Jon Cohn's post telling single-payer advocates to take transition seriously -- i.e, don't underestimate the level of disruption it'd entail for our economy to break down the old system and create a new one while still providing health care -- is a good one, and folks should give it some thought. But how good? I mean, it's smart to think hard about how a transition would work, but if we're putting aside the political to look at the policy, as Jon says, then I've got to push this one back. After all -- we're considering a top-to-bottom reorganization of health care, a little disruption for a sounder long-term system strikes me as a much smarter way to go than a less sustainable system that entails less disruption. Further, I'm not sure how bad the disruption would need to be. After all, we're starting single-payer -- it's not as if the doctors won't know who to bill.
But policy fantasies aside, single-payer is not going to spring full born from Ted Kennedy's head and find itself legislation. It just won't. I don't, in fact, think there's much chance at all of moving America to single-payer legislation. Which is why I like sneaky single-payer. Let everyone buy into Medicare, and when that gets big enough, make it single-payer. More to the point, that's the sort of plan conservatives and liberals, if we were all honest, would endorse. If Medicare can do a better job, let's let people buy in and set the two competing. We'd have to rejigger the finances a bit, but it's quite possible to create a pilot Medicare program that could be widely used and, if well-liked, widely joined. Anyway, more on this a bit later -- right now, it's time for pancakes.
