Today's ACA win does not mean the end for the push for single payer, VT and Minnesota are leading

[TheKentuckian]

21. First a public option is not the same as single payer.

Single payer would mean that everyone is in a single pool with everyone required to contribute via taxes and the benefit spread to every citizen.

A public option would be a government sponsored alternative plan that one could select among the various other plans and its construction could follow any number of rules and guidelines including being forced to account for the need of other plans to promote themselves, pay dividends, and even account for the profit motive such as was being discussed before the "sliver of competition" went the way of the dinosaur the last time.

Single payer means single payer not an option of payers among several that happens to be government sponsored.

Do I agree a public option can still happen? Perhaps, it depends by what your specific definition is and how you expect it to function. I don't think it significantly matters if most people have no access to it and further believe it will have less than optimal results if it is stuck in state operated and exclusive segmented pools.

As things sit currently, a Public Option would simply serve as a dumping ground for the cartel to dispose of undesirables in the small percentage of the population allowed to participate in a system of choice and competition, even if fueled by self selection. A sick person in need would be more likely to take the government option and that means that pool would be far more expensive to operate and eventually would collapse under its own weight while the private companies would take the more healthy and less likely to use services.

As far as what reforms are needed, I have suggested several approaches including a similar approach dependant on market forces and have discussed modifications nearly constantly for years.

The founders sure as hell didn't get free from George by strengthening the crown and sending him more money or by requiring oaths of loyalty to the monarch.
We have shaped reality with this very law and that reality comes with baggage and systemic limitations and it does no good to pretend it away.

Look, optimistically you can get anywhere from anywhere. If you persevere, know where you are trying to go, have tools and/or "landmarks" to guide you, and decent fortune you can get from A to B, no matter how far apart and actually you can start in ANY direction and eventually arrive at the destination if you are okay with a longer time frame, any possible level of difficulty of terrain, and are equipped to make greater adjustments in navigation.

That is fine and dandy, but forgive me for also understanding that if I'm trying to leave my house and end up in San Francisco that going to Niagara Falls isn't in the list of best routes. I can get to San Francisco from there but I've made the trip far more expensive and long while decreasing the odds of getting there by putting the extra miles on the vehicle. I have added a huge resource burden and wasted lots of time.

We have constructed a "reform" that required remaking the damn wheel in order to make functional improvements rather than a more bare bones but solid structure to build on by amending. Well, you can't amend your way from state exchanges to a national one, the latter is a wholly new system that must be put in place and supersede what exists now, including the oppositional political forces that prevented such now.

We can amend access but you still have to have 60 votes, the House, the Presidency, revenue streams, and some serious changes to the tax code to do it and still have to overcome the same political obstacles.

The "reform" requires not additions or amendments but actual reform its self because it was designed to maintain and bolster what already exists not to replace it.