At the end of this month, the GOP's "reconciliation" budget authority to repeal and replace Obamacare with a simple majority in the Senate will expire. Unless they pass an eleventh-hour bill -- and this piece of legislation from Lindsey Graham and Bill Cassidy has the interest of John McCain and the support of the White House -- the best conservatives can hope for is some tinkering at the margins of the failing law. Obamacare will continue to lurch along in relative dysfunction even if "fixes" are applied to it, and as predicted by conservatives all along, public dissatisfaction with their terrible law will afford Democrats an opportunity to swoop in with a yet another "solution:" Total government control. It's no surprise that the dominant Sanders-Warren wing of the party -- and the presidential aspirants who want their votes -- is embracing single-payer healthcare. This trend speaks for itself and highlights the rapidity with which Democrats have sprinted to the left:

In 2008, no leading Democratic presidential candidate backed single-payer. In 2020, all of them might. https://t.co/VDMI3uOXP1 — Vox (@voxdotcom) September 10, 2017



What's considerably more eye-opening is the shift among more moderate Democrats, from Ohio Congressman Tim Ryan (who challenged Nancy Pelosi from the center), and Montana Senator Jon Tester. Support for a full-blown, VA-style, government-run healthcare system is quickly becoming a litmus test within the party -- and a prominent player in the passage of Obamacare just gave wavering Democrats an ideological permission slip to jump aboard the single-payer express. In a start reversal, former Senate Finance Committee Chairman Max Baucus now says it's an idea whose time has arrived:

“I just think the time has come,” Baucus told NBC News Friday, after stunning healthcare observers earlier in the day by seemingly coming around on single-payer at a public forum. “Back in ’09, we were not ready to address it. It would never have passed. Here we are nine years later, I think it’s time to hopefully have a very serious good faith look at it.”… “I started out by saying everything is on the table,” Baucus recalled. “But I did make an exception and that was single-payer. I said, nope, we’re not going to put single-payer on the table. Why? In my judgement, America was just not there … It’s branded as socialistic by too many people.”… Baucus compared the issue’s evolution to that of gay rights. “It’s anathema for a long time, and then suddenly — acceptance,” he said.

The gay marriage analogy works to some extent, in that a deluge of Democratic politicians -- eager to keep pace with their party's base and noticing movement in public polling -- have fairly abruptly "evolved" on the issue. But (setting aside the vindictive program of viewpoint enforcement among some on the Left) a core, successful message of the gay marriage push appealed to Americans' sense of 'live and let live' fairness: Same-sex couples' codified relationships wouldn't affect other people's marriages or lives, so why deny them the government-assigned benefits of marriage? That message resonated, and the resulting progress was bipartisan. People were not persuaded that excluding same-sex couples could continue to be justified by vague impalpable "harms" to society.



Healthcare is a very different story. The vast majority of Americans were statisfied with their healthcare arrangements prior to Obamacare's implementation, which is why Obama and his cronies spent so much time and energy lying about how people would be allowed to maintain their plans and doctors "no matter what." Under a single-payer regime, the employer-provided plans that tens of millions of people have come to reply upon would be threatened in an unprecedented way. Voters would also be asked to pay much, much higher taxes for a system with inferior health outcomes and worse accountability. There are a lot of stakeholders in the current US healthcare constellation who would fight single-payer tooth and nail, likely bolstered by a strong public disinclination towards disrupting the status quo (as well as broad opposition to tax increases on middle- and working-class households). Late last month, Philip Klein argued that Republicans' face-plant on 'repeal and replace' helps illustrate why imposing single-payer would be a very heavy political lift for Democrats:

Viewed one way, the GOP failure to repeal and replace could be seen as evidence of renewed public acceptance of a government role in healthcare, on the flip side, it could be viewed as an affirmation of the power of the status quo bias that has traditionally doomed any major overhaul of the U.S. healthcare system. For decades, Democrats had tried and failed to pass some sort of national healthcare plan, and the biggest obstacle had always been Americans' fears that it would disrupt their current coverage. It was why the Clinton effort went down in flames. It was the central reason why Barack Obama abandoned the idea of single-payer. And it was why he made his infamous promise about people getting to keep their doctors and plans if they liked them. By the time Republicans had the power to do anything, Obamacare had become the new status quo in healthcare and tinkering with it would have implications for the health coverage of millions of Americans. Suddenly, it was Republicans who looked like they were engaging in a radical plan of social engineering...



While, if passed, the Republican bill would have affected millions on Medicaid and on the individual market, any true single-payer bill would have to impact the employer-based healthcare system, which covers 49 percent of the country, or 156 million people, according to the Kaiser Family Foundation. Any proposal that tries to expand Medicare to all will have the additional task of convincing seniors – a reliable voting block, especially in congressional elections – that it won't affect their care. Creating a Medicaid buy-in would involve trying to figure out how you're going to get doctors and hospitals to accept rock bottom payment rates for tens of millions more people if you want to keep any control over the cost of the program. This doesn't even get into the massive tax increases required to support a single-payer system. An analysis of the Bernie Sanders single-payer plan from the liberal Urban Institute projected that it would cost $32 trillion over a decade.

It's a dreadful, unaffordable, callous idea that was unanimously defeated in the Senate last month. Granted, dozens of Democrats voted "present" to avoid an up-or-down referendum on an idea many of them support in principle, but half a dozen vulnerable Democrats voted against the plan, along with every Republican. Via Allahpundit, I'll leave you with this prescient tweet from Reason's Peter Suderman. If the GOP doesn't pull a rabbit out of a hat in the next few weeks, this disspiriting assessment about the future of healthcare policy battles feels right on target these days: