In a great interview, Physicians for a National Health Plan's Steffie Woolhandler explains why Obama's health care plan could be worse than no change at all. The gist of her argument is that trying to expand public programs while maintaining the private industry is incoherent and a fiscal black hole:
There’s no reason to think that would work. I think the private health insurance industry is not going to allow the government to run a program that really competes with them. That’s not just my opinion. If we look historically, when state governments have tried to run public programs side-by-side with private programs, the private health insurance industry has intervened to make sure that the public program is very low quality, with very limited coverage, because the private insurance industry doesn’t want the competition.Woolhander argues that the US, which spends twice as much per capita on health care as other industrialized countries, doesn't need to spend a dime more, but instead to spend the money wisely.
One consequence of Obama-type plans that she doesn't mention is their ideological impact. Given that these state run programs in competition with private ones tend to become totally fiscally unsustainable, they serve as fodder for right wing arguments that government run programs are simply too expensive and inefficient.
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