Avoiding single-payer as Obamacare collapses
There are many analysts on both ends of the political spectrum who see Obamacare as a stalking horse for single-payer, Canadian-style government-run healthcare. The latest person to warn of this is none other than Scott Serota, head of the Blue Cross Blue Shield Association, who is shilling for political support to subsidize health insurer losses due to the adverse selection problem, which sees unhealthy people rushing to sign up for Obamacare, while healthy Invincibles sensibly decline to become milch cows whose higher rates will subsidize the others.
"We are becoming increasingly concerned about momentum that is quickly building among some leading conservatives for elimination of the risk corridor and reinsurance programs," [Blue Cross Blue Shield Association CEO Scott] Serota wrote...
"Their efforts, along with growing support for repealing the risk corridor and reinsurance programs, could combine to create a perfect storm to, at a minimum, dissuade the Administration from modifying risk corridor program rules to provide increased funding in light of the recent 'transitional policy' allowing insurers to offer consumers the option to renew their 2013 health plans for 2014," Serota wrote.
In attached talking points, seemingly directed at Republican lawmakers opposed to risk corridors and reinsurance, BCBSA is asking members to argue that eliminating the risk corridors will lead to the eventual downfall of Obamacare and lead to a single-payer system: "It jeopardizes the entire private health insurance market and will ultimately lead to a single-payer system. Furthermore, it will close the door to pro-competitive health care reform alternatives."
I have never bought into the notion that the failure of Obamacare would lead to a complete government takeover of healthcare. The nation has witnessed epic incompetence due to the inherent qualities of government bureaucracy - the avoidance of responsibility, and the substitution of process for goal-achievement as the imperative of action. Having witnessed government screwing things up, the political momentum will not favor handing more control over to the same band of bureaucrats.
It wouldn't be hard for Republican repealers to write a law that got rid of Obamacare while somehow keeping those few million who've signed up on some form of similar insurance. "If you like your Obamacare you can keep your Obamacare." Exchange policies could be converted to non-exchange policies in a special, no-new-enrollments program, for example. Over time, attrition would whittle this grandfathered class down to trivial size-a process with which you'd think Obamacare's architects would be familiar.
I don't know if Obamacare will survive or not. Even its cockiest defenders, now whistling past the graveyard of missed deadlines, concede** that (as one of them, Josh Marshall,puts it) if "the mix of young and old people, healthy and sick" is "significantly out of whack you'll have problems."*** Problems that include, in Greg Sargent's words, the possibility that "insurers pull out, and the exchanges collapse."
But I do know that if Obamacare isn't repealed it won't be because two (or ten) million people in a country of 300 million have already signed up.
Seems pretty clear to me. Our job now is to highlight the inherent inability of government to get the job done.