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A pair of articles theorizing that single-payer would follow any repeal of the Affordable Care Act popped up in my news feeds today. First, Ezra Klein posted an article on Vox titled Republicans are about to make Medicare-for-all much more likely:

“I will tell you,” says Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, “Democratic politicians I never thought would utter the words have mentioned single-payer to me in a non-joking way of late.”

If Republicans wipe out the Affordable Care Act and de-insure tens of millions of people, they will prove a few things to Democrats. First, including private insurers and conservative ideas in a health reform plan doesn’t offer a scintilla of political protection, much less Republican support. Second, sweeping health reform can be passed quickly, with only 51 votes in the Senate, and with no support from major industry actors. Third, it’s easier to defend popular government programs that people already understand and appreciate, like Medicaid and Medicare, than to defend complex public-private partnerships, like Obamacare’s exchanges.

In passing a bill that polls at 20 percent even before taking insurance away from anyone, Republicans will give Democrats a driving issue in 2018 and beyond — and next time Democrats have power, they’ll have to deliver on their promises to voters. Much as repeal and replace powered the GOP since 2010 and dominated their agenda as soon as they won back the White House, if the American Health Care Act passes, “Medicare for all” will power the Democratic Party after 2017.

Democrats have long been divided between two camps on health reform. There are the incrementalists who think, for reasons of both policy and politics, that Democrats need to build on the existing health care system and work with private insurers. And then there are the transformationalists, who think Democrats need to push the United States toward something approximating a single-payer system as closely as possible.

The crucial fact about this divide, however, is that many of the pragmatic incrementalists are philosophical transformationalists: They would prefer a Medicare-for-all system, but they haven’t thought it’s politically possible. Barack Obama is a good example. “If I was starting from scratch, I would have supported a single-payer system, because it’s easier for people to understand and manage,” he told Vox in 2016.

Obamacare was the test of the incrementalist theory, and, politically, at least, it’s failed.

Several hours later, Kevin Drum posted a follow-up piece on Mother Jones titled If Obamacare Dies, National Health Care Will Take Its Place, in which he basically says "Pretty much, yeah.":

This sounds pretty plausible to me. If passing a cautious, incrementalist program like Obamacare doesn’t provide any protection against Republicans destroying it, Democrats have no motivation to bother with cautious, incrementalist programs. They might as well just bend the rules, pass national health care, and be done with it. If insurance companies don’t like it, tough. Democrats contorted themselves into pretzels to design a program acceptable to insurers, and were rewarded with disaster. Insurers screwed up both their pricing and participation so epically that they brought Obamacare to its knees, and when Republicans proposed ditching the whole thing they just sat on their hands. It’s obvious now that the support of the insurance industry provides zero—or maybe negative—benefit. So the hell with them.

And that’s all in addition to the fact that the Bernie movement has made single-payer health care a live possibility in a way it’s never been before.

I agree with Ezra Klein, and I'd much prefer a single-payer system to anything like Obamacare.

Thoughts?

 

[HStallion]

Go for it Democrats. I know there are some big hurdles to clear besides just passing the bill but I think its something really worth fighting for.

 

[StrongBad]

Incrementalism is for cowards. What's the best way to take a band aid off? Xactly. I understand that there's a world of difference between healthcare reform and a band aid needing to be removed, but this is just prolonging the inevitable. There is no way to effectively reduce the cost of medicine and medical services in our system without a single payer. I still doubt that the GOP will get a bill through the Senate, though.

 

[Foffy]

Even David Frum said what the GOP is doing is forcing us into single-payer.

Have you noticed that certain members of the Republican party have been using the "socialized medicine" terminology lately? I bet some know the AHCA is gonna do massive harm and are trying to already negate a response to it.

 

[MrGerbils]

Only if the democrats grow a fucking spine!

 

[akira28]

after a freaking riot and a battle, yeah. probably.

 

[Trakdown]

The trouble is we'd have to have a democratic party with a super majority that has no interest in reaching across the aisle for it to even be discussed. I don't think the current party has that in them.

 

[Mammoth Jones]

Only if the democrats grow a fucking spine!

This.

 

[cdyhybrid]

Shouldn't we examine the fallout of the GOP ramming their bill through before we try to speculate on what it means for future bills?

 

[Dartastic]

These are terrible takes that gamble with the lives of millions. Not. Worth. It.

I do agree with this: " If passing a cautious, incrementalist program like Obamacare doesn't provide any protection against Republicans destroying it, Democrats have no motivation to bother with cautious, incrementalist programs. They might as well just bend the rules, pass national health care, and be done with it. If insurance companies don't like it, tough." however, we shouldn't let AHCA pass just to be like "See how shitty this is? Single payer!"

 

[StrongBad]

Shouldn't we examine the fallout of the GOP ramming their bill through before we try to speculate on what it means for future bills?

By and large single payer has better/more support than the current healthcare bill. The situations aren't the same at all.

 

[jay]

Only if the democrats grow a fucking spine!

The bigger fear than this is how many Democrats actually want this.

 

[pigeon]

Also, not repealing Obamacare at this point would still probably lead to single payer.

 

[cdyhybrid]

By and large single payer has better/more support than the current healthcare bill. The situations aren't the same at all.

Well yeah, and Hillary Clinton had more support for filling the office of President.

It's not as simple as a majority of people wanting it, especially if the government remains red.

 

[Maxim726X]

This.

No... No, it's a lot more than that.

Not that the jolt isn't needed, but you're talking about blowing up the entire insurance system in this country. Logistically, I'm not even sure it's possible.

 

[dramatis]

The trouble is we'd have to have a democratic party with a super majority that has no interest in reaching across the aisle for it to even be discussed. I don't think the current party has that in them.

Obamacare was designed, written, and rewritten multiple times with efforts to reach across the aisle and appease moderate Republicans, who ultimately didn't vote for it because of Mitch McConnell's strategy of obstruction.

Single payer wouldn't be an issue that we could reach across the aisle for, because Republicans are wholly adverse to it altogether. They wouldn't be the ones to want to discuss single payer! Your logic is confusing.

 

[Kevinroc]

The trouble is we'd have to have a democratic party with a super majority that has no interest in reaching across the aisle for it to even be discussed. I don't think the current party has that in them.

Republicans are rushing to pass AHCA without Democrats.

 

[Cesare Borgia]

Spoiler alert: it won't happen, it's not going to work nationally.

What's more likely to happen is a broader expansion of Medicaid (raising the income requirement to include more people), and an increase in reimbursement fees for hospitals.

 

[Iksenpets]

Yep. Moderate Dems can hold the line on "protect and expand Obamacare" so long as Obamacare exists, but if they're knocked back to square zero and have start over from scratch, there's no way they're going to be able to resist the pressure from the base to go full single payer. Or at the very least, single payer will be the baseline they're negotiating down from, the end result of which will still be way to the left of even the most progressive Obamacare proposals.

Not that any of this is good. I would rather work towards universal coverage through steady progressive reforms than giving the nation the whiplash of throwing things into chaos with repeal, and then amidst that chaos trying to build something pretty radical to fix it.

 

[Widdle Puppy]

Spoiler alert: it won't happen, it's not going to work nationally.

What's more likely to happen is a broader expansion of Medicaid.

single payer medicaid? medicaid for all?

 

[Zach]

I'll try to keep this in mind if that trash AHCA actually happens.

 

[SodiumBenzoate]

People forget it wasn't the GOP who removed the public option and a bunch of other ambitious policy from the ACA, it was Max Baucus, Joe Lieberman, Blanche Lincoln, and Mary Landrieu.

People like that aren't in office anymore.

 

[GoldenEye 007]

Incrementalism is for cowards. What's the best way to take a band aid off? Xactly. I understand that there's a world of difference between healthcare reform and a band aid needing to be removed, but this is just prolonging the inevitable. There is no way to effectively reduce the cost of medicine and medical services in our system without a single payer. I still doubt that the GOP will get a bill through the Senate, though.

Incrementalism traditionally has been the default. The US is an extremely slow-moving country and it has been dominated by that. To reduce it to "cowardace" is a bit disingenuous.

But yes with the shit going on now and a batshit insane GOP that doesn't give a fuck and anyone not a rich white human, the only answer can be a single-payer system. That has been accelerated now. 2018 is critical. Hope Democrats and liberals show up even if every candidate out there isn't 100% charisma.

 

[Dartastic]

People forget it wasn't the GOP who removed the public option and a bunch of other ambitious policy from the ACA, it was Max Baucus, Joe Lieberman, Blanche Lincoln, and Mary Landrieu.

People like that aren't in office anymore.

Oh, I remember. Fuck Joe Lieberman.

 

[Cesare Borgia]

single payer medicaid? medicaid for all?

Basically. A public option. It's less expensive than single payer and the infrastructure is already there. Increase income eligibility, change the name ("Medicaid" has a certain stigma to it), and make sure hospitals are getting paid decently for accepting it.

 

[DietRob]

Can someone please explain to me what 'Single Payer' is? I like to think I'm fairly knowledgeable but I've completely missed the boat on this.

I hear everyone talking about it like it's the holy grail so I'd like to understand it.

 

[TestOfTide]

I don't think it would lead to outright single-payer once Dems retake power unless by then you end up with numerous states already passing their own statewide versions of single-payer.

But I DO think that you will end up with a much stronger version of healthcare reform that will include:

- A Public Option for health insurance for those below the age of 65
- Stronger regulations on pharmaceutical companies
- A Public Option for many prescription meds
- Much, much tighter regulations on private health insurance that makes them function more like non-profit or not-for-profit organizations instead of for-profit
- Training/jobs program that increases the available size of the healthcare workforce
- Much Harsher Mandate that will work better with a public option available.

 

[BitStyle]

Only if the democrats grow a fucking spine!

Yep

 

[Trakdown]

Obamacare was designed, written, and rewritten multiple times with efforts to reach across the aisle and appease moderate Republicans, who ultimately didn't vote for it because of Mitch McConnell's strategy of obstruction.

Single payer wouldn't be an issue that we could reach across the aisle for, because Republicans are wholly adverse to it altogether. They wouldn't be the ones to want to discuss single payer! Your logic is confusing.

That's exactly what I'm saying. The Dems would have to be in control and not go down the road of asking what the Republicans think for single payer to properly be implemented. I don't know that they have them in, they always seem to want to do that to not seem partisan.

 

[pigeon]

People forget it wasn't the GOP who removed the public option and a bunch of other ambitious policy from the ACA, it was Max Baucus, Joe Lieberman, Blanche Lincoln, and Mary Landrieu.

People like that aren't in office anymore.

I mean, it was both. Every GOP senator had the opportunity to be the 60th senator and they declined.

Also, be fair to poor Blanche Lincoln, she threw her political career away to vote the ACA through. On the Dem side the blame belongs to Lieberman, who explicitly sent out a press release killing the public option when all the other Dems were lined up.

 

[StrongBad]

Well yeah, and Hillary Clinton had more support for filling the office of President.

It's not as simple as a majority of people wanting it, especially if the government remains red.

I didn't imply that it was. I merely stated that the two situations are different. The current iteration of Healthcare Reform being backed by the GOP is incredibly unpopular on all sides. They are ramming it through in spite of that. Ramming through legislation that is largely only opposed by lobbyists and politicians is a different can of worms altogether than what we are seeing today.

 

[Slayven]

People still going to die in the gap in between

 

[Kevinroc]

Can someone please explain to me what 'Single Payer' is? I like to think I'm fairly knowledgeable but I've completely missed the boat on this.

I hear everyone talking about it like it's the holy grail so I'd like to understand it.

Basically the Government pays for people to get healthcare. People can't be rejected for pre-existing conditions. People don't have to worry about going bankrupt over medical procedures. And it would be paid through taxes.

People still going to die in the gap in between

I feel articles like these are meant to try to give liberals something to look forward to because of the awful days that would follow the passage of Trumpcare.

 

[StrongBad]

Incrementalism traditionally has been the default. The US is an extremely slow-moving country and it has been dominated by that. To reduce it to "cowardace" is a bit disingenuous.

But yes with the shit going on now and a batshit insane GOP that doesn't give a fuck and anyone not a rich white human, the only answer can be a single-payer system. That has been accelerated now. 2018 is critical. Hope Democrats and liberals show up even if every candidate out there isn't 100% charisma.

There was a bit of hyperbole, but I should hope that Trump would cure that tendency for liberals. He got me to vote for Hillary.

 

[NoFaceNico]

It's a trap

 

[Snowman Prophet of Doom]

I've been saying this for a while. If Obamacare gets canned, why the hell would Dems not swing for the rafters instead of trying to bring it back?

Be exactly what the GOP claims we are instead of running away from it.

 

[TestOfTide]

Only if the democrats grow a fucking spine!

It's not so much that they need to grow a spine. It's that we as liberal and progressive voters need to prove in upcoming elections that they would win if they went with single payer on a national scale, because unfortunately while Cali and NY are showing headway in going for Single Payer, we don't really see evidence of it being popular elsewhere. Colorado voted against it 20/80 last year, for example.

 

[NH Apache]

Incrementalism is for cowards. What's the best way to take a band aid off? Xactly. I understand that there's a world of difference between healthcare reform and a band aid needing to be removed, but this is just prolonging the inevitable. There is no way to effectively reduce the cost of medicine and medical services in our system without a single payer. I still doubt that the GOP will get a bill through the Senate, though.

The country needs and, unless I mistake its temper, the country demands bold, persistent experimentation. It is common sense to take a method and try it: If it fails, admit it frankly and try another. But above all, try something. The millions who are in want will not stand by silently forever while the things to satisfy their needs are within easy reach.

Franklin Roosevelt about the New Deal
Address at Oglethorpe University, May 22, 1932

http://newdeal.feri.org/speeches/1932d.htm

Spoiler

Been watching House of Cards and this stuck out.

 

[hobozero]

I think there's a typo in the article. Should read "Repeal of the ACA would lead to Single Doctor"

Single remaining doctor pictured here:

 

[DietRob]

Basically the Government pays for people to get healthcare. People can't be rejected for pre-existing conditions. People don't have to worry about going bankrupt over medical procedures. And it would be paid through taxes.

Sounds like it would require a massive tax increase for everyone, right?

 

[Jibbajabbawockky]

It's not so much that they need to grow a spine. It's that we as liberal and progressive voters need to prove in upcoming elections that they would win if they went with single payer on a national scale, because unfortunately while Cali and NY are showing headway in going for Single Payer, we don't really see evidence of it being popular elsewhere. Colorado voted against it 20/80 last year, for example.

From what I've read, something like Single Payer is easy to get people in favor for on an abstract level. Like, in theory it sounds great. But depending on how you actually structure such a system, once you start putting actual concrete numbers in play and people look at how much such a system could cost in terms of taxes and so on, I think people cool off on the whole thing awfully quick- this little poll from CA shows that.

Its kind of like the Republicans right now- they had a great time for the past 8 years voicing opposition to Obamacare when they could talk in vague terms. But once it comes time to actually put something concrete on the table, its not so easy. I don't doubt it would be the same and then some with a national Single Payer system which would be far far more disruptive.

 

[cdyhybrid]

I didn't imply that it was. I merely stated that the two situations are different. The current iteration of Healthcare Reform being backed by the GOP is incredibly unpopular on all sides. They are ramming it through in spite of that. Ramming through legislation that is largely only opposed by lobbyists and politicians is a different can of worms altogether than what we are seeing today.

Yes, but you still need the seats to ram it through, which is what this is all about.

Spine has nothing to do with it.

 

[StrongBad]

Franklin Roosevelt about the New Deal
Address at Oglethorpe University, May 22, 1932

http://newdeal.feri.org/speeches/1932d.htm

Spoiler

Been watching House of Cards and this stuck out.

+1

 

[Kevinroc]

Sounds like it would require a massive tax increase for everyone, right?

It would require a tax increase, which is why it can be a hard sell.

 

[kittenbreath]

The thing standing in the way of single-payer is and always has been public opinion. In a nation where the incremental, market-based approach of Obamacare was instantly derided as "socialism" by half of the population, the idea that only lack of will stands in the way of nationalized healthcare is ludicrous.

That said, I do think that passing AHCA would be the sort of game changer that could make single-payer a reality. Having millions of people suddenly (and unexpectedly - I doubt many people who are at risk realize it yet) lose their health insurance would cause a political earthquake and open up enough space for the left to make their case, while energizing activists to pressure Democrats in the center. This is how radical change has historically occurred in the US: as a response to events which upset the normal political process and bring diverse interests around a common goal (hence, why it took the Great Depression to make the American welfare state).

People still going to die in the gap in between

Which is why no one should ever take the "single-payer or bust" crowd seriously. If you have the opportunity to save lives, you take it, even if the solution isn't perfect.

 

[n0razi]

Can someone please explain to me what 'Single Payer' is? I like to think I'm fairly knowledgeable but I've completely missed the boat on this.

I hear everyone talking about it like it's the holy grail so I'd like to understand it.

Basically socialized healthcare... get rid of Blue Cross, Molina, Aetna, etc... no more "shopping around" for healthcare, instead everyone just pays higher taxes and the government provides healthcare for everyone.

Pro: no more shopping around, simpler, less gotchas and fine print, everyone is covered

Cons: everyone is covered so higher chance of abuse, less competition could lead to less innovation

 

[Amir0x]

Incrementalism is for cowards. What's the best way to take a band aid off? Xactly. I understand that there's a world of difference between healthcare reform and a band aid needing to be removed, but this is just prolonging the inevitable. There is no way to effectively reduce the cost of medicine and medical services in our system without a single payer. I still doubt that the GOP will get a bill through the Senate, though.

Cowardice has nothing to do with it, and putting your commentary in this context makes your point seem comically juvenile as a result.

Incrementalism is about understanding how your system of government works and resolving to achieve your agenda despite the slow speed of your results.

 

[StrongBad]

Yes, but you still need the seats to ram it through, which is what this is all about.

Spine has nothing to do with it.

I thought you were talking about waiting to see what the political fallout would be re: the GOP ramming this through.

 

[Ziltoidia 9]

Oh man guys, don't wanna try for too much!

 

[The Greek Freak]

The DNC and Democrats in the U.S. are far too greedy and cowardly to actually give a real push for single payer like a first world country.

I'd love to be proven wrong but I just got off a decade of "liberals" acting like single payer is turning the U.S. into nazi Germany.

With democrat shitbags like booker? No chance.