For once in my life, I actually agree with Megan McArdle. It is much more likely that a relatively successful ObamaCare will lead to a single-payer system than it is that a major failure of the law will lead us there. The main obstacle to single-payer is, as Ms. McArdle correctly agues, that most people have employer-provided health insurance that is working fairly well for them. Many of the problems they were having with their insurance have been fixed as part of the Affordable Care Act‘s reforms. People don’t want to give up what they have.
But, over time, a successful individual market that provides good prices will destroy the logic of employer-provided health care. A greater share of the population will get their insurance for themselves. And then the political pressure will be to improve the individual market, which would always be cheaper for the consumer of the government ran it than for-profit corporations.
We may never get a true single-payer system, but it becomes more likely if the individual market works and grows.
