Repeal-and-Go-Fuck-Yourself: Will GOP's Effort to Destroy Obamacare Get Us to Single-Payer?


cynic here: its not actually darkest before the dawn. we're going to go back to the way it was before the ACA, and single payer is decades off, at best. you and I won't live to see it, dan.

I suppose if there is "good" news from what appears to be a very shitty bill in the AHCA, it is that people are now used to some of the more popular provisions of the ACA, namely the removal of pre-existing condition rules, the expansion of a dependent to age 26, and cost free preventative care (especially birth control).

When consumers get used to something, they begin to demand it, and there is nothing keeping health care companies from providing plans with all of the ACA benefits. It is simply that the law will likely no longer requires them to. So if consumers demand such aspects of the plans to remain, companies will go with market forces. Hopefully.

Also, a part of why the ACA was never going to reduce costs is that it essentially forces a lot of young people to be far over-insured. Simply put, a young and healthy person does not need coverage for many of the things required under the ACA, or forced people to pay for coverage they will never need, like a single woman paying for prostate cancer coverage. This made many young people decide to forgo buying insurance, and their participation in the pool was essential for the ACA to work. Some people needed more flexibility than the ACA allowed for, and they were the very same people the ACA was depending on.
@1, At the speed neo-liberalism is rolling along from both sides of the aisle, we may not have Medicare nor Medicaid in the next 10 years.

Even if single payer is decades off, by the time those decades come around, climate change will have wrecked the planet and the environment to the point that superior health care may not matter much to your quality of life.
@3: more cynical than me - good work!
Democrats may be moving left on healthcare but their wealthy donors aren't, and never will if they don't profit from it.
Single-payer is already a majority position by most ways of phrasing the poll question. Legislators need to shape up or ship out.
I don't think it is as simple as there being 'two camps' regarding health reform, or at least it is not entirely accurate to say that 'incrementalists' are all for working within the existing system. What we have are dreamers with no apparent grasp of how politics works in this country who are adamant that the Democrats should go all in on single payer and those who are actually aware of reality and understand that pushing to 'take away the healthcare' of the majority of the electorate who have employer provided plans would unleash a shitstorm that would make what we went through during the crafting of Obamacare look like a quiet sober debate.

If we are going to get true universal healthcare it needs to be done by stealth. An actually doable way to make progress would be to push for a public option for the insurance exchanges.
@2 Aaaaand this is why people shouldn't be allowed to choose specific coverage and why we need single payer. It doesn't matter that as a female, I'll never get prostate cancer, or that a guy doesn't need pregnancy coverage, by paying into a completely pooled system, where everyone has approximately the same plan, it spreads out risk. That was the whole point. Companies selling these bare bones plans were frequently doing so just to minimize payouts and maximize profits at the detriment to us all.
I don't need health insurance.

I need health care.
@8: What a plan actually covers has no bearing on the size of the insurance pool. The only thing that matters is how much money or subscribers are in the pool.

When you have plans that are so expensive (partially because they cover things many young people will never need) that young people opt to pay the tax penalty instead, you have a smaller pool, rather than a larger one.

The people who need these types of coverage the least are young people, who the insurance pool relies on the most since they are healthy but still pay in about as much as people who need more services.

I agree that single payer is the best option, but that does not change this simple fact.
We'll be lucky if Social Security survives into the 2020 election cycle. Well, at least for anyone under 55 years of age.
@7: "What we have are dreamers with no apparent grasp of how politics works in this country who are adamant that the Democrats should go all in on single payer and those who are actually aware of reality and understand that pushing to 'take away the healthcare' of the majority of the electorate who have employer provided plans would unleash a shitstorm that would make what we went through during the crafting of Obamacare look like a quiet sober debate."

I actually strained a muscle rolling my eyes, so thanks for that. With the neoliberal Democrats managing to continually lose power for two decades, it's not at all the "dreamers" who are disconnected from reality or don't understand how politics works in the US.
@9: Indeed. Single Payer is the compromise, a public health care system (state-run hospitals and clinics) is the goal.
As long as business get a tax right off for providing health insurance to employees, there will never be single payer in America.
Done in one. Max @1 is right.

Republican/conservative voters hate hate HATE the concept of "liberal" so much that they'll vote against universal health care and their own self-interests because stigginit.

Paul Ryan (and many others) have said on several occasions that they need to move fast to repeal the ACA and do everything in their power to stop anything like single payer because "once people have it, they'll like it, and then you'll never be able to get rid of it." That's an astounding statement to make publicly. They purposefully want to go out of their way to deny what people desire in order to more deeply fellate their corporate masters, and their voters will gladly keep voting for them all because of stigginit.
I completely agree with Dan that (a) single-payer is preferable to the ACA, (b) a repeal of the ACA would be a fundamental repudiation of that kind of centrist approach, and (c) if Trumpcare goes through the Dems really, really ought to wage war on the insurance industry as it exists and make single payer (or at least a Medicare buy-in) the party line.

That said, his oft-repeated claim that the ACA is the Heritage Foundation plan is simply false. The only similarity is the requirement to carry insurance. That's a real similarity, sure, but the benefits provided by the ACA are vastly more generous and more redistributive in effect than the Heritage Plan. I wish we could retire that meme, especially when there are many real criticisms to be made of the ACA (again, I want single payer! or at least a hybrid system more along the lines of the Swiss model).

(Before anyone says "But Obama himself cited the Heritage pl…, I am aware of that, but in context it's pretty clear that this was a rhetorical point meant to highlight the absurdity of Republican intransigence on the ACA. Politically savvy, sure, but not exactly accurate.)
Another cynic here:

I find it ironic that, for the most part, Americans don't mind or reluctantantly accept that risk is inherent in configuring automobile, malpractice, life, homeowner‘s, et al., insurances. Insurance companies aren't primarily in business because they want provide insurance that you will actually use. They, like all businesses are in the business to make money, except insurance companies do it by gambling on the hope that you won't use your insurance to the point that it is not profitable to offer you their product. Offering coverage for services that an individual will likely not use guarantees that profits will come their way.

Why is it they are so adamantly opposed to single payer healthcare/insurance, yet, let the gods(esses) forbid that their flood insurance, Medicaid, Medicare, or disability checks be taken away. Many even resurrect that virtually all-but-dead whipping boy, !SOCIALISM!, when the possibility of single payer is introduced.

Beginning with Nixon, the health insurers gradually gained a relatively huge control of a piece (and, arguably, control), now in fact 20%, of our economy. They will go kicking and screaming if pushed out of the market. Their employees will represent a huge chunk of the unemployed if the insurers are suddenly removed from the economy. US politicians are likely too arrogant to learn and extrapolate how other countries (e.g., Canada) moved to single payer and adapt those countries' experiences to us.

Yesterday's shooting attack on the Congressional baseball practice has spurred at least one congressional GOP member to suggest cutting back on Town Hall Meetings with constituents. This is likely as much a cynical excuse to hide from angry constituents and prevent the media from taking notice of how many actually are against what the GOP is doing as looking to minimalize the Congresspersons' exposure to potential violence.
"If the GOP repeals Obamacare... millions of people will lose their health insurance and tens of thousands of people will die—annually—as a result."

I keep hearing this comment again and again. The fact is, the causal link between having health insurance and having good health (typically measured by life-span) is much weaker than you think. Having or lacking access to health insurance predicts some important life events, but health status is not a major one. We're all familiar with anecdotal exceptions, from which most people extrapolate a causal link, but that just doesn't hold up at the population level. This has been well established by respected economists and health services researchers (see Kronick, 2009; Levy & Meltzer, 2004; Card, Dobkin & Maestas, 2004; Finkelstein & McKnight, 2005).

So what does lack of health insurance predict? It predicts with great power your odds of foreclosure, eviction, and bankruptcy. In fact, lack of health insurance is a greater predictor of foreclosure than all the other forces to which we typically ascribe blame (e.g., exotic mortgages, over-borrowing, and even job loss). See for example: Cutshaw, Robertson, Woolhandler & David Himmelstein, 2015.

If the goal was to produce good health, then a much more effective strategy than Obamacare would have been to implement universal free college. Your education, and your mother's education, are the most powerful predictors of whether you will have a long healthy life, or not. In implementing Obamacare, democrats were addressing a much different equity problem than most realize: financial vulnerability of the poor and uneducated.

Repealing Obamacare, if it ever happens, will first and foremost result in a foreclosure boom and increased homelessness. This is the outcome that progressive news outlets should be warning about.
If only we had a Democratic candidate for President who supported single payer...
Please don't call your readers kids.
do you honestly think that the dnc gives a damn about the poor and rapidly declining middle class? as long as insurance companies have campaign contributions to give they will continue to control access to health care.
Single payer is going to happen in the next decade. It's actually amazing for those of us who have been fighting for this for decades. Unless there is a total economic collapse or an attack/war that leads to martial law (which though unlikely, is not something I rule out altogether anymore) then we will have some sort of single payer system in the not too distant future. I bet it will involve a mix of public option and market though.
"It may get us a Democratic House, Senate, and President and a single-payer/Medicare-for-all health care system that will save lives in the long run."

Here's hoping. If enough Ds can win to thwart GOP gerrymandering at the next census that would be a real win.
@21: yes, I actually believe that Democratic Politicians as a whole (not the "DNC" boogeyman) give more of a damn about the poor and the rapidly declining middle class than any Republican living today.

but that doesn't mean single payer will happen.
Just before the provisions of Obama care set in, I had a friend die in her 40s of, basically, a pre-existing condition.

Couldn't get health insurance, couldn't get treatment -- in time.

She was a single mother who left behind an orphaned, adopted daughter.

She was an educated, responsible person, and I have no doubt it's possible versions of her story are repeated 35,000 times a year in the USA.

Or that the Republicans will kill millions more with the AHCA.
max: maybe i'm just a cynical old fart, but when you follow the money, it seems that the policies adopted usually reflect the preferences of the largest donors. gilens and page at princeton did an excellent study of the phenomenon. you may want to read it. it's very depressing.
Was coming here to say much what @16 said. But I brought a link!…

Basically: the Heritage plan didn't expand Medicaid (huge deal), turned Medicare into a voucher system, and while it mandated coverage, it didn't put minimum requirements on health insurance plans or provide subsidies to the poor. While I understand why rhetorically it was useful to try to attack the GOP, during the primaries it was instead pernicious - leading supporters of a certain candidate to attack it as a Republican neoliberal proposal (neoliberalism apparently means funding healthcare for millions by taxing the rich) and probably helped dampen enthusiasm for Clinton in the general among those who are fixated on single payer as the only path to universal healthcare (France isn't single payer... they still have one of the best systems in the world).

On Romneycare, instead... You have to face the fact that the Massachusetts legislature was controlled by a Democratic supermajority. Romney didn't have the option of stopping them. In fact, he tried to veto a number of sections (including dental coverage for the poor) and the Democrats overrode him each time. It was a Democratic plan, passed by a Democratic legislature and they didn't need to give a shit about Mitt Romney. Giving him credit is far too generous.

Again, it was useful to use against Romney in 2012... But in truth, it was not his plan.
The defacto leaders of the Democrats -- Nancy Pelosi and Tom Perez -- in addition to a host of other prominent Dems, are against single payer. It's the progressives who are for single payer, but the way you shit all over them before and after the election confuses me. If you want Tim Kaine and not Elizabeth Warren as the next candidate, fine. But you're not getting single payer, because the wing of the party you support is owned by the insurance lobby.