Note: single payer and universal health care are not the same thing.

[DanTex]

Also, the rest of the first world does not have single payer. These seem to be points of confusion.

The top rated health-care system in the world by the WHO is in France. This is not a single payer system. It is a two-tiered public-private hybrid. There is more government involvement than in the US: the government there pays for about 3/4 of healthcare, whereas in the US the government pays for about 1/2.

There are also countries that have successfully achieved universal coverage and cost control with what are essentially stronger versions of Obamacare -- an individual mandate. These include Switzerland and the Netherlands.

Obamacare, when it was proposed, was also a stronger version of itself. The purpose was to put us on track to universal coverage. What happened? First, the public option died in congress. Then, the medicaid expansion died in the Supreme Court. But overall, Obamacare is a huge improvement over the status quo, and it gives us a path to universal coverage, in a similar way to what many other countries with public/private hybrid systems had.

However, for some reason, the far left is insisting that it's either single payer or you're some kind of Republican sellout. Pointing out that single payer failed in Vermont once they saw the price tag is heresy. In fact, even pointing out that single payer entails a huge tax increase (which is obvious) is heresy.

There are good arguments for single payer, but there are also good arguments against it. Building a single payer from scratch and tossing out the system we have now is very different from having grown a single payer system from the get-go. The transition will be expensive, as Vermont discovered. There will be a lot of taxes, and no, they won't all be on the 1%. Some people will save money and get better coverage, other people will lose money and end up with worse coverage. And you will definitely not be able to keep the coverage you have if you like it, as was mostly the case with Obamacare.

On top of that, politically single payer is totally infeasible. Sure, in DU la-la-land, calling taxes "taxes" is a right-wing talking point (I was actually told this), but in the real world taxes are called "taxes". We barely got Obamacare with large majorities and Democratic president. There will be no single payer, and trying to pass it will just result in a big failure and waste of political capital.

What can possibly be done is improving Obamacare. How? Well, for starters, the reason we didn't get the medicaid expansion is the supreme court. The solution to that is get a Dem into the White House. With a friendlier congress, push for the public option again, which polls very well. Push for all-payer pricing nationwide, and so on.

[Hoyt]

1. Excellent and accurate post. Obama got the heavy work done despite strong opposition

and criticism.

Now, it's time to make it better. A public option with expanded subsidies is the next big step, along with drug pricing and getting some of the profiteering out of healthcare.

If Obamcare had failed, it would be years before anyone else put that much on the line for health care.

[PoliticAverse]

2. Note that only 2 of the 9 justices completely upheld the Medicaid expansion in the ACA.

The way the law was written poor people in states that didn't go along with the ACA's Medicaid expansion
would lose their existing Medicaid coverage.

[Admiral Loinpresser]

3. Two big points.

First, countries such as Canada and the UK provide free health care to all comers, but allow affluent people to get private health care on top of the basic coverage. I am fine with that. Such a system would bring down health care costs dramatically.

http://www.commonwealthfund.org/~/media/files/publications/fund-report/2015/jan/1802_mossialos_intl_profiles_2014_v7.pdf?la=en

Second, all of these countries have dramatically less wealth and income inequality than the US (the UK is the only one with a remotely similar problem, but even there it is not as bad as here).

Any plan which will address our insane health care system must factor in a shrinking middle class and the poor. No more bullshit!

[DanTex]

5. Yes, Canada and the UK have single payers.

In fact, the UK has socialized medicine, which is a different category. I didn't say no countries have single payer, just not all of them.

Single payer is one way to get universal coverage, but it is definitely not the only way. What I don't get is why people insist that single payer is the only way to go in the US, despite the fact that there are highly successful non-single-payer systems around the world. Particularly since single payer is politically impossible here, it would require building a whole new system from scratch in a country of 300 million people, and the single payer experiment in Vermont failed.

[Admiral Loinpresser]

6. Canada and UK are public option systems.

They are free to buy private insurance and some do.

I am fine with an expanded Medicare-for-all public option. We will get the lion's share of economic efficiency from that. But no more half stepping. People are dying every day because of our insane system. No more half stepping!

[DanTex]

7. Not really, because you can't opt out. You can buy additional coverage,

but that supplements rather than supplants the government coverage. The public option, as it was proposed here, was actually an option. You can buy into medicare, or else you can pay for private coverage in which case you don't get medicare.

Regardless, I agree with you that a public option would be good. In fact, a public option could be a step to single payer. For example, first step, medicare buy-in option. Second step, make the buy-in option the default, so unless you opt out, you get medicare and the premium is part of your usual taxes. If you decide to buy private insurance, you get a tax rebate so you don't end up paying a medicare premuim, and you also don't get medicare coverage. And then down the road, they end the opt-out, so everyone ends up with medicare, and private plans become supplemental, like in Canada and the UK.

But the thing is, that's not the only way to universal coverage. You can also get universal coverage without single payer, like they have in Holland or Switzerland, where it's basically an improved Obamacare.

[Admiral Loinpresser]

12. I agree, except as to buy-in.

The public option should be free to everybody making less that a certain household figure, such as $100k. We must address wealth and income inequality in our health system, because our economic situation is so desperate.

[SonderWoman]

4. I gave up on my op about this because...

In typical DU fashion I got insults and name calling but no actual policy rebuttals. KNR for persistence.

[DanTex]

8. Yup. Insults and name calling and no policy rebuttals. That's basically the theme.

And then there's the insistence that really it's about "policy". Except, when discussing policy, you're not allowed to call the government "the government" and you're not allowed to call taxes "taxes".

[Bonobo]

9. Keeping private insurance companies that complicate redtape and increase costs is a non-starter.

It is self-evident that it is a drain on the efficiency of any system.

[DanTex]

10. Actually, getting rid of private insurance is a non-starter politically.

As far as what is "self-evident", you probably should tell that to the Swiss and the Dutch. And the French and the Germans...

[Bonobo]

13. Do middlemen add cost to the final product? Yes or no?

Simple question.

Let's see if you dodge it.

[DanTex]

14. Of course, but there are middlemen in either case. The government or a private insurer.

It's not like the government doesn't have to administer a single payer system.

Like I said, there are plenty of examples of efficient public-private hybrid systems.

[Bonobo]

15. But without the need to make a profit fir shareholders

it is in theory going to be able to operate more efficiently.

[DanTex]

17. That's according to one theory. According to another theory, without the need to make profit,

the middlemen will operate less efficiently.

In practice, both kinds of systems have been made to work. Which is why the insistence on single-payer over a Swiss or Dutch style system doesn't make much sense to me, particularly getting to a Swiss/Dutch system will be much easier.

[Hoyt]

18. Private insurance companies administer Medicare right now, further Medicare Advantage plans

which over 30% of Medicare beneficiaries choose, are private insurance companies paid by the government. I like Advantage plans because you get some extras, a cap on out-of-pocket cost, drug coverage, and most importantly some of the Advantage plans are really good at coordination care. The later just doesn't exist in traditional Medicare, and beneficiaries without a costly supplement risk bankruptcy if they get really sick.

With a public option, most people will choose the public option if it is better. Truthfully, I'm not sure it will be better compared to 3 or 4 large private insurance companies having to compete for patients (with premiums properly subsidized for lower income individuals), but I think citizens deserve the option.

The government would have to up its game in the public option compared to what they've done with Medicaid, VA, and even Medicare. Medicare is not nearly as great as most people think, although it is definitely better than having to choose between eating and health care. BTW, I did not always believe this until I started evaluating whether I should sign up for Traditional Medicare, or pay a relatively small additional amount for a Medicare Advantage Plan with drug coverage, cap on out-of-pocket exposure, and much more coordinated care.

[NCTraveler]

11. Excellent op.

I also really like the first reply to your op.

[mcar]

16. K&R