Sen. Reid: Obamacare ‘Absolutely’ A Step Toward A Single-Payer System

By Avik Roy for Forbes

When I speak to conservatives about health care policy, I’m often asked the question: “Do you think that Obamacare is secretly a step toward single-payer health care?” I always explain that, while progressives may want single-payer, I don’t think that Obamacare is deliberately designed to bring about that outcome. Well, yesterday on PBS’ Nevada Week In Review, Senate Majority Leader Harry Reid (D., Nev.) was asked whether his goal was to move Obamacare to a single-payer system. His answer? “Yes, yes. Absolutely, yes.”

In one sense, this isn’t shocking. Reid and many other Democrats, including President Obama, have often stated that their ideal health-care system is one in which the government abolishes the private insurance market. Video of the PBS discussion isn’t yet online, but here’s how Karoun Demirjian of the Las Vegas Sun described it:

Reid said he thinks the country has to “work our way past” insurance-based health care during a Friday night appearance on Vegas PBS’ program “Nevada Week in Review.”

“What we’ve done with Obamacare is have a step in the right direction, but we’re far from having something that’s going to work forever,” Reid said.

When then asked by panelist Steve Sebelius whether he meant ultimately the country would have to have a health care system that abandoned insurance as the means of accessing it, Reid said: “Yes, yes. Absolutely, yes.”

Reid noted that he and other progressives fought hard for a “public option” in the exchanges as a Trojan horse for single-payer, but Democrats didn’t have 60 votes in the Senate to achieve it:

The idea of introducing a single-payer national health care system to the United States, or even just a public option, sent lawmakers into a tizzy back in 2009, when Reid was negotiating the health care bill.

“We had a real good run at the public option … don’t think we didn’t have a tremendous number of people who wanted a single-payer system,” Reid said on the PBS program, recalling how then-Sen. Joe Lieberman’s opposition to the idea of a public option made them abandon the notion and start from scratch.

Eventually, Reid decided the public option was unworkable.

“We had to get a majority of votes,” Reid said. “In fact, we had to get a little extra in the Senate, we have to get 60.”

Reid sees the tax exclusion for employer-sponsored health insurance as the primary obstacle to single-payer health care:

Reid cited the post-WWII auto industry labor negotiations that made employer-backed health insurance the norm, remarking that “we’ve never been able to work our way out of that” before predicting that Congress would someday end the insurance-based health care system.

It’s one of the key things to remember when you look at polls saying that Obamacare is unpopular. A small percentage of the people who oppose Obamacare—around 7-10 percent—oppose it because it doesn’t go far enough.


  1. Gerry Hunt on August 12, 2013 at 4:35 pm

    The private health insurance industry’s standard business practice is capitalizing deception. Their efforts to attract clients are based on misrepresentations and their health plans are glamorous promises full of deceptive exemptions that make the paper document more valuable then the promises to cover your medical needs.

  2. Eugene Barufkin on August 15, 2013 at 10:23 am

    Via the Back Door Is America On The Way To SINGLE-PAYER???? –
    – Especially before next years elections. –
    Did you know ACA limits annual out-of-pocket costs for everyone???
    And, limits are less if you are low income?
    – The new exchange marketplaces have Federal tax subsidies, not just for premiums, but also out of pocket costs?
    ~~ ACA law – An individual between 100%-200% of the poverty line has an annual maximum out-of-pocket limit of only “$2000”.
    – Not great but better than it is now and it can be lowered over time.
    All because ACA has annual limits for everyone on out-of-pocket costs that include insurance premiums.
    – (Although a delay has requested for this ACA feature until 2015) –
    Annual Limits for people ‘above’ 200% of poverty line –
    – Individuals – $6,350
    – Families – $12,700, (not known – is this scaled to family size)
    = THUS – as years go by, the annual limits can be decreased down to ‘ZERO’, and VOILA! Single-Payer!!!

    DID Obama pull the wool over the Right’s eyes and drive us on the way to Single-Payer, slowly???
    This will work better if most people go into the exchanges for their coverage and large companies ‘do not’ provide coverage, thus forcing more people into the exchanges, thus more people will have subsidized coverage..

    It gets better and will be better when most people (80%) are getting Federal Subsided Coverage. Thus about 80% will be under one umbrella and morphing easily into Single-Payer.

    Eugene Barufkin, Wisconsin Single-Payer Network Facilitator, Single Payer Health Care/Medicare For All)

    • Steve Blank on October 23, 2013 at 11:44 am

      Hi Eugene,
      We met in Madison after Claudia Fegan’s presentation. I have to disagree with your analysis here because the tax subsidies are really a gift to the insurance industry. The ACA mandates that everybody participates in buying expensive private insurance plans, and if they can’t afford it, we use tax revenues to pay the private insurance companies. This set-up actually solidifies the grip insurance companies have over the delivery of health care.
      I agree with Dr. Quentin Young. “Had I been in Congress, I would have unequivocally voted against Obamacare,” Young writes. “It’s a bad bill. Whether it’s worse than what we have now could be argued. We rather think because of its ability to enshrine and solidify the corporate domination of the health system, it’s worse than what we have now. But whether it is somewhat better or a lot worse is immaterial. The health system isn’t working in this country — fiscally, medically, socially, morally.”

  3. Alex on August 15, 2013 at 10:32 am

    Like many who viewed Michael Moore’s film Sicko I signed up to receive updates from Health Care Now. Subsequently, my family’s access to employer-based health insurance made me complacent. I believe this is a major deterrent to mobilizing voters to demand a single-payer system. It is very hard to get people to support single payer when they don’t experience the anxiety of living without health insurance. Obamacare has given the health insurance industry a new lease on life. For example, young people are already notoriously indifferent to the need for health insurance, as I was in my 20s & 30s. By extending coverage to people up to the age of 26 under their parents’ policies, this potential source of support for single-payer is diminished. In addition, state-sponsored coverage for those under 18 blunts the demand for single-payer from parents who would otherwise be terrified that their children were without coverage. Change often requires a failure of existing institutions. I do not believe we have reached this point with our health care system.

    • DHFabian on August 15, 2013 at 10:57 am

      You make an important point that shows why we so greatly need to change the public discussion. Since Reagan, Americans embraced not only a “Me First” philosophy, but a “Me Only” philosophy, the idea that, “I’m doing OK, and no one else matters.” That complacency can easily happen, and it’s poison for a society, a nation. We need to re-learn to think in broader terms.

      • Carla on August 15, 2013 at 8:57 pm

        You are absolutely correct. This nation has been in a downward spiral since Reagan! Reagan turned me from a Republican, albeit not a strong Republican into a Liberal Democrat.

  4. DHFabian on August 15, 2013 at 10:41 am

    I’m skeptical about Sen. Reid’s implication that today’s Dem legislators largely support single-payer, or that Sen. Joe Lieberman was an exception to the rule. Since Clinton, Dem legislators have taken the lead in dismantling the “safety net”/social programs. It was Democrats who made the first successful attacks on Social Security, during the Clinton admin., specifically targeting the disabled. I don’t recall that Sen. Reid had a whole lot to say about those policies. It’s worth remembering that aid to impoverished women and children (later known as AFDC) was actually written into FDR’s Social Security Act, and this was wiped out by Democrats. The fact that Al Gore selected an anti-New Deal running mate when he chose Sen. Lieberman – with the support of Dem legislators – should have made it clear that today’s Democrats have gone in a direction that makes it foolish to assume that the party would support single-payer. When there is strong public support for a policy that the Dem legislators don’t want, they inevitably claim to “fall just short” of votes needed to enact it.

  5. Bruce on August 15, 2013 at 1:05 pm

    NOT! (with terminal DEM reneging):

  6. John on August 15, 2013 at 4:32 pm

    Thinking that the ACA is precursor to single payer is a pipe dream. By forcing ALL Americans to purchase insurance will strengthen these companies and their lobbyists influence over our government, and prevent single payer from ever happening. It’s simply feeding the beast and maintaining the status quo! Reid is blowing smoke.

  7. lambert strether on August 16, 2013 at 11:49 am

    Revisionist history from Harry Reid. I suppose he’s feeling a little pressure to look like he’s an actual Democrat.

    • - bill on August 20, 2013 at 8:51 am

      Revisionist, indeed. Harry seems to have conveniently forgotten that while the Senate did pass the ACA with 60 votes, it immediately thereafter passed the Health Care and Education Reconciliation Act (which amended the ACA in ways demanded by House members who would otherwise not have voted for the ACA) with only 56 votes (they actually needed only 50, assuming that Joe Biden would have broken any tie in favor of the bill).

      Being a reconciliation measure this second act could have included a public option – hell, it could even have expanded Medicare to cover everyone – since such a measure would indisputably have had a significant effect upon the federal budget. But Obama, Reid, and Pelosi twisted arms so effectively that no one (not even Bernie Sanders, who had intimated that he would do so) proposed such an amendment to the second act, thus leaving us with the continuing mess we have today which Reid so charmingly claims he wished he could have improved.

  8. Ronald on August 24, 2013 at 8:14 pm

    Enjoyed the comments. To Alex, I agree they are trying their usual tricks of buying our complacency. But our healthcare system is broken. Just ask anyone struggling with healthcare when uninsured or underinsured. Ask people who have lost a loved-one because of the financial demands of our crass system. To DHFabian, right-on! these Democrats are complete cowards who have both forgotten their own history and have sold-out to the corporate financed right-wing (remember the money-changers in the temple!). To John, absolutely ACA enriches the insurance industry and makes it more likely they will have a huge say in anything we try to do. To Bill, you are right about the way the legislation was put together then amended to avoid angering the insurance people and then even Sanders was forced to swallow a pro-insurance industry fraud packed as healthcare reform. Now Sen. Reid wishes to rewrite history rather than have people remember his and Obama’s sorry-ass role in this affair. The only thing that I can add to this very interesting discussion is that we in America can no longer depend on politicians the likes of Obama, Reid, Pelosi or even former Congressman Kucinich. We must lay the foundations for a mass party of labor such as the New Democrats in Canada. The Canadian NDP is by no means perfect but is a far cry better than a political party that defended slavery and segregation, included hypocrites like Jefferson and “Indian removal” President Jackson, and now says to right-wing Republicans “we can negotiate” slashing the social-safety-net.

  9. beverly on August 25, 2013 at 7:06 pm

    Harry Reid is a liar just like the President and Congress. The single payer idea was never on the table from the get go. Tepid single payer advocate John Conyers didn’t even get invited to the health care reform meetings until the WH was flooded with angry emails about his being left out. Those few in Congress who supported single payer did little to raise a ruckus to demand it be given serious discussion. If anyone has any deluded notion that Obamacare is a stepping stone to single payer, that notion should be quickly vanquished by knowing that the insurance and drug industries literally wrote the health care reform bill. If Obama, Reid and Co. really wanted to push the single payer agenda, why didn’t they? At the time, the president had a Democratic majority in Congress which made it easier to get bills passed. Why didn’t the reform debate and meetings include supporters of Medicare for All? Obamacare is the same health care “deform” as Romneycare. Ask Massachusetts citizens about how great that turned out. The only entities benefitting from Obamacare are insurance and drug companies who will continue to reap huge profits and provide stumbling blocks, headaches, and heartaches to people trying to navigate a byzantine bureaucracy designed to ration and limit care.