Just a few hours after the House passed its replacement for Obamacare, conservative columnist Charles Krauthammer saw the future.
Krauthammer’s timetable is too aggressive, but in substance, he’s right. The path to single-payer national health insurance is clearer than it has ever been, in part because of the bill the House passed Thursday.
There are two reasons why, one political and one practical.
Republicans who support repealing and replacing the Affordable Care Act believe it’s a disaster.
We can argue with the specifics, but the critique is basically right: Obamacare is in serious trouble.
But the GOP has responded with a bill that’s even more doomed than the ACA. It has high-risk pools, tax credits, states setting insurance standards, all the rest of it. With an added bonus: It would kick 24 million people off their coverage, most of them poor.
Republicans who supported the legislation don’t see this, but they will if it ever becomes law. They’ll face a fierce backlash from voters as premiums still go up, policies are still canceled, procedures are left uncovered, and people die unnecessarily.
These problems are not fixable. They aren’t fixable in Obamacare, either, and for the same reason: It’s impossible to fully reconcile a public good — health care — with a half-public, half-private health insurance system.
It leads to a constant game of whack-a-mole. Fix one health care problem, and another pops up. Someone pays more, someone gets less.
Congress faces the prospect of tinkering with health care for decades with no solution in sight.
How to respond?
The government could get out of health care altogether. But, as Krauthammer and others point out, Americans now expect the government to provide a baseline of coverage for everyone.
They aren’t wrong to want this. They know the free market doesn’t really work in health care. No one lies in a hospital bed thinking about a cheaper alternative down the street.
So, if a free market in health care fails, and public-private systems like Obamacare or the GOP bill are unavoidable disasters, what’s left?
National health insurance would be simpler. Imagine a world without exchanges, pre-existing conditions, risk pools, surprise deductibles, high premiums.
Everyone is in. Everyone pays taxes for health care. It would be easy. It would also be ruinously expensive.
It could work only if the government capped costs, leading to the usual cries of socialized medicine, rationed care and substandard treatment.
But health care quality in America is already mediocre, on average, compared with other countries. And the House bill rations care; it just does so inefficiently.
In any case, single-payer health care would end half-measures like the ACA and the GOP alternative. As the current system continues to collapse, Medicare for all will increasingly seem like a viable option.
The politics are also clear. Democrats cobbled together Obamacare eight years ago under the assumption Republicans would join in.
No dice. The GOP hammered the ACA then and wants to repeal it now. That’s their right. They’re in power.
At some point, though, Democrats will have majorities in Congress and control the White House. The pressure for single-payer will be enormous.
As U.S. Rep. Kevin Yoder explained his indecision on the GOP bill, the Kansas Republican said he wanted to get it right. “If Congress fails, single-payer is knocking at the door, and we don’t like that,” he said.
Congress has failed. And single-payer is knocking at the door, whether Yoder or anyone else likes it or not.