March 28th, 2012

The plan: from Obamacare to single payer?

I’ve long thought that Obamacare was just a prelude to what Obama and the left really want, which is single payer health insurance. Obamacare was an unwieldy compromise, complex and cobbled together and passed because it could be done, whereas single payer’s time had not come. Yet. But Obamacare had the added plus of being so potentially problematic to the private health insurance industry that it might indeed lead to that entity’s demise, to be replaced by single payer.

In addition, I’ve long admired retired blogger Steven Den Beste’s acumen, and I’m happy to see him writing again about something other than anime. But although I’m in agreement with some of what he says here about Obamacare and single payer, I’ve got some disagreements, too.

Den Beste writes that Obama actually wants the mandate to be declared unconstitutional yet severable, because then:

That makes private health insurance economically unviable, and the insurance companies will all exit the business or they will go out of business. At which point the Democrats will try to implement “single payer”, a total nationalization of the entire health care industry, financed by a huge rise in taxes.

Single Payer is what they always wanted. The bill wasn’t originally written that way, though, because they knew that even with twin Democratic majorities, there was no chance of passing it. So they included the mandate instead.

So far that’s in line with what I think, although I don’t believe that Obama and the others thought in advance that the bill would be challenged in the Supreme Court; my sense is that they thought it would lead to single payer ultimately, without that detour along the way. But once the obstacle was thrown up it wasn’t seen as insurmountable, because it could also wind up leading to the ultimate goal of single payer.

More of Den Beste:

If the mandate is struck down, then Congress will have to act. There won’t be any way to repeal the rest of the law because Obama will veto, and the Senate will sustain the veto. The only thing he will agree to is implementation of single payer.

This is where I disagree, at least sort of. It was always clear that, unless the Supreme Court struck down the entire bill (which I don’t think most people ever considered tremendously likely), Congress would be faced with the question of repeal, now or later. That doesn’t change if the mandate is found unconstitutional but severable; Congress is still faced with the task of what to do.

But why would Congress have to act in the few months left before the 2012 election? What’s the big rush? Repeal could be used as a huge issue in the election, both for members (and prospective members) of the House and Senate and for the presidential candidates.

Obama would be forced to take a stand on a bill that’s become increasingly unpopular, and his opponent (yes, even if it’s Romney) would run on the idea of repeal, and indicate that Obama, if re-elected, would be likely to veto any repeal. My prediction is that then, just as in the 2010 election, candidates who would run against Obamacare would be likely to be elected, and Republicans would do quite well in Congress. That would set the stage for a repeal under a Republican president who would not veto it—or at the very least, a defunding.

30 Responses to “The plan: from Obamacare to single payer?”

  1. Conrad Says:

    Maybe what Den Beste describes represents some Dem strategist’s view of a good fallback position if the Court strikes down Obamacare, but I don’t think it makes a lot of sense in the real world. If Obama and Pelosi had the votes for single-payer, they would have enacted single payer in 2010. If the Court nixes the mandate but leaves the rest of Obamacare untouched (which now doesn’t seem so likely anyway), Obama cannot realistically get single-payer through this or the next Congress. The idea that he could get single-payer enacted by refusing to sign any other legislation that would fix the gaping hole the Supreme Court will have put in Obamacare is equally farfetched. Remember that Obama promised everyone that the ACA would not take away whatever existing health plan they had. It would only supposed to extend coverage to people who couldn’t afford it, or were being denied coverage for various reasons. He can’t very well say to the American people that the unconstitional mechanism employed by Obamacare to extend coverage to the uninsured now means that every private insurance company in America is about to go bankrupt, and therefore we have to scrap the whole HC system (which 80% of the country was happy with) and implement a fully government-run alternative. He’d be run out of D.C. on a rail.

    Frankly, I’m not sure how Obama can bounce back if the Supreme Court goes against him. If they declare the whole ACA unconstitutional, then Obama will be deprived of his signature accomplishment. Combined with the debt crisis he will have hastened to bring about through the so-called stimulus, it’s going to make his whole term in office look massively misguided and counterproductive.

    If “only” the mandate is struck down, I suppose one possible, if risible, response would be to declare that “it’s only a flesh wound” and that ACA still holds within its pages loads of other wonderful, free goodies for the American HC consumer. But this is problematic because America understands the mandate was the linchpin of the whole Obamacare reform scheme. And it would do nothing to erase the impression that Obama had foisted an unconstitutional scheme on the American people in the first place, manifestly against their will. I just think there’s too much water under the bridge on this issue for him to convince people that the striking down of the individual mandate is just a minor setback for the Dems’ vision of responsible HC reform. And, realistically, the insurance companies and the government WOULD have to deal with the hole this left in the legislation sooner rather than later.

    It would also hurt Obama indirectly by strengthening Romney’s candidacy. “True” conservatives wouldn’t have to worry about whether Mitt really intended to repear Obamacare or not, and it would implicity validate Romney’s point that an individual mandate at the federal level is a different kettle of fish than a state-level mandate.

  2. JuliB Says:

    IIRC, didn’t the dems put that it was not severable in the whole law? This way, their favorite programs couldn’t get axed individually.

    I can’t imagine that Obama thought we wouldn’t challenge it in court!

    In related news, Alabama (their AG?) joined in the lawsuit against the feds started by EWTN. The birth control mandate (for lack of a better shorthand phrase) has many groups considering lawsuits.

  3. Conrad Says:

    @ Julib: I don’t think they put in that it wasn’t severable. I think that they failed to put in a provision stating that it was severable, which provision is often included in legislation. From what I’ve read, the failure to make the provisions of the bill expressly severable was intentional, not simply an drafting oversight.

  4. Occam's Beard Says:

    When did “socialized medicine” become “single payer?” Was it about the time “tax increases” became “revenue enhancements?”

  5. Don Carlos Says:

    Anyone who thinks Obamacare was cobbled quickly together as a bunch of compromises is flat wrong. This was put together piece by piece over a period of some years and stashed until the time to strike (the recent anti-Limbaugh campaign was conceived two years ago, and pounce they did when that time was right). The Left has the Long View. They are experienced chess players, indeed masters, who see moves and moves ahead, identifying responses to those moves before they make their next move. Conservatives play checkers in an old country store. The Left never quits and is extraordinarily hard to kill. It must be regarded as a most powerful adversary.

    The whole saga of Progressivism has played out over the past 100 years, to where we are today, struggling against the merciless, the bullshitters, the propagandists who have done extremely well, better than they likely expected, in their campaign to take the USA from the inside.

    SCOTUS this week reveals the depth of our degradation. Most of the Justices are not acting as judges, but politicians. There is no basis for optimism. They will find their ‘penumbras.’

  6. OlderandWheezier Says:

    Conrad: According to the following, severability was intentionally removed from the bill:

    As I mentioned yesterday, the only judge to rule against the government on severability in the ACA litigation was Judge Roger Vinson, of the U.S. District Court in Florida. He was reversed by the 11th Circuit. Vinson argued that the intent of Congress was clear as the ACA did include a severability clause at one point, which was later removed. Vinson contended that showed clear intent to make the ACA rise or fall on the fate of the individual mandate.

    found at policymic.com

  7. Occam's Beard Says:

    This was put together piece by piece over a period of some years and stashed until the time to strike (the recent anti-Limbaugh campaign was conceived two years ago, and pounce they did when that time was right).

    Don Carlos is right on the money, as usual. The bill was substantially drafted by a shadowy Red outfit in SF, the name of which escapes me at the moment. Art, do you recall the name? IIRC, the article indicated that they’d had the guts of the bill essentially sitting in a drawer, waiting for an opportune time to dust it off.

  8. neo-neocon Says:

    Don Carlos: I never said it was written quickly. It was cobbled together quickly, however, from pre-existing proposals that were ready to go, written earlier by policy-makers on the left, with the addition of things like the cornhusker’s kickback.

    I am also sure the left had and still has many proposals for single-payer—and perhaps other plans as well—ready to go. This particular plan that became the HCR bill was a pastiche that was considered the one with the best chance of passing, IMHO.

    There is nothing so especially unusual, by the way, about politicians on left or right having policy plans and policy proposals ready to go. What was particularly unusual about HCR was that it was raced through the usual processes for give and take and debate on such a large and sweeping bill. And this was no accident, either.

  9. Parker Says:

    ‘Obamacare’ was indeed a patchwork quilt of proposals sitting in dusty boxes dating back to ‘Hillarycare’. That is its most damning feature. It like choosing to kill a fly on the wall with number 6 birdshot instead of picking up the fly swatter. The fly is dead but there is much to repair and a lot of plaster dust to sweep up.

    I think we have to re-think healthcare and hope this monstrosity is first stymied by a ruling that the individual mandate is unconstitutional and then the various pieces of the quilt are scattered to the wind. Healthcare reform is needed, but it must be straightforward and left to the states; not DC.

  10. Michael Adams Says:

    Not exactly off topic, no matter what anyone thinks: Santorum lost my support precisely because he revealed himself to be such a poor chess player. There may have been times when a Biden-of-the- Right could blunder along. There might be, some day, again. We are not living in such times. The saddest thing about losing Breitbart, for anyone outside his circle of family and friends, was that he played the Long View so very well.

    Look at how the Left so shamelessly screams about Trayvon Martin. They shout the lie, three days after the true facts have leaked out. Everything that a future President might attempt to do will be created by a shrill chorus of irrational opposition, because reasoned argument would not work for their intended purpose.

  11. Curtis Says:

    They are experienced chess players, indeed masters. . . CAN YOU SAY SATAN?

    Kidding, c’mon, let’s be rational about SATAN.

    Seriously, I was listening to Krauthammer’s Oct 11, 2011 address to the Hillsdale Constitutional celebration and he made a point at the end of his speech how if there is ever a choice between conspiracy and incompetence, the latter wins every time. So, who are the grand chess masters hidden from view?

  12. Michael Adams Says:

    Oops “Created” should read “greeted.” Sorry

  13. Curtis Says:

    That first line, Michael: a classic.

    “Not exactly” followed by “no matter what anybody thinks.” That is certainly a way to certify uncertainty.

  14. Curtis Says:

    What to say everyday to the liberal in your life:

    Your opinion is wrong! Wrong, I say. Wrong.

  15. Occam's Beard Says:

    I hate to say it, but the key to reducing health care costs is … to cut Federal funding for biomedical R&D, specifically the NIH.

    New treatments are invariably expensive, because the costs sunk in their development by the innovative company have to be amortized over the five years or so of patent life typically remaining after a drug is FDA approved. (The situation is not generally as severe for medical devices, but the same considerations obtain.) Moreover, most of the new therapeutic options add a bit more time on the end of a person’s life; relatively few are Salk/Sabin vaccine-type breakthroughs that essentially eliminate a pathology.

    If the pace of biomedical innovation were slowed most of the therapeutic options would be in the public domain, and therefore cheap, their developments costs either previously paid off or eaten by their sponsors.

    In contrast to many citizens of other countries, every American (including me), perhaps as a function of our individualism, wants and expects heroic efforts to save his life, regardless of expense, or any cost-benefit consideration (i.e., cost per period of life extension, and quality of life thereof).

    I’m not necessarily advocating this (sometimes I would, sometimes not, in candor), but pointing out that biomedical innovation peculiarly drives medical costs in the U.S. much more than in other countries (because other countries buy medical technologies on a cost-plus rather than market value basis, and can do so because companies of whatever nationality recover their R&D costs in the American market).

  16. Artfldgr Says:

    But why would Congress have to act in the few months left before the 2012 election? What’s the big rush?

    all the crap they are holding back with games and such will finally bubble by then…

    and if you think their games playing with the realities of a percentage of americans which puts them in opposition to others is nasty. well, add it all up with the other stuff, like bounties, random acts, rising prices but inability to raise welfare to meet them causing a big problem, and so on..

    the boy with his finger in the hole in the dike cant stand there forever…

  17. Mr. Frank Says:

    If the Supreme Court kills Obamacare, we will have dodged a bullet. Another two Obama appointments to the Court could change America forever. That’s his objective.

    What we need to do is get behind the Republican candidate for president even if we have to hold our nose. All the talk about a candidate not being conservative enough or exciting enough is playing with fire.

  18. Pat Says:

    If there was a plan to go from Obamacare to single-payer, aka Medicare for everyone, then it is now dead in the water. If SCOTUS rules any part of Obamacare unconstitutional, the whole thing goes into limbo. I agree with Neo: Nnthing can happen without the House and the House won’t move before the election. Why should they? SCOTUS killing Obamacare is a great election issue. It destroys the idea that Obama, the constitutional scholar, is actually competent.

    But we cannot count this SCOTUS out. Kennedy remains a wild card. On the other hand, one of the lefties, seeing the writing on the wall, may jump ship. I suspect poll-watching is going on inside SCOTUS.

    I work in Healthcare IT. I don’t actually care much about the business stuff; I’m more interested in technical stuff like connection pooling, browser independence, performance tuning and managing the quality of off-shore programmers. But it is remarkable how much of our 2 million lines of code (and that’s just one application among hundreds) has exceptions to deal with Medicare. Obamacare would make our lives unbearable. The problem is how much is left up to the discretion of bureaucrats. Until the discretion is exercised, we don’t know what we need to do to stay compliant. And we can’t rush stuff or we won’t be SOX compliant.

  19. J.J. formerly Jimmy J. Says:

    Universal health care. Sounds so good. Everybody gets health care when ever they need it. And it’s free. Wow, utopia, right?

    Not so fast my friend. I experienced a form of universal (government provided) health care when I was in the Navy. I’ve related far too many of my life stories here already, so won’t bore with more. I can tell you medical horror stories, stories of poor medical practices, stories of long waits, etc. The incentive to excellence that we find in our private medical care just does not exist in military medical care. There are individuals that try hard but somehow the care becomes bureaucratized and mediocre as a result. Yes, they have advanced severe trauma care and battlefield procedures to an amazing level. But the post operative, recuperative care can be sub par, even indifferent. Remember the big brouhaha over sub-par care at Walter Reed some years back? Didn’t surprise me. Routine care is not that great. Dependent care is atrocious. Especially for children. I could go on, but that should be sufficient to get my point across.

    What I’m saying is we need to fight to get rid of Obamacare and especially to keep it from morphing into universal or single payer care. A Republican Congress and a Republican President will be a good start in that direction no matter what the Supremes do.

  20. Don Carlos Says:

    O.B’s anti-NIH has merit. But I would also gut and reshape the FDA, with its new mission being to encourage new drug development and expedite approval. Stop invoking the Thalidomide defense, FDA. Stop the onerous, burdensome and actually sometimes immoral clinical trials; trial after trial; and eliminate the barriers to ‘off-label’ prescribing.

    The cost of drugs and devices is a modest fraction of overall health care costs. There are ‘providers’ (a word I despise) and hospitals to consider. The present reimbursement schemes make price-based competition impossible. Price-based competition is the one criticality to lowering health care costs. If the measurable outcomes are the same, but ‘provider’ A does it at half the cost of B, or in a shorter treatment span, who you gonna call?

  21. Artfldgr Says:

    Art, do you recall the name?

    no… not at the moment…
    ya got the drop on me :)

    had to do some looking..

    “Red Army: The Radical Network that must be defeated to save America” by Aaron Klein and Brenda J. Elliott

    and so i would guess your referring to George Soros – Economic Policy Institute…

    also mentioned
    Alliance for American Manufacturing
    Campaign for America’s Future;
    Apollo Alliance

    I haven’t read the book or do i plan to…

    dont bother going to the wiki, a search will show you that the wiki copies the Economic Policy Institute websites text.

  22. Don Carlos Says:

    Curtis:
    One need not invoke a Soros as a grand chess master, though he is a snake. There are many masters of the game; they sit in the House and Senate, Federal and State, governors, judiciary, the various Departments; they people the Federal bureaucracy in their tens of thousands, all tenured by Civil Service rules. And they talk and plan and collude and act; of course they do! That is their chess-playing.

    It is a long game. It started here before Woodrow Wilson, it is still being played, and I submit most of our pieces are no longer on the board. GW Bush was a poor player of the game; the DOS civil servants clearly run the show at State, for example: bring 50000 goat-herding Somalis in, put ‘em in Minneapolis, on the dole, etc., etc. Why, for Pete’s sake? Well, to weaken us from within. They surely do not strengthen our national balance sheet.

    Clinton fired ALL US Attorneys on taking office. Alberto fired five, and he and W were utterly unable to cope with the Left’s vigorous response.
    That’s the game we’re playing.

  23. Artfldgr Says:

    So, who are the grand chess masters hidden from view?

    interesting question, and by definition, we would not know (as they are hidden).

    but everyone knows the answers to that, they just ignore it. Go read the list of the people who are part of the CFR (and its twin in the UK), the Trilateral Commission, Bilderberg (who just got together)…

    the people there kind of get their ideas aligned and then go out and kind of push in the same direction as they are in agreement where things should go and so do their part…

    he earliest origin of the Council stemmed from a working fellowship of about 150 scholars, called “The Inquiry”

    The Inquiry was a study group established in September 1917 by Woodrow Wilson to prepare materials for the peace negotiations following World War I. The group, composed of around 150 academics, was directed by presidential adviser Edward House and supervised directly by philosopher Sidney Mezes. The Heads of Research were Walter Lippmann, who was later replaced by Isaiah Bowman.

    Mezes’s senior colleagues were geographer Isaiah Bowman, historian and librarian Archibald Cary Coolidge , historian James Shotwell, and lawyer David Hunter Miller.[1]. Progressive confidants who were consulted on staffing but who did not contribute directly to the administration or reports of the group included James Truslow Adams, Louis Brandeis, Abbott Lawrence Lowell and Walter Weyl.

    Also included in the group were such academics as Paul Monroe, a professor of history at Columbia University, was a key member of the Research Division who drew on his experience in the Philippines to assess the educational needs of developing areas such as Albania, Turkey and central Africa,[3] and Frank A. Golder, a history professor from Washington State University specializing in the diplomatic history of Russia, who wrote papers on Ukraine, Lithuania, Poland, and Russia.

    Walter Lippmann.. the man who thought the press should tell us what to think not tell us facts? the man who invented the “cold war”?

    Noam Chomsky and Edward S. Herman used one of Lippmann’s catch phrases—the “Manufacture of Consent”– for the title of their book, Manufacturing Consent, which contains sections critical of Lippmann’s views about the media.

    it was they who started it all and still meet and decide the fate through Manufacture of Consensus…

    the book public opinion is an interesting read…

    if you look up the others, and who else was involved (also involved in the UN) and many accused of helping that funky Austrian come to power… while others were very influential in changing our whole society based on ideas that were shared there…

    the idea that if one cant find a child’s idea of rulership that could function across the sea of billions there must be none is not logical.

    in this game the rulership is in whose ideas win and who has access to the people who when they like an idea then act on them..

    its more a court of powerful people who others vie to influence. the CFR has been influencing them for just under 100 years…

    http://en.wikipedia.org/wiki/Public_Opinion_%28book%29

    “The real environment is altogether too big, too complex, and too fleeting for direct acquaintance”, between people and their environment (reality). That people construct a pseudo-environment that is a subjective, biased, and necessarily abridged mental image of the world; therefore, to a degree, everyone’s pseudo-environment is a fiction. Hence, people “live in the same world, but think and feel in different ones”. Human behavior is stimulated by the person’s pseudo-environment and then is acted upon in the real world.</blockquote?

    so when we are arguing about what is going to happen, we are really arguing from the pseudo realities we have constructed from the facts we have been exposed to..

    the actual facts which tends to become evident the more you read the different abridgments people use to construct pseudo realities to get groups of people to act.

    very few read it as they are looking to be entertained more than educated…

    the more these pseudo realities are separated and disjointed by consciousness raising games of the different groups (ranging from feminism to race hucksters), the less we can be the peaceful society they are promising.

    do they run the world? you tell me…
    but the kind of power that is intimate and we imagine when numbers are small, is not the same as the more ephemeral illusory power that is large… and its fickle… just read history of groups and things… and note that around the main players your watching is a cadre of others who are not noted and who are all part of what happens from money to ideas.

  24. Artfldgr Says:

    oh.. (from another source)

    the Golos spy ring used Mary Price, Lippmans secretary, to garner information on items Lippmann chose not to write about or names of Lippmann’s sources, often not carried in stories, but of use to the Soviet Ministry for State Security.

    Philosopher John Dewey (1859-1952) agreed with Lippmann’s assertions that the modern world was becoming too complex for every citizen to grasp all its aspects, but Dewey, unlike Lippmann, believed that the public (a composite of many “publics” within society) could form a “Great Community” that could become educated about issues, arrive at judgments, and reach solutions to societal problems.

    read about john dewey “the father of american education” the mass education kind..

    they are all there for you to read and see.. no hidden at all… you just dont know them, and what you do know of them is not linked to the others…

    some of the people doing their thing today are their children, or grandchildren…

    rather than control its a rather wicked game of king of the hill..

  25. SteveH Says:

    Just everyone consider what they do for a living, where their expertise lies. Then consider a govt employee tasked with pulling off what it is you do.

    I asked my lib friend who’s an excellent maker of video presentations for corporations and government entities this same question. He just couldn’t make the connection that healthcare will suffer tremendously with govt takeover, just like video presentations would suffer ( and presently do big time) if/when they are in charge of that.

  26. Occam's Beard Says:

    Stop invoking the Thalidomide defense, FDA.

    Particularly since FDA lucked into that through sheer inefficiency. They were sufficiently dilatory in reviewing thalidomide (which in many respects is a wonder drug, still used today, but of course under very strict conditions) that by the time they were ready to approve it disturbing reports had begun to emanate from Europe.

    So it wasn’t vigilance that saved FDA; it was inertia.

  27. Artfldgr Says:

    Did you hear about the $1 million Russian lottery? You win $1 a year for 1 million years.

    a perfect illustration as to the game of using the defaults yet meaning something else in actuality. the default is the million is in some form that you can use… but unless stated, that may not be so. its this kind of thing that replaced competent debate and such in a socialist system as everything is about manipulation and not about winning a debate and agreeing…

  28. Kustie The Klown Says:

    Obamacare is toast. The whole thing. There’s no way the supreme court is going to leave any of the law in place after striking down the mandate. The law is an out of control monstrosity. They are going to use the legislative history of the severability question (a previous version of the bill had severability, the final version did not; thus congress intended that the law is not severable).

    That’s it. Game over for obamacare. There’s no way it is going to be upheld. By the time we’re done with this a 9-0 ruling wouldn’t surprise me.

  29. Don Carlos Says:

    Kustie:
    I wish you were right. Unfortunately, SCOTUS consists of tenured politicians (of varying degree and bias), not Justices.
    In my view, the indiv mandate is likely dead. In the Severability Issue now hangs the balance for the nation, and that could go 6-3 against nuking the whole thing.

    I hope all the Justices have tight, tight security and don’t take strolls after dinner in Georgetown or wherever.

  30. uncleFred Says:

    Don Carlos

    The questioning that I heard (I’ve not listened to the entire six hours) from the conservative justices and Kennedy dealt with the constitutional questions surrounding the mandate and severability, and some practical limitations on the ability of the court to effective review 2700 pages of legislation should they elect to sever.

    Would you share some of the questions that were asked that have caused you to bemoan “Most of the Justices are not acting as judges, but politicians. ”

    As for the topic under discussion:

    If the court does find the mandate unconstitutional I am certain that they will not sever it. Without a severability clause that states what congress intended to happen to the various part of the bill this event, the judges are required to review it literally paragraph by paragraph and determine what stays and what goes. In the real world that is an impossible task and there is no shortcut.

    Given that Kennedy focused on the lack of a limiting principle if the mandate is up held and the complete inability of anyone to find one (since there is none) I am mildly hopeful that the entire bill will be found unconstitutional.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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