I'm not arguing whether single payer is a good idea. I'm not arguing that it's tantamount to communism. I'm not arguing that there are many politicians (Obama, included) who are in favor of it. I'm arguing about the feasibility of it in light of naive statements.
It's easy for a politician to endorse a policy, particularly a populist one like Medicare for All. It's entirely different to craft a policy, within the current system, that pragmatically implements it.
My claim is that Obama endorsed the idea because he both thought it was good policy and populist idea that worked in the favor of his politics. But that's entirely different from crafting a pragmatic policy that actually can get passed into law.
I think he's been on the record stating that he didn't like the ACA, but the goal was to pass something, even if it's broken, to try to force it into policy so that it would eventually be fixed into something better. So with so much support, why can't the U.S. implement it? That's central to my point.
"President Obama was clear that – while he would have preferred single payer if we were starting from a clean slate – it would be too disruptive given our current system."[1]
Point being, in many ways it is against the current system. So while you haven't directly addressed my questions, I get the impression you think "Just expand Medicare" is the answer. My point is that it's a bit naive because it really doesn't address the systemic effects that have kept single payer policy from already being implemented.
Medicare/Medicaid is on track to be the largest proportion of the entitlement budget, before expanding it and it doesn't count the Dept. of Veterans Affairs budget (I don't think healthcare is a bad way to spend the budget btw). I know many people will say the Defense budget can be cut to pay for it. But how do you plan on getting that passed when nearly every senator wants to protect the DoD jobs in their state? I'm not even against that idea, I'm just not seeing you advocate a real strategy to implement it. The U.S. is perpetually running against the debt ceiling and your proposal will exacerbate that. This is just the beginning; how do you address the medical insurance industry, particularly when they are heavily lobbying Congress?
If the answer was "Just expand Medicare", it probably would have been implemented already but the fact that it's not should tell you something: maybe it's not that easy. So my question is not whether or not you think it's a good idea, my question is how do you get from the current state to your goal of a single payer system?
> I'm arguing about the feasibility of it in light of naive statements.
I have directly addressed your question with the fact that already a third of Americans are in a single payer system, and most of the world has a single payer or hybrid system.[1] It's naive to think we don't know how to do it, and that we can't learn something from other nations when we expand it.
If you don't think we're capable of achieving the same results as a bloc of nations that has twice our population and many more cultural differences between them, why? Low confidence in America as a whole? Math and science fundamentally change in different time zones? Nobody in America knows how to read German, Spanish, French, Japanese, Korean, Italian, Swedish, Norwegian, Dutch, Belgian, or English?
> If the answer was "Just expand Medicare", it probably would have been implemented already but the fact that it's not should tell you something: maybe it's not that easy.
There's an even simpler explanation: S.1129 was not passed.[2]
> So my question is not whether or not you think it's a good idea, my question is how do you get from the current state to your goal of a single payer system?
No, your question is, "How can I keep the conversation going pretending that I'll accept an answer?" So let's nip that, and you can answer the following question: what evidence would convince you it is feasible?
Yes, the bill was not passed. Neither were any of the proposals for the last 3 decades. Why do you think that is??
I mean, it’s “obviously” just so easy. Do you have better answers than President Obama? Or President Clinton before him? Or Bob Dole? Or John McCain? Yet with all their knowledge and connections, they couldn’t get it accomplished. Note that in nearly 20 years, Medicare for All bills only made it out of committee once. Why do you think that is?
Perhaps because it’s an enormously complex problem with lots of stakeholders and lots of competing interests. One that doesn’t get fixed by just copying a different model that operates outside of the U.S. constraints.
You still never addressed why those bills don’t pass. It’s like your answer is the trivial (and useless) one that “it’s because not enough people voted for it.”
Saying “we already cover 100MM” doesn’t explain how it can be more than tripled. I didn’t claim it can’t be done, I’m asking why none of the proposals have worked out so far. I’ve never claimed the US “doesn’t know how”, I’m saying they haven’t shown political will to implement it. I’m asking for a pragmatic answer that shows why it hasn’t worked despite previous efforts.
I’m asking for your opinion why that’s the case that nothings has been passed in the last 30 years despite the desire among many, many people to do so. I’ve already outlined a few examples that you just blow past for the naively simple answer. That’s not helpful nor does it demonstrate anything beyond a simplistic understanding of the problem.
I have no problem accepting an answer that actually shows an understanding of the complexity of the problem, even if I don’t agree. I’ll help you: I think the very first problem needs to campaign finance reform. Because without that, any proposed bill that goes against the monied interest is dead in the water. But that’s just the first of many things that has to happen before the bills you’re talking about have any chance.
Again, I’m not arguing whether it’s technically feasible. I’m saying the US has not yet shown its politically feasible. I think you’re conflating my position on these.
That latter part is a much tougher and complex problem but every bit a necessary part of the solution. So take just a very small subset of that problem: how do you plan on mitigating the insurance industry’s influence in preventing the passage of a bill that goes against their interests?
Once you figure that out, you’ll have dozens of other political concerns to solve before you ever get to consider implementing the technical solution.
I'm not arguing whether single payer is a good idea. I'm not arguing that it's tantamount to communism. I'm not arguing that there are many politicians (Obama, included) who are in favor of it. I'm arguing about the feasibility of it in light of naive statements.
It's easy for a politician to endorse a policy, particularly a populist one like Medicare for All. It's entirely different to craft a policy, within the current system, that pragmatically implements it.
My claim is that Obama endorsed the idea because he both thought it was good policy and populist idea that worked in the favor of his politics. But that's entirely different from crafting a pragmatic policy that actually can get passed into law.
I think he's been on the record stating that he didn't like the ACA, but the goal was to pass something, even if it's broken, to try to force it into policy so that it would eventually be fixed into something better. So with so much support, why can't the U.S. implement it? That's central to my point.
"President Obama was clear that – while he would have preferred single payer if we were starting from a clean slate – it would be too disruptive given our current system."[1]
Point being, in many ways it is against the current system. So while you haven't directly addressed my questions, I get the impression you think "Just expand Medicare" is the answer. My point is that it's a bit naive because it really doesn't address the systemic effects that have kept single payer policy from already being implemented.
Medicare/Medicaid is on track to be the largest proportion of the entitlement budget, before expanding it and it doesn't count the Dept. of Veterans Affairs budget (I don't think healthcare is a bad way to spend the budget btw). I know many people will say the Defense budget can be cut to pay for it. But how do you plan on getting that passed when nearly every senator wants to protect the DoD jobs in their state? I'm not even against that idea, I'm just not seeing you advocate a real strategy to implement it. The U.S. is perpetually running against the debt ceiling and your proposal will exacerbate that. This is just the beginning; how do you address the medical insurance industry, particularly when they are heavily lobbying Congress?
If the answer was "Just expand Medicare", it probably would have been implemented already but the fact that it's not should tell you something: maybe it's not that easy. So my question is not whether or not you think it's a good idea, my question is how do you get from the current state to your goal of a single payer system?
[1]https://washingtonmonthly.com/2015/09/13/obama-the-negotiato...