Ross Douthat has written an interesting “after Obamacare meltdown” scenario that seems to me far more likely than Democrats trying to get a single-payer system through a Republican House or even past the Senate with 60 votes.
But if the fix-it effort moves too slowly, it’s possible to envision a worst-case scenario unfolding. If the Web site doesn’t work soon, even liberals concede that the mandate would have to be delayed, because you can’t very well fine people for failing to buy a product they can’t access. And that combination — a hard-to-navigate online portal and no penalty for staying uninsured — could effectively discourage all but the most desperate customers from shopping, which in turn would create an unsustainably expensive insurance pool, driving prices up and driving people away, and potentially wrecking the entire individual insurance market in short order.
If this happens, there will be a lot of schadenfreude on the right at the spectacle of technocratic failure. But the wreck of the exchanges may actually be worse for conservative policy objectives than a more successful rollout would have been.
That’s because while conservatives think the Obamacare exchanges are overregulated and oversubsidized, they are actually closer to the right-of-center vision for health care reform than the Obamacare Medicaid expansion, which is happening no matter what transpires with Healthcare.gov. So if the exchanges fail and the Medicaid expansion takes effect (and, inevitably, becomes difficult to roll back), we’ll be left with an individual market that’s completely dysfunctional and a more socialized system over all.
In that scenario, the Democratic Party would probably end up pushing, not for the pipe dream of true single payer, but for a further bottom-up/top-down socialization, in which Medicare is offered to 55- to 65-year-olds and Medicaid is eventually expanded even more.
Meanwhile, the task for serious conservative reformers — already not the most politically effective bunch — might actually become harder, because they would have to explain how their plan to build an effective, exchange-based marketplace differed from the Obama White House’s exchange fiasco.
So while Republican politicians may be salivating over a potential Obamacare crisis, the conservative policy thinkers I know are not. They’re hoping, as I’m hoping, that this isn’t as bad as it looks. The chance to say “I told you so” is always nice, but not if the price is a potentially irrecoverable disaster.
The problem with the “set up to fail” conspiracy theory — aside from the fact that dozens of HealthCare.gov website contractors, HHS employees, and White House officials would all have to be involved and presumably sworn to silence — is the same one that Republicans had in trying to defund the law: it’s impossible to get through Congress. No Republican is going to vote for a single-payer system, nor would they support, as Douthat suggests, an expansion of Medicare. Obama and the Democrats are stuck with what they have and if it proves to be impossible to implement, it is extremely unlikely that Republicans will support further top-down, pseudo-socialist measures to fix it.
This is why it would behoove the GOP to have, at the ready, a concrete, modest proposal to introduce in both Houses after the president delays the individual mandate: a repeal of certain sections of Obamacare in order to substitute far more realistic and workable, market-based solutions to the health insurance problem.