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Single Payer Support Makes a Bipartisan Health Care Deal Impossible


The Senate is leaving town at the moment with no vote set on the proposed Obamacare overhaul, but the possibility that they could be voting within the next ten days is real. The number one thing opponents of the Graham-Cassidy-Heller-Johnson proposal need to understand is the impossibility at this juncture of true repeal on the one hand or a bipartisan solution on the other. True repeal, while promised by Republicans repeatedly, was a lie that they were never going to deliver on. So we must deal in the real world, and not the imaginary one where principles matter.

The real world also tells us that a so-called “bipartisan fix” – called for this week by Governors John Kasich and John Hickenlooper, is utter fantasy. Paul Ryan and the White House have already rejected the Senate’s supposed Alexander-Murray bipartisan health fix – what really amounts to a bailout of insurers in favor of more catastrophic plan allowances.    “Late on Tuesday, Alexander officially waved the white flag, for now at least. He said that two could not find the “necessary consensus” to move forward; Murray said she was “committed” to moving forward eventually and blamed Republican leaders.”

This was completely predictable, of course. The fact is that Republicans have been granted a lot more flexibility on Obamacare repeal by their supposedly stringent voters than Democrats, who cannot budge on this to the point of offering a true compromise. They are stuck in a position where Obamacare must be defended at all costs, including opposition to anything that is seen as changing or altering it, even in a prudential policy manner. Why? Because Murray, Chuck Schumer, and the rest of Democratic leadership are now leading a party that has moved on from Obamacare to overwhelmingly support single payer. Not even one out of five Democrats opposes single payer now, which remains anathema to Republicans.

Don’t believe me? Today’s Morning Consult poll: “67% of Democratic voters support single-payer, and just 18% don’t. In April, 54% of Democrats said they supported single-payer, while 30% didn’t. Among all voters, a plurality (49%) of Americans support single payer, while 35% oppose.”

This is what the experience under Obamacare has wrought: a willingness for half the country to embrace a proposal that was once reserved to the likes of Bernie Sanders. No deal can happen at a federal level when the two sides are so opposed, and where Republicans know that is where we are headed next. There is no bargain to make.

The best argument against GCHJ is Rand Paul’s critique that this is by no means a full repeal of Obamacare. It retains 1.2 trillion dollars in spending and essentially reforms of how we deliver existing Obamacare funding. (The other big concern I have is about the waiver program, and whether states will actually have the stones to apply for waivers, without which much of Obamacare’s other mandates will remain in place.) The funding and waiver cliff it creates in 2027 will almost certainly make for massive and permanent new expenditures by Congress for the foreseeable future.

The best argument in favor of the GCHJ proposal, even with these weaknesses, is that it will take a major step toward removing the debate about health care policy out of Washington. This is a good thing for a number of reasons, both practical and political. As a fiscal matter, it should be viewed as of a piece with Republican efforts to eliminate the state and local tax deduction: the idea is simply that if states want to tax their citizens highly to provide more generous social services, then the citizens of that state ought to pay their way and not be bailed out by other taxpayers in other states, with no representation in other states, for the cost of those social services.

You want low taxes and low social services? Move to Texas. If you want more social services and are willing to bear higher taxes? Move to New York. Obviously this logical piece of policy advice is not popular among high tax, high benefit blue states – but it has the virtue of being a more federalist solution to our current problems and it would invest far more significance in the policy decisions at the state level, where money cannot be printed at will to solve any perceived need. And so when Jimmy Kimmel takes to his high horse to blast Cassidy, accusing him of lying to his face and saying he should not even utter Kimmel’s name, the response should be: if Kimmel wants a single payer regime, he can have it, and he can pay for it. The rest of us shouldn’t have to.

As a political matter, what GCHJ would do is break up the existing dynamic in Washington surrounding Obamacare repeal and transform it into 50 different battles at the state level about what ought to be done to fix health care markets. This is likely to be messy in the short term, but also more representative of what citizens in these states want their marketplaces to look like than the current trajectory around the country toward higher premiums, more monopoly control, and fewer insurance choices. It pushes this whole decision and fight back to the states and forces them to make real decisions about how to cover their people. That’s where these decisions belong in the first place: as close to the people as possible.