Republicans waiting for insurance markets to collapse due to the Affordable Care Act should be careful in what they wish for. Just as Massachusetts’ “Romneycare” was the precursor to Obamacare (with its mandate that everyone purchase insurance), that state is now leading the way with the next logical step — a single-payer system.
Massachusetts gubernatorial candidate Don Berwick — a former head of the Centers for Medicare and Medicaid Services — is basing his campaign on a promise to bring a single-payer system to the state.
In an interview with the Washington Post, he cited a similar effort in Vermont.
“The more I thought about it and looked at the data and the Vermont plan, the more I realized that having a single-payer system, Medicare-for-all at the state level, could be a big accelerator to the delivery system redesign that we need,” he said.
His position says two things about the ACA. First, it acknowledges that the ACA will ultimately fail to insure the uninsured. Despite the individual mandate (which requires everyone to have insurance or pay a fine), the expansion of Medicaid (something that many states have rejected over costs) and subsidies to help the “working poor” purchase plans, too many people fall through the cracks. If the problem is people not having insurance, then the answer is not the Affordable Care Act.
Second, Berwick’s position is an acknowledgement that ACA-type changes in the rules for insurance have effectively doomed the industry.
Forcing insurance companies to offer more services to sicker people, often at lower rates, is unsustainable.
Because of the math, writes the Heartland Institute’s Peter Ferrera, either taxpayers will soon have to bail out insurance companies as they collapse under the weight of new mandated coverage and too few healthy enrollees, or we’ll soon see that single-payer system.
“Next on the horizon is an Obamacare ‘death spiral’ for the private health insurance industry,” Ferrera warns. “Taxpayers will now be told a new bailout of hundreds of billions for the private health insurers must be passed, or else private health insurance will go out of business under Obamacare. That would leave the government in complete control of American health care, especially as he who pays the piper calls the tune.”
Americans are in no mood to bail out anything, much less the private insurance companies they’ve been told for five years are the real villains in American health care.
That will likely set the stage for many Democrats to offer up the Medicare-for-all option. After all, Americans love Medicare. Why not expand it to include everyone, not just seniors? And they’ll point to the north as evidence of how well it could work.
“Single-payer’s cheerleaders cite Canada as proof of the system’s superiority,” notes Sally Pipes of the Pacific Research Institute. “Our northern neighbor’s health-care system is plagued by rationing, long waits, poor-quality care, scarcities of vital medical technologies and unsustainable costs.”
That’s what single-payer looks like.
Republicans who call for the repeal of Obamacare had better be ready with real alternatives — because the Democrats already are.