Friday, March 31, 2017
A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system. It’s what Barack Obama once admitted he would have preferred but didn’t think the country was ready for. It may be ready now.
As Obamacare continues to unravel, it won’t take much for Democrats to abandon that Rube Goldberg wreckage and go for the simplicity and the universality of Medicare-for-all. Republicans will have one last chance to try to convince the country to remain with a market-based system, preferably one encompassing all the provisions that, for procedural reasons, had been left out of their latest proposal.
Don’t be surprised, however, if, in the end, single-payer wins out. Indeed, I wouldn’t be terribly surprised if Donald Trump, reading the zeitgeist, pulls the greatest 180 since Disraeli dished the Whigs in 1867 (by radically expanding the franchise) and joins the single-payer side.
Talk about disruption? About kicking over the furniture? That would be an American Krakatoa.
It would represent a kind of equilibrium, where are our aspirations came to match the illusion of our competencies. It wouldn't lead to better health care, or longer lives, or better people, but it would give us the feeling that we were striving for all those things, not in the best way we know how, but in the best way that could be taken maximum advantage of by nearly everyone in the business of selling ideas about what we should do to those of us who spend most of the time thinking about other things. At least it's not the worst outcome; pretty bad, but not the worst.