The Leninist Plan For Single-Payer Health Care

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My take on the Ponnuru/Levin effort to revive John McCain’s 2008 health care proposal is that it shows how you’d ultimately need to adopt the full Affordable Care Act tripod of regulation, mandate, and subsidy in order to make it work. Brad Delong retorts that we should actually understand it as a kind of Leninist path to single-payer health care that would be so unworkable as to make an evolution in the direction of Universal Medicare unavoidable.

Certainly I recall back during the 2008 campaign reading some of my colleagues’ critiques of McCain’s ideas on this score occasionally having the impish notion that this was right. If he wants to burn down the status quo, maybe we should let him? After all, as this briefing from the dynamic trio of James Kvaal, Peter Harbage, and Ben Furnas (PDF) points out not only would the McCain plan not work, it would be a big tax increase for most people:

In the very short term, we have a tax cut paired with the unraveling of the employer-based system. In the longer-term, we have a health care disaster but a bunch of extra tax money. Money we could use to create a single-payer system. At the end of the day, I don’t believe in “the worse, the better” as an approach to improved public policy. But it is true that this might be the result over the long term.