The bill we are supporting in Washington is not perfect. It’s not what I’ve worked for in the last twenty months. But it will save tens of thousands of lives, keep hundreds of thousands out of bankruptcy, reduce the suffering of millions, and improve the living standard and reduce the anxiety of tens of millions. And like all the other half-way measures and compromised bills that have characterized American reform efforts, including the Social Security Act of 1935 and the Medicare Act of 1965, it will create its own pressure for expansion and further reform.
First, under the legislation, the federal government as well as individuals will bear the burden of increasing insurance premiums. So to avoid the tax increases needed to pay for higher subsidies, there will be pressure to create a public option to provide the competition needed to hold those premium increases down.
Second, once the principle of subsidizing health insurance premiums is established, there will be continuous pressure to increase the subsidies and offer them to more and more of the population.
Third, there will be continuous political pressure to raise the standards for the health insurance plans covered in the Exchanges.
And fourth, the Exchanges will gradually be opened to those who work for large businesses which means that they will eventually include everyone.
So over time, almost all of us will purchase health insurance in the heavily regulated Exchanges, more and more of us will purchase it from a public insurance company or genuine non-profits, and a greater share of our premiums will be covered by tax dollars.
We may or may not get to single payer that way. But France and Germany have the best health care systems in the world and they don’t have single payer. They have hybrid systems that have multiple, heavily regulated insurers and in which insurance is paid in part by employers and employees but mostly by the state.
So though we might not get to single payer, if we get to France and Germany, as a result of the legislation we can enact this week, that will be OK too.