Clinton doubles down on Sanders criticism, warns that he's promising 'the moon'

[ehrnst]

125. OK...

If someone in Boston pointed to Chicago and said, "Look at our mess of tangled streets, and compare it that orderly grid of streets in Chi town! First responders can get places faster, you know how long you will need to walk to get from one address to another! They did it, why can't we?"

You'd know immediately what to tell them. You'd need to go back in time to get streets like Chicago has, and even if you could do that, the hills in Boston are still going to be there. You can't just retrofit that onto what we have now - the disruption would be massive, and the expense... what we can do is address one part of the city at a time, do traffic studies, figure out how to keep traffic flowing with lights, dig a subway, but we are not going to get what Chicago has, starting now, and retrofitting."

Anyone who promises a Chicago grid - within an 8 year period - to Boston is promising the moon.

The health care system in this country is intertwined with the payment systems. It is also much, much more difficult to cut costs than it is to prevent them from rising too much.

If we had a time machine and could go back to the Truman administration, before the massive jump in technology, and start then, and grow the system and adjust as technology grew, that would be the way.

But no other industrialized country in the world with UHC could start NOW, working with and against the massively baked in system we HAVE, and get to what they have NOW, in just a few years.

Canada took decades. All the provinces when single payer individually, over decades, and then in the 1960's, a very liberal federal government was voted in, and they added a federal layer over the system. It's still manage primarily at the province level, unlike a federal program that Sanders is proposing.

Most countries with UHC don't use single payer, they use a hybrid of public private systems to deliver care - more similar to the ACA than Single Payer. As with many other areas, governments outsource delivery of some services, and hire contractors.

And none of them got where they are in 2 years as Sanders is promising. He was promising it in 8 years in his 2016 plan, but i guess he felt a need to differentiate himself from other candidates by reducing the implementation time in his plan....

So yes, there is an element of "promising the moon." But I think that some people promise the moon knowing that they aren't ever going to be called on to deliver, and if they some how are, they can blame 'the establishment/big Pharma/big insurance/The Senate/ SCOTUS for thwarting them, while never really addressing how to deal with those obstacles during the campaign.

The ACA is the furthest down the road to UHC than we've ever gotten. Besides, if the 2010 SCOTUS struck down the requirement that states expand Medicaid, how do you think the 2022 SCOTUS will rule when red states don't want to participate in the expansion of "medicare?" And there will be no way to administer this for the full population at the federal level - there will need to be some medicaid type state participation in the administrative functions and delivery...

Sanders has never addressed that. But he's not known for listening to people who don't agree with him, and gets testy when asked questions that he can't answer easily, that are outside his talking points.