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« State Legislation | Main | Walking Across America For The Dream Act »


Obamacare, Plan B

By Peter Herbert
April 1, 2012

Back during the health care debate, I argued on these pages that a mandate without (at least) a public option was a mistake. I thought that forcing people into the private health care market, without at least giving them a public option, was immoral. Little did I imagine that it might also be unconstitutional. But now the Supreme Court may rule that way. They seem to be leaning that way. Then what will we do? What is our Plan B?

I’m sure the President and Senate Democrats have people furiously working on that now. I hope different people than the ones who advised them to give up on single payer and the public option without a fight! Meanwhile, since no one has blogged on this site lately, I’ll throw out a half-baked idea – I’ll think out loud for a moment. Let’s let states decide by referendum whether to join one of two blocks. One block will adopt a single-payer system, or at least Obamacare with a public option. The other will adopt a Paul Ryan plan – one that is exactly like the status quo, only without Medicare and Medicaid. Joining one block or the other will have to be binding for a long time, at least a decade, and we may have to restrict the benefits of moving between blocks, so that refugees from the red states don’t bankrupt the blue ones, or (ha ha!) vice versa.

This plan is not yet complete, and perhaps no version of it can work. After the referendum there is a danger that lots of Red state poor and sick people would flee to blue states, and maybe lots of young, healthy working people would flee from blue to red states. I’m not sure how great that danger is, frankly. In the red states there are relatively more jobs, but far fewer skilled jobs with a middle-class standard of living. For the poor and sick people in the red states, it is not that easy to move to blue states, where the cost of living is higher because the standard of living is better.

I suspect that even if this approach moves more young talent than usual towards the red states, and more dependent people than usual towards blue states, that the progressive cooperation in the blue states will cut health care costs more than enough to cover the difference. Before long, everyone will see that Darwin’s (rather Christian) observation that cooperation has greater survival than competition applies to health care, and Paul Ryan will be forgotten, as he deserves.


Comments (4)

gypsytoo Author Profile Page:

do young people really refuse to get insurance because they think they do not need it? or do they not get it because they can't afford it? not sure if my 30ish sons are considered young anymore - but neither has insurance - because they cannot afford it - both have had hospitalizations and not been able to pay the bill - it is just too expensive.

we need a public option or put everyone on medicare - and have premiums taken out of paychecks just like social security and medicare today - except 1.43 is way too little. that's my opinion and i'm sticking to it!!!

Peter Tramel Author Profile Page:

I think that in many cases young people don't get health insurance as a gamble, so they can finish college, move out on their own, get married, and things like that. They have to choose whether to risk going without health insurance or settling for a dead-end kind of life. In many other cases they simply can't afford it.

But it is not just young people who go without health insurance as a gamble. I recently read a testimonial from a 53-year-old conservative man who was furious at the idea that he would have to purchase health coverage. He said he doesn't smoke and he eats right; so he ought to be allowed to put off getting health insurance. As I read that, I thought of another conservative man I knew -- a good friend of mine -- who complained bitterly as he died of liver cancer that it wasn't fair: he never smoked or drank, he ate right, he exercised...

Most of us will need health care coverage sooner or later, we don't know when, and fewer than one percent of us can afford that out of pocket if it's serious. So I want a mandate, to bring down health care costs to the point that few, or (better) none of us will have to choose between health insurance and college, or whatever. Single payer health insurance is the best way to do that. Obamacare with a public option is maybe a decent, temporary compromise with the far right. Obamacare without a public option was a huge mistake.

Angelo Lopez Author Profile Page:

I think you're right Peter. I remember your comments two years ago after the health care law passed, about the immorality of a mandate if it didn't include a public option. I didn't think there was much of a risk of the mandate being ruled unconstitutional, so I'm pretty surprised at how things are unfolding. If the Supreme Court rules against the mandate and strikes down the whole reform law, I think your criticisms two years ago will be proven to be prescient.

Your idea of a state referendum sounds like a good idea. I think some states are already considering public options to be put up for the vote. If you can't get it done nationally, it's good that health care reform advocates go state to state and persist.

Diane Author Profile Page:

The U.S. is backward when it comes to health care and other social services for its citizens. The public option is the only way to go to make sure everyone has access to health care. But as with many other things in this country, it's every man and woman for him and herself.

I do like your Swiftian solution, Peter. I'm also quite sure Kansans would vote for the Paul Ryan plan, in the name of "liberty."

In that case, my husband and I would have to move in order to survive, but I doubt if the right-wingers would miss us.

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