Friday, February 23, 2018
Opinion

Column: Is single payer next?

Without a viable health care agenda of their own, Republicans now face a choice between two options: Obamacare and a gradual shift toward a single-payer system. The early signs suggest they will choose single payer.

That would be the height of political irony, of course. Donald Trump, Paul Ryan and Tom Price may succeed where left-wing dreamers have long failed and move the country toward socialized medicine. And they would do it unwittingly, by undermining the most conservative health care system that Americans are willing to accept.

You've no doubt heard of that conservative system. It's called Obamacare.

Let me take a step back to explain how we got here and how the politics of health care will most likely play out after last week's Republican crackup.

Passing major social legislation is fantastically difficult. It tends to involve taking something from influential interest groups — taxing the rich, for example (as Obamacare did), or reducing some companies' profits or hurting professional guilds. Those groups can often persuade voters that the status quo is less scary than change.

But when big social legislation does pass, and improves lives, it becomes even harder to undo than it was to create. Americans are generally not willing to go backward on matters of basic economic decency. Child labor isn't coming back, and the minimum wage, Social Security and Medicare aren't going away. Add Obamacare to the list. "Americans now think government should help guarantee coverage for just about everyone," as Jennifer Rubin, a conservative, wrote.

Trump seemed to understand this during the campaign and came out in favor of universal coverage. Once elected, though, he reversed himself. He turned over health care to Price, a surgeon and Georgia congressman with an amazing record, and not in a good way.

Price had spent years proposing bills to take away people's insurance. He also had a habit of buying the stocks of drug companies that benefited from policies he was pushing. Preet Bharara, the federal prosecutor, was investigating Price when Trump fired Bharara this month, ProPublica reported.

Price and Ryan were the main architects of the Republican health bill. They tried to persuade the country to return to a more laissez-faire system in which if you didn't have insurance, it was your problem. They failed, spectacularly. Again, Americans weren't willing to abandon basic economic decency.

But Price may not be finished. This weekend, Trump tweeted that "ObamaCare will explode," and Price, now Trump's secretary of health and human services, has the authority to undermine parts of the law. Here's where the irony begins: He can more easily hurt the conservative parts than the liberal parts.

Obamacare increased coverage in two main ways. The more liberal way expanded a government program, Medicaid, to cover the near-poor. The more conservative way created private insurance markets where middle-class and affluent people could buy subsidized coverage.

The Medicaid expansion isn't completely protected from Price. He can give states some flexibility to deny coverage. But Medicaid is mostly protected. On Friday, after the Republican bill failed, Andy Slavitt, who ran Medicaid and Medicare for Obama, was talking on the phone to a former colleague. "Virtually the only words either of us could say," Slavitt relayed, "were 'Medicaid is safe.' "

The private markets are less safe. They have already had more problems than the Medicaid expansion. Price could try to fix those problems, and I hope he does. Or he could set out to aggravate the problems, which he has taken initial steps to do. Above all, he could make changes that discourage healthy people from signing up, causing prices to rise and insurers to flee.

Now, think about the political message this would send to Democrats: It's not worth expanding health coverage in a conservative-friendly way, because Republican leaders won't support it anyway.

Politics aside, private markets in many areas of the economy have substantive advantages over a government program. They create competition, which leads to innovation and lower prices. But private markets in medical care tend to be more complicated and less successful.

And government health care programs turn out to be very popular, among both Democratic and Republican voters. Medicare is a huge success. Medicaid also works well, and some Republicans have defended it in recent weeks.

So if voters like government-provided health care and Republicans are going to undermine private markets, what should Democrats do? When they are next in charge, they should expand government health care.

They should expand Medicaid further into the working class. They should open Medicare to people in their early 60s. They should add a so-called public option to the private markets. They should push the United States closer to single-payer health insurance. It will take time and involve setbacks, but they are likely to succeed in the long run.

Until then, the future of socialized medicine is in the hands of Dr. Tom Price.

© 2017 New York Times

Comments
Editorial: The time to act on guns is now

Editorial: The time to act on guns is now

The nationís conversation on guns took an encouraging step this week in three essential places ó South Florida, Tallahassee and Washington ó as survivors, victimsí families and elected leaders searched painfully and sincerely for common ground after ...
Published: 02/22/18
Editorial: They value guns, not kids

Editorial: They value guns, not kids

They value guns over kidsSix days after 17 were killed at Marjory Stoneman Douglas High by a teen-ager firing an AR-15 semi-automatic rifle, the Florida House refused to even debate a bill banning the sale of assault weapons. The vote, 71 to 36, wasn...
Published: 02/21/18
Editorial: Listen to Marjory Stoneman Douglas students demanding change

Editorial: Listen to Marjory Stoneman Douglas students demanding change

Students from Marjory Stoneman Douglas High School are traveling to the state capital today and declaring "never again.íí A prominent Florida Republican fundraiser vows he wonít raise another nickel until his party approves new gun controls. Across F...
Published: 02/19/18

Editorial: No more doubt about Russian meddling in election

The latest indictment by the Justice Department special counsel, Robert Mueller, refutes President Donald Trumpís claims that Russian interference in the 2016 election was a Democratic hoax. The indictment details the lengths Russian conspirators too...
Published: 02/19/18

Another voice: Tips should belong to workers, not their bosses

The Trump administration is under fire for proposing a Labor Department regulation that could result in hotel and restaurant employers dipping into the tips customers leave for their employees, depriving the nationís 14 million hard-working restauran...
Published: 02/18/18
Updated: 02/20/18
Editorial: Trumpís rising deficits and misplaced priorities

Editorial: Trumpís rising deficits and misplaced priorities

Itís not popular in Washington or virtually anywhere else these days to express concern about the rising federal deficit. Congressional Republicans who used to be deficit hawks first voted to cut taxes by $1.5 trillion over the next decade, then rais...
Published: 02/17/18
Editorial: Buckhorn should not appeal verdict in firefighterís case

Editorial: Buckhorn should not appeal verdict in firefighterís case

The city of Tampa should have taken Tanja Vidovic seriously from the start when the Tampa firefighter complained about her treatment in the workplace. Now that a jury and judge have spoken, itís time for City Hall to cut its losses, learn from its mi...
Published: 02/15/18
Updated: 02/16/18
Editorial: CareerSource troubles mount as public trust drops

Editorial: CareerSource troubles mount as public trust drops

The dark cloud enveloping Tampa Bayís job placement centers keeps growing. There are accusations of forged documents, evidence of nepotism and concerns about grossly inflated performance numbers that could be tied to receiving more public money and b...
Published: 02/15/18
Updated: 02/16/18
Editorials: Prayers and platitudes after shootings arenít enough

Editorials: Prayers and platitudes after shootings arenít enough

Even before the victims of another mass shooting at another public school were identified, Gov. Rick Scott, Attorney General Pam Bondi, state legislators and members of Congress rushed to South Florida or to social media to offer their thoughts and p...
Published: 02/15/18
Editorial: DCF review should get to the bottom of Hillsborough foster care issues

Editorial: DCF review should get to the bottom of Hillsborough foster care issues

The Florida Department of Children and Families is right to call for a timely and "comprehensive" review of Hillsborough Countyís foster care system. Though the probe is a reaction to a recent case involving a child who was left unattended, the revie...
Published: 02/14/18