Matthews asks Gruber about starting over with single payer

Hardball with Chris Matthews

MSNBC, March 27, 2012

Chris Matthews:  Professor Gruber, I've got a curve ball for you, from the left field, all right? I'm mixing my metaphors here. If the Supreme Court strikes down the individual mandate today, which is the most conservative way to have national health for everybody, requiring people to take responsibility as individuals. If that fails, and the progressive left of the Democratic Party says, no, now's our chance to go for single payer, or what's called the public option - I guess they'll wind up being the same thing because there won't be another option really. Is that a better economic proposition? That the government simply provides health insurance for the country? Single payer. Is that a better economic deal with no profit motive?

Jonathan Gruber:  I think that single payer, if you could start over, I think that single payer has a lot to recommend it, but we can't, and I think the bottom line is...

Chris Matthews:  But we might have to start over after tonight.

Jonathan Gruber:  No. I agree, but if we start over, the problem with failing, if this ruling goes against... this law fails, we'll see the same pattern we've seen for the past century, which when we start over again which will on average be about seventeen years from now, because it's about every seventeen years we start over, it's going to be further to the right of where we are.  Every seventeen years... Remember Richard Nixon proposed something to the left of the Affordable Care Act. Every seventeen years we move to the right. If this fails, the next round is not going to be single payer. It's going to be even more conservative than what we have now.


By Don McCanne, MD

What is the basis for this conversation about starting over if the Affordable Care Act (ACA) is struck down by the Supreme Court? Implicit is the concept that the Affordable Care Act actually accomplished the reform that we need. Of course, it didn't. So, regardless of the decision, we wouldn't be starting over since no iteration of ACA would hardly even begin to complete the process of reform.

For those who believe that ACA is the most feasible path to reform, there are some issues in this debate that would have the appearance of a make-or-break outcome (even though ACA itself isn't a make-or-break model).

Based on the first two days of deliberation before the Supreme Court, it appears that the individual mandate to purchase private insurance may well be struck down. If it is, then both sides (plus an amicus from America's Health Insurance Plans) agree that guaranteed issue and community rating should be declared inseverable and struck along with the individual mandate.

Though an intact ACA falls intolerably short on reducing uninsurance, underinsurance, and unaffordability, a decision eliminating guaranteed issue (eliminates pre-existing condition exclusions) and community rating (prevents insurers from gouging those with greater health care needs) would leave yet many more uninsured, especially those with greater health care needs plus the healthy invincibles whose funds are needed for the insurance risk pools. That should be enough to cause ACA supporters to take another look at single payer, though the mess we have with an intact ACA should make them reconsider anyway. ACA did not turn out to be the affordable-care-for-everyone model that supporters had hoped for at the beginning.

So we wouldn't be starting over again since ACA was merely a misfire that gained us very little. A misfire is not enough to restart the seventeen year clock, not to mention that the clock is only an illusion anyway.

And Gruber's contention that our next reform efforts will move further to the right because that's the way history has led us? Really? Was Social Security a move to the right? Was Medicare a move to the right? Was the Civil Rights Act a move to the right?

Does health care really fall at some point along a linear, bipolar, one-dimensional span between right and left? Of course not, though we should tell the ideologues in Congress who believe this that such in-the-box thinking is why we are replacing them in the forthcoming election. We want not just the elderly but everyone in America to be able to say, "Leave my Medicare alone!"