EZRA, DON'T ASSUME THAT THE ARC OF THE HEALTH CARE UNIVERSE BENDS TOWARD JUSTICE

Ezra Klein is one of those Beltway insiders who think that if the Supreme Court overturns the Obama health care law, single payer could well be what replaces it. That prospect doesn't fill him with joy, because he thinks it will happen slowly if it does happen, and a lot of people will remain uninsured before we get to the Promised Land. But he thinks it's quite reasonable to expect that we'll get to the Promised Land someday:

If the individual mandate is overturned, it will essentially wipe out the only plausible path to a sustainable private health-care system and single payer will be the eventual result. So: Yippee?

Not in my view. I think that path would look something like this: With health-care reform either repealed or overturned, both Democrats and Republicans shy away from proposing any big changes to the health-care system for the next decade or so. But with continued increases in the cost of health insurance and a steady erosion in employer-based coverage, Democrats begin dipping their toes in the water with a strategy based around incremental expansions of Medicare, Medicaid, and the Children's Health Insurance Program. They move these policies through budget reconciliation, where they can be passed with 51 votes in the Senate, and, over time, this leads to more and more Americans being covered through public insurance. Eventually, we end up with something close to a single-payer system, as a majority of Americans -- and particularly a majority of Americans who have significant health risks -- are covered by the government.

He loses me early. Why does he assume that Republicans will "shy away from proposing any big changes to the health-care system for the next decade or so"? When have Republicans shied away from seizing any issue and trying to drive the public's sense of what's "reasonable" on that issue as far to the right as possible?

And I guess Ezra's not defining the right's health care wish list -- which is focused primary on "tort reform" and buying insurance across state lines, as well as turning Medicare into a Ryan-esque nightmare -- as a set of "big changes." I think these changes would be huge. (Read Steve Benen, in particular, on why the purchase-across-state-lines provision would be awful.) And I think Republicans will eagerly try to sell this package -- or possibly just ram it down our throats -- as soon as they seize the White House and both houses of Congress.

If they don't get control of the government for a while, they'll just keep telling us about the wonderfulness of their "reforms" and assure us that they add up to FREEDOM!!!1! They'll also say that our proposals -- yes, even the small, incremental ones Ezra talks about -- add up to full-throttle socialism and fascism and dictatorship and tyranny.

If Obamacare is overturned and Democrats manage to poke their heads out of their mole hole in a few years and take baby steps toward expanding Medicare or S-CHIP, Republicans will declare even that to be a "government takeover" of health care -- and if Democrats respond with their usual wonktastic, bloodless talking points, Republicans will win the day again. OK, maybe Democrats will learn how to message the next time around, but their learning curve has been slow to nonexistent over the past few decades, so I'm not holding my breath.

You'll say I'm forgetting one thing -- public anger. Won't the public demand a solution?

Well, I'm 53 years old, and the last time I remember Heartland America sustaining a sense of outrage on an economic issue until progressive change happened was ... um, frankly, I can't remember that ever happening in my lifetime.

Heartland Americans have lost so much in the past few decades -- unions, defined-benefit pensions, good salaries -- and they've never fought back. The only fight they've mounted is against progressivism. The right has them permanently angry at us.

Don't like the gloom in this post? Then go out and find a way to get heartlanders angry at the right people for a change. Then maybe the arc of health care will bend toward justice.