Will ObamaCare Turn Out to Be (Partial) Single Payer?

Making the exchanges work for individuals looks to be difficult. Expanding Medicaid seems to be easy. And state governments’ incentives to acquiesce in Medicaid expansion in order to avoid creating an our-safety-net-hospitals-are-closing problem are very strong, while state governments’ incentives to spend energy and money on a working state or on their citizens’ access to a working federal exchange are less immediate: failing to do so does not create an urgent immediate problem.

Will ObamaCare turn out to be (partial) single-payer via Medicaid expansion in disguise?

Paul Krugman: The Medicaid Cure: “Something really interesting is happening on the health-care front: costs are rising much less rapidly than anyone expected. This is good news for the budget; it’s also good news for Obamacare….

One thing I haven’t seen mentioned much, however, is that another aspect of recent developments — the rapid rise in Medicaid enrollment, despite Republican efforts to block it — adds to the prospect of continuing good news on health costs. Medicaid gets a bad rap… a poor people’s program… it’s widely assumed that this means poor care. In fact, there’s not much evidence that this is true…. Beyond that, however, Medicaid is the piece of the US health care system (aside from the VA) that does the best job of controlling costs…. by being able to say no… in a way Medicare so far can’t….

One way to think about this is that Medicaid is actually the piece of the US system that looks most like European health systems, which cost far less than ours while delivering comparable results….

Medicaid enrollments have outpaced insurance through the exchanges. This is often reported as if it were a bad thing…. But… rising Medicaid enrollment is, aside from a huge benefit to the previously uninsured, a step toward better cost control in the system as a whole…. Don’t apologize for Medicaid growth. In economic and human terms, it’s just what the, um, doctor ordered.