– November 15, 2017

The American welfare state is three reforms away from becoming a Scandinavian welfare state: universal child care, paid family leave, and single-payer medical care.

Thanks in equal parts to President Trump and members of Congress from both parties, we are inching closer to paid family leave. Obamacare gave us the first taste of a comprehensive, government-run medical system.

With their first, botched effort to repeal and replace Obamacare, the Republicans in Congress drastically increased the likelihood that we will end up with single-payer medical care.

What seems to be a contradiction in terms — Republicans paving the way for socialized medicine — is in reality a case of cynical, political logic. In the October issue of Commentary Magazine, Tevi Troy, CEO of the American Health Policy Institute, points to a serious consequence of the Republican surrender before Obamacare:

If the Republicans could not repeal Obamacare at a time when they hold the House, the Senate and the White House, and when nearly all of these GOP officials were elected in no small measure on the basis of their personal commitments to repeal and replace Obamacare, when might they ever repeal it – or any large-scale government program?

The feature of President Obama’s medical reform that brought Republicans to their knees is a combination of:

a) the individual mandate, forcing every American to get covered, and

b) the tax-paid subsidies to make coverage “affordable” for everyone.

Together, the mandate and the subsidies constitute “universal coverage” of health insurance. In the eyes of congressional Republicans, they also constitute an insurmountable bulwark that makes Obamacare de facto irrepealable. Republicans admitted defeat to Obamacare because they could not guarantee the same level of medical-insurance coverage as the individual mandate and the tax subsidies could do.

Republicans are still making feeble attempts to repeal the individual mandate, but even though the last word has not been spoken yet on that particular issue, it is a relatively safe bet that the mandate survives at the end of the day. Tevi Troy explains why: when Republicans put universal coverage beyond reach of their repeal efforts, they de facto accepted it as a legitimate ideological foundation for tax-paid entitlement programs. For example, it is now impossible for Republicans to resist the idea of universal coverage of a general income security program, also known as paid family leave.

As Troy points out, congressional Democrats will seize upon this opportunity at their earliest convenience to complete the construction of the American welfare state: the way the debate has shifted is smoothing the path to single-payer. If coverage is the ultimate good, a system that “guarantees” coverage with no exceptions will have a leg up in all arguments, regardless of its impact on cost, quality, access, and freedom.

Entitlements that blanket cover all citizens are the ultimate goal for an egalitarian welfare state. In the period from the late 1930s to the late 1950s, Sweden built a welfare state where universal coverage was the motivating factor behind every new government program. A similar effort began in the United States with President Lyndon Johnson’s War on Poverty.

With their apparent political agony before the universal-coverage principle, Republicans in Congress have opened the door for America’s egalitarians to further expand government’s role in medical care, and our lives in general.  

More than ever, this country needs a vigorous, respectful conversation about the future role of government in our lives. Without that conversation, America’s egalitarians are going to finally, and soon, fulfill Obama’s promise to “fundamentally remake” this country, and do it entirely the way they want it done.

Images: NIXERKG.

Sven Larson, PhD

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