Dem lawmakers call for single-payer healthcare

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38. For several reasons. It's important to know what failed before you can determine what is "doable."

1. Green Mountain Care was what would be considered a "platinum" insurance plan, instead of a much more limited plan like Medicare, making it way more expensive than Medicare. What Sanders proposes is more along the lines of what Vermont had, than actual Medicare for all. Medicare does not cover dental, vision, hearing or prescriptions - you have to buy private insurance to cover those.

2. The costs of that plan wound up needing to be covered by an 11.5 percent payroll assessments on businesses and sliding premiums up to 9.5 percent of individuals’ income. Even with the federal government offsetting Medicare and Medicaid patients care, it was still too costly to finance the plan for the rest of the population.

3. It exempted taxes on big businesses that had employees in multiple states - which cut into a major funding stream. That was a huge mistake. If the few big business interests could get exemptions in lefty Vermont, imagine what a lot of them could do in a national debate over this. I'm not defending them. I'm pointing out the reality of the massive political will that would be necessary.

"In Europe, many countries built their universal health care systems from scratch, with some starting early last century when most citizens had no medical coverage and any services provided by governments were welcome, the Brooking Institution’s Aaron said. That allowed those countries to slowly build and expand health care systems over decades.

But in the United States private insurance arrangements between employees and employers have expanded and matured over the decades, with many people with insurance expecting a high level of medical service. So, switching to a single-payer system would need to meet those higher expectations — and higher costs — all at once, Aaron said.

“It’s easier to build from scratch than when a system is already up and running,” he said. “We could have maybe created a single-payer system 60 or so years ago, when insurance wasn’t as complete and widespread. But it would be very disruptive and costly today.”

https://www.bostonglobe.com/business/2015/01/25/costs-derail-vermont-single-payer-health-plan/VTAEZFGpWvTen0QFahW0pO/story.html

The expectations that Americans have for health care coverage make European style health care delivery (such as facilities and clinics that look more like DMVs and government buildings than gleaming new facilities with fountains and atriums) make US citizens think that they are not getting good health care. I lived in England and really loved the health care I got, but I know that my father would have turned his nose up at the local clinic waiting area that needed a coat of paint, had old furniture, and old but servicable medical equipment.

There are so many obstacles in place for overhauling the payer system in the US that aren't taken into account by many people without knowledge of how health care funding and delivery works. Single payer is as "doable" as converting all cars over to plug-in electric in 5 years. A great goal, both environmentally and energywise, but you have not only big oil, but the need for outlets to be as handy as gas stations, and the economy would also need to absorb the effect of all the industry jobs that would be phased out that quickly (drivers that transport gasoline, gas station attendants, refineries, drilling, etc) but the expense of those cars standing in the way of implementation.

I would LOVE solar on all businesses and residences, and know that eventually, the panels pay for their initial expense - but I also know the obstacles. I would not demand legislation that would require all Solar, at the expense of supporting a tax break or federal subsidies for some in the meantime... I think the same about universal health care coverage. Single payer isn't the only way to do it, and could be more damaging than a gradual expansion of subsidized health care coverage.