Slippery Slope vs. Scaling the Mountain…

Does Obamacare lead to single-payer healthcare? At the beginning of this government shutdown, Sen. Ted Cruz’s 20+ hour speech on the Senate floor may have broken the record for the frequency of mentions of “single-payer,” as he and his tea-party allies invoked that this was where the United States was headed.

It wasn’t clear the path–since the Cruz and his allies were so sure the Affordable Care Act would fail, they seemed to think the plan was that after the failure of the ACA, Democrats would then replace it with single-payer. Since it’s unlikely that a failed health reform would then lead to another failed health reform, another theory is that the ACA was a “slippery slope” to single-payer.

If only. We at Health Access California support single-payer health care, as well as other types of systems and reforms that get us closer to the goals of universal access to care, reduced cost, and improved quality. The ACA took important steps in this direction. But given the political lift it was to pass Obamacare, and the continued opposition, it seems highly unlikely that single-payer will happen automatically or easily. My sense is that the metaphor is the reverse–rather than a slippery slope, the ACA helps the United States scale the mountain of health reform, by elevating key principles, and gives advocates something to build on. But we can’t pretend going further up the mountain is any easier, and likely will be harder than passing the ACA.

That seems to be the opinions of others. Last week, there was a panel on Democracy Now by Amy Goodman between Steffie Woolhandler, a doctor, professor, and longtime leader of Physicians for a National Health Plan which is focused on single-payer, and John McDonough, professor, former state legislator and consumer advocate who supported single-payer but also worked closely on the RomneyCare and ObamaCare efforts. The discussion was instructive, to indicate an ongoing debate within progressive health reform circles, about the extent of the victory that is the ACA, and where that leaves us for future efforts.

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