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October 21, 2013 4:54 PM The Restive Single Payer Tribe

By Ed Kilgore

As noted a couple of times earlier today, there are no signs the IT problems with the Obamacare exchange enrollment process are significantly affecting public attitudes towards the Affordable Care Act itself. But if I were in the White House, I’d keep an eye on one issue they might not have thought much about in quite some time: the revival of progressive hostility to Obamacare on grounds that the law reflected a “sell-out” of the obvious single-payer solution to the problems of the health care system.

You saw a pretty good indication of how a backlash might develop right here at PA over the weekend from Max Ehrenfreund:

The technical problems with the new insurance exchanges established by the Affordable Care Act, which according to Yuval Levin are serious and could potentially have non-technical, very real and lasting consequences, support an argument that liberals have been making for a long time. I don’t mean neoliberals or progressives — the people in the Obama administration who thought the whole individual mandate thing was a good idea. I mean real liberals, who believe that requiring everyone to buy medical insurance on their own is needlessly complicated, and a better policy would simply be to create a system with a single payer.
To use Steven Teles’s preferred term, our new health care system is a kludge, meaning it is an inelegant, improvised, and complex solution to a problem that could be solved better and more simply….
Obamacare is a perfect example: if we hadn’t been so concerned about protecting hospitals and insurers, we might have found our way to a simpler system with a better chance of success.

I’m not going to relitigate the whole single-payer-versus-managed-competition debate that’s been going on for decades, or even the argument that a managed competition model requires a “public option” to function properly. But whatever else it is, a single-payer system is a whole lot simpler and more predictable than anything that not only accepts but insists upon a publicly regulated and subsidized private health insurance marketplace.

Single-payer fans (or those strongly favoring a public option in a hybrid system) are never going to have much in common with conservatives who don’t believe in universal access to affordable health care and want to disable or repeal the public programs we already have. But if the one thing they do have in common—disdain for the messy hydraulics of any hybrid system—becomes the center of attention and stays there, watch out!

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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