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[ehrnst]

8. More thoughts

If we assume healthcare is a right, then we extend that to everyone equally.

That is what the ACA is addressing. Universal Health Care. We won back the house on preserving it in 2018..

Medicare for all who want it. Sure, it would be great to be able to provide health care for everyone who needs it. That's an amazing goal, and if that's ALL we can get, I'll take it!

That's not going to work, actually. There has to be a limit on who can join up, because insurers will stop subsidizing anything if they can simply tell people to go get Medicare. That's why the structure in the ACA on who could get a subsidy.

But if we ONLY do that.

Like I said, it would have to be everyone, if we did that, because it would end up that way without restrictions on who could join.

However, if we make it a right, and go with m4a under bernie or warrens plan, then we eliminate other forms of payment for medical care.

There are other options than single Payer, such as expanding the ACA. Most other industrialized countries do not use single payer to accomplish Universal Health Care, but use different, customized hybrids of programs, depending on things like the % of population concentrated in urban areas, etc.

If we go with a single system for everyone, then making improvements to that system benefit everyone. If we go with a multi-tier system, making changes to the programs that only benefit the poor becomes all that much harder.

You're unclear here - are you talking a 'system' or a 'payer' because the ACA is intended to expand to become the national health care system. We're already partway there

I see this as the difference between liberals and progressives.

You mean that no one who isn't promoting Sanders' MFA can't be a progressive? I see it as a difference between listening to non-partisan, neutral health policy experts talking about reality, and politicians running for office on promises of upending and restructuring a massive baked in system, with no interruption in health care delivery in just four years - wait, is someone else also promising M4A? - I'll promise it in TWO years, and that makes me the very most progressive!!!

Canada didn't have a national health care single payer system until all the provinces went single payer individually, over about 15 years, then a very liberal administration was elected in the 60's and added a federal layer over it, and it's been changed and tweaked to what it is over the last 50 years. Two years - and having to retrofit? Not a chance.

The same is true for almost all programs. Giving to just those in need creates unneeded divides. Giving to all eliminates those divides. FDR was very smart in this regard with social security. if it had been optional it would surely be gone by now.

Actually, SS was only available to the elderly at first. It did not cover near what it does now. It expanded incrementally to kids whose parents died, etc over 75 years. Medicare works in part because the funding mechanism requires everyone to pay in, while only a portion is eligible to use it.

Also, congress has to pass it, as does the Senate. And in the unlikely event that happens, it has to survive the inevitable challenge from the red states to SCOTUS. If the SCOTUS of 2010 refused to uphold the state mandate to expand Medicaid in the ACA, what do you think that the current SCOTUS is going to do when states refuse to participate in the administration of the expansion of Medicare?

And as we see in Canada, which has less of a population than the US, it is managed at the province level, far more like Medicaid delivery than Medicare.

You're welcome.