The Democrats don’t like the idea of unequal/tiered healthcare, b/c unequal is unfair to them. Everyone should have the same healthcare, otherwise some people have worse healthcare. It’s why they love to ask Congressmen gotcha questions about whether they’d give up their healthcare to take what the public gets.

That might be part of it (all humans should enjoy all human rights equally, which repulses many republicans). I think I also recall some sort of economy of scale argument. That is not a gotcha question, btw.

There are some substantive arguments for preferring a single payer system over a public option alongside current employer-provided private plans and the ACA exchanges. For example it seems reasonable to expect it to be beneficial to healthcare consumers to have not-for-profit insurance, and a single payer can probably realize some efficiencies of scale as Max mentioned. There's also some benefits to de-coupling health insurance from employment, particularly because it reduces friction related to changing jobs, reduces the risk of starting a new small business, and things like that. This Current Affairs piece covers a lot of those arguments.

But I also think the current mood among Democrats (particularly more liberal Democrats) is relevant to the question. The public option seems like a compromise proposal and there isn't a lot of enthusiasm about compromise right now. I'd paraphrase the mood as something like: "if the Republicans are going to obstruct and block everything while calling it socialism then we should give up looking for incremental compromise solutions (like the Heritage Foundation designed ACA) and push an actual leftist policy vision."

I find some of the arguments for single payer pretty persuasive and it seems like a good goal to have. At the same time, I'd guess a public option is probably still more realistic to get implemented and I wouldn't say I was opposed to it. Incremental improvements are still good IMO.

Every school can’t be the same
Every hospital can’t be the same

What can be guaranteed are minimal standards.

Without differentiation there cannot be improvement. What’s the point?

It’s beneficial to some healthcare consumers not to have private insurance.

Having choices is the essence of consumption.

Okay, all the schools and all the hospitals can't be the same. And so? Yeah, the minimal standards can be the same for everyone without a private option.

Without differentiation there cannot be improvement ... huh?

Having choices is the essence of consumption ... huh?

I just feel having a private and public option for us makes the most amount of sense. if you are a die hard sander/waren nut then thats the best way to go about it since whetever you want will take a coutnry not 4-6-8 years but 10-20 years to implement.

I dont think the public option is going to be THAT much worse anyways. like I said only those that are poor and super fragile will opt in, those making 100-20k a year who think are "healthy" can opt in to whatewver they see fit

to me its a win win no brainer/ i see what you guys said but I dont think the differential in healthcare is going to be that big of a deal becuase of reasons i stated above

While the bolded might be the mood among more progressive Democrats, it is as foolish now as it was in 2016. I don't see any realistic route to single-payer following the 2020 election. We're not getting to 60 votes in the Senate, so the only way it could happen is if Democrats won the Senate in 2020 and voted to get rid of the filibuster and have over 50 votes for single-payer. While the first of those might happen (unlikely), the other two are extremely unlikely. Thus, if we want to actually do anything around healthcare, it'll have to be through compromise - and single-payer isn't a compromise.

So I think the emphasis on single-payer by Democrats is a mistake. There are arguments to prefer a single-payer system over a public-private insurance system, but given that it is so unlikely to happen, presidential candidates should be focusing more on how they can improve ACA or other features of healthcare - something that really can happen in the next administration. All these single-payer plans seem pointless as actual policy to me. If Bernie Sanders wants voters to know that he prefers single-payer to a market-driven system like the ACA (or even a public-private system like the ACA+public option), then fine, tell us. But much more important is telling us what he'll do in 2021 and 2022 if he is elected president to improve healthcare, not what he hopes will happen someday in the future if enough people change their minds.

Compromise isn't very fun and exciting maybe, but it is how things actually get passed by legislatures. Our party leaders should be reminding party regulars of this.

The liberal wing of the party is obsessed with their vague notions of “negotiating”.

They think if we ask for single payer, they’ll give us more than what we have.

But if we only ask for public option they won’t give us anything.

It’s nonsense of course.

Many posters in this thread have said insurance companies shouldn't be allowed to make a profit.

It's a pretty common sentiment actually. A lot of people just find it repulsive to make profits off sick/dying people.

Should we ban supermarkets also? Isn't it also repulsive to make profits off hungry/starving people?

I don't have any problem with people being motivated by the desire to make money, and I don't think doctors, nurses, hospital administrators, insurance assessors, etc should be held to a standard of altruism that repudiates that motivation.

I think I can understand where the mood comes from. But yeah, I also think it's probably a bit counter-productive.

I'm by no means an expert on healthcare, but it seems facially reasonable to draw some distinction between the healthcare industry as a whole and health insurance. I don't think it's a great idea to try to remove the profit motive in healthcare as a whole (full disclosure: I work for a healthcare tech startup :P), because I can see reasons why a capitalistic approach would have some better outcomes. But for insurance specifically it doesn't seem likely to me that profits are actually going to lead to much useful innovation, and it also seems like a single-payer system has advantages that are unlikely with private insurance. Maybe the latter part is wrong with enough industry regulation a la the ACA, I'm not sure.

Health Insurance companies have very thin margins. The only players making huge profits in healthcare are pharmaceutical/medical devices companies and surgeons in certain specialties.

A lot of the oft cited admin/cost overhead is due to an anti-trust/reg carve out that allows states to regulate insurance companies. You have similar carveouts in healthcare providers. In effect, national health insurance companies/providers are dealing with 50 states + CMS + NIH + CDC + research grant departments at DoE among others, sets of regulations. This has created very fragmented markets (despite Cigna/Aetna's best efforts to integrate products geographically for a short while) and stupidly bloated paperwork. In the immediate aftermath of ACA, there were some efforts in a lot of states to essentially standardize/synchronize their regs to be in line with ACA. That's not happening anymore.

Just eliminating that exception, bringing back individual mandate, and keeping ACA otherwise in tact will get us something very close to the Swiss system.

Thanks for the info. What you're saying makes sense to me, as far as locating some of the problems. To be clear, I didn't mean to imply that I thought the problem with private insurance was that it was removing too much profit. I do think profit motive creates some problematic incentives absent regulation (hence the usefulness of the ACA rule about pre-existing conditions). But mostly I just mean it doesn't seem like the market can accomplish universal coverage in a more efficient way than a federal insurance pool could. Then there's also the previously mentioned point about wanting to decouple insurance from employment.

But it does make sense that there may be other regulatory changes that would fix some big problems with private insurance.

I think the health insurance industry is just BADLY (I actually do think health insurance should be very heavily regulated due to information asymmetry among other issues) regulated. A lot of the state-level regulators just have no idea what they are doing and just see insurance companies as loot pinatas and political footballs.

We need the CMS. We don't need the state regulators, most of whom just add another layer or two to the regs just to let insurance companies they exist... and that they need to pay fees.

bernie has lost zero fire. brought the heat to moscow mitch today. biden is soft.

i want bernie. monmouth poll today bad for biden.

Orp,

Why would mitch McConnell ever give any democrat any kind of win? He's been pretty ****ing explicit on that point.

If Democrats win back the Senate in 2020 or 2022, then I think it's possible that some legislation gets passed. It's plausible to me that McConnell might not be able to hold his caucus as tightly if all they get out of the Tea Party and GOP obstruction is four years of a Trump-led government.

Maybe it's Warren

the beauty of the democratic party is that they all like to eat each other. notice the bile for biden now that he is longer obamas spare wheel. these people have to come together or trump wins in a landslide and then the shoe really drops when we get four years of mike pence. yes that guy. people dont even talk about pence but what are they going to do when a known gay basher is prez. you know like obama was before biden forced him to come over to the real world. the minds that will be blown will create a chasm in the democratic party that finally then we will get a third party on the ticket. these nincompoops they have going now are really just too old and white too get over on the old white folks and you cant be prez without the old white vote. i predict that trump rolls and pence packs the supreme court so that even roberts cant give liberals a win for decades to come. see y'all in 2024.

maybe. Polling been really bad for Trump lately. seems the economy will be pretty weak. not saying recession (that's probably coming fairly soon but cant say it will be next year), but slow growth. Trump also appears to be getting more erratic. who knows what he will say or do by November. hard to predict anything. and 2016 made dems very wary about being at all confident.

Elizabeth Warren is the nominee.

Mayor Pete long shot.

Al Gore if brokered convention.

Anyone laying odds I can bet?

Agree on Warren but if it's a brokered convention then it's Michelle Obama.

I will take odds against Michelle Obama on brokered convention. Not going to happen. Would be Trumps worst nightmare if it happened, though.

Um.... it's a primary. They are literally competing with each other. And they are being very tame about it at that. Not sure wtf you're talking about.