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.