TNR: Why, yes, ObamaCare is a trojan horse for single-payer

Now it can be told. Emphasis on “now”:

Precisely. ObamaCare will stumble along for the rest of the year, with a new wave of public irritation to come once small businesses start dumping employees onto the exchanges en masse, but the prospects for repeal will remain dim even if the GOP takes back the Senate. The numbers in Congress just aren’t there to beat an Obama veto, and by 2017 so many millions will have been assimilated into the program that some critical mass of GOP centrists will end up taking a “mend it, don’t end it” approach. Only an adverse-selection catastrophe on the exchanges will raise premiums enough (or require a hefty enough federal bailout) to endanger the program. And lefties like Michael Moore and Noam Scheiber, who wrote the TNR piece, know it. That’s why you’re starting to hear them talk more openly about single-payer: Partly it’s because they want to get a jump on nudging the Democratic agenda to the left for 2016, partly it’s because they want repeal-minded Republicans to be happy with the status quo, but partly too it’s a simple product of safety. They can talk about this now because, unlike early 2010, there’s no political risk in doing so.

[O]ne day soon, especially if Medicaid becomes more generous, the working-class person who makes 175% of the poverty level will look at his working-class neighbor making 130% of the poverty level and think, wow, his health insurance seems a lot better than my private Obamacare plan. How long can it be before most people earning 175% or 200% of the poverty level are allowed to buy in, too?

The same goes for Medicare. Many health-care reformers believe some version of Obamacare—government-subsidized private insurance—will eventually replace Medicare, something that will surely become more likely if voters feel warmly toward Obamacare and demand to keep it when they turn 65. But if private Obamacare plans stay stingy, the opposite may happen: As people age out of Obamacare and into that single-payer program we all love and support, their fondness for Medicare will only increase. Before long, their slightly younger friends and family members will be clamoring to join Medicare, too. How long before some opportunistic pol proposes that everyone on Obamacare who’s 55-and-up can enroll in Medicare? Not very long, I’d guess. In wonk terms, progressives are likely to get their beloved public option one way or another, and probably not too far in the future.

The basic point is that, by pooling millions of people together in one institutional home—the exchanges where customers buy insurance under Obamacare—the Affordable Care Act is creating an organized constituency for additional reform. And since threadbare coverage is the only affordable option under Obamacare for many of these people, the law is giving them a whole set of grievances to get exercised about.

As Jim Geraghty says, it’s a strange defense of ObamaCare to say that it’s just “threadbare” and crappy enough to build a consensus for throwing the whole thing out, but it’s perfectly in keeping with the trojan-horse approach. They want the law to fail — not so suddenly and horribly that the industry melts down and frightens the public away from ambitious new federal “fixes” but slowly and incrementally so that people don’t lose all faith in federal management of this sector. I’m old enough to remember when it was a sign of utmost wingnuttery to suggest that ObamaCare was but phase one in a government takeover of health care, but three years later, now that the law’s momentarily out of political danger, we’ve got HHS ordering insurance companies every other week to change their business practices willy nilly and lefty pundits babbling excitedly about how this is all really just a stepping stone to bigger and better statist interventions. (Some liberals will object that the wingnuttery lies in believing that liberals designed the law to fail. Fair enough — although Scheiber’s own language is revealing, describing O-Care at one point as “a deceptively sneaky way” to get single-payer and saying of GOP efforts to play up the law’s problems that “Republicans are in some sense playing into the trap Obamacare laid for them.”) This, not “if you like your plan,” is the real Big Lie of O-Care. This is where we’re at we’re six days into full implementation.

Here’s vid from John Sexton’s old blog, Verum Serum, from 2009 sampling a few lefty luminaries in unguarded moments discussing the type of health-care system they want. Why anyone thought they’d be content with a public/private hybrid like O-Care, I have no idea. Two thoughts in closing. One: Lots of ink was spilled over the past two weeks about America’s drift towards libertarianism on pot, civil liberties, gay rights, etc. True enough, but given what it means for America’s fiscal stability, the acid test is on health care and entitlements. Will Americans’ alleged libertarianism lead them to reject single-payer as a fix for O-Care or is Scheiber’s prediction right? If the latter, then we’re not drifting libertarian, we’re drifting left. (Peter Suderman of Reason is naturally optimistic.) Two: What does Scheiber’s point about O-Care portend for, oh, say, immigration reform? Democrats were willing to take half a loaf on health-care reform because they hoped/expected that political pressure would get them the other half over time. Meanwhile, congressional Democrats are murmuring lately that maybe they don’t need a path to citizenship included in the next amnesty push after all. You trust that they won’t immediately turn around and begin agitating for that once their half-a-loaf compromise bill passes, don’t you?