Bernie Sanders voters helped Trump become President

[JHan]

333. Yes, but what kind of Universal Healthcare do we want?

How can we speak with conviction when there's barely been a proper debate about it?

These days, talk is Single payer should be the only option, but there are many different versions of Universal Healthcare and now there is a litmus test by some progressives instead: accusation instead of discussion.

You can't make a case without details. It doesn't help when there's jostling for a power play in the party, where single payer has become a political bargaining chip among progressives.

And with regard to the ACA, isn't it more than passing strange that instead of the blame put at the foot of republicans for their obstruction to fix the ACA, Democrats - who are trying to improve access to healthcare for Americans - are the ones "without the message" ? Obama's push for the ACA was him at his most idealistic, yet the meme from greens and some progressives was that the ACA was just a handout to Insurance companies, and these are self described "people of conviction" by the way, who missed the point of keeping insurance companies incentivized to participate in exchanges and run different plans. And have we forgotten the difficulties getting the ACA passed? I recall the public option was omitted because blue dog dems didn't want it included ( Still Hillary included the option in the Dem presidential platform): Obama's rhetorical powers failed in that regard, but the ACA passed and it was an improvement, even while imperfect, for millions of Americans. After 2010, real fixes didn't come because Democrats stayed home in a census year, lost the house, then Obama faced obstruction after obstruction.

The tea party crazies claimed that more healthcare coverage for Americas created a toxic swamp in Washington that needed to be drained - how were they able to sell the ACA as a bad thing, implement cuts in their own states, prevent expansion in their own states, and STILL turn around and blame Democrats, even after they worked hard to hamstring fixing the ACA ?

Now let's look at what's on the table before us right now: Medicare for All - worth noting at this point the origins of Medicare in light of all the criticism the ACA received, as Jonathan Chait wrote about a month ago:

Today the left holds up Medicare as a shining example of health-care policy designed by social democrats, before it was corrupted by the modern Obama-era party and its suborning of the insurance industry. In reality, powerful financial interests deeply influenced the design of Medicare. The law’s sponsors had hoped to achieve universal health insurance, but retreated from that ambitious goal in large part because insurers wanted to keep non-elderly customers. (They were happy to pawn the oldster market off on Uncle Sam.) Likewise, the law defanged opposition by the powerful American Medical Association by agreeing to fee-for-service rules that wound up massively enriching doctors and hospitals. And the creation of Medicaid as a separate program for the poor relegated them to a shabbier and more politically vulnerable category.

Fast forward a couple decades, and you'll still find healthcare a priority for Democrats. Conyers has had a Medicare for all bill in existence for ages and Sanders has one as well: How would you want it funded? At Federal level or State level? Details are requirements, not afterthoughts, this is a significant chunk of the economy we're talking about and slogans are not enough. And how do you change the system yet again when barely a decade has passed since passage of the ACA?

And even with Medicare for All what would be the challenges? Administrative costs will go down, but it will not be easy, given the American framework. Any system will require Government bargaining for bulk medical supplies and prices, and see to the health of the fund invested in by workers and employers to offset healthcare costs, especially at retirement age... And this barely addresses other challenges like supplement plans and associated co-payments and deductibles.

It will not be easy, and it not a question of Democrats not "Trying" hard enough, or capitulating, the problem is the expectation that there are easy answers and simple fixes where there are not.. I couldn't put it better than this:

"And maybe there’s a better way still that hasn’t yet been discussed. The fight for a universal health-care system in the United States is now in its 105th year, and if we don’t admit that financing any kind of universal system is going to be especially difficult given how much we spend, or acknowledge the role that loss aversion plays in the politics of reform, then we’re going to fail again the next time we get a shot at it.

Above all, progressives need to learn something from the Republicans’ effort to replace the ACA. They promised that facile slogans like “freedom” and “choice” would magically increase coverage and bring down costs. They were selling snake oil, and one way or the other, it’s going to come back and bite them.

We shouldn’t make promises that we aren’t going to be able to keep. “It’s not going to be easy to do,” Jacob Hacker says, “and anyone who tells you that the most expensive health-care system in the world is going to undergo a sudden shift to highly efficient and low-price medicine has not been studying American medicine.”

https://www.thenation.com/article/medicare-for-all-isnt-the-solution-for-universal-health-care/

The problem is not a politician understanding these challenges and crafting sensible legislation, and taking an incremental approach to healthcare reform. The core difference between Dems and Republicans are the way both solve problems: Dems address problems by tending social institutions, Republicans believe the market solves everything, and whatever can't be solved by the market, must remain a problem. What we could do better is communicate that essential difference more aggressively by countering the propaganda about liberal ideas.