1. The Democrats were debating single payer while this bill, which they dread, nearly passed (and still has some chance of passing). This was not a random mistake, rather it reflects a more general tendency of the Democratic Party to focus on the wrong kind of expressive values, in a manner which does not seem remediable. We need to re-model what they are, and build this kind of un-educability into the new model.
2. One lesson of Graham-Cassidy failure is that American health care, at the state level, is a race to the bottom not to the top. Recall that the Canadian health care system also leaves key decisions to the provinces + block grants, but American Progressives love the results. Most observers know the American states would not copy the Canadian provinces in their policies, and it is not only because fiscal equalization is weaker to the south. The reality is that spending much more on health care would not make most American states much more desirable places for most people to live in. If it did, Graham-Cassidy would be a better idea than in fact it is and a race to the top would ensue. Better health care would brighten up states all around, attract more population, and increase the revenue going into governor’s coffers.
Democrats and Republicans both find this inadequacy of state-level outcomes difficult to accept, though for opposing reasons. Democrats hate having to recognize that all the extra health care spending might be mainly redistribution rather than remedying a market failure or providing a broad-based social public good. Republicans hate to see that giving states control over health care policy, and allowing them to revise Obamacare, won’t improve those states and probably would make most of them worse.
Of course my points #1 and #2 relate. I agree Graham-Cassidy is a bad idea, but every time I hear the critics say it is heartless, or would “take away” people’s health insurance, or “kill people,” what I really hear is “If we let everyone vote again on Obamacare, with a real time balanced budget constraint, they wouldn’t vote for nearly as much health care next time around.”
Which is why you should not be obsessing over single-payer systems.
Across the board, pondering Graham-Cassidy, including its failure, should make you more pessimistic about economic and social processes.