Most people, including myself and Barack Obama, would concede that single-payer, probably financed by a VAT, would be the way to go if you were designing a national health care system from scratch. We aren’t; every American has a vested interest of some sort in the current system. And so, the questions for today are:
- Will the Democratic platform in 2020 include single-payer?
- Should the platform include single-payer?
My thoughts on this are as follows:
- It depends largely on how successful the Republicans are in dismantling Obamacare. I have seen quotes from multiple GOP members of Congress to the effect that Obamacare repeal is necessary to stave off single-payer, but that strikes me as being exactly wrong; if Obamacare is destroyed, the Democrats will have no compelling reason to stay wedded to it, and are much more likely to go straight to single-payer.
- Remember the failures of the Clinton health care plan, the problems getting Obamacare though the system with large Democratic majorities, and even the difficulties the GOP is having with Obamacare repeal today. Then consider that single-payer would be opposed ferociously by: (a) virtually all of the GOP; (b) the insurance companies, who would be losing a huge amount of business; (c) most health care providers, whose negotiating leverage would be diminished; and (d) millions of Americans with employer-based plans, who might well wind up with a plan that is worse than the one they have today.
In short, a pure form of single-payer, based on our historical experience, is a pipe dream, and a more plausible incremental version of it (such as the public option) is not really single-payer. Regardless of the views of the Democrat nominated in 2020, in the real world after the election, the debate is going to be about a much more moderate program than true single-payer. And that’s OK with me.