In light of some of the comments to my post yesterday arguing that that the real reason that healthcare insurance companies are now madly encouraging Obamacare enrollment is fear of a pro-public-option or pro-single-payer political juggernaut, I want to make clear that by single-payer I do not mean Medicare-for-all. Single-payer would be, in essence, “the public option” extended to everyone rather than limited to the 5% of Americans who have private healthcare insurance through the non-group (i.e., non-employer-provided) market. It is not tax-funded identical-for-all healthcare insurance, which is what Medicare is. I do think that eventually this country will have Medicare-for-all-type healthcare insurance, but not in the near term. If single-payer works well, then of course that would be the longterm solution, with no need for Medicare-for-all.
I also want to make a point about federalism as it relates to the ACA insurance-market exchanges and, especially, to Medicaid and, for that matter, to any other federal social-safety-network program. I said in my post yesterday what I think is obvious: that federalism has been a disaster for Obamacare. But I want to point out that the only reason that Medicaid works under current pre-Obamacare Medicaid is that that program came into being and was effectuated before the hard-right turn of the Republican Party. Ditto for food stamps. The really weird, but successful, argument by rightwing governors and state attorneys general to the Supreme Court in the ACA litigation on the Medicaid-expansion provision in the ACA is that, well, y’know, now that traditional Medicaid has been a part of each state’s law for decades, and is popular, it would be politically impossible for state legislators to end that program–the result under the ACA as the statute was written, if a state refused to agree to the ACA Medicaid expansion. This, they argued–successfully!–meant that the ACA was effectively coercive of state legislators and therefore infringed upon state sovereignty. On that “ground,” the Supreme Court struck down that part of the Medicaid portion of the ACA.
That’s also known as the conservatives-having-their-cake-and-eating-it-to theory of constitutional law. The argument was so deeply hubristic that its actual success is stunning and outrageous. But I have no idea why anyone would think that federalism must be a part of a national healthcare insurance law. It does not.
As for whether or not the public will catch on that the main problems with the Obamacare-exchanges-and-private-policies part of the Act is a failure of the healthcare insurance market and of the healthcare market itself–a question that several commenters raised–well, that was what my post was about. Yes, the public will catch on, once the Dems have a smart, committed, knowledgeable and articulate spokesperson with a high enough national profile to educate them about it. I expect that that will happen fairly soon.
Finally, although this should be the subject of a separate post, a hallmark of the current Supreme Court is how many really weird, outlandish rightwing arguments the current conservative-legal-movement five-member majority have made the law of the 50-state-soverign-lands. As I said in an ignored post here last weekend, the Court’s neo-federalism-on-steroids jurisprudence has quietly but profoundly and thoroughly upended federal-in-relation-to-state constitutional law as it had existed since the post-Civil War era. This is a deeply dangerous juggernaut.
I wish more readers would read that post. It does deal with really important stuff. Honestly.