The road to a sin­gle- payer health care sys­tem

The Denver Post - - OPINION - By Charles Krauthammer E- mail Charles Krauthammer at letters@ charleskrautham­mer. com.

Re­peal- and- re­place ( for Oba­macare) is not quite dead. It has been de­clared so, but what that means is that, for now, the pres­i­dent has ( ap­par­ently) washed his hands of it and the House Repub­li­cans ap­pear un­able to rec­on­cile their dif­fer­ences.

Nei­ther con­di­tion needs to be per­ma­nent. There are ide­o­log­i­cal dif­fer­ences be­tween the var­i­ous GOP fac­tions, but what’s over­looked is the role that pro­ce­dure played in pro­duc­ing the dead­lock. And pro­ce­dure can eas­ily be changed.

The House lead­er­ship crafted a bill that would meet the del­i­cate re­quire­ments of “rec­on­cil­i­a­tion” in or­der to cre­ate a ( more achiev­able) thresh­old of 51 rather than 60 votes in the Se­nate. But this meant that some of the more at­trac­tive, mar­ket- ori­ented re­forms had to be left out, rel­e­gated to a fu­ture mea­sure ( a so- called phasethree bill) that might never ac­tu­ally ar­rive.

Yet the more stripped- down pro­posal died any­way. So why not go for the gold next time? Pass a bill that in­cor­po­rates phase- three re­forms and send it on to the Se­nate.

Septem­ber might be the time for res­ur­rect­ing re­peal- and- re­place. That’s when in­sur­ers re­cal­i­brate pre­mi­ums for the com­ing year, pre­cip­i­tat­ing our an­nual bout of Oba­macare sticker shock. By then, even more in­sur­ers will be drop­ping out of the ex­changes, fur­ther re­duc­ing choice and ser­vice. These should help dis­si­pate the pre- emp­tive nos­tal­gia for Oba­macare that emerged dur­ing the cur­rent de­bate.

At which point the House lead­er­ship should present a re­pealandre­place that in­cludes such phase- three pro­vi­sions as tort re­form and per­mit­ting the buy­ing of in­surance across state lines, both of which would sig­nif­i­cantly lower costs.

Even more sig­nif­i­cant would be strip­ping out the heavy- handed Oba­macare cov­er­age man­date that dic­tates what spe­cific med­i­cal ben­e­fits must be in­cluded in ev­ery in­surance pol­icy in the coun­try, re­gard­less of the pur­chaser’s de­sires or needs.

Best to man­date noth­ing. Let the cus­tomer de­cide. A 60- yearold cou­ple doesn’t need ma­ter­nity cov­er­age. Why should they be forced to pay for it? And I don’t know about you, but I don’t need lac­ta­tion ser­vices.

This would sat­isfy the House Free­dom Caucus’ cor­rect in­sis­tence on dis­man­tling Oba­macare’s sti­fling reg­u­la­tory strait­jacket— with­out scar­ing off mod­er­ates who should un­der­stand that no one is be­ing de­nied “es­sen­tial health ben­e­fits.” Rather, no one is be­ing re­quired to buy what the Jonathan Gru­bers of the world have de­cided ev­ery­one must have.

It is true that even if this re­vised re­peal- and- re­place passes the House, it might die by fil­i­buster in the Se­nate. In which case let the Se­nate Democrats ex­plain them­selves and suf­fer the con­se­quences. Per­haps, how­ever, such a bill might en­gen­der de­bate and re­vi­sion— and come back to the House for an old­fash­ioned House- Se­nate con­fer­ence and a pos­si­ble com­pro­mise. This in and of it­self would con­sti­tute ma­jor progress.

That’s pro­ce­dure. It’s fix­able. But there is an ide­o­log­i­cal con­sid­er­a­tion that could ul­ti­mately de­ter­mine the fate of any Oba­macare re­place­ment. Oba­macare may turn out to be un­work­able, in­deed doomed, but it is hav­ing a pro­found ef­fect on the zeit­geist: It is uni­ver­sal­iz­ing the idea of uni­ver­sal cov­er­age.

Ac­cep­tance of its ma­jor premise— that no one be de­nied health care— is more wide­spread than ever. Even House Speaker Paul Ryan avers that “our goal is to give ev­ery Amer­i­can ac­cess to qual­ity, af­ford­able health care,” mak­ing uni­ver­sal­ity an es­sen­tial premise of his own re­form. And look at how sen­si­tive and de­fen­sive Repub­li­cans have been about the pos­si­bil­ity of peo­ple los­ing cov­er­age in any Oba­macare re­peal.

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, sin­gle­payer 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 ofMedi­care- for- all. Repub­li­cans will have one last chance to try to con­vince the coun­try to re­main with a mar­ket­based 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.

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