We might end up with single-payer healthcare, whether we like it or not
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While Republicans fret over how many taxpayer-funded patches they will have to stick on ObamaCare to keep it on life-support, Democrats are already moving on to their real goal: a government-run, single-payer healthcare system.

Moderate Republicans like Sen. Lamar AlexanderLamar AlexanderAuthorities link ex-Tennessee governor to killing of Jimmy Hoffa associate The Republicans' deep dive into nativism Senate GOP faces retirement brain drain MORE (R-Tenn.) are hoping to find bipartisan support for legislation that will save the individual (i.e., non-group) health insurance market and keep the ObamaCare exchanges from collapsing.

Of course, with enough taxpayer bailouts, you can probably keep any sinking ship afloat for a while.


But it’s not clear Democrats really want a short-term fix because they increasingly see the collapse of ObamaCare, and the uncertainty swirling around it, as an opportunity, not a failure.


They believe they benefit from the current health insurance turmoil and Republicans’ feckless efforts to fix it — and they’re probably right. The more people grumble about a dysfunctional health insurance system, the more willing the public is to throw up its hands and embrace a single-payer program — and Democrats are already setting that stage.

To be clear, while some Democrats’ single-payer proposals are limited to specific populations, they are only the first steps. Their goal is to force everyone into government-run healthcare — including the 155 million workers and their dependents who have employer-provided coverage.

Those with employer-provided coverage have been much less negatively affected by ObamaCare’s changes than those in the individual market. But single-payer advocates’ goal is to have everyone in the system, which means ending all employer coverage. At least we won’t be told the now-proven lie that if you like your health plan you can keep it.

Democrats may appear to be interested in a short-term effort to “stabilize” the health insurance exchanges, but no one should be fooled. If the exchanges fail, Democrats and their echo chamber in the media will just blame Republicans and President Trump — even though health insurers, including United Healthcare, began their exodus back in 2015.

Alexander might argue that stabilizing the market with bipartisan support would reduce the pressure for a single-payer system. The problem is ObamaCare’s individual health insurance market cannot be stabilized because Democrats ignored long-standing actuarial principles when they created it. 

It’s unclear at this point what Trump and Republicans will do when they return to Washington in September. 

Recent news stories have focused on whether the president will continue making the cost-sharing reduction (CSR) subsidies, which lower the out-of-pocket costs for lower-income participants. He has said he will do so for August, but he’s made no further commitments. That decision is hampered by the fact that those payments are unconstitutional because Congress never actually appropriated the money for the CSR subsidies.

If the country is going to have a major debate over shifting to a government-run, single-payer system, it’s probably better to have it sooner rather than later, while people can still recall the days before ObamaCare when, although not perfect, the individual health insurance market worked reasonably well for the vast majority of people.

The longer we wait, the worse and costlier ObamaCare will become, making a single-payer system look like a reasonable, and perhaps the only, alternative.

Merrill Matthews is a resident scholar with the Institute for Policy Innovation in Dallas, Texas. Follow in on Twitter @MerrillMatthews

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