On Monday I tweeted:
I'm also waiting for someone to point out that doing a Medicaid expansion for anyone uninsured might have worked better…
— Aaron E. Carroll (@aaronecarroll) October 21, 2013
Yesterday, Ross Douthat answered:
Why Not Medicaid For All?
My Sunday column on the potential consequences of Obamacare’s botched rollout ended by sketching a scenario in which the program’s Medicaid expansion is deemed a success while its reform of the individual market leads to much-higher-than-expected costs and much-lower-than-expected participation rates. This combination would no doubt be politically helpful to the Republican Party in the short run, but (I argued) it would actually leave liberals with a fairly clear path forward: Keep pressing the Medicaid expansion on states that haven’t taken it (and look for John Kasich-style Republicans to partner with), return to the Joe Lieberman-killed idea ofexpanding Medicare to 55-and-overs, and basically try to further shrink the percentage of Americans who aren’t eligible for one or both of those single-payer programs. This wouldn’t amount to the full-on push for single payer that some people expect from the left if Obamacare fails or gets repealed, but it would move the U.S. toward the closest thing to single payer that we’re ever likely to get: A system in which both the late middle-aged and the lower middle class gradually get folded into government-run insurance alongside the poor, the disabled, and the aged; the individual market survives as a kind of de facto high risk pool (overpriced but technically accessible); and the employer mandate helps prop up employer-based health insurance for a shrunken but still substantial share of the population.
It’s a long and thoughtful piece, and worth reading in full.
