In an op-ed in the New York Times to commemorate the new year and beginning of Obamacare coverage filmmaker and activist Michael Moore suggested it was time for everyone to acknowledge that “Obamacare is awful.” That the program is a pro-insurance nightmare that does nothing to rein in the costs from a rent-seeking insurance industry that allows the overcharging for procedures and pays its corporate executives exorbitant amounts of money.

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get…

I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.

Some have always theorized Obamacare was purposely awful, a Trojan Horse to usher in a single payer system by getting everyone on board as stakeholders with insurance who would then collectively band together and ask to dump the parasitic insurance companies. Moore suggest he aligns somewhat with that camp by claiming that President Obama really wanted single payer all along.

The next step should be, according to Moore, going state by state and adding a public option to each exchange as wall as pushing for in-state single payer as Vermont now is.

In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)

All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

Is universal health care now a state by state battle? Now that the federal law has provided the skeletal structure it is up to local activists to flesh it out?

It is an interesting idea but it remains to be seen how easy it is to win these fights on the state level. Vermont is tough enough, how about Alabama? Though blue states having universal health care may ultimately effect where people live and pressure other states to adopt similar policies.

The only thing that’s clear about the future is the health care fight is far from over.

 Photo by Glucke under Creative Commons license.