Yesterday’s post on the decline and fall of the Vermont single payer experiment will be leading to a couple of long responses from me as there was a great discussion on building universal coverage and default enrollment schemes in the comments. I think single payer in this country will be extraordinarily hard to do because it is such a massive disruption of middle class and upper middle class lives. And those are the people who vote in disproportionally large numbers, so pissing them off is a great way to lose political power.
I also think that if PPACA is not gutted at the Supreme Court this summer, the groups that benefits from single payer will continue to shrink as more and more people will get and maintain either Medicaid expansion coverage or Exchange individual policy coverage. Single payer is hard. It is also not necessary for universal or near universal coverage as the rest of the OECD has examples of successful systems that produce better results, at less cost than the pre-PPACA cluster fuck and still better results at lower costs than the improvement upon status quo kludge that is PPACA.
JGabriel asks if continuing a campaign for a public option would be a good way to get single payer:
The most obvious answer – to me anyway, but I am not a health policy expert – would appear to be a public option that could become single-payer by default as more and more people began using it.
So, Richard, is a public option a viable route for transitioning to single-payer?
I don’t think a public option as passed by the House but disapproved by the Senate in 2009/2010 would lead to de facto single payer. I think in several states, such a public option would be the market leader, but in most states given the experience that we’ve seen in the 2014 and 2015 rate cycles, a public option as passed by the House with three votes to spare in 2009 would be an interesting choice but not a market leading choice.
I am only looking at public options that are no stronger than the 2009 House public option that passed with three spare votes. I think I am putting my thumb on the scale signficantly in favor of a public option with that qualification as it is as I don’t see a more liberal public option passing any chamber of Congress at any point in the next ten years.
Why is that?
Public options and single payer going forwardPost + Comments (19)
