The path to single payer healthcare in the USA is making it sound normal and reasonable and unthreatening (because it is all these things) not making it sound like a radical, revolutionary change.
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"Most of you won't even notice" is definitely the way to pitch it because most people are happy enough with their health care. "Happy with your health care? Don't worry, you won't notice. Unhappy? We're going to help you".
If Elon is really looking for govt efficiency, someone might point out to him the US spends more on healthcare than any developed nation w/ single payer and gets mediocre health outcomes.
Then again, could be Elon ISN'T looking for govt efficiency
If you want to do radical leftist stuff my advice is go a step further and advocate for like, nationalizing all hospitals and pharmaceutical companies and make the single payer people seem reasonable and centrist by comparison
like some sort of program of direct actions whose purpose is to create a situation so crisis-packed that it will inevitably open the door to negotiation?
If single-payer is "Medicare for everyone" or "Canadian-style healthcare", then nationalized healthcare is "VA for everyone" or "British-style healthcare". Really not that unreasonable-sounding.
I mean, I do think there should be a government manufacturer of public domain/generic pharmaceuticals- has worked for some countries, I think CA is trying it with insulin, the private sector markups can be steep
I don’t think that you can normalize one position by advocating a more extreme position. I think the extreme one makes the platform seem unreasonable. It seems to me you have to take policy you think is right, and just advocate for it as common sense
What is considered "normal" or acceptable is what people are *comfortable with*.
People are largely uncomfortable with the status quo so proposing something *more extreme* 1) produces hope and 2) compels power to move towards The Middle.
I haven't said it much, but I do believe that if we have the right to life (liberty, etc) then we have the right to stay alive, and that means a right to healthcare.
I think health care should be as inherent as it is in city building games. We're the government, of course we build fire stations and police stations and hospitals that we dispatch city ambulances from
Nationalizing hospitals sounds good to me, why not? You could argue some form of market competition is beneficial for pharmaceutical innovation, but hard to make the same case for hospitals.
You know, this ”shoot-for-the-moon/land-in-the-stars” approach could have benefits over the Democrats’ traditional “shoot-for-the-means-tested-premium-support-vouchers/land in the tax-advantaged-healthcare-savings-accounts” method.
They refined it with Obama. A semi-remembered joke after the 2011 Virginia earthquake:
Republicans & Democrats were negotiating over the magnitude of the quake. The Dems wanted it to be 5.5 on the Richter Scale; the GOP insisted on limiting it to a 4.2. So the parties compromised & made it a 3.9.
I think on the places where the GOP is farthest outside of public opinion (abortion, tax cuts) they do the opposite. They talk about the most centrist version of the thing (“states rights”, “small business”) and then do the most extreme version
sort of like how "total nationalization of all industries" is a good way to make "so there's some industries that tend to natural monopoly and some pieces of critical infrastructure it's difficult or impossible for the private sector to manage well..."
I'd start with creating an entity like Fannie or Freddie and having employers give their employees the choice of the private insurance or the "Healthie" plan. Provide benefits descriptions for both, and treat it as just another entity, except this one will be administered by the government.
I understand your point about framing single-payer healthcare as a reasonable and achievable goal. However, I think it's essential to recognize that the current healthcare system in the US is already quite complex, with many stakeholders and interests involved.
That being said, I agree that advocating for a more radical approach, like nationalizing hospitals and pharmaceutical companies, could be a way to shift the conversation and make single-payers seem more centrist by comparison.
That’s why the public option is the best route imo. Give people the option to buy Medicare (and support based on their income) and let “the market” sort it out. If private insurance is better, people will buy it, if not, oh well!
Throw in comments like “you shouldn’t have to talk with your employer about a colonoscopy” and “imagine having the freedom to leave a crappy job to start your own business” and I think you can get people on board.
I'm in the camp that to single payer healthcare we build off of Obamacare and just keep expanding medicaid eligibility up and medicare eligibility down until we've closed the donut (while also improving both services)
LOL!!! Have you not heard who win the election? There is no single payer healthcare coming to America. There is nothing but increased premiums, copays, deductibles and of course PROFITS coming. And sadly enough we deserve it cuz we allowed it. 40% can’t even be bothered to care.
I’ve always thought it looks something like, as a practical matter, the top age for CHIP goes up a year every year, the minimum age for Medicare comes down a year every year, and the threshold for Medicaid goes up like $10k a year, and then we reconcile the three programs as they collide.
I'm an incrementalist too, and my thought has been to first do #Pharmacare4All, where most prescriptions would be covered for everyone by the FedGov. That's the simplest part to administer and use economic scale. Then "Health Insurance" would be chopped down to just the doctors + hospitals parts.
There might be something to that. The tricky part would be avoiding incentivizing insurers from pushing providers to offload cases to pharmacological treatments just because it’s cheaper for them, even if another intervention might produce better outcomes.
Not to put you on the spot, but I worry about the amount of fraud that would take place in a country the size of the US. To me, that's the only barrier to single payer. Am I wrong to feel this way? Legitimately asking, not trolling
Yes, there will be some amount of fraud. Some of it may even go undetected. However, that is the tradeoff for universal benefits. I have no doubt that Medicare, Social Security, and other programs have some small level of fraud and that's acceptable compared to the alternative.
If you think of fraud as an inefficiency in the system, is it greater than inefficiencies in the current system? Fraud is unacceptable, but I doubt the margin of fraud would be as costly overall as some of the deleterious costs in the current system.
Feels pretty fixable if we actually wanted to fix it. The solution for a lot of those types of problems is like "administer the program effectively" not something that stems from the overall design
we can't effectively administer Medicare or the PPP program w/o billions being stolen via fraud. It seems like a difficult/impossible problem to solve now, let alone if we added hundreds of millions of ppl into the system.
we absolutely could administer those programs with significantly less fraud. we don’t, which is not the same thing! It would require investing more in state capacity and enforcement (which may be a tough sell to Senator Medicare Fraud)
The answer to this is, luckily enough, employing more civil service people to audit this stuff and having the will to prosecute the offenders. Rick Scott committed massive Medicare and Medicaid fraud, the fines aren’t enough, he belongs in prison, not the Senate.
this is my most conservative-coded opinion. Yes, clearly other countries can pull off single payer w/o opening the doors to rampant theft. I;m not sure America can. I'd also love to be proven wrong!
Individuals would never receive cash or anything cash-like, so it’s hard for patients to defraud the system by somehow getting money they aren’t entitled to. There’s receiving unnecessary treatment, which seems like a weird thing for a *patient* to do, or ineligible people receiving treatment…
…which is less of an issue for a universal program. So the concern is fraud by providers/administrators. On the admin side there’s no reason to think there’d be any more fraud than in any other social program. And on the physician side, I think the Canadian experience is that there aren’t many…
Even if your fears are founded, it's a choice between "If I get a major illness, I am either dead or forever in debt" and "some scam artists made more money off the govt than he would have my Grandma." I'm taking the latter.
Anyway, I doubt we lose more to scams than we do billionaire yachts.
Even if bad actors were stuffing their pockets with Medicare for All fraud left, right, and center it would still be less money than what we spend on ostensibly good-faith administration of the current multi-payer, private, for-profit system
Any time we have something like this, the misconduct is miniscule and *usually* either so small that fixing it is more expensive (drug testing welfare recipients) or so inconsequential that it finding and fixing it costs less than the inherent waste in the system it replaced.
It also opens up a jobs possibility. Single payer would put some insurance company employees out of work, but they have experience detecting insurance fraud. With appropriate resources and training, they could be hired to detect and prevent fraud against the single payer system instead.
In fact, fraud is easier to commit against a system with multiple entry and exit points and service nexi than it is against a single-path system because pattern recognition and transaction history is spread across multiple competing victims.
The path is honesty about what it will take, tradeoffs and convincing people it is worth it. It would be nice to know why that approach seems to fail or be avoided.
The path to single payer healthcare in the USA is capitalist at it's core: point out that it would supercharge small business and startup America and job mobility in general if health care was no longer attached to employment.
My dad was a small-town veterinarian. His small practice provided insurance for the employees. It was that experience that made him support single-payer. (A non petty petit-bourgeoisie.)
I’m not attached to any single solution - there are plenty of models that work in other countries besides pure single payer - but running a startup briefly was more than enough to teach me that tying insurance to employment was Fucking Stupid On A Galactic Level.
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"Most of you won't even notice" is definitely the way to pitch it because most people are happy enough with their health care. "Happy with your health care? Don't worry, you won't notice. Unhappy? We're going to help you".
Profits that have put the USA in a class by itself.
https://bsky.app/profile/mtsw.bsky.social/post/3ldza3j5tws2c
Then again, could be Elon ISN'T looking for govt efficiency
People are scared of that, because Medicare sucks in several important ways.
Call it Tricare for all.
Our active duty military healthcare is so fucking good we make memes about how it is all we have to offer on dating apps.
What is considered "normal" or acceptable is what people are *comfortable with*.
People are largely uncomfortable with the status quo so proposing something *more extreme* 1) produces hope and 2) compels power to move towards The Middle.
https://bsky.app/profile/deadcarl.bsky.social/post/3ldyh3qm6is2n
Republicans & Democrats were negotiating over the magnitude of the quake. The Dems wanted it to be 5.5 on the Richter Scale; the GOP insisted on limiting it to a 4.2. So the parties compromised & made it a 3.9.
Let people buy in to Medicare, if they want to.
Then, keep Medicare well funded
Eventually, nearly everyone will just sign up.
Anyway, I doubt we lose more to scams than we do billionaire yachts.
We'll all pay for it via taxes, and it will be free -- just show up. Like we already do public schools now."
Then I remembered how they feel about public schools...
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