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.