Single-payer by attrition

So, I found an interesting article that alludes to how we might eventually wind up having single payer healthcare reform by way of the Supreme Court. I watched some political talking head show that said if health care reform were passed, the Republicans would challenge the constitutionality of its mandate in the courts, all the way to the Supreme Court.

According to this article from this past January, that would probably backfire on the Republicans, because the court would agree that the mandate was unconstitutional, but they would rule that a single payer form of health care would have to take its place. Read on:

Conservatives should embrace the health-insurance mandate
Jan 15th 2010
by The Economist

I'VE posted before on the perverse results that would be generated by a Supreme Court ruling that a mandate to buy health insurance would be unconstitutional. Yesterday Ezra Klein made the same point. Basically, a lot of Democrats would love to establish a single-payer system for universal health insurance, like Canada's, or a single-payer system for basic insurance with private supplementary insurance, like France's. They've shied away from attempting such a reform because it's agreed that America's private insurance industry is too powerful, and American political culture makes it easy to demagogue any national centralised system (though this rests on a mighty rock of cognitive dissonance—Americans like their Medicare and Social Security just fine).

Hence, Democrats have spent the past two years working out a private-sector universal health-insurance reform plan that's similar to those of Switzerland and the Netherlands: private health insurance with community rating and a buyer mandate. But that kind of system is impossible without a mandate; it would get ripped apart in a vortex of adverse selection. A Supreme Court ruling that the mandate is unconstitutional would mean that the only kind of universal health insurance America can have is the British, Canadian or French kind, where the government runs the whole show (for basic insurance, anyway). It seems perverse that America's constitution would mandate a more socialist approach to universal health care than the Netherlands has. It's also, as Mr Klein says, a disaster for free-market conservatives, in the long run.

But it's also worth thinking about exactly how this would play out. The clearest way to explain it is that right now, what we have already is a system that's getting ripped apart in a vortex of adverse selection. Health spending is rising at 8% per year. PriceWaterhouseCooper says medical costs will grow 9% in 2010; health insurance premiums generally rise even faster than costs. Premiums now amount to 18% of the average household's income, up from 11% in 1999. As insurance costs rise far faster than wages, unsurprisingly, the number of uninsured keeps rising too, to 46.3m in 2008. And those who aren't uninsured are increasingly insured by the government. Medicaid added 3m people to its rolls in 2008. The Children's Health Insurance Program (CHIP) picked up another 1.5m. As this process continues, federal spending on health insurance keeps climbing; it grew 10.4% in 2008. Sick people, poor people, and older people are increasingly unable to afford insurance, and many are winding up on the government's dime. As premiums rise, people at higher and higher income strata find they cannot afford them, drop out of private insurance, and end up being covered by the government or not covered at all.

This is single-payer by attrition. The health reform measure in Congress now proposes to use tax subsidies to get America's working poor into private insurance plans. If it is ruled unconstitutional, the country will face a choice: allow the numbers of uninsured to continue shooting up, or enroll more and more people directly in taxpayer-funded government insurance plans. It's not impossible that America will choose the former, and become an increasingly bimodal two-class society where the working class simply doesn't get adequate health care. But it seems more likely that, after whatever number of years elapses between health-care reform efforts, universal health insurance will be back on the agenda of some future Democratic president. And this time, it will be single-payer, because nothing else will be constitutional.

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So, is it possible Obama's plan is that he is counting on the current health care reform bill to be ruled unconstitutional by the Supreme Court, thus setting up a single payer system administered by the govt. because since it is closest to what exists in limited form currently (only for poverty level Americans too poor and/or too sick to afford to provide their own insurance), the court would have to revert back to the current plan and increase its enrollment for all those who could not afford the mandate? Wow, that's ingenious! It is the epitome of the back door plan. I will be impressed if that was the overall plan. It seems very conniving and dishonest, so it must be politics 101. Wow...