A Note on Impetus

#SomethingTerrific | #WhatTheyVotedFor

A portion of the U.S. Capitol dome. (Detail of photo by Win McNamee/Getty Images, 2013)

There is always this:

Sen. John Kennedy, a Republican freshman from Louisiana, said yesterday that he likes the idea of turning health care over to the states—the core rationale behind the pending Graham-Cassidy proposal—but he’s not entirely comfortable with the direction some blue states might take.

“If you give California and New York a big chunk of money, they’re gonna set up a single-payer system,” the GOP senator said. “And I wanna prevent that.”

It’s curious. Republicans only seem to like turning over authority to states and local governments when they’re confident states and local governments will govern in a conservative way.


Perhaps a bit more directly:

Perhaps the oddest thing about the last-ditch Republican plan to repeal Obamacare is that it is being sold not as a repeal of Obamacare—which is popular—but instead as a rebuke to a law that does not yet exist. “If you want a single-payer health-care system, this is your worst nightmare,” Lindsey Graham has boasted of his plan. “Hell no to Berniecare.” Graham’s weird promise that his plan “ends single-payer health care” has somehow taken hold, to the point where Republicans appear to believe it would foreclose even public debate on left-wing alternatives. The bill “stops us from having conversation in the future about Medicare for all,” claims Senator Tim Scott.


There are a couple points worth considering. Noting both Steve Benen and Jonathan Chait simply has to do with the one looking to the other and stating the obvious.

What Republicans are doing is essentially lowering the bar. If you want to radically change one-sixth of the world’s largest economy, affecting the health security of millions of Americans, GOP leaders are now saying you don’t hold committee hearings or listen to subject-matter experts. You don’t need scrutiny or any meaningful sense of consequences. All you really need is a majority and a partisan goal.

But once that door is open—once the governing norms of the United States are shattered—there’s no reason Democrats won’t take advantage of the opportunity.

John Kennedy is worried about Democrats in blue states pursuing single-payer? What he should be worried about is Democrats in Congress taking a page from the Republican playbook and passing single-payer in 2021 with 50 votes and no CBO score.

Benen even includes the point in his headline, that “Republicans may regret opening this door”.

Chait, meanwhile, offers a headline of his own: “How Cassidy-Graham Would Make Single Payer More Likely”. And this is an interesting notion in no small part because his point is tied up in Benen’s thesis. It is worth recalling that the individual mandate, the Heritage Foundation’s tail to pin on any donkey, the device at the heart of the HEART Act of 1993 (failed), RomneyCare (passed), and Obamacare (passed), was always intended as the alternative to single-payer, a last bastion to preserve private sector rule over life and death, heaps of cash, and all that. The effort Democrats have spent passing, then running from while struggling to preserve, the Affordable Care Act. Democrats, Chait explains, “see two main obstacles in the path of passing a Medicare-for-all bill”, namely the need for a supermajority and the political costs of disruption at such a scale:

The internal Democratic debate concerns whether it is worth taking on these costs. Senate institutionalists are loath to alter the chamber’s rules to weaken or abolish the filibuster. And many Democrats shy away from the costs of a large welfare-state expansion. What bolsters their hesitation is precisely the assumption that Obamacare is working well. As Bill Scher argued very recently, “[W]hy should Democrats prioritize junking what was just successfully defended, at enormous political risk, when there are so many other moral imperatives that warrant a robust and urgent policy response?” If Congress passes a bipartisan bill to fund the state exchanges, and the Trump administration’s sabotage efforts fail, Democratic advocates of maintaining Obamacare would be vindicated.

What could alter that internal calculus? If Republicans repealed Obamacare. It would make it easier for the left to argue that the program’s compromise structure is a failure, that its markets are inherently susceptible to sabotage by Republican administrations, and that the risk of political capital is worthwhile. And the method used to pass repeal—a hastily assembled reconciliation bill devoid of serious analysis—would make fools of the party’s Senate institutionalists. Democrats would be incentivized to pass a sweeping 50-vote Medicare expansion, with the goal of creating as many beneficiaries as possible, as quickly as possible.

Heightening the contradictions of the system is a longtime tactic of radicals on the left. How strange to see this very dialectic embraced by the far right.

Still, even stranger than Democrats defending the individual mandate is the Republican crusade against their own progeny. If this system fails, then the next stop is single-payer. There really is no alternative charted on the map. Americans generally only break leftward when it is the only remaining pathway; Republicans seem rather quite determined to force the question, and it might behoove us to wonder why. Certes, there is at least some slender possibility that this really is a neurotically ruptured pathology of broken traditionalism, that Republicans, being human, still have some sense of right and wrong, and for whatever reason can only contribute to just outcomes by behaving so abysmally as to force everyone else to make it happen over conservative objections. To the other, and well more proximal and practical, yes, there are very real and precise reasons why the GOP is digging in against a single-payer bill that does not yet exist. Nonetheless, we might wonder about the claim that Graham-Cassidy prevents a Medicare-for-all future; indeed, the bill would seem to invoke such disaster as to require some manner of single-payer solution.


Image note: A portion of the U.S. Capitol dome. (Detail of photo by Win McNamee/Getty Images, 2013)

Benen, Steve. “On health care, Republicans may regret opening this door”. msnbc. 19 September 2017.

Chait, Jonathan. “How Cassidy-Graham Would Make Single Payer More Likely”. New York. 19 September 2017.

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