Well, our boondoggle is going to be a failure, so let’s set up the next boondoggle!

    The idea of scrapping the previous one never occurs, does it?

  7. Market failure!

  8. I don’t believe..There is no way they will cut off the crony capitalists at the insurance company. It will be the worst of both worlds: Insurance-involved socialized medicine.

    It would make too much sense to think they intended to fail upwards into single payer.

    1. Insurance-involved socialized medicine

      In short, Medicare, where the insurance companies act as “fiscal intermediaries” administering Medicare and offer supplemental policies on the side.

  9. 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…

    Sadly, yes.

    They were promissed their cheap, unlimited health care for everyone and they want it.

    The Dems will blame the GOP for obstructing the ‘repairs’ that need to be made. (They already are, haven’t you noticed.)

    —-

    Overall, however, Reid’s comments are the least surprising ‘revelation’ this year.

  10. Duh.

  11. I have long thought that the plan was to fuck up the entire health insurance industry so badly for the consumer, that after the endless demagoguing, the easily duped public would openly welcome socialized medicine.

    They’ll get it right this time, for sure.

  12. OK, Libertarian organizations, please get on the ball here. Obamacare is failing, even the GOP is offering a new plan, so what we need is a concise, easily explainable, palatable-to-moderates plan for a free market reform of health care.

    Do not make it purist, pie-in-the-sky libertarian. Make it incremental, some steps in the right direction. Boil the frog slowly, the way the socialists have for a century. But come up with a package of reforms that Rand Paul etc. can wave on the floor of Congress and talk about in the media. Yes, I know that you have done this before, but now’s the time to blow the dust off, update it a bit, and make some noise.

    1. There is no way to offer a low-payment, unlimited and unrestricted health care plan to everyone. Good old supply and demand says that, if the demand is not restricted, people will want unlimited quantities of a good or service.

      And there is no political way to sell people a plan that says “You can have X amount of health care, after that you are on your own.”

      1. There are numerous ways to make health care cheaper, and these days we are busy doing the opposite. For example, let people buy high-deductable, capped-benefit plans, but set up a large foundation for people whose needs end up exceeding their plans. Start it with a big chunk of tax money and then cut it loose and get celebs to have benefit concerts to fund it further. The idea would be to make a charity the focus for those now screaming that the government should fund health care.

        1. And you are going to have people screaming about “allowing granny/the poor/minorities die”, because no amount of charitable plan is going to cover everything that people want.

          1. You’re just full of helpful, positive suggestions today.

    2. a concise, easily explainable, palatable-to-moderates plan for a free market reform of health care.

      (1) No more deductibility for employer health insurance. Pair this with a rate cut so its revenue-neutral.

      (2) No more federally required minimum coverage, community rating, prohibition on underwriting, etc. Federal deregulation of health insurance, in short.

      (3) A federal law, consistent with the actual Commerce Clause, prohibiting states from blocking the sale of out-of-state policies on any basis other than the financial condition of the issuer. This is, effectively, federally mandated state-level deregulation of health insurance, and should sweep away state requirements for minimum benefits, etc.

      This will open the door to a robust national market for insurance ranging from bare-bones catastrophic all the way to full first-dollar coverage.

      1. Good plan. I was thinking along the same lines, except I’d make health insurance deductible for everyone, not just if it’s bought through the employer, but that’s just nearly the same thing done differently.

    3. Get rid of Certificate of Need

    4. Get rid of Certificate of Need

    5. “Do not make it purist, pie-in-the-sky libertarian. Make it incremental, some steps in the right direction.”

      Reform 1:

      The real purpose of ObamaCare is to cover all the losses providers suffer by treating people on Medicaid and Medicare.

      There is no reform of the rest of the healthcare industry that will cover the losses the system is taking from Medicare and Medicaid, so there are no solutions without reforming Medicaid and Medicare.

      Not libertarian pie-in-the-sky solutions? Okay, if you’re want to have a government welfare program for retirees, you need to means test it. Stop treating Medicare like it’s an insurance program and start treating it like a welfare program. Hell, in addition to the other benefits, taxpayers will start to worry more about the cost of the program and worry less about getting out in services what they put in.

      Reform 2:

      Designate a minimum number of ERs as free clinics–and let the hospitals that aren’t part of the government, free clinic network opt out of having ERs altogether.

      One of the problems we have with our healthcare system is that there is no private option. Hospitals can’t operate without an ER, and that means they can’t refuse to admit people who come through the ER and can’t pay. Once private hospitals are no longer bearing the burden of the losses they suffer from the government programs, they’ll do crazy things like compete on price and quality.

      1. #1: Yes. #2: Hmm, maybe.

        Also:

        – Allow nurses to do more of what doctors do.

        – Allow pharmacists to dispense drugs. (They could, up until the late ’40s.)

        – Reform the FDA and allow drugs to be sold (with warnings) that aren’t fully approved or are used for “off-label” purposes.

        1. YES regarding reforming the FDA. If you sign a waiver, you should be able to buy whatever the hell you want.

  13. “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?”

    Yeeesssss?

    1. How many ways to say….. Mistah Speakah…..Madam President!

  14. “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…”

    I don’t recall “the public” ever turning to Democrats in the first place. The Democrats manufactured a crisis, deliberately excluded everyone outside their party from the process, and rammed through a horrible law of dubious Constitutional standing without ever even reading it. Not that it matters what it says, because what they’re actually implementing is simply made up on the fly or rewritten at the whim of the President, no voting or discussion or congressional representation required.

    Given how we got here, is it really plausible that “the public” will be given a choice about what the Democrats decide do next?

    1. If the public were involved, do you really think that our selfless, wise and pure-of-heart electorate would have made the right decision? The public isn’t capable.

  15. “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.”

    Who says it has to work in steps?

    All it takes is one crisis–one “crisis”–and you can sell the American people the Patriot Act, the AUMF, massive surveillance of all of us–courtesy of the NSA, total war in Iraq, torture, denying American citizens a trial, not to mention assassinating American citizens…

    We’re one “crisis” away from single paper–and ObamaCare is a crisis waiting to happen! All we need is for what everybody expects is going to happen to ObamaCare–to actually happen–and it’s:

    Oh, we got trouble,
    Right here in River City,
    With a capital “T”
    And that rhymes with “P”
    And that stands for…whatever the president wants it to stand for!

  16. 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?

    Fuck yes it is. By this logic it wouldn’t have been plausible for the Democrats to pass Obamacare to begin with, because of their 150+ years of public policy fuck ups. It’s plausible to think that the public has it’s head up it’s ass when it comes to lawmaking, it always has and it always will. It’s how democracy works.

    1. “By this logic it wouldn’t have been plausible for the Democrats to pass Obamacare to begin with.”

      Exactly.

      Besides the Republicans are racists–and I can prove it! Why just the other day they fished some Christians out of the ocean from a boat they were sailing around–with their children–under God’s orders! Do you know Sarah Palin thinks she can see Hawaii from her back yard? And, besides, Christine O’Donnell was a witch in high school! Don’t you see? They want to shoot guns, and, like I said, that proves they’re all racists!

      Why would you let the racist Republicans save us from the insurance companies? It’s time for Single Payer now!

  17. Conservatives have long worried that Obamacare is just a stalking horse for an eventual single-payer health system.

    Considering Obamacare’s likelihood of success, it’s difficult to reach any other conclusion.

    1. Its not like this is the first time the mask has slipped, either. Hell, Dems were on the record before it even passed that this was the plan all along.

  18. 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.

    Hegelian Dialectic in action? Say it ain’t so, Sudserman. Say it ain’t so.

  19. In other news the Sky is in fact blue.

  20. “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.”

    Counting on the proponent’s incompetence to prevent a policy you oppose is not a sound strategy.

    1. When did you expect libertarians to have sound strategies?

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