For now, the GOP attempt to repeal Obamacare is dead. Despite White House threats and demands intended to once again revive Repeal and Replace, Mitch McConnell has been clear in his desire to move on. With the contentious fight that will be tax reform – which Republicans are eager to get passed – and the looming debt ceiling debate, the GOP would need a political miracle to get healthcare reform passed in the next year. Once that time passes, it will be even more difficult as Representatives and Senators focus on reelection. With GOP infighting over the best way to ‘fix’ healthcare and Democrats expected to take back seats in both the House and Senate, the odds that Obamacare gets repealed are generously slim to none.


Furthermore, as the debate goes further along, the GOP bill gets less and less popular. At the same time, Obamacare’s popularity has been steadily rising and Americans have been increasingly receptive to the idea that everyone should get coverage. It’s hardly the success of Obamacare that has revamped its popularity but rather the GOP proposal to get rid of protections for preexisting conditions and Medicare. Obamacare has still left Americans paying outrageous deductibles and co-pays at the doctor’s office, but it turns out we don’t like the idea of people being denied coverage.


Here comes into play Single Payer, and there appears to be something of a perfect storm brewing.


The first indication, as I just noted, is how unpopular Obamacare repeal has been. But Obamacare itself was extremely unpopular before the GOP tried to repeal it, and it still retains an approval rating of only around 50 percent. That’s still not exactly a ringing endorsement, especially in context. As the GOP gives on repeal and repeal leaves the spotlight, expect that number to dip into the 40’s, especially as premiums continue to rise.


The second indication is growing Democratic support, even from members generally known as part of the establishment. Representative John Conyers (D – MI) introduced a Medicare-for-All bill in the House back in January that received 116 Democratic cosponsors. Democratic lawmakers in states like California and Vermont have also been trying to set up their own forms of universal health coverage at the state level.


Even Dems who oppose Single Payer, like Hillary Clinton, support a public option. The gap between a public option and a single-payer system is not very wide, suggesting moderates would likely be willing to take the leap if the party opted for Medicare-for-All. It’s widely believed that Democrats are going to make big gains in the House and Senate in 2020 on the coattails of Trump’s historical disapproval ratings. If Democrats find themselves in control of Congress and the White House in 2020, which isn’t inconceivable, universal healthcare would certainly be on the table.


The third indication is that Republicans are acknowledging that Single Payer may be around the corner. This has taken two forms. The most common form has been to begin smearing advocates of universal healthcare as big government socialists. Senator Steve Daines (R – MT) introduced a single payer healthcare bill in the Senate with the goal of ‘embarrassing’ Democrats by making them vote for it. Mitch McConnell slammed Democratic supporters of single-payer after John McCain casted the deciding vote that killed ‘Skinny Repeal.’ This shows Republicans trying to get ahead of the message on what they see as the coming storm.


The second form, the much rarer one, has been conservatives who embrace a universal health system. In some ways this started with our President who, on the campaign trail, promised that we would cover everyone. Many Trump supporters who need expanded health coverage but agreed with the President on other policies like immigration loved this rhetoric. A growing portion of the conservative base, especially younger conservatives, are open to the idea of universal coverage.


Writing in The American Conservative, Chase Madar predicts that within the next 5 years, the GOP will embrace Single Payer:


“So even if there is some banshee GOP resistance at first, universal Medicare will swiftly become about as controversial as our government-run fire departments.” Madar concludes in his piece “Such, after all, was the trajectory of Medicare half a century ago.”


The fourth indication that America is headed down the road to Single Payer, and perhaps the most important, is that public opinion demands it. An Economist/YouGov poll recently showed that 50 percent of Americans support “expanding Medicare to provide health insurance to every American,” while only 23 percent were opposed. A poll from Morning Consult/Politico showed 44 percent of Americans support a Single Payer plan “where all Americans get their health insurance from one government plan.” 36 percent were opposed. A Pew Research tracking poll showed that in November of 2013, 42 percent thought that government has a responsibility to “make sure all Americans have health coverage” compared to 56 percent who didn’t. In January of 2017, 60 percent say government has a responsibility and only 38 percent say it doesn’t, a dramatic reversal in the span of four years.


It’s important to note a remarkable point about the 2016 election here. There were three candidates with a real shot at the Presidency; Bernie Sanders, Hillary Clinton, and Donald Trump. All three campaigned on reaching some form of universal coverage. If that’s not an indication that the tides are shifting towards Single Payer, then I don’t know what is. Combine this with public opinion, the failure of Obamacare repeal, and the expected gains by Democrats over the next 3 and a half years, and those tides look like a monsoon.


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