Thursday, June 15, 2017


Ezra Klein believes that if the GOP passes a health care bill, it will make single payer all but inevitable the next time Democrats control the federal government.
If Republicans unwind Obamacare and pass their bill, then Democrats are much likelier to establish a single-payer health care system — or at least the beginnings of one — when they regain power....

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.
Klein sees "a Democratic Party moving left, and fast, on health care," as the incremental approach to health care is discredited. He predicts this:
... if Republicans leave Obamacare gutted and the political arguments that led to it in ruins, there’s not going to be a constituency for rebuilding it when Democrats win back power.

Instead, they’ll pass what many of them wanted to pass in the first place: a heavily subsidized buy-in program for Medicare or Medicaid, funded by a tax increase on the rich. A policy like that would fit smoothly through the 51-vote reconciliation process, and it will satisfy an angry party seeking the fastest, most defensible path to restoring the Affordable Care Act’s coverage gains.
Yes, but if recent history is any indication, it's going to be a while before Democrats get the chance. I expect real Democratic gains in the House in 2018, but I'm not at all certain that Democrats will win a significant majority in the House, or even a small majority. The Senate seems out of reach because of the large number of red-state Democrats up for reelection. And in 2020 there's plenty of reason for hope of a Democratic victory, but no reason to be certain of one. Many Sanders voters might vote third party again if the nominee isn't Sanders or a substitute deemed acceptable. If Sanders does run, he might struggle to energy the non-white portion of the base. Other possible candidates might be too bland, too corporatist, too dark-skinned, or too female to win back enough heartland white voters for a victory.

Yes this could all be true even after four years of Donald Trump (or Trump followed by Mike Pence). And even if a Democratic presidential candidate triumphs in 2020, don't assume long coattails are inevitable, given GOP gerrymandering of House districts and widespread voting restrictions.

And even if Democrats seize control in 2020, don't assume a quick move to single payer. The Democratic Party is still full of incrementalists -- including possible 2020 presidential candidates such as Andrew Cuomo. In our system, Democrats still depend on money from corporate bigwigs -- are they all going to be willing to bring about the demise of the private health insurance industry? And there'll still be a right wing in America, with rhetorical skills and endless funding. Maybe some of the talking points that damaged the reputations of the Clinton and Obama health care plans won't work anymore, but don't assume they'll all fail. We're going to be talking about higher taxes. We're going to be talking about something that can be described as "command and control." In the insurance industry at least, this will literally be "job-killing." And the popularity of Sanders notwithstanding, there are still plenty of people in America for whom "socialism" is a very bad word.

So let's not assume the Trump/Ryan/McConnell health care disaster will have a happy ending in the long term. It could, but that's not inevitable.

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