Single Payer Insurance System
The ironic conjunction of the impasse over a continuing budget resolution and the rollout of the Obamacare enrollment process suggests a possible way for Obama and the Democrats to get to yes with the Republicans on the budget. The GOP (especially in the House) has been obsessing on killing or delaying Obamacare for years, and that has been the principal bone of contention in the present government shutdown.
At the same time, the administration has been faced with considerable difficulty in actually getting this thing up and running. For example, they have had to delay for a year the mandate for employers to provide health coverage, and there have been well-publicized computer glitches in the first days of individual enrollment.
The Democratic line up to this point (a correct line, I think) has been to accept no changes in the Affordable Care Act (Obamacare) as part of any stopgap spending bill. The Republicans, of course, keep voting precisely such changes. That’s why we have a government shutdown at this writing. The Republicans are taking most of the blame for this, in the public eye, and they know it. The adults in their caucus will ultimately have to take the wheel and agree to negotiate. They’re not there yet, but they’ll get there.
That’s when Obama and the Democrats should make an offer: pass a simple bill to keep the government running, and we’ll agree to a systematic process to study the implementation of the healthcare law, possibly leading to significant changes as we learn more about how it’s working in practice. The administration would surely do this anyway, and come up with proposals for revisions in the law. If they could get the Republicans to buy into the idea of reviewing the implementation, they will have changed the subject from its repeal to its reform.
One of the prime candidates for such review will be the employer mandate. Many small employers seem uncertain what their obligations are, and reluctant to take on new, full-time employees. Larger employers are probably less affected because most of them already administer some kind of healthcare program. But the law as written gives a perverse incentive to employers to avoid hiring full-time workers, since they don’t have to provide healthcare to part-timers.
The fact is, even before Obamacare, providing health insurance for employees has been an escalating burden to employers, requiring them to employ large numbers of people just to administer these complex programs. Suppose that employers could get rid of this obligation, offloading it onto the federal government: we could back into single payer as a way to respond to employers.
Single payer as the business-friendly approach: how could the Republicans refuse?
Wednesday, 2 October 2013