I’ve indicated this in other topics, but seriously, the individual mandate is the only way to a universal health care system in which the government plays little part, so striking that down will leave the ONLY solution as a single-payer, government-managed system. I still think that universal health care is inevitable in this country, even if the ACA is overturned, and the only question in the event of an ACA repeal would be when the politicians - yes, even the obstructionist Republicans - would be able to muster the political will to advance HC reform legislation again.
But as I’ve also said before, the most likely route to true UHC in the US is going to be state-by-state adoption of single-payer. Just look at Vermont.
Well, yes. If we have single-payer, all government has to do is run a public-utility version of a not-for-profit insurance company. From what I hear from Canadians, that’s a whole lot simpler than anything we’ve got here in Jesusland.
The critical mass for health reform in the US isn’t the uninsured, it is the middle class who realize the best they can do in life is junk insurance that won’t cover anything when they get sick and that will leave them bankrupt.
The 50 million uninsured in the US are mostly made up of young people, immigrants and the poor. ie, people with very little political clout. Insuring them is seen as an act of charity by and large.
However a lot (a whole lot) of middle class people are realizing that even with a good education and hard work the best they can hope for is high deductible junk insurance with tons of loopholes. That is what is going to pressure the system to change. The 100 million or so underinsured. They are more politically involved, better educated and their opinions are more valuable to politicians than young people, the poor and immigrants.
So the overturning of the cost control and consumer protections (which would protect the underinsured) will backfire. However I don’t know if it’ll lead to a single payer system.
True single payer is a threat to private insurance companies, pharmaceutical companies, hospitals and physicians (because it can negotiate lower prices and because it will push private insurance out of the market). Those industries have way too much clout to ever be pushed aside by a single payer system.
If health reform is overturned we will probably just see another incarnation of a similar law in 10-20 years (same as Obamas health reform came about 15 years after Clintons and was pretty similar).
In 15 years, if current trends continue, it is reasonably safe to say that only 30% or so of employers will offer health coverage, employee deductibles and copays will be insanely high and all but the most elite 20-25% of the country will be able to say ‘I have reliable health care’.
So another stab at regulation, universal coverage, mandates, etc.
I totally agree with that. But I think the motive will be economics more than anything else. The guy who designed Vermont’s plan has designed and worked with plans all over the world. His predictions are about a 16-25% savings on health care over the next decade in Vermont depending on what kind of plan Vermont picks (the single payer, a public/private partnership, a public option to compete with private insurance). The single payer plan saves about 25%. In 2024 it will cost about $12,500 in health care to cover every citizen in Vermont if nothing is done. If single payer is enacted in 2014, by 2024 it will only cost $9,500 per citizen, a savings of 3k.
Other states like Montana, Pennsylvania, Illinois, California, etc have talked about setting up single payer systems. but I have no idea if they are serious or if that is just pandering to the base with no intent of passing the legislation the same way the GOP proposes laws on abortion they know will never be enacted to pander to their base. I’ve been assuming the latter (Vermont is the only state that seems to take the issue seriously. Maybe Montana too, but mostly just Vermont now).
I’ve often said, “The Republicans better watch out what they ask for because they just might get it.”
Repealing Obamacare isn’t going to solve any of the problems that led up to it. The crisis will continue to build until something has to be done. Then what?
Philosophically but not politically Obama might be fine if it gets struck down. It’s a patchwork bill that panders to the insurance companies who are a big part of the problem in the first place. It’s not what Obama and most intelligent people wanted but it was the best compromise they could get passed.
Strike it down and let the fun begin. Problem is, a lot of people will suffer in the meantime.
I live in California; our single-payer health care bill, SB 810, recently died (again) in the Senate. Still, the same senator has reintroduced the bill a number of times so I don’t doubt that he’ll give it another shot. Ironically, the senator who introduced the bill, Mark Leno, comes from San Francisco, the only city in the country (to my knowledge, there may be more) that already has a form of universal coverage in place.
Aside from Vermont, I don’t know how other states are proceeding with their single-payer HC plans.
The problem is how much is serious political legislation and how much is empty bills that nobody expects to pass that are just being brought up to pander to the progressive base? I assume the majority are just pandering bills, not serious bills.
The thing is, in our state, single-payer legislation HAS passed before; it was just vetoed by our last governor every time. Now, I remember reading an op-ed after the most recent defeat that the reasoning behind its failure to pass this time is that here in CA our legislators are too busy trying to successfully implement the federal overhaul, and there probably is an element of truth to that.
Unlike much of the country, there really isn’t any gridlock in CA insofar as enacting the provisions of the ACA is concerned. As the article states, the political will to do all of that is there, but the larger issue is whether the money is there. If the USSC throws out the HCRB, yes, we’re going to run into some serious problems in CA; I can only imagine in that event that we’ll either (a) continue implementing the federal law (somehow) at the state level, or (b) toss out everything, allow the problem to fester for a few more years, and then take a serious look at single-payer. By that time, Vermont’s system will have been up and running for a while, so we’ll probably just try to emulate that.
I don’t live in California, so I don’t really follow the events there.
But California still has a 25/15 democratic majority in the senate. However the last attempt to pass single payer failed because it was 19/15 with 6 abstaining.
Looking at wikipedia, the California state senate has almost always been 25/15 in favor of the democrats, at least for the last 10 years or so. So it isn’t like the makeup of the Califronia senate is changing drastically.
So yeah, the california democrats could pass single payer every session when they knew that governor Schwarzenegger was going to veto it. But now that they have a democratic governor the law can’t get the votes to pass the state senate, despite the fact that this was easy to achieve three separate times with a GOP governor who was going to veto it. Like I said, it sounds like pandering. I’ve heard the previous versions of single payer had no real funding mechanism. I don’t know if that is true, but if so it sounds like just passing an empty bill you know will not pass to win political points. Now that they actually can pass single payer since they have the governorship, they can’t get the votes (despite not having a problem doing this in the past).
Yup, I don’t disagree with anything you just said. I just have to think that there is some element of political calculus at work here; CA is moving forward with implementing the federal overhaul, so maybe if the ACA hadn’t have been passed by now and if there was no federal plan to enact in its place then our SP bill would have passed this time.
I know that there’s a significant aspect of pandering happening here; I just prefer to think that not everybody is being resoundingly disingenuous.
But this is politics, so everybody is a fuckin’ liar haha.
Aren’t there some more substantive nits to pick rather than what forum this belongs in?
Back to the OP, the idea of striking down Obamacare bring the guarantee of single payer just isn’t right, at least for the foreseeable future. Just like when Clinton’s health care reform effort foundered, it will be a long time before a future president will want to take on a massive overhaul of the system.
This is especially true if Obamacare is struck down and Obama loses re-election. I just can’t see any mainstream candidate wanting to charge in with a platform that says, “The problem wih Obamacare is that it didn’t go far enough!”
Considering that Congress evaded America’s Affordable Health Choices Act and the United States National Health Care Act, each of which were alternatives to the mandate, I’d say no.
Seriously? Universal single-payer healthcare will emerge from the rubble after ObamaCare is struck down? Seriously?
Hell, no; the political world will flee the whole topic as radioactive and Congress will gladly stand back while the all-seeing, all-knowing, all-benevolently wise Invisible Hand of the Market sorts it out, untrammeled by nanny-state big-government tyranny.
If only there were some mechanism for notifying the moderators…
I agree, but even if he wins re-election, how is he going to get Single Payer through the House? Then you’ve got the filibuster-prone Senate to deal with, even with the Dems in control.
I’ve said all along that I think this should be a state matter, and maybe that’s what would happen. Messy, but given our current system of government, I don’t see any other way.
I don’t see any indication from the GOP that their leadership or constituency even believes that the pre-ACA system had any problems that need to be solved, other than the pesky inability of the insurance companies to institute a Delware-style interstate pricing structure.
They don’t actually give a shit about making health care more affordable; hell, it looks to me like they think it’s too affordable as-is.
Yeah, even if he is re-elected, when I said nobody is going to attempt health care reform for the foreseeable future, I wasn’t talking about the next year or two… I’m thinking that Obamacare being struck down will probably push single payer healthcare out another 15 or 20 years.
When I say that striking down the HCRB will guarantee a single-payer system, I don’t intend to mean that that platform will somehow emerge out of the rubble within the next year or two, or Hell, even with the next few presidential terms.
What I’m saying is that, in the wake of the individual mandate being found unconstitutional, there is literally NO OTHER way to address universal health care in a manner in which private insurance is still at the center of everything. Yes, a deathly blow to the ACA will make health care reform absolutely toxic for the next 15-20 years, but by the health care industry is just going to get astronomically worse during that period without any intervention, so by the time some future politician or president decides to tackle UHC again, the only way to achieve that will be with a government-run single-payer system (because the private-based alternative would be unconstitutional).
