That is a truly innovative idea. I never would have thought a state could pull that off by itself, but if any can it will be California. Great work Mr. Khanna!
@Matt I think Congressman Dennis Kucinich in Ohio passed a law related to this same idea before he was redistricted out of his seat.
We still have time to get it right, and I'm proud of Rep Khanna. Erisa and Medicare aren't the gorillas Ms. Howard believes. California can finance Medicare through payroll taxes, and companies or public agencies could pay public and private insurance or offer supplemental insurance beyond what CA Medicare offers. Vermont failed to enact statewide Medicare because they exempted their largest employers. AARP runs one of the largest Medicare Advantage plans, the reason they vociferously oppose state or national proposals to create a single, public, non-profit insurance pool administered. They spend good money on TV, but could participate in public insurance available if we develop multi-payer systems like Germany, France or Japan.
Medicaid and ACA subsidies are welfare programs that limit the economic potential for people, especially Medicaid that requires people remain paupers for care. MediCal traps 55% of adults and 80% of young children where I live in Merced County in generational poverty where the underground economy is their only way to create a nest egg.
I organized focus groups for a NIH study on quality of life issues for caregivers. Participants in the parent's group were incensed they had to remain paupers or were locked in jobs that weren't conducive for their family, so their children could thrive. California Medicare financed through payroll taxes, equally split between employers and employees will enhance economic performance in many ways.
1
This problem of 50 separate health care solutions cries out for a one solution for all. Health is the same issue wherever you live. Good health is not transportable from state to state. It is only achievable with consistently good care. 50 different systems is not a solution. Medicare for all, phased in incrementally according to a reasonable plan works.
California can't even get the DMV right. I'm supposed to trust them with my health care? And what about the doctor shortage? This is insanity. Welcome to the new CA.
If California, Oregon, and Washington became one united Saskatchewan of a single payer system, the thing would spread across the country very quickly.
Saskatchewan on the Canadian prairie, a land of wheat fields and potash mines, came up with better healthcare delivery than any of the continental states.
Shame on us.
When I visit the great white north, I talk to the citizens, and they would not change places with us for anything. It was best summed up by a young lady on PEI who said, "Once I had to wait a short while for a female procedure in Halifax, but I really love our healthcare system. It's great."
Ma and Pa Kettle down in a Southern Backwater voting for Trump. They're dupes.
5
Several states have looked into single-payer in recent years and none of them found a way to make it work, so what is going to be different this time?
1
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@Louis Scale. Once California (most likely), Florida, or Texas adopts and successfully implements it, other states will feel pressured to follow (but likely have to create regional exchanges), and ultimately a national program will develop.
How about universal healthcare, where all or virtually all of the citizens have health insurance? Well, welcome to my state, Massachusetts where 97% of our citizens are covered, which is the same percentage as most of the European countries have covered. We implemented RomneyCare 13 years ago and it became the blueprint for the ACA.
Governor Mitt Romney was able to convince the federal government to allow Massachusetts to block grant some of the federal program money, most notably Medicaid, with the agreement that Massachusetts would be able to insure more people, and still insure that no one currently receiving Medicaid would be thrown off Medicaid. It worked. We spent the federal money better in Massachusetts by insuring more people than the Federal Government was doing.
Like California, Massachusetts stopped waiting for the Federal Government to move on all these critical issues. We have done the same with education, marijuana, rural high speed internet, opioid abuse, gun legislation, etc.
We just cannot wait any longer for the do nothings in Washington to help us. And, more importantly, many states are not interested in having the same access to quality education and healthcare for all their citizens, as for example, Mississippi, Kansas, Alabama or Arkansas.
9
The New York Health Act (NYHA) is being put forth right now in New York State. It will, if enacted, provide a robust form of Medicare for All in New York State. It will pay for dental, vision, prescription drugs and even long term care--all without restrictive networks. A Rand Study has shown that it is financially viable and will reduce most people's medical costs (insurance,copays,etc.). It has already passed the New York State Assembly several times and will come up in the New York State Senate and Assembly again,this spring. It is strongly supported by many groups including the New York State Nurses Association, Physicians for a National Health Program, NYPIRG and many many more. It is surprising that a NY Times article mentions California's attempts but not the more advanced efforts in New York.
6
1. Ian this really any different than the GOP advocating block grants to the states?
2. Bravo Congressman Khanna for copying another country’s experience (Canada)
On the other hand, if you just got states and the federal government to work together on Obamacare, then why don’t we just do that? You know the saying: a bird in the hand beats two in the bush.
1
So the obvious question is how will one’s state insurance transfer to another state when you travel/move etc?????
1
The Warren and Sanders plans use the name Medicare for All because Medicare is relatively popular. In this Congressman's plan it is likely the plan is Medicaid for All, as the author points out in the third paragraph. How much public support would there be for a plan honestly labeled Medicaid for All? It doesn't strike me that there would be much.
1
Big states may be able to enact single payer, but small states would struggle to do so. The real problem is bargaining power over the excess costs. Can that be done piecemeal, state by state?
2
@SAO Small States could group themselves together and have larger impacts.
2
An "investigative reporter" who does not even mention in this report that Washington now has a public option for health insurance, just as most of the media ignored Jay Inslee's campaign and mentioned only his climate change emphasis in most reports. He could have been the centrist candidate that so many want now -- and one who has actually DONE what people are talking about, who has experience, yet he was pushed aside.
Legislation for it was passed earlier in 2019. It's call Cascade Care.
EXCERPT: "The Evergreen State is the first to authorize the creation of a state-run public health insurance option on its Affordable Care Act exchange. Gov. Jay Inslee, a 2020 Democratic presidential candidate, signed legislation on Monday that will make the option available in 2021.... But so far, Washington is the only one to make a big move....
"Here's how the public option will work: The state will contract with insurers to provide a standardized set of policies -- which state and exchange officials have yet to develop -- on the Obamacare exchanges to compete with the plans already offered by private carriers. Premiums for the public option policies will vary by area, but deductibles and co-pays are expected to be the same in each plan tier across the state."
https://www.cnn.com/2019/05/18/politics/washington-state-public-option-health-insurance/index.html
3
Beautiful! The world's fifth largest economy still can't finance its own health care system from its own taxes and goes to the Feds for special dispensation. One of the many ways in which oh-so-progressive California demonstrates its total inability to be really progressive.
1
@Daedalus As a medicare recipient, I would not expect my state to assume my costs, especially since I paid into the system. Of course the feds should send dollars to my state in this situation.
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@Daedalus. You're comparing apples and oranges.
California could finance its own health program if it didn't cover Medicare recipients and military families/veterans, and it was freed of ERISA mandates. It could definitely finance the programs if it wasn't sending more to the federal treasury than it received in return.
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@FreedomRocks76 You would be surprised at bureacracy involved to do this for any state.
Rep. Khanna has written this bill to make it easier for CA and other states as well.
Here are the cosponsors:
Original Cosponsors: Rep. Jayapal (WA-07), Rep. Blumenauer (OR-03), Rep. Bonamici (OR-01), Rep. DeFazio (OR-4), Rep. Garcia (IL-04), Rep. Grijalva (AZ-03), Rep. Lee (CA-13), Rep. Ocasio-Cortez (NY-14), Rep. Omar (MN-05), Rep. Pocan (WI-02), Rep. Pressley (MA-07) Rep. Raskin (MD-08), Rep. Schakowsky (IL-09), Rep. Adam Smith (WA-09), Rep. Watson Coleman (NJ-12)
3
How about no. Tasking the states with implementing single-payer is a not-so-clever way to make sure the concept dies in the cradle. Much like Medicaid expansion before, the backward states (that incidentally need universal healthcare desperately) will choose to take the money but refuse to implement. Not to mention insurance companies simply fleeing progressive states to soak the poorest and least geographically mobile among us.
The medical/insurance industry sacking of America can finally end if we stay on path to true universal healthcare the likes of which the rest of the developed world enjoys.
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@W Mahoney MA has implemented Romneycare to nearly all its citizens. Can't we learn something from them?
1
@FreedomRocks76 , sure we can. That WAS the experiment. So why not do the real thing nationally now? What's the real hang up then?
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@W Mahoney
I would prefer to see it done on a national level rather than a state level too, but unfortunately the backwards states are a drag on the progressive and at some point the progressive states are better off moving forward on their own rather than being bogged down forever by the dead weight of the red MAGA states.
1
If states are to lead the way, then Texas will either be last or never. Rural voters will never approve healthcare for city dwellers.
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@qisl The majority of Texas voters are urban and suburban.
The irony is that the federal government (Dept. of the Interior) has far more power over the states when it comes to environmental policy and land management than it does over the welfare of people.
We either live in the same country or we don't. There's no reason that one country should have such disparate healthcare, education, infrastructure and taxation policies.
What unites America as a country, if not the welfare of its people?
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@Viv
"We either live in the same country or we don't." Great comment. I feel the same way about our elections. How can we claim a fair or even accurate election if voting rules and access vary widely from state to state?
1
Enough already!
While I appreciate Rep. Khanna's attempt, he is just removing another excuse for the DEMs like Gavin Newsom to use. Basically we are in a whacko-a-mole game.
We have been waiting since 1965, when Johnson lost Medicare for All because of the AMA obstruction.
Now we are dealing with a bigger Mob, the Health industry in total that has learned how to turn itself into a profitable commodity.
Medicare for All now!!!
8
What this article doesn't say is that the New York Health Act is written and ready to go. It has passed the NYS Assembly four times. How to pay for it, transition--it's all worked out. Of course we need a national single payer system, but New York State, bigger than some countries, can lead the way, as Saskatchewan did in Canada.
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@ebb
I wish NYS well in their efforts.
I thought CA would join you and we would lead East to West coasts.
Then I realized you have Gottfried, a committed advocate, something that CA has not had.
Here Single Payer is a political football to advance politicians up the ladder, but empty of any resolve!
3
A fully-open Medicare option is probably the best path. That being said, the reality is that the picture painted by the candidates is misleading. First of all, nothing is free, somebody has to pay for the care.
An open to all Medicare would make for a healthier population and system but everyone under 65 (or lacking the requisite 40-quarters of payroll deductions) will have to pay for all parts of the program not just parts B & D.
There is still a lot of room for the insurance companies with an open Medicare system to sell "Part C" coverage as well as supplemental plans. Unfortunately, that means that there is also room for a lot of scams that promise the world and deliver zilch.
Evolution, not revolution, will be successful but will never fill the dreams of creating a medical care process that satisfies everyone and costs zero dollars.
If I have learned on lesson in life it is that you cannot please everyone.
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@George N. Wells
Think about how the Defense industry is treated with its newest and best weaponry project.
Does it take decades to be approved?
Are there discouraging deductibles, copays, pripr authorization hoops it has to jump through?
Do media pundits and Washington puppets wring their hands over 'cost'?
Why is it different with health care?
7
If you let states "experiment" with critical and or life saving institutions like medical care, IT, SS, Military etc. you get what you get today, ie states like Mississippi vying with third world countries re medical care as opposed to states like NY and Calif that have first rates care.
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This state based model is exactly how ACA got stranded. Do you think this time it will work better?
3
Didn't Colorado and Vermont already try this? The citizens could not afford it so they overwhelmingly voted it down. And I thought that only the "rich" had to pay for our healthcare, for everyone else it's free. Or let them implement this in AZ, CA and TX and watch the population explosion from the border.
1
@Sarah99. The reason that individual states can't afford it is that, without rule changes at the federal level, is that so many people are exempt from the plan -- Medicare recipients, Medicaid recipients, military/veterans, employees of large companies. In addition, individual states have to contend with adverse selection. Really sick individuals would move to those states to be eligible for care.
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@Sarah99 We disagree. I live in Massachusetts and we did this in 2006, it is called RomneyCare and we insure 97% of our citizens, highest in the nation. And, since then Massachusetts population has only grown, and we now lead the country in education and the highest per capita GDP in the country. Also, the lowest divorce and teen pregnancy rates as well. Universal healthcare does not destroy the population or the economy, and Massachusetts is Exhibit A.
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Will never work. Unless a state can not provide these benefits to newcomers, it will be swamped with the sickest and poorest this country has. Persons are already bussed for “ geographical cures”, this would accelerate greatly. It really needs to be a
“ all or nothing”, with single payer. This is something Warren and Sanders have exactly right. Whether it will play in Peoria is an entirely different question.
2
@Dr. Zen, Nonsense.
NYS has better HC coverage than neighboring states, thanks to AM Gottfried and his allies (including in the NYS Senate when it was controlled by GOP) — and vastly better than most others. Yet we do not see people from MS or AL or GA or NC flocking to NYS. It doesn't happen.
While national SP makes sense for lots of reasons, state-by-state SP is viable ... and makes more political sense since states like NY and CA appear to have legislators who care more about the public heath and general welfare of their constituents, rather than ideologies without practical purpose or evidence on their side.
Our current healthcare payment system (note: the delivery of healthcare won't be changed by SP) is
*devouring our economy with sky-rocketing prices;
*wasting as much as $1T per year (out of $3T);
* killing 40,000 Americans too early every year ("medically unnecessary deaths");
*ineffective for epidemics (like substance abuse treatment that actually works);
*achieving health outcomes for half our citizens that rival third-world countries;
*making our for-profit, corporate-controlled health system scorned around the world.
Yes, the rich have great HC here. Women, the middle-class, people of color, and rural residents do not. Why is our maternal death rate 3-4 times those of Europeans? Obstetrics, maternity and infant care are not profitable. Ditto mental health: not profitable.
Let's get this fixed — federal M4A or statewide. Yesterday, if possible.
7
@Dr. Zen
One of the biggest selling points for Medicare for All is it will bring an end to employer-based health care.
The Medical underwriter groups that fashion these employer plans are also on the list of opponents to Medicare for All.
With Medicare for All, we would no longer be an indentured labor force willing to accept any labor standards to have health care!
Workers across the spectrum are working harder than ever. High wage and low wage workers both!
No longer will employers be able to excuse themselves from raising wages, using the excuse of their bloated healthcare costs.
Imagine being able to cut hours, take a family leave or retire early without worrying about health care for yourself or your family!
Having health care, regardless of one's job is a BIG benefit of Medicare for All that many Americans would support regardless of party.
And you hardly ever see it showcased in the Mainstream Media nor do you see it included in any polls about Medicare for All.
6
I believe that the claim that Canada only went to a single-payer system after two decades is incorrect. Canada implemented national healthcare right after WW II. It may have made modifications, but as with Britain, it moved quickly to national, universal healthcare soon after the end of the war.
Further, in the 1990's, Switzerland also implemented national universal healthcare all at once.
We have no need for endless incrementalism. It's a matter of guts. Senator Warren has laid out a plan that is clearly doable. All it takes is enough Democrats' being elected to overcome the obstructionist Republicans. That's how we got Medicare (which Reagan campaigned against), Medicaid, SCHIP (for children), and the ACA.
All it takes is guts. And a president with guts. Elizabeth Warren.
Enough with the endless unworkable tinkering. Single payer now.
7
@Sean Not quite right: Canada did not get national single-payer until after it had passed in individual provinces: Saskatchewan and then Manitoba. And single-payer for hospitals came in at a different time than single-payer for physicians. ONly after it had captured most provinces did the federal Parliament Act. And even then much less than Congress already has. The Canadian federal government finances a much smaller share of health care than the U.S. federal government does (about 22 percent when I last checked, versus 100 percent for U.S. Medicare and about 60 percent for Medicaid plus the tax break for employer-sponsored benefits).
4
@Elisabeth Graham My understanding is that though the federal government does not pay the lion's share of subsidies, it sets the subsidies, negotiates drug prices and procedure prices, and does so on a national basis. So that means that there is much more uniformity of coverage and cost in Canada, despite the delivery of those healthcare benefits being administered at the province level.
Further, it is my understanding that that buy-in came relatively quickly, and that most coverage was in place much sooner than the 1967 date claimed here.
3
@Sean — Taiwan went to single-payer financing (not changing delivery) in 1995 ... and is now considered one of the world's best — and cheapest.
Since the US already spends 3- 4 times/person what Taiwan spends, SP could give us a really great SP system, spending less than now.
American "private insurance" isn't what countries with great healthcare have. No other country depends on for-profit, unregulated as to price/coverage, corporate-run insurance for basic HC.
When we hear about OEDC "private insurance" — like Germany — it's heavily regulated around reimbursement, benefits covered, and premiums. And, mostly, NON-profit.
In many countries any "for-profit private" insurance must be complementary — NOT the same benefits as public insurance, like Medigap policies or Part D. With no "networks" restricting care.
Unlike in the US, private insurers have no mechanism for denying care to increase profits, for arguing with doctors about what treatment this patient (vs that patient) will be allowed, no mechanism for using unbalanced negotiating power over reimbursements to increase profits; no mechanism around delaying payments to providers to increase profits ... can't set up narrow networks, etc., etc.
American health insurance corporations have a business model that prioritizes shareholders over customer health. It is one reason why our public health lags peer countries.
Let's eliminate for-profit corporations from our HC to cut costs and improve our health.
7
We don't need states to experiment with different health-care systems. There are many different kinds of universal-care systems among advanced countries, and they all work better than ours. The experimentation has been done.
The common element in keeping costs down is control of prices by the government. A "free market" system does not work, primarily because health-care consumers do not have the knowledge or opportunity to shop for price. The government must essentially bargain on behalf of all consumers, and the risk pool must have the maximum size. All other systems are much less costly than ours, but the ones with the most private role tend to be the most expensive.
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@skeptonomist Lasik eye surgery works in a free-market. A surgeon shoots a laser into your eyeball! The government has never got involved and prices have dropped and quality improved. If we allowed the market to work for the rest of health care the same would happen. All markets are typified by ill-informed consumers. I do not know how a car works, or a smartphone, or even how a pencil is made (per L Reed's famous essay, "I , Pencil") and yet I can acquire these items in the market with little risk.
1
@Elisabeth Graham
We ARE letting the free market work for virtually all procedures. And what we've seen is that patients are being cheated. The increasingly huge hospital networks are gaining massive power over setting rates, with smaller hospitals and doctor groups being bought out.
Every other nation on the planet controls costs through the intervention of the government. And in those medical systems, prices are vastly lower, while access to those medical benefits are vastly wider than in America.
We've gone down this road, and it's a dead end.
9
@Elisabeth Graham — Lasik eye surgery is mostly DISCRETIONARY. Customers can choose not to have it. Think about buying a car: markets work because you can walk away, use a taxi, keep an old car, use public transit.
Now think about a heart attack, and what it means to "walk away" from treatment. Every minute you dawdle reduces your odds of recovery: "Time is muscle." So do you shop around?
Essential and urgent medical care is NOT a rational market.
A. There is asymmetry of information (the MD spent years gaining expertise; the customer didn't) — hours of internet searching are not equivalent.
B. There is asymmetry of negotiating power — insurers and hospitals have consolidated into behemoths to gain power over reimbursements — and there is no equivalent power for the patient, other than the govt. SP corrects that asymmetry, while focused on ensuring providers get reimbursed sufficiently to meet community health needs.
C. The current system looks much more like extortion than a free market. Ambulances staffed with EMT and O2 — no car accident victim negotiates or calls Uber. Your dad suddenly can't breathe — you don't start shopping ERs.
D. Similarly, providers who mothball low-profit services — obstetrics, mental health, substance abuse rehab — reduce services we REALLY need, despite demand. (Opioid epidemic anyone? ) Why do you think so many rural hospitals have closed.
If you think HC is a market, read Kenneth Arrow — and open your mind.
23
The Hillarycare proposal from 1993 allowed for regional health alliances. Today for example, California could team up with Oregon and Washington to come up with new solutions. Or maybe with Nevada also, or instead.
Sometimes bigger is better. Vermont could join with Massachusetts, Connecticut, and Rhode Island, or other such regional alliances.
Perhaps it is an idea whose time has come. Maybe Hillary was ahead of her time after all. I'm willing to try it. The federal government would have to open the door, of course.
(Been missing reading your work at Vox, Sarah. Glad to see it here.)
11
@Polaris so little, so late
Arkansas threw 18,000 people off their health care as they were trying to implement work requirements so ... no , we need Medicare for All. A diabetic patient in Alabama has the same needs as a diabetic patient in Vermont and DESERVES the same high quality care. Medicare for All is the ONLY system that provides equity, quality, cost control and the beauty is , WE ALREADY HAVE IT SET UP ! We only need to expand it , love it ,cherish it and preserve it because it is like our very own NHS ( just look at how Britons fiercely defend their system )
4
@L. Finn-Smith, et al.,
There are those that like the idea that your "rights" and benefits as a citizen should be dependent on you race, gender, political affiliation and zip code. Those who espouse those positions also claim to be the staunchest defenders of the constitution.
4
@L. Finn-Smith. Medicare for All is not the ONLY system that provide equity, quality and cost control. While we tend to think mainly of the centralized Canadian and UK systems, they are not the only mechanisms that countries have followed when instituting universal healthcare.
1
It is worth considering. Especially, if the majority of voters are opposed to single payer. If only Warren and Sanders would listen to what people are saying. They risk losing in 2020 over this issue.
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@richard
Medicare for All polls well,( if the questions asked are fair)
Notice how the argument is being framed by the opposition , "they are TAKING AWAY your (employer sponsored ) healthcare". NOT TRUE
The truth is ,they are REPLACING your ( employer sponsored ) healthcare with GUARANTEED Medicare and you don't lose it if you lose your job!
2
@L. Finn-Smith,
With respect to Medicare for All, at least as envisioned by Bernie Sanders or Elizabeth Warren, can characterized is however you want.
However, regardless of whether it's characterized as "replacing" or "taking away" the same problem remains: it relies on a "trust me" mentality that is asking people to take a leap faith that what they will end up with will be better than what they currently have, which may or may not be the case.
1
@Louis
well I guess we all "trust" Medicare because when we turn 65 we sign up for it !
I know of NO ONE who, at 65 , has refused Medicare and kept their private plan , do you ?
1
An interesting approach and perhaps a worthy experiment. But even California would have to run a trial for at least a decade to determine how effective and sustainable single-payer could be, how satisfied all people would feel, and if medical services would continue at the scope and quality of today.
2
@Bob Krantz — Actually, Saskatchewan started with a doctors' strike in 1965 (heavily influenced by the American Medical Asso that HATED the idea of US Medicare and SP in Canada).
That strike caved within a few weeks ... and within months, the SP legislation was wildly popular.
Similar to American Medicare: the AMA and GOP fought it tooth and tong — screaming about socialism and the end of freedom as we know it— but 19 million seniors were enrolled in under 11 months (with segregated hospitals becoming integrated in the final 5 months).
And, like our neighbors to the north, doctors and patients became enthusiastic supporters within weeks/months. And politicians who screamed "DOOM!" haven't been fool-hardy enough to end it.
It will NOT take a decade for immediate savings and simplicity, improved HC and improved public health to become apparent. It may take a decade of continuingly increased savings and public health benefits to startle Americans into thankfulness to whoever pushes it over the finish line.
The NY Health Act, ready to go, with multiple economic analyses already showing its benefits (including lower costs and better cost control) is one path. The Jayapal or Sanders bills are also good, but if NYS gets it over the finish line first — all the states not controlled by "alternative facts" ideology over pragmatism will follow suit within a year or two.
No other country has for-profit insurers controlling essential HC. Our payment system: criminal. NYHA now!
5
The US can get to universal coverage over a period of years by initially dropping the eligibility age for Medicare to 60, and creating a public option to buy into Medicaid for individuals and small employers. This needs to be coupled with initiatives to use the purchasing power of the public plans to lower prices of drugs, procedures and hospital care. Trying to get to single payer through one-shot legislation is destined to fail because their are too many stakeholders adversely affected in the short-term. The Medicare for All advocates need to get smart about a longer-term transition strategy. The transition strategy is not a detail that can get worked out. It is essential to building political support for universal coverage.
21
@MVonKorff
look how even a public option was opposed and is still opposed by the health care " industry", there will be incredible push back and lobbying against ANY changes.
Bernie's plan has a 4 year phase in and no one will lose coverage or fall between the cracks.
3
@L. Finn-Smith And how many votes will M4A receive in Congress? It can't be passed. Reducing the eligibility age for Medicare to 60 and then 55 can be passed. Creating a public option for Medicaid or perhaps the federal employee health care benefit could also be passed. This could get almost everyone covered, and it would get enough people in public plans to exert price controls.
2
@MVonKorff — how do you pay for the public option. It's FAR more expensive than M4A.
It's a pipe dream — politically and financially.
2
A significant percentage of our citizens are covered by employer health insurance. Companies that have employees in many states may see their administrative costs skyrocket if many states implement separate health care insurance systems.
Federal single payer is the way to go, not state based.
5
Vermont failed to install universal health care paid for via taxes because it went alone. Its tax base was too low. Less than 1 million population.
What states can dow however to succeed is to join forces. Here is how they could do it.
The blue states could put in place Medicare for All by implementing a single system that would include all the blue states. If they could rope in the purple states then even better because that would include 200 million people, total. Besides blue states pay much more taxes to the federal government so their tax base is much larger.
Ideally Medicare at a Federal level should only include Medicare A, the emergency type, heart attacks, cancer etc which cost more to treat and can be terminal.
Medicare B should be handled at the state level, routine exams, doctors visits etc.
4
@Indian Diner
States have to balance their budgets every year and so cannot stand up this huge program on their own. Why do we think we cannot do this nationwide?
3