Avik Roy: Redeeming Obamacare

Sometimes it is hard to accept defeat. On December 18, 1974, Teruo Nakamura, the last known holdout from the Imperial Japanese Army, finally surrendered to Indonesian authorities. It may take three decades, too, for some conservatives to accept the defeat of the movement to repeal Obamacare. But just as Japan reinvented itself after World War II to become one of the wealthiest countries in the world, there is an opportunity in this moment: for conservatives to coalesce around a long-term strategy for reforming our entitlements and liberating our health-care system.

The first thing to understand about Obamacare is that its existence stems directly from a blind spot in the postwar conservative movement. The coalition forged by Bill Buckley and others in the 1950s — famously, a fusion of anti-Communists, free-marketeers, and cultural conservatives — focused, in practice, on lowering taxes and defeating the Soviets. Health-care policy rarely appeared on conservatives’ radar.

Progressives, by contrast, from the Truman administration on, have had one public-policy goal above all others: universal, single-payer health care. And they have been spectacularly successful at sneaking health-care half-loaves into their policy agenda. Even LBJ, with historically large Democratic majorities, couldn’t push single-payer through Congress. Instead, he created health-care programs for the very poor (Medicaid) and the elderly (Medicare), leaving everyone else, in theory, in the private system.

Continue reading…