The Single-Payer Fantasy

Obamacare isn’t a Republican idea, and liberals could never get their dream of single-payer.

By Charles C W Cooke

As Obamacare declines toward a possible fall, the assembled denizens of the professional Left are scrambling in earnest to register their excuses with the public. Thus far at least, the award for the most creative contribution goes to former labor secretary Robert Reich, whose Saturday paean to single-payer health care managed to combine all of the most dishonest talking points that have bubbled up since October 1 while constructing in tandem a counterfactual so dazzling that only the truest of apostles could be persuaded by it.

Reich’s column has the Upworthy-worthy title, “The Democrats’ Version of Health Insurance Would Have Been Cheaper, Simpler, and More Popular (So Why Did We Enact the Republican Version and Why Are They So Upset?).” In it, Reich claims that if “Democrats [had] stuck to the original Democratic vision and built comprehensive health insurance on Social Security and Medicare, it would have been cheaper, simpler, and more widely accepted by the public.” And, he adds for good measure, “Republicans would be hollering anyway.” 

The underlying conceit here, that the Democratic party had the option of “sticking to the original vision” of single-payer but that it instead settled on Obamacare as part of some sort of grand compromise, is fairly popular among the law’s apologists these days. Republicans, this story goes, are opportunistic hypocrites who dropped their longtime support for a system that looked just like Obamacare the very moment that a black man was elected to the White House. Democrats, meanwhile, are presented as being too nice and too solicitous of their opponents, and criticized for having elected to placate the Republican party by forgoing pursuit of what they truly wanted: Medicare for all.

Reassuring as this tale might be to those who are worriedly surveying the damage that Healthcare.gov has wrought upon their project, it remains self-evidently absurd. Obamacare was passed into law without a single Republican vote; its passage led to the biggest midterm blowout since 1948; and repealing the measure has been, to borrow Harry Reid’s favorite word, the “obsession” of Republicans for nearly five years. It is a law based upon an idea that Republican leadership failed to consider, debate, or advance during any of the periods in which they have held political power — and one that they actively opposed when it was suggested in a similar form by President Clinton during the 1990s. If Republicans were desperate to get something done along the lines that Obama proposed in 2009, they have had a funny way of showing it over the past 159 years.

Champions of the Republican Idea Theory tend to respond to the presentation of these facts by charging that that the concept of an individual mandate was the product of a 1989 paper issued by the conservative Heritage Foundation (something its author vigorously denies), and that Republicans were so taken by the idea of forcing everybody to buy a private product that . . . well, actually herein lies the problem. Truth be told, Republicans were so taken with Heritage’s design that a grand number of two of them ever went so far as to introduce a federal bill based on it and Mitt Romney used it as the basis of reform in deep-blue Massachusetts. Oh, and Newt Gingrich once said something nice about it — in 1995. This, suffice it to say, is hardly a ringing endorsement.

Whatever historical weight the Left chooses to attribute to the Heritage proposal, it cannot change the salient fact that “Heritage” is synonymous with neither “Republican party” nor “conservative movement,” nor that, even if it were, such a link would serve only to confuse matters. As Avik Roy notes over at Forbes, the so-called “Heritage plan” was actually “killed” by another Heritage employee, Peter Ferrara, whose first act after leaving the organization was to campaign vehemently against the idea and to “[convince] 37 leaders of the conservative movement, including Phyllis Schlafly, Grover Norquist, and Paul Weyrich, to sign a petition opposing” it. Ferrara was joined in his opposition by the Cato Institute, the Galen Institute, and almost everybody on the Republican side of Congress. 

Reich’s fantasy account of a restrained Democratic party does not hold up either. There is a devastatingly dull reason the bulletproof Democratic majority of 2008 didn’t build “comprehensive health insurance on Social Security and Medicare,” and that is that it didn’t have the votes. Indeed, with full control of the government, Democrats didn’t even have the votes to set up a public insurance option, let alone to take over the whole system. Long before Scott Brown was elected to the Senate, Ezra Klein was lamenting that the public option was dead on arrival. Joe Lieberman, Klein noted sadly, has “swung the axe and cut his deal cleanly, killing not only the public option, but anything that looked even remotely like it.”

Lieberman did this for a solid reason: Despite the best efforts of the president, the mooted health-care bill remained deeply unpopular throughout the legislative process, and the public option even more so. Americans, remember, didn’t even want the bill as it currently ended up, and they were so determined to stop it that the progressive stronghold of Massachusetts elected to the Senate a Republican who ran promising not only to “kill” that specific bill but also to end the Democratic party’s filibuster-proof majority. Are we honestly expected to suppose that if the proposal had been farther to the left, it would have had a better chance? Does the progressive movement really think that the public can be persuaded that Democratic legislators “compromised” with an intransigent opposition out of the goodness of their hearts? I think not.

As for Reich’s claim that a single-payer system would have been “more widely accepted by the public”: Is he joking? So acutely aware were the president and his allies in Congress of the fact that the vast majority of Americans did not want to lose their current insurance that, like so many traveling salesmen on the frontier, they just brazenly lied, promising things of their product that it could never possibly deliver and assiduously playing down the scale of the chance that their customers were taking. Again, with Obamacare as it is now, the president was forced onto the defensive, provoked into repeating as mantra that “if you like your health-care plan, you will be able to keep your health-care plan” and into reassuring voters that “no one will take it away — no matter what.” One can only imagine what he would have had to promise if he had been peddling single-payer.

The New York Times’ Paul Krugman, who has dismissed the law as an “immense kludge” and is open about his preference for a Medicaid-for-all single-payer model, has managed to grasp that “the reluctance of workers who currently have good insurance through their employers to trade that insurance for something new” meant in practical terms that “the Affordable Care Act was probably all we could get.” It was indeed, and if the Republican party plays its cards right and can turn the disastrous rollout of the law into a setback not just to this particular scheme but to the technocratic model itself, it will be all that the Left “can get” for some time to come.

Nevertheless, as any good liar knows, it is the chaotic and amorphous opening days of any disaster that provide the opportunities for the most ambitious spin. Refusing to allow anything as prosaic as truth to intrude upon their fantasies, progressives are engaged in an audacious attempt to blame their opponents for their signature mistake and, worse, to pretend that the solution to the havoc wrought by magical thinking is to commission even more magic. “We must do what we can,” William F. Buckley Jr. wrote in a letter to Henry Kissinger, “to bring hammer blows against the bell jar that protects the dreamers from reality.” With Obamacare failing in precisely the ways that they predicted it would, conservatives have been given an extraordinary hammer. They must not let their opponents take it from their hands.