This raises the question of what alternative Democrats should present. About a year ago Paul Krugman wrote that single-payer was a “distraction from the real issues,” the argument being that the policy space has been so influenced by ObamaCare that the left has no option but to build and improve upon it. With the benefit of hindsight, I think we can safely conclude this notion is disastrously mistaken. The basic formula of the law could work, but it needs a serious overhaul already. Instead, it’s either going to be blown apart, severely damaged, or just left to rot for years.
This is a structural feature of American policymaking these days, due to how our incompetent federal government interacts with our anachronistic and poorly designed Constitution. With extreme polarization making compromise impossible, policy has to come through in great big momentary glugs when one party manages to get total control of government. A parliamentary democracy in Europe could no doubt get something like ObamaCare going on a permanent basis, but our fumble-fingered and routinely paralyzed government is much better suited to big, blunt, set-it-and-forget-it programs like Medicare and Medicaid. They require regulation of course, but not the same sort of deft and constant touch.
So Democrats must tread a thin line here. They must hammer whatever monstrosity the GOP caucus vomits up, while presenting a case for better policy that would fix ObamaCare’s problems. Ideally it would look something like this: Take Medicaid fully under federal control, put everyone up to 26 and above 55 on Medicare, and run a Medicare buy-in public option through the remains of the exchanges. Control costs with all-payer rate setting. That’s a policy that would be easy to understand, and would stick.
But above all, don’t try to convince people that ObamaCare is already great. It simply isn’t true.