He writes (email newsletter, I can’t find a web link),
This is a $3 trillion industry and basically all the special interests want to keep the basic structure of Obamacare. Each wants to get rid of its own Obamacare tax. But they want to keep the taxes on everyone else. That’s the main reason why the Obamacare revenues will stay in the system and there will be almost no federal health reform.
My takeaway is that the optimistic case for the bill is that it will allow the states to go in separate directions on health care, and perhaps in some states more market-oriented approaches will have an opportunity to succeed. The pessimistic case is that the health care system will remain a kludge, and the next time the Democrats are in power they will institute single payer.
But the single payer that we get will be much uglier than what other countries have, because of the power wielded by the provider interest groups. In fact, don’t be surprised if it turns out that the health insurance companies stay smack dab in the middle of our version of “single payer.”