People rally in favor of single-payer health care for all Californians on Tuesday in South Gate, Calif. (Robyn Beck/AFP/Getty Images)

We still don't know who will ultimately prevail in the debate over the future of American health care: the Republicans who want to overhaul Obamacare, or the Democrats who want to keep it in place.

But after weeks of debate, there is one clear winner so far: single-payer health care.

No, single-payer isn't going to happen at the end of this debate — or even the end of this year or this decade, necessarily. But the logical foundations for it are being laid in our political debate just about every single day. And when you pair that with the rising public support for government-run health care, it's clear in which direction this whole debate is trending.

The most surprising aspect of the current health-care debate, for me, has been how Republicans have essentially given up on making the conservative case for their bills. They aren't even arguing that the free market would lead to higher-quality care, efficiency and medical advancements, as the GOP of old might have. Instead, they are trying to obscure the reality that their bills would cut Medicaid by hundreds of millions of dollars (versus where funding is currently set) and would increase the number of uninsured Americans by potential 20 million or more.

President Trump and his advisors claim spending for Medicaid will continue to increase under the Senate health-care proposal. CBO projections suggest otherwise. (Meg Kelly/The Washington Post)

Part of this is because that's a losing argument. The reality of entitlement programs and government benefits is that, once they are instituted, it's very, very difficult to get rid of them or even scale them back. Just look at what happened to the GOP when it suggested privatizing Social Security last decade.

That political reality has also basically forced Republicans to concede this point: that people being uninsured is a very bad thing, and that cutting funding to Medicaid is a bad thing. They have basically conceded that government involvement in health care is a good thing — or, at least, a necessary thing. That wasn't the argument they were making against Obamacare eight years ago.

Democrats, meanwhile, are gradually talking themselves into supporting single-payer, it would seem. Their laser-like focus on the number who are uninsured and the Medicaid cuts has a logical conclusion. There is only one way to make sure nobody is uninsured, after all.

And there are signs that both parties' bases are indeed moving toward government health care. A Pew study in January showed 60 percent of Americans felt it was the government's job to guarantee health-care coverage for all Americans — up from 51 percent in early 2016. About 8 in 10 Democratic-leaning voters and 3 in 10 Republican-leaning voters agreed with this statement.

That's not quite single-payer, of course, so Pew broke it out a little bit more in its most recent study. It asked those who supported a government guarantee whether they backed single-payer or a mix of government and private programs. In this case, support for single-payer was 33 percent overall — 52 percent on the Democratic side and 12 percent on the GOP side.


One of the realities of polling, though, is that when you give people more than two options, they will tend toward the middle-ground response. A "mix of government and private programs" is a pretty safe middle ground, it would seem, and may actually undersell single-payer support.

And sure enough, a Gallup poll from mid-2016 actually showed a 58 percent majority of Americans wanted a "federally funded healthcare program providing insurance for all Americans." A CBS News poll in February 2016 asked more directly about single-payer and found 44 percent support. NORC pegged it at 38 percent — but only 24 percent if people were told that it would greatly increase government spending. (Philip Bump summarized all of these data here.)


What we can say with certainty, though, is that the debate over this topic has taken on a new flavor as Republicans have been working to finally undo Obamacare. And it's a flavor that reflects a growing move toward government health care.

The GOP may yet move the needle away from government health care by the time all is said and done, but the center of this political debate has moved noticeably to the left.