Quote:
Originally Posted by well named
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.
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.
Last edited by Original Position; 08-26-2019 at 05:58 PM.
Reason: missing words