Things are shifting in the economic policy world. John Cochrane, an economist at the Hoover Institution and a staunch free-marketer, has been a leading critic of Obamacare and an advocate of a laissez-faire approach to health care. But in a recent blog post, he expressed sympathy for the idea of a single-payer health system:
A single provider or payer [that] anyone in trouble can use, supported by taxes … while allowing a vibrant completely competitive free market in private health care on top of that, is not such a terrible idea. … A single bureaucracy that hands out vouchers, pays full market costs, or pays partially but allows doctors to charge whatever they want on top of that would work.
This is actually closer to a public option (though Cochrane also suggests a system of government-run hospitals and clinics similar to the Veterans Health Administration).
Cochrane’s endorsement of government-provided universal health care seems to mark an important milestone. Just nine years ago, during the debate over the Affordable Care Act, the notion of universal health care was itself considered radical — Obamacare was an enormous, complex compromise, and the public option was considered a bridge too far. Now there seems to be a spreading realization that the government needs to do more, not less — to simplify the U.S. health care system, if nothing else.
Where once the left could only dream of a hybrid system like Obamacare, today politicians like congressional candidate Alexandria Ocasio-Cortez and U.S. Senator Bernie Sanders are openly calling for a system where the government is the only health-insurance provider. Meanwhile, center-left leaders are rushing to come up with compromise proposals that preserve some role for private insurers.
Some of these proposals amount to extensions or reinforcements of the Obamacare system; some are more ambitious. My personal favorite is Medicare X, proposed by Senators Michael Bennet and Tim Kaine, which would allow any American to buy into a somewhat expanded version of the current Medicare system. That system would leverage Medicare’s proven ability to hold down costs, while offering consumers a menu of choices — basically, Cochrane’s idea.