
Upending American health care is intended as a steppingstone to single-payer
President Obama's Affordable Care Act is practically dead. Meanwhile, the old system it was meant to replace is dead. Thus, Americans face a long and bitter struggle over what kind of health care system they will have.
Looking at it from Mr. Obama's political philosophy, the situation isn't all bad. True, he took a huge credibility hit with his oft-repeated promise that Americans could keep their doctors and health insurance if they liked them. His political standing isn't likely to recover from that.
Still, he moved the country several steps closer to governmental control over health care, which is what he really wanted. As the country struggles to pick up the pieces from the mess he created, one big option will be a system even more fully under governmental control. Expect a new liberal push for something approaching a single-payer system, in which the government pays for all health care costs, either through governmental contracts with insurance companies (as in Canada) or by constructing and running its own health care program (as in the United Kingdom).
Though Mr. Obama favored such an approach, he couldn't sell it for two reasons: First, most Americans liked their medical plans under the old system; and, second, America is intrinsically wary of big-government solutions that intrude unduly into their private lives. So he opted for Obamacare.
Obamacare brought forth a tremendous increase in federal intervention into health care and held out prospects for even more. The idea was to control the price and parameters of coverage in ways that pushed more and more Americans into the health care exchanges set up under governmental auspices. No more individual-market cherry-picking, in which health care customers could select insurance plans designed for their specific needs — no prenatal care for women past childbirth age, for example, and no big deductibles for largely catastrophic care for young and healthy people not worried about routine health needs.
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