On July 22, 2009, Obama said in a press conference, "Now, the truth is that unless you have what's called a single-payer system in which everybody is automatically covered, then you're probably not going to reach every single individual." Bingo. Too bad he didn't hang on to that insight, and use his rhetorical skills to make the case strongly to the American public. If he had fought for single-payer health care at the beginning of his administration, while he had both houses of Congress, and mobilized public opinion behind it, he might have made it. After all, the only thing members of Congress need more than industry money is votes.
Doctor, heal thyself. You're suffering from Firebagger's Disease: blame Obama for not achieving the impossible. Josh Marshall calmly explains why single payer was never a viable option at the time.
But this is a good moment to pierce the liberal delusion that single payer was out there for the taking — even possibly out there for the taking — had President Obama or any other president simply set his mind to it. After the ‘public option’ hit the brick wall that it did, it’s difficult to believe that anyone could really believe that single payer was even remotely possible. It was virtually impossible — with massive majorities in both houses — to push through a bill that left the mammoth health insurance industry intact and forced no one with their current private care plan to give what they know in exchange for something they don’t. So surely it would have been possible to push through a reform which essentially abolished the health insurance industry and forced big change on the overwhelming majority of the population who already has private coverage. To believe that you have to be totally submerged in the lethal progressive/liberal purism of loving defeat.
It’s proved incredibly hard to lasso this horse. So … fuck it, I’m just going to lasso a unicorn instead.
But it’s more than just that. Single payer supporters do themselves a disservice by imagining that the only or even the main obstacle to single payer is the money power of the health insurance industry. That’s obviously a big obstacle. It was a huge issue in 2009. But the biggest is the simple fact that the overwhelming majority of people, especially most people who vote, have health insurance coverage. And even though most don’t like it and hate their insurance companies, in most cases, they’re easily scared off by being told they’re going to lose what they know, lose access to their doctor and get something new that they don’t know. This is a fact. Anyone who’s ever tried to run a political campaign tied to health care reform will tell you this. I’ve been shown various polls showing support for fairly self-serving descriptions of single payer that are totally divorced from how the rhetoric would actually play in the political wild.
This is what I've been trying to tell people for years now. People were not going to stand for losing their insurance. To blame "Obama's oration skills" for the existence of resistance from the American people and his own party is ludicrous. If all it took was explaining to people why single payer was better, we would have had it long ago.
So now we have a law that needs fixing on the way towards something approaching single payer, yes. Under the circumstances it was the best option we could have gotten. How sustainable is it? Depends on who you ask. Dr. Angell believes our health care system will unravel more slowly, but will still unravel as more and more people refuse to buy insurance and pay the penalty instead, causing premiums to rise, causing more people to refuse to pay the premiums in a feedback circle that will crash the entire market. Eventually, every criticism of the ACA gets to "And then insurance premiums skyrocket".
I've also noticed how practically every criticism that the ACA is doomed, from both the left and the right. also gets to "And it's all Obama's fault." Dr. Angell's criticism is just like the rest in that respect. It's tiresome to see people who might have otherwise good arguments always use it as an excuse and a platform to pound on the President for what Congress and the American people decided to do. Instead of focusing on what needs to be done for the ACA, we're focusing on what couldn't have been done in 2009, refighting that battle over and over again to no avail.
Change the future then. You can't change the past.