[My Thursday column from this week. I wrote it before the Supremes upheld the law, but this still applies if Mitt Romney wins and repeals the law.]
Throughout the last four years, whenever healthcare reform has reached critical mass -- either when it was in danger of failing or close to passing, big dumb Nebraska Senator Ben Nelson (D-In Name Only) has invariably shoved his bulbous skull into the mix and blurted out something unforgivably stupid. Part of the reason is the aforementioned "big dumb" thing I just wrote, and the other part is that Omaha is the insurance capital of America.
“Many expect an activist Supreme Court will strike down part or all of health reform,” Nelson said in a prepared statement. “If they strike down the mandate, the Supreme Court will be paving the way to a single-payer system, or back to the old broken health care system — neither of which are good for Nebraskans.”
First things first. The House Progressive Caucus is planning to reintroduce a single-payer law if the ACA dies today. That bill will predictably fail because there aren't enough votes, and the House is controlled by the Republicans who will rapidly poop all over it.
Next, single-payer would be fantastic for Nebraskans. And Iowans and Virginians and Texans and New Yorkers. Why? Because it would be a wildly affordable and accessible form of providing insurance for everyone. It would be more accountable to the people than a corporate insurance provider. Financially, it would have inimal overhead to maintain (Medicare's overhead is around 3-cents on the dollar), zero profit tacked onto the premiums -- essentially Medicare, but without the "over 65" part. And as near as I can tell, old people love Medicare so much so that they want government to keep its hands off the program. Doctors, prescription drug companies, medical supply companies and hospitals would remain autonomous (though fairly-regulated as they are now).
The only people who would lose in a single-payer system are greedy whores like Ben Nelson. Everyone else would fight to keep it once they discovered how inexpensive and accessible it was.
The other error in Ben Nelson's quote is less fun. No. Sorry. Single-payer will not become more likely if the Supreme Court strikes down the law today (as I write this at 5AM EDT, there's obviously still no decision).
History has proved that every time a healthcare reform effort fails, the next version is more conservative. LBJ's version was more conservative than Truman's (LBJ tried to reform the whole system, but settled for just the elderly with the creation of Medicare). Carter's was more conservative than LBJ's. Clinton's was more conservative than Carter's. And President Obama's law is more conservative than Clinton's. It's not because Democrats are becoming more conservative -- though some of them are. It's because repeated failure has naturally shifted the parameters of the reform ideas closer to what might actually pass. Clearly more liberal reform failed, so, the reasoning goes, there must be greener grass to the right.
That's not to say the new law is conservative by today's standards. There are liberal things about it (Medicaid expansion and subsidies) and there are conservative things in there, too -- ironically, the individual mandate is a conservative idea created by Republicans including Mitt Romney. Either way, the law is a massive achievement and not only includes significant reforms to the system, but it makes insurance more affordable while providing a superstructure upon which additional reforms can be added, such as a public option program which could eventually lead to single-payer.
I sincerely hope I'm wrong, but none of that will exist if the law disappears today. None of it. Single-payer won't become more likely. It'll be an even greater pipe dream. It'll be even more unattainable. The likely scenario is a far more conservative bill, perhaps offered up by the next Republican president or even President Obama in his second term, but probably not.
I hate to be a Debbie Downer about single-payer, but as much as I like the idea of it, there's just no way it gets past Ben Nelson's gigantic head -- or Joe Lieberman's gigantic head, and so forth. This is what some progressives (and Ben Nelson) fail to realize. When the ACA was about to become law, Jane Hamsher and others thought that if they managed to kill the bill, another law -- perhaps single-payer -- would take over. Okay, sure. 50 years from now. But in the meantime, 45,000 Americans will die every year because they can't afford insurance. That's a new 9/11 every month. The stakes are too high to play the idealistic long-game. Like the climate crisis, changing the system is urgent and immediate and the smart money is on this "Obamacare" law because it's opened the door to more reforms and, yes, that coveted path to single-payer.