The rhetoric on the Republican bill in Congress to overhaul Obamacare has been a bit overheated, to say the least. Specifically, the preferred criticism of the bill seems to be that it will kill hundreds of thousands of people.
Of course, one of the grand mistakes of Obamacare was that it instilled a great deal of confusion in the public mind between having insurance coverage and receiving actual health care, when the two things are different. The studies that purport to have a direct link between insurance coverage and mortality, especially in the context of Obamacare and Medicaid, have serious problems to say the least. (On this point, it’s worth reviewing Oren Cass’s latest essay in National Affairs on “evidenced-based policymaking,” which has an unfortunate tendency, as the title suggests, to lead to “policy-based evidence making.” )
If we want to engage in this kind of sophistry, we could also point out that Obamacare itself killed thousands of Americans through it’s enabling of the opiate crisis. It turns out that the moral hazards associated with rapidly expanding entitlement programs can be literally hazardous. But mostly, screaming “people will die!” in response to tough policy choices is an unfortunate and immature argument. However, assuming that critics of the GOP plan are not about to abandon this argument, and assuming they sincerely believe they are fighting for people’s lives, why are they waiting for Congress to implement their preferred health care policies? They have an opportunity to implement it for 40 million Americans right now.
Last week California, which has a Democratic supermajority in its legislature, abandoned a plan to implement single-payer health care in the state. The proposed legislation had problems, and the price tag for universal health care was bigger than the state’s entire budget. Nonetheless, California Assembly Speaker Anthony Rendon also cited “the realities of needed action by the Trump administration” as a reason why the state was abandoning plans for universal health care.
Still, California has it has the sixth-largest economy in the world. California has a significantly larger economy than Canada, so there’s no reason why universal health care can’t work. And given the state’s role in developing new technology in the last four decades or so, there’s an argument that the state is currently host to the greatest pool of intellectual capital in history. If California wants provide health care for all its citizens, citizens have the ability to raise their own taxes, as well as the innovation expertise to make it happen.
Is it simply a matter of budgetary priorities? If people are dying, why is California spending—at minimum—$40 billion on a high speed rail line so that lawmakers can get back and forth between Sacramento and San Francisco and L.A. much more easily? That $40 billion could pay for a lot of health insurance. Perhaps the state’s exorbitant pension program could be shaved in exchange for redirecting that money toward health care, especially since we are constantly told universal health care will dramatically lower health care spending and save hundreds of billions of dollars.
This is not a facetious proposal. This is how federalism is supposed to work. California wouldn’t even be the first state to attempt universal health care. Just to the north, Oregon actually implemented a plan for universal health care in the state in 1993. It was an epic policy disaster. A few years back, Vermont earnestly tried to implement single-payer, but abandoned the plan as being too expensive. But both of these states lack California’s immense resources—Oregon has about a tenth California’s population, and Vermont is about 60 times smaller, and given the California’s wealth, the relative tax-base disparities are even bigger than a strict population comparison suggests. Facebook’s IPO alone resulted in billions in tax revenue for the state.
I realize the challenges of universal health care in California would be daunting, but it hardly seems impossible. (Besides, the challenges might be even greater about implementing single-payer health care nationally, as influential senate Democrats such as Bernie Sanders and Elizabeth Warren are agitating for.) Anyway, if the argument against GOP health care proposals is going to be that people will die, it would be nice to see Democrats lead on the issue and seize the opportunity to prove their proposals will work.
Obamacare is collapsing, and Democrats reject Republican suggestions that it needs to be scaled back and market-based reforms are necessary to lower costs. They counter that Obamacare it didn’t go far enough in terms of nationalizing health care. Proving single-payer works in a state as large as California would go along way toward proving Republicans wrong, and speeding up the adoption of universal health care nationally.
In other words, Democrats have a real chance to lead on this issue and prove the superiority of their health care ideas. In the absence of doing that, they have saddled America with a health care regime that is foundering badly, and are only offering the worst sort of demogoguery in response to Republicans who have been tasked with voters to fix their mess.
