Ezra Klein tapped into an issue that's dominated the comment threads here lately. Briefly, there's an argument floating around some progressive circles that if we scrap healthcare and start over again at some later date, we can achieve a more robust set of regulations and reforms -- maybe even single-payer -- despite the fact that history doesn't vindicate the "start over" strategy. And, of course, I've been arguing that starting over is a profoundly bad idea.
Ezra lays out the last half-century:
Truman sought single payer. His failure led to Kennedy and Johnson, who confined their ambitions to poor families and the elderly. Then came Nixon, whose reform plan was entirely based around private insurers and government regulation. He was followed by Carter, who favored an incremental, and private, approach, and Clinton, who again sought to reform the system by putting private insurers into a market that would be structured and regulated by the government. His failure birthed Obama's much less ambitious proposal, which attempts to reform not the health-care system, but the small group and nongroup portions of the health-care system by putting a small minority of private insurance plans into a market that's structured and regulated by the government, and closed off to most Americans.
He doesn't paint a very pretty picture of the current effort. But what we're getting is a work in progress -- a framework that can be made more robust over time. That's always been the central subtext behind the public option, for example. Start with this public program and expand it as a gateway to single-payer. More from Ezra:
Failure does not breed success. Obama's defeat will not mean that more ambitious reforms have "a better chance of trying again." It will mean that less ambitious reformers have a better chance of trying next time.
Conversely, success does breed success. Medicare and Medicaid began as fairly limited programs. Medicaid was pretty much limited to extremely poor children and their caregivers. Medicare didn't cover prescription drugs, or individuals with disabilities, or home health services.
Naturally, the Medicare and Medicaid programs of today are far more expansive than they were when they were passed. Should we have scrapped those programs as flawed half-measures back in 1965? Of course not.