The Democrats may be subverting their own ultimate goal (a U.K.-style single-payer system) by pushing single-payer, the public options, etc., right now. Taking a long-term view, our current medical care system is politically unstable. People are generally unhappy with the system; they see that it is overly complex, leaves many people out, and contains obvious waste and duplication of effort. But they also fear change. Radical reform of any type will only be popular when dissatisfaction with the status quo exceeds the fear. In the meantime, the debate rages between centralized "single-payer" plans and decentralized market-based plans.
It's pretty clear that the leaders of the Democratic Party want single-payer. Obama and his advisers have said so on several occasions. Ted Kennedy has been working towards this for decades. Howard Dean supports it. I've spoken to several committed Democrats privately and they nearly universally wish for single-payer.
The question is how they get it. Single-payer is unpopular today, and the Democrat leadership knows this. So they propose the "public option" instead. This would be a government-run insurance program that anyone could buy into, and would establish a minimum standard for private plans. But this would push us towards a single-payer system. A study by the Lewin Group showed that over 110 million people currently insured through their employers would shift to the public plan (or be shifted by their employers). That would represent over two-thirds of all privately insured Americans. Once that happens, not only would private insurers be financially gutted but voters would view a step to single-payer as a smaller reform than it currently is. We don't even have to speculate on this. Prominent Democrats have publicly announced this strategy on multiple occasions.
However, the public option is also coming under fire, because the "camel's nose under the tent" strategy is so transparent. Obama has also done a poor job selling it. He used the Post Office, of all things, as an example of a well-run competitor to privately-run FedEx and UPS! (He ignored the fact that the Post Office actually has a monopoly on first-class mail delivery and is not competitive in the reliable package delivery business that FedEx and UPS specialize in.)
So Democrats have shifted the debate to focus opprobrium on insurers. They are broadly disliked already, so this tactic may be effective. So much political capital has been spent on health reform so far that some bill is almost sure to pass.
As a result of all these factors, here's the way I see the future of medical-care insurance: This year, we will get insurance "reform" which will contain measures that will push rates higher, cause more people to lose their private coverage, and create more financial burden on states. The reform will be unpopular with Democrats, who will view it as a compromise. Republicans will be relieved to have avoided the public option. But over the next few years, the "reform" will create ever more dissatisfaction with private care. Health insurance will, in effect, be transformed into a publicly regulated utility.
Increased dissatisfaction, an increasing number of uncovered citizens, and increasing regulation all work to the Democrats' favor. They are all steps leading to the sort of ultimate goals they want: either the creation of a public option a few years hence, followed by single payer a few years beyond that, or even a direct move to single payer.
Luckily for us conservatives, a lot of rank and file Democrats don't grasp this progression or are too impatient to wait for it. They are pushing for the most radical reforms now. We should encourage these feelings. If we are really lucky, they will be so busy attacking the current push for reform from the left, while we attack it from the right, that no compromise comes to pass. With Republicans completely out of power, that is the best result we can hope for this time around.