Evolving Towards Universal Healthcare, Thanks To GOP Intransigence

Since I wrote on Thursday about Rick Perry refusing to implement a State health exchange in Texas as part of the Affordable Care Act’s reforms, a bunch of other Republican governors have followed suit. Both Politico and FDL note that in every case this will strengthen the federal government’s hand in future because the single federal exchange will step in to meet people’s needs.

And I have to wonder: do Republican’s realise these governors playing petty politics are helping the US system evolve towards the single-payer, universal healthcare system they are so sure they don’t want?

The federal exchange is going to have economies of scale – in both administration and purchasing clout – over any single-state exchange because it’ll be working with the same IT system for 30 states and the same negotiations on premiums over those 30 states worth of potential customers. In my ideal “It’s Saturday, not enough coffee yet, be utopic” world, the steps seem pretty clear.

1) Democratic governors announce they’re dropping their state exchanges to join the more efficient and more competitively priced federal one.

2) The federal exchange ensures that a government-run insurance, which has economies of scale in administration and doesn’t have to make vast profits, is cheaper than the private company alternatives, and everyone buys the government insurance.

3) The federal government says that since everyone is using the federal exchange to buy federal insurance, we may as well streamline and formalize the system.

4) Universal Healthcare.

Now, I’ve had my second cup of coffee so I figure at some stage Republicans will see the writing on the wall and start to figure out new blocking moves to scuttle this progression – but even so, I don’t see how that isn’t the evolutionary path eventually unless somehow they succeed in gaining the House, Senate and Presidency and then repeal the whole thing. Even so, I figure by the time the GOP can organise well enough to pull the three way win off, the ACA will be so imbedded they’ll “support” it in the same way conservatives in the UK “support” the NHS; that is, they’ll be able to cripple it some but not do away with it altogether without massive public outcry.

5 comments to Evolving Towards Universal Healthcare, Thanks To GOP Intransigence

  • Jeff Wegerson

    Remember that Vermont is working on its own statewide single payer system.

  • chalo

    There will be a growing number of people who, like me, make too much money to qualify for Medicaid, but too little money to buy coverage for less than 8% of their gross. That means a large and growing uninsured group under ACA.

    I reckon things go one of two ways:

    1) They’ll raise the percentage of your income you can be required to spend on for-profit health care.

    2) For-profit insurers will come up with products that fit into a moderately poor person’s 8% allowance, but don’t provide actual health care in practice, due to prohibitive co-pays and limited benefits.

    In either case, these measures will not address the core problem, which is that many folks just can’t afford health care because it costs too much in our profit-centric system.

  • nihil obstet

    I haven’t seen that programs naturally evolve rationally. There’s the post office, which does quite a good job, but has been so crippled by Congress (must pre-fund pensions for employees not yet hired, cannot run related services, et al.) that it’s supposedly constantly on the verge of collapse, and most people think UPS and FedEx are more efficient, not realizing that the private companies use the postal service to deliver over unprofitable routes. There’s municipal WiFi, which state legislatures are making impossible. There’s Medicare itself, which for most of the elderly, has become inadequate without a secondary insurance policy.

    One hangover of the New Deal is that liberals assume that you can start with a good policy and it will get better because it demonstrates its superiority. Over the past thirty years, it appears more true to me that you can start with a good policy, and corrupt legislators will kill it with a thousand cuts.

    I’d guess the for-profit insurance company would rather deal with the U.S. Congress than with 50 states anyway. Going national certainly benefited banks, and it will probably do the same for the insurance companies.

  • And if the “massive public outcry” isn’t heard before then…, it will certainly be heard when the “mandate” kicks in in 2014. I am thinking that Obama is a better chess player than many (including yours truly) gave him credit for.

  • Skriz

    I am not certain if it will play out in the manner you describe, but if our society survives (and that is a very big “if” at this point in time), I think universal, single-payer health insurance is inevitable. Just as you can’t build a functional interstate highway system by having 50 fiefdoms working independently, you cannot build a functional healthcare system for a highly complex and integrated society without going to one central administrative body.

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