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Despite whatever happens to the ACA, I think you’re right — “single-payer” is going to be an excellent meme for those on the left who refuse compromise to the point that their advocacy is no longer constructive. At the end of the day, being too far on either extreme gives you the same lack of a vote — idealism is great, but useless without a sliver of pragmatism.

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WalterKovacs said on January 9th, 2017 at 4:49 pm

On the other hand, the right isn’t going to give up it’s extreme side, so if the left is the only side that’s pragmatic, you end up with the Overton Window constantly moving to the right, and centrist positions are considered ‘far left’, because one party is center right, and the other party is far right.

Starting the negotiation (even if the other side isn’t willing to negotiate) at the point where you’ve already given up as much ground as your are willing to give seems like a bad move. Lead with single-payer, and fall back on the more reasonable plan. Show you are willing to compromise to shame the other side. Instead of doing all the negotiation ahead of time, and make it look like you are forcing your plan down their throats when neither side is willing to budge. It’s all political theater at that point, so might as well play it out in public, instead of doing it behind the scenes and not getting anything out of it.

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Single payer is also unreasonable in the US because of it’s diversity.

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Single payer is also unreasonable in the US because of it’s diversity.

What diversity do you mean?

Because of the way each State seems to do something different? Or are you talking about racial, cultural or other diversity?

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WalterKovacs, how about starting with a public option?

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Both, but mostly the former and that’s why health care was going to suck no matter what.

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Single payer could be relatively easily reached in the US by allowing people to buy Medicare-based insurance (with the subsidies and mandates from Obamacare for the same reasons that they’re necessary for Obamacare). But apparently there are clauses in the Patient Protection & Affordable Care Act that prevent that, which means the president can’t do that by executive order.

I share your general assessment of Joe Lieberman, but it’s worth noting that he was a senator from Connecticut, which is the home state of several of America’s largest insurance companies (The Hartford, Travelers’, and health insurance giants Aetna and Cigna). He and the senior senator from Connecticut, Chris Dodd, were both supporters of Obamacare because they understood that overall the program was a giant cash giveaway to insurers. However, there was pretty much no way they were going to agree to anything that might even begin to threaten the insurers’ bottom lines.

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SleepOnBarryO said on January 10th, 2017 at 11:40 am

“Well, except for the bit where most of the anti-Obamacare animus is actually racially driven. Good luck with that”

And that’s why you call it the ACA. If you can bypass their kneejerk bigotry, the “get your government hands off my Medicare” crowd might actually vote in their own self interest for once.

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While the statements in the post aren’t exactly inaccurate, per se, I think they’re a little misleading. The health systems in the UK, Canada, Australia, New Zealand, France, Italy, Spain, Denmark, Holland, Belgium, Finland, Norway, and Sweden are far from identical, varying primarily in the effective percentage of private provision and the extent of primary care gatekeeping. But they are, especially at point of care, quite similar state-run and funded systems – they are different interpretations of the single payer system and those in the U.S. who tend to group them together as an example of a functional alternative overseas are, I think, quite correct in doing so.

Whether such an alternative is feasible in the U.S. is definitely debatable, and it’s quite possible it may never be. I’d agree that the ACA contains some large steps in the right direction (such as aiming for universal insurance coverage). It’s also worth mentioning that there already is a single payer healthcare system for a small proportion of the U.S. population – the Veterans Health Administration, which basically provides universal care to 10 million veterans and their families. It is less efficient than it could be, due to the distribution of providers and having to cope with the costs set by a much larger private insurance market, but it does exist.

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philippos42 said on January 11th, 2017 at 2:38 am

Do you know why USA-Americans keep talking about single-payer? Because we already pay for single payer. Every business in the country pays a Medicare payroll tax for every employee, and the employees don’t access it. No, they have to go and get private insurance for themselves, after they pay for retirees’ Medicare.

USA Medicare was originally proposed and designed as universal single-payer. It was changed to a retirement benefit. So the workforce? The productive members of society? They’re not covered by it. Instead they’re covered by insurance through their employer or labor union, which means that changing jobs is much, much harder. Or they buy their own at a steep markup compared to the per-person cost to someone in, say, the Teamsters.

Oh, and if you’re near retirement, guess what private insurers try to do to you.

If you were actually from here, you’d understand. Age-based eligibility for single-payer insurance is completely absurd. But that’s what we have.

Medicare for all is not a pipe dream. It is the most obvious solution to the nightmare of cost overruns, additional profit centers, and institutional denial of care that plagues the USA.

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philippos42 said on January 11th, 2017 at 3:01 am

Also, it is beyond ridiculous to say that the UK, with its mix of public hospital & clinic infrastructure and a small amount of private medicine for the wealthy, is “true single-payer”; but imply that Spain, with its public hospitals & clinics for 90% of patients and private elite facilities for only about 10% of the public, is something else entirely.

They’re both socialized medicine systems.

I’m sorry, MGK, but you are trying to sound authoritative about something where you don’t even know the facts, including basics of terminology many of us in the USA made a point of learning several years ago during this debate.

Canada, France, & Australia all have substantially what we would call “single-payer” systems, although I guess you could argue that Australia’s is really a partial subsidy or reimbursement system. Canada’s is the most extreme, as it bans private insurance for Canadians in Canada.

The UK and Spain have “socialized medicine” systems with public hospitals.

The USA has both. The Veteran’s Administration (VA) is a public hospital system. Medicare is a French-style single-payer system, and Medicaid is a Canadian-style single-payer system–yeah, really! And between them, they leave most of the taxpayers who fund them without any entitlement to them. Instead workers and businessmen have to hope they’re not swindled by “health insurers” who take your money and use it to fund their investments. It makes me cry.

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Will Shetterly said on January 11th, 2017 at 2:52 pm

It’s sweet to think Obama didn’t use the bully pulpit because he thought he would lose, but what he did is consistent with the guy Adolph Reed described in 1996: “In Chicago, for instance, we’ve gotten a foretaste of the new breed of foundation-hatched black communitarian voices; one of them, a smooth Harvard lawyer with impeccable do-good credentials and vacuous-to-repressive neoliberal politics, has won a state senate seat on a base mainly in the liberal foundation and development worlds. His fundamentally bootstrap line was softened by a patina of the rhetoric of authentic community, talk about meeting in kitchens, small-scale solutions to social problems, and the predictable elevation of process over program — the point where identity politics converges with old-fashioned middle-class reform in favoring form over substance.”

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Single-payer systems mean that every medical concern can become political drama because the government ultimately decides which treatments it is willing to pay for.

Americans (and perhaps other nations but nobody seems quite as dumb in this specific way as us) automatically assume that anything gummit-run is going to be bad, and be the wrong decision, and etc. But I dislike having a private for-profit corporation making decisions about what treatments it is willing to pay for quite a lot, actually.

I find it absolutely baffling at the immense raging froth that comes up at the idea of a government making a decision that affects peoples’ lives, but a corporation doing it just gets a shrug and ‘that’s the market.’ As if bottom lines erased all questions of suffering or common sense.

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The other thing about the single payer meme is that there have been multiple state-level initiatives to look into creating a single-payer system. In Vermont (one of the most liberal states in the union), it tanked the popularity of the incumbent Democratic governor to the point that he almost lost re-election; in Colorado, as a ballot initiative this year, it tanked completely. People just do not want to pay the level of taxation that would be required to run a single-payer system in the USA.

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Tom Galloway said on January 15th, 2017 at 5:01 am

IMO, there are several problems with modifying the US health system.

1) Everyone wants Bill Gates level of care for their loved ones. No one wants to hear “There’s a procedure that might help, but it flat out costs too much”. See “death panels”.

2) What things actually cost is completely out of whack. Figuring out reimbursements would require a top to bottom reevaluation of what’s reasonable.

3) Way too many people say/think “health care should be free” or “health care is a a basic human right” (with an implied “unlimited” appended. When someone says this, I tend to consider less what else they say. Because there are real costs involved, and not thinking about them or where the money comes from indicates you don’t know what you’re talking about.

Combine them, and the sheer scope of the matter, and you should get an idea why it’s so hard to change things significantly.

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@Tom Galloway
Your points all dovetail together nicely. The key is figuring out how much healthcare should cost, how we can ensure that the agreed amount is what’s charged, and how to pay for it all. Unfortunately, health care doesn’t work like most markets. If I’m in a hospital for something, I’m very unlikely to shop around to several hospitals to see who has the best prices for my care. So while I agree that it’s hard to say, “Unlimited health care is a basic right,” I also have trouble with “The market should determine how we handle rationing care.”

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@Tom Galloway: But that happens now. Insurance companies find excuses to cut off care or cap benefits, treatments are deemed “experimental” in order to avoid having to pay out for them…we’ve got death panels now, they’re just private instead of public.

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You're_super_cool said on February 13th, 2017 at 1:31 am

Chris please return to this blighted land and rescue us from the dreary waste of flesh that is John Seavey

Whatever it was we did that warranted such a vile punishment, we repent of it with all our hearts

Hear our plea

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@You’re_super_cool: Hey, pal, if you don’t like Seavey or what he writes, don’t read it. Skip his comments if you find him especially annoying.

Don’t just make cowardly ad hominem attacks in a long dormant thread whilst hiding behind a pseudonym.

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