The difficulties the Obama administration has encountered in implementing the Affordable Care Act has convinced at least some observers, mostly on the left but also at least some on the right, that the U.S. is headed for Medicare-for-all. The theory is that left-liberals will point to the ways in which Obamacare has been a bureaucratic mess and will ask voters to contrast the maddening exchanges with the (supposed) simplicity of Medicare. Peter Suderman of Reason disagrees, and he uses Noam Scheiber of The New Republic as his foil:
For one thing, [Scheiber] assumes that irritation with Obamacare—a law designed and implemented exclusively by Democrats—will somehow generate public support for additional Democratic health legislation that is even more sweeping. But judging by the beating Democrats have taken at the polls over last few months, public frustrations with Obamacare will turn the electorate toward Republicans. Democrats won’t be given a second chance, with a mandate to do even more.
Scheiber’s theory also overlooks how tough passage of Obamacare was in the first place—and how much support the administration had to get from health industry stakeholders in order to eke out a legislative victory. Single payer would be even tougher. Moderate Democrats who were nervous about Obamacare the first time around would be even less likely to support single payer, especially given how the law cost Democrats at the voting booth. And there’s no way that doctors, insurers, hospitals, and other major health industry groups would play nice with a single-payer push. Quite the opposite: Even beyond the insurers, much of the industry would see single-payer as a de facto nationalization of the health system, and they would fight the transition with everything they could muster.
Finally, Scheiber’s argument rests on the odd idea that individuals with private coverage will become jealous of people with Medicare and Medicaid.
I might be willing to believe that some people would prefer Medicare to private coverage, but Medicaid isn’t going to become a consumer favorite any time soon.
The question for Suderman is why Medicaid would be the more relevant frame of reference than Medicare for swing voters, and whether the single-payer partisans might prove more successful if they pursue an incremental strategy, e.g., if they advocate Medicare buy-in for older workers below the Medicare eligibility age to serve as a public option. The CBO has yet to score the Affordable Care Act in light of the various administrative changes we’ve seen in recent months, and in light of the very real possibility that the risk corridors program and other initiatives designed to shield private insurers from an unanticipated surge in expenditures. But if single-payer advocates are able to deploy projections which find that expanding Medicare will yield savings, whether or not these projections are borne out, they will have a powerful political weapon at their disposal.