I was planning on writing a 2,000 word response to an incredible article by Joshua Holland in the Nation. But I would get bored writing “ditto” too often. You should just read it. Here are some of the highlights of the pragmatic concerns about transitioning to a pure single payer system as the means to achieve universal or near universal coverage.
momentum is tempered by the fact that the activist left, which has a ton of energy at the moment, has for the most part failed to grapple with the difficulties of transitioning to a single-payer system. A common view is that since every other advanced country has a single-payer system, and the advantages of these schemes are pretty clear, the only real obstacles are a lack of imagination, or feckless Democrats and their donors. But the reality is more complicated.
For one thing, a near-consensus has developed around using Medicare to achieve single-payer health care, but Medicare isn’t a single-payer system in the sense that people usually think of it. This year, around a third of all enrollees purchased a private plan under the Medicare Advantage program….
fundamental problem is that compelling the entire population to move into Medicare, especially over a relatively short period of time, would invite a massive backlash.
The most important takeaway from recent efforts to reshape our health-care system is that “loss aversion” is probably the central force in health-care politics….
current Medicare-for-All proposals, we would be forcing over 70 percent of the adult population—including tens of millions of people who have decent coverage from their employer or their union, or the Veteran’s Administration, or the Federal Employees Health Benefits Program—to give up their current insurance for Medicare. Many employer-provided policies cover more than Medicare does, so a lot of people would objectively lose out in the deal.
Go read it. And then think long and hard.
Is your objective single payer as an end in and of itself? Or is your objective universal coverage as an end in and of itself with single payer as a potential means?
I am firmly on the universal coverage as the desired end in and of itself side of the argument. And that influenced how I read this piece as the pragmatic transition and loss aversion problems are real, they are are tremendously huge and they are tough problems to even frame much less solve.