We can win single payer if we fight for it.

[Bjorn Against]

I am tired of being told that we can not win single payer, we most certainly can win and I am sick to death of being told that it is not worthwhile to fight for it.

Yes, I know the Republicans in Congress will not vote for it. I don't know about everyone else but I certainly don't base the battles I fight on whether or not they get Republican approval, in fact the battles I have chosen to fight in my lifetime have almost always met with Republican disapproval.

I expect the Republicans to disapprove, what really bothers me however is that despite widespread support for single payer within the party our leadership has completely failed to stand up and advocate for an issue that is so popular with the public.

There are tens of millions of single payer supporters in this country and I am sick of a Democratic leadership who ignores these tens of millions of people and refuses to push for the system that so many of their constituents want.

I am sick of seeing the party cave to their corporate donors and the Republicans on the issue, we need a President that will appoint new people to lead the party that will push forward on single payer and fight the Republicans tooth and nail.

Of course the Republicans are going to resist, it is up to us to make sure they look really bad when they fight us.

I know there are a lot of people out there who have suffered both in health and finances because of our extremely overpriced health care system. It is time that the Republicans had to be confronted with these people face to face.

That is what a political revolution can do, it puts ordinary people on the ground that will look the Republicans in the eyes and ask them why they are denying them healthcare when they desperately need it.

A political revolution means that the Republicans will not just have to fight Bernie, they will need to fight ordinary people who are standing up for what is right.

And make no mistake about it, when we have millions of Americans from all across the country stand up on this issue our message will be heard loudly.

We know the message will be heard loudly because many of us have known people who have not been able to go to the doctor because they can not afford it.

Our message will be heard because most people are forced to pay large health insurance premiums for plans that have enormous deductibles and co-pays.

Our message will be heard because we are talking about an issue that effects the lives of everyone, and most Americans know that our healthcare system in this country has failed us.

We most certainly can win single payer in this country in this country but in order to win it we need to fight for it.

It is long past time to replace the current Democratic leadership with a new leadership that will fight for single payer.

We can win this battle.

[daleanime]

1. K&R.....

[DanTex]

2. They couldn't even get it working in Vermont.

ACA barely made it with a supermajority. And ACA was basically the least disruptive path towards universal coverage. With Obamacare, with few exceptions, if you liked the plan you had, you could keep it. It expanded coverage to people who didn't have it, got rid of preexisting conditions, and didn't cost very much. Single payer is the total opposite. Nobody gets to keep the coverage they have. The resistance is going to be enormous. Not to mention how much it would cost -- when it comes to actually implementing a plan, as Vermont found out, pie-in-the-sky projections about cost savings like the ones that Bernie has made don't fly.

Also, I don't get the single payer obsession. Sure, single payer is a good system, but there are other routes to universal coverage. Part of the confusion is Bernie's fault, because he keeps implying that the rest of the world has single payer systems, which is not true. There are countries like Holland and Germany that achieve universal coverage through a better version of Obamacare. Since we already have Obamacare in place, the sensible thing to do is to improve it.

[Bjorn Against]

5. You sound as if you think we want to keep the coverage we have.

You make it sound as if it is a good thing we are keeping the coverage we had before Obamacare, but the reality is that for most of us the coverage we have sucks. We pay huge premiums and even with Obamacare many of us continue to see our deductibles skyrocketing.

We pay far too much for our insurance and far too many people are left uninsured. Most of us don't want out high deductible plans, we are sick of paying huge premiums for crappy coverage.

While Obamacare certainly improved our system it by no means fixed it, our healthcare system is still in need of major overhaul and all you have to do us take a look at a typical person's insurance premiums to see that.

[DanTex]

15. A lot of people do want to keep the coverage they have.

For example, here's a Gallup poll showing that 69% of Americans rate their own coverage as "excellent" or "good". That's a large majority. In a single payer system, all of those people will lose the coverage they like, and be forced to take the single payer coverage instead.
http://www.gallup.com/poll/165998/americans-views-healthcare-quality-cost-coverage.aspx

For some people, the single payer coverage will be better, for others worse. So there will be a large group of people who will be forced out of healthcare plans they like into a new plan that is worse. And even for those who would ultimately get better coverage under the single payer, there's still a huge amount of uncertainty, which people don't like when it comes to healthcare.

[rusty quoin]

34. When the public option was pushed under the rug, we librels/progressives went with the ACA

because we knew it was a step to single payer. We don't believe, like we didn't believe that Hillary Clinton's plan was bad in the 90s, that single payer is bad.

You ain't gonna change me. I am immune to your bullshit that our insurance care cannot be improved upon. Fuck those insurance companies. We need basic health care in this country.

[Tommy2Tone]

29. It is pure fantasy and that's why the critics are starting to form.

I am not saying it's a bad thing but it is not going to happen but then Bernie is never held to call for promising everything to everyone.

[JDPriestly]

39. Based on the experience of other countries and our own Medicare, let's face it,

the administrative costs of Medicare for all otherwise known as single-payer, are far lower than they are for the ACA which is for-profit insurance.

We already pay for medical insurance for the great majority of Americans, and we are paying more for that insurance and healthcare than is any other country on earth. Alone, when it comes to pharmaceutical products, we pay more than people do in other countries.

We now have high deductibles. Single payer or Medicare for all would reduce those deductibles.

The only additional cost with Medicare for all is the fact that we will insure everyone. No one will be without medical insurance.

So how in the world can Medicare for all, also known as single payer insurance, cost so much and be so difficult to get through Congress?

There is one answer. The very wealthy and others who invest in the health insurance companies (possibly including some in our Congress) like being able to skim profit off the top of our health insurance premiums. It's easy, sure money. It is one of the factors, along with the money that comes from investments in our military that makes the bank accounts of the rich so much larger than our own.

The only reason we cannot have single payer is that the powers that be make a lot of money on the for-profit system we now have.

I'm pretty sure that when I was a child in the 1950s and a young adult in the 1960s, the health care insurance we had was non-profit.

I recall the legal issues that arose when so many insurance companies went private. You see, tax deductible donations to the hospitals, etc, (many run by religious non-profits) had to be devoted to charitable purposes. Legally, you can't use money raised as tax deductible donations for non-charitable purposes.

So that is the reason. Profits. That's why we can't have single payer.

I have said this many, many times. I lived in Europe for years, had single payer and loved it. Germany has had single payer since I believe the time of Kaiser Wilhelm in the 19th century. They are happy with it. As are the people in other countries that have it.

There is utterly no good reason why we can't have it too. Just takes the votes.

There would be several good ways to gradually get single payer. Adding a public option is one. Gradually extending our Medicare system by gradually raising the people covered by it downward from 65 to 64 and on down each year while gradually increasing the taxes that would cover Medicare for all. We'd be a healthier country for it.

[DanTex]

44. Not all other countries have single payer.

Actually most of them don't. Canada does. The UK has socialized medicine. France has a hybrid system. Holland and Germany have a mandate system similar to Obamacare. It varies from country to country. Look around the world, there are various ways to obtain cost control and universal coverage, but for some reason for a segment of the left it's single payer or bust. Why is that?

The other misconception is that profits from drug and insurance companies are why our system costs so much. That's not true. There are a lot of reasons, and those are two of them, but the biggest reason is simply that we pay more for inpatient and outpatient care.

[Armstead]

3. You nailed it with this one line:

"Of course the Republicans are going to resist, it is up to us to make sure they look really bad when they fight us. "

That, IMO is the whole problem. The only reason there isn't an open clamor for it, is because The Democratic establishment has been allowing the GOP (and the Insurance Industry and Bog Pharma) to set the terms of the debate. They don't clearly explain how it wold benefit people.

Instead of selling the idea, they demonize it as "too much" and now as "too socialistic." And now Hillary joining in the demionization as "raising taxes on the middle class" and clasiming it is "unworkable."

[Bjorn Against]

6. Yes, we can never forget that it is not just money that is at stake, people's lives are at stake

Those who try to fight against health care for all need to be challenged head on with the fact that people are dying because of lack of health care.

[Armstead]

8. My brother died needlesly because of the shitty system we have...

and left his wife with a stack of bills, even though he had insurance.

It makes me ill when Democrats want to perpetuate that.

[Bjorn Against]

23. Sadly stories like yours are not at all uncommon

I am sorry for your loss.

[Armstead]

25. That's one reason I get so angry at the bullshit being spouted

[Vincardog]

45. Democrats don't want to perpetuate that Conservative operatives who have infiltrated the party do.

[Gothmog]

4. Why single payer died in Vermont

If single payer can not work in Vermont, then there is no chance that it will be adopted in the entire country http://www.politico.com/story/2014/12/single-payer-vermont-113711#ixzz3xciq2Nj5

So single-payer advocates looked instead to make a breakthrough in the states. Bills have been introduced from Hawaii to New York; former Medicare chief Don Berwick made it a key plank of his unsuccessful primary race for Massachusetts governor.

Vermont under Shumlin became the most visible trailblazer. Until Wednesday, when the governor admitted what critics had said all along: He couldn’t pay for it.

“It is not the right time for Vermont” to pass a single-payer system, Shumlin acknowledged in a public statement ending his signature initiative. He concluded the 11.5 percent payroll assessments on businesses and sliding premiums up to 9.5 percent of individuals’ income “might hurt our economy.”

Vermont’s outcome is a “small speed bump,” said New York Assembly member Richard Gottfried, who’s been pushing single-payer bills for more than 20 years. But opponents says it’s the end of the road.

“If cobalt blue Vermont couldn’t find a way to make single-payer happen, then it’s very unlikely that any other state will,” said Jack Mozloom, spokesman for the National Federation of Independent Business.

“There will never be a good time for a massive tax increase on employers and consumers in Vermont, so they should abandon that silly idea now and get serious,” Mozloom added.
Read more: http://www.politico.com/story/2014/12/single-payer-vermont-113711#ixzz3xdKH1mGn

Sanders is proposing a skeleton of a plan (not a real plan at all) that has no chance of passage. The refusal of Sanders to answer the question was an admission that even Sanders knows that this plan is not real.

[Bjorn Against]

7. Single payer died in Vermont because the national system is hostile to single payer

Vermont is a tiny state that was trying to set up a single payer inside of a nation in which the people in charge of health care are very hostile to single payer. You can not expect a tiny state to be able to challenge the medical establishment on their own, it needs to be a national battle.

[brooklynite]

10. That's irrelevant...

...Whether or not "the medical establishment" is hostile to Single Payer, Vermont could have implemented it if they were willing to cover the costs. They weren't.

[Bjorn Against]

12. No the tiny state of Vermont did not have the money to establish their own healthcare system

Thankfully there are a lot more resources nationwide than there are in a small rural state.

[brooklynite]

14. Of course they did...

...all you have to do is raise taxes on the 1% or business or...someone. I keep hearing that's a solution for everything.

[Armstead]

19. Restoring some balance is a start. That's all this is ultimately about.

But heck, let';s denigrate all efforts to reform a system that has gone bad.

[Bjorn Against]

21. Raising taxes on the 1% most certainly would raise lots of money nationally

The problem is Vermont does not have nearly as many millionaires to tax as a state like New York or California would.

[Gothmog]

28. The percentage of tax increases will be the same

There is no real difference in the per person funding needed and so the same tax increases that were impossible in Vermont will be impossible to impose nationwide

[JDPriestly]

40. Nonsense. The savings on administrative costs and duplicative costs

plus the profit that is now being taken from our insurance premiums would cover a lot of the difference if any between what we pay now and what we would pay if we had single payer.

Health care services in the US are not very efficient. And the amounts people pay for insurance plus their deductibles in many parts of the country are just outlandishly high.

My mother lived in a small town in the Midwest. She was retired, had Social Security and small pensions. Her healthcare insurance under Medicare was absurdly high. Just absurdly, out of proportion high. And she was rarely sick even as she aged.

We just have a very greedy bunch who invest in healthcare insurance companies and literally bleed sick and dying people as well as healthy people in order to make profits from misery. That's what private health insurance amounts to. It makes no contribution whatsoever to the wellness of our country. It is useless for any purpose other than taking the hard-earned money of the middle class and everyone else for that matter and putting it in the pockets of rich people who invest in healthcare.

We could pay all medical providers the same amounts we do now and we would still save money overall with single payer. The reason the overall cost of single payer works out and appears to be higher than what we have now is that we would be covering more people if we had single payer.

This is logical. When you take the profit out of the health insurance system, you necessarily reduce the overall cost of health insurance.

Any additional cost with single payer is due to broader coverage -- including more people as insured.

Private, for-profit insurance companies cannot be cheaper than single payer. Just does not make sense. Does not compute.

[Gothmog]

47. Krugman-Sanders health plan looks a little bit like a standard Republican tax-cut plan

I trust Prof. Krugman on this http://krugman.blogs.nytimes.com/2016/01/19/weakened-at-bernies/?_r=0

On health care: leave on one side the virtual impossibility of achieving single-payer. Beyond the politics, the Sanders “plan” isn’t just lacking in detail; as Ezra Klein notes, it both promises more comprehensive coverage than Medicare or for that matter single-payer systems in other countries, and assumes huge cost savings that are at best unlikely given that kind of generosity. This lets Sanders claim that he could make it work with much lower middle-class taxes than would probably be needed in practice.

To be harsh but accurate: the Sanders health plan looks a little bit like a standard Republican tax-cut plan, which relies on fantasies about huge supply-side effects to make the numbers supposedly add up. Only a little bit: after all, this is a plan seeking to provide health care, not lavish windfalls on the rich — and single-payer really does save money, whereas there’s no evidence that tax cuts deliver growth. Still, it’s not the kind of brave truth-telling the Sanders campaign pitch might have led you to expect.

Again, as noted by Prof. Krugman this plan does not add up.

[JDPriestly]

48. As with every plan, the details can be negotiated.

As I have told everyone on DU, I lived in Europe and had single-payer for quite a number of years -- four countries in all.

Single-payer does work. The cost savings are enormous. Everybody lives better in the end.

People wonder how Germany keeps is industrial base in spite of imports and trade agreements. A healthy single-payer insurance plan SINCE the 19th century under the Kaisers is part of the secret.

Our children are sick and parents don't get the health advice to help their children stay well. That's because doctors are paid fees for services and are not considered to be advisers to the community but rather are employees of the health insurance companies.

Health insurance companies make good profits in this country at the expense of the health care providers and the patients. Profits are a good thing. They are an incentive to efficiency and to creativity.

But it's sick to be profiting off people's cancers and diabetes, etc.

A lot of people blame doctors for the cost of medical care. I know some doctors and believe that they are paid commensurate with the sacrifices, the responsibility, the education, the intelligence etc. they bring to the job. Nurses and technicians in health care are not paid enough in my view.

But the health insurance companies hire armies of bureaucrats to vet our every procedure, every move the doctors make. Those employees could be better employed working as caregivers or in other fields. We do not need the profits or the bureaucracies that accompany for-profit insurance.

Not-for-profit insurance was as I recall the rule when I was a child. The for-profit insurance companies sort of raided the field.

If you don't think Bernie's plan is quite right, please suggest one that will a) provide health care to every man, woman and child in America including visitors at low or no cost, b) make it affordable for all, c) make doctors and their work a part of our communities (make doctors advisers to parents, teachers and all in the community), d) get it passed through Congress.

The ACA is a step forward. It should have had a public option. Were it not for the greed of those who have invested in private, for-profit health insurance companies, we would have had that public option and the arguments about Medicaid in some states might never have occurred.

If you think Bernie's ideas are bad, offer better solutions. So far I have not heard of any. The idea that so many Americans remain uninsured in spite of the ACA is troubling. We can do better.

And while you are at it, visit your local dependency court. That's the court where child abuse cases are reviewed and children are placed in foster care. The ignorance of many American parents about what constitutes decent discipline, about the dangers of beating a child for example, speak to the lack of good community healthcare in this country.

We need healthcare that is for the community and for the entire person. We especially need this for our children. We need healthcare that educates people about the problems of addiction, about how people become addicted, about how to avoid the pitfalls of addiction.
Universal healthcare that is not just about fees for services can fill that gap. The information on healthy living is out there. But our for-profit insurance companies do not see it as part of their jobs to get that information to their patients.

We can do better. So what if Bernie's plan line by line is not passed by Congress. It is a good start. Much better than what we have now. Everyone has the right to the information and opportunities to enjoy good health for as long as their DNA permits it.

I back Bernie on this 100%.

We were not born yesterday. (Well. Actually I was but a lot of Bernie supporters were not.) We know that Congress will decide on the line by line bills that are passed.

We back Bernie's concept and direction. That's what matter here. Congress, and especially Democrats in Congress, need to respond to the spirit of what Bernie is advocating for.

The DNC has the mentality of defeat. We cannot afford that. We cannot afford a government that is defeatist in the face of Trump.

Read the history of the Weimar Republic and how its defeat led to Hitler.

The Democratic Party has to do better for Americans. They have to offer hope. Hillary cannot and does not offer that.

[Ron Green]

55. +1.

A post this good needs a rec.

[pnwmom]

36. They were given funds through the ACA that they could have spent on

establishing a single payer system, but they would have had to raise additional funds --- ie., agree to tax themselves at a higher rate.

And people weren't willing to raise taxes.

If they wouldn't in VT, they're not going to in less liberal parts of the country.

[Armstead]

16. What's relevant is that Obamacare did not set up a national system for it

Not even a modest little public option as a start.

No they chose to totally cave in and placate ConservaDems and the GOP and Big Pharma and Big Insurance.

[Armstead]

9. It is a starting point. Why the hell do Democrats hate the concept?

[brooklynite]

11. I've met almost every Senate candidate we have...none are campaigning on Single Payer.

The symbolism of getting rid of DWS as Party Chair might be heady, but where are these new Party leaders you have lined up?

[libdem4life]

17. It starts with Bernie. Hard as that must be to get...it's true. Top down.

He doesn't give a flying rip about the Big Insurance and Big Pharma, et al. Seeing you have met almost all of them, you should know that. They are what we call, beholden.

[Bjorn Against]

18. The fact that none of them are campaigning on single payer shows we need better candidates

The party leadership does push a lot of shitty candidates, but having a President that will appoint real progressives to the party leadership will move us in the right direction. I am not saying it will happen overnight, but if we get better leadership we will get better candidates as well.

[brooklynite]

20. Great...who've you got?

Or is it someone else's job to stoke the revolution?

[Bjorn Against]

22. Right now the battle is to get Bernie in, once that happens we move on to new campaigns

As much as I wish I had an army of Congressional candidates at my fingertips ready to hit the campaign trail, I don't have that. I think you know as well as I do that your question is absurd, you are asking me what I got when it should be obvious that it is not about me. It is not just my job and someone else's job, it is the job of millions of people. Bernie is doing a great job of organizing those people and the organizing that is happening now can continue even after the campaign ends.

[JDPriestly]

41. I spoke personally to my Representative about the problems with the ACA

and why I did not expect costs to be controlled even with the provision that supposedly limits the profits of for-profit insurance companies.

I explained to my Representative that the insurers would hire accountants to fix the books. He just looked at me with wonder in his eyes. I like him very much, but it is a no-brainer that the insurance companies will work around the limits on their profits.

It is in my opinion absolutely crazy, insane, absurd and corrupt to have for-profit insurance companies handling our healthcare insurance. At the least, we should, with the ACA require that healthcare insurance companies be non-profit.

Then we could gradually move to single payer one age group at a time. Say add 64-year-olds to Medicare and increase payroll taxes (lifting the cap would be a good start) and Medicare taxes to cover the cost gradually.

I have lived in countries in which I had single payer. I loved it. Much easier to change doctors, get services, etc. in my experience with single payer.

It's a matter of the fact that Americans are just ignorant when it comes to how other countries do things and the utter absurdity of having for-profit health insurance companies.

Step by step we will get single payer insurance. It is just a matter of time. Gradually, the federal government will have to step in and take care of things. Our current system makes no sense. It's too expensive. More expensive than the systems in other countries.

It's the profit in for-profit insurance that we can't afford. That's why so many Americans are uninsured.

[Gothmog]

30. Have you ever recruited a candidate to run for office?

It is not an easy job. I have been helping recruit local candidates for office and it is not easy. Adding a program that is impossible to adopt will not make that job any easier

[Ed Suspicious]

51. The guy rich enough to buy access tells us it can't be done. I think your comfort with the status

quo is to be suspect.

[brooklynite]

52. ...except that I don't play favorites

As long as you don't trigger one of my dealbreaker issues (currently gun control, Syrian refugees and Planned Parenthood), I'll support you as long as you're competitive. That covers people as liberal as Elizabeth Warren and as conservative as Baron Hill.

[libdem4life]

13. It does not work state by state, as the economy of scale is not there. Kind of like Medicare

by state? Some would and could, others could and won't and still others couldn't and wouldn't. It's really not that complicated. But there must be a national Bully Pulpit. Obama still owed too many corporatists to pull it off. Bernie, as President, stands a much higher likelihood.

[KittyWampus]

24. Single payer is NOT the only path to Universal Health Care. Fixing the ACA

is the sane alternative.

[Bjorn Against]

26. That battle will be just as hard to get through Congress

The Republicans are going to fight just as hard to fight any efforts to strengthen Obamacare as they will to stop single payer.

If we are going to have to fight the Republicans just as hard either way we might as well fight for a system that covers everyone and does not require payments to an insurance industry middleman.

[PatrickforO]

31. I disagree, and I'll tell you why.

A single payer system removes the profit motive from healthcare, which is a great thing because the profit motive is in direct conflict with the practice of healing.

No matter how much we tinker with the ACA, it is and will remain a giant corporate welfare system for the insurance industry and big pharma. Why? Because the profit motive is still there and will remain there as long as ACA is in existence.

This is why Clinton is wrong to advocate fixing ACA in the face of so many Americans who are suffering with expensive, shitty, rationed healthcare and so many others who are uninsured because they can't afford to 'buy in' on the exchange. This system is so flawed that we CONTINUE to experience annual premium increases in double digits while our copays go up and service levels go down. We pay out the nose for prescriptions because big pharma can gouge us at will - why? because Congress failed to put the power to negotiate costs with the government. In fact, I consider Obama's failure to allow a single payer option when he COULD have rammed it through in 2009 unconscionable - just as bad as his stated desire to reform 'entitlements' when in office. It's just wrong, Kitty. Morally wrong.

As I've said before, I want single payer. I worked my ass off for Obama's 08 campaign BECAUSE he promised national healthcare, and I'm fervently supporting Bernie because he wants a single payer system while Clinton was quoted as saying that a president leading the people to single payer is somehow not 'real.'

Well, my shitty, rationed healthcare and my wife's chronic suffering IS real. I want single payer and I'm not backing down.

[Recursion]

43. I can't count the number of ways this is wrong

The easiest one is baffling, though:

Single payer leaves for profit hospitals and physicians' practices in place.

So, I mean, obviously your initial sentence is just flat out wrong, yeah?

[PatrickforO]

27. Yeah baby!!!! You can count on me to stand with you! You bet!

I want single payer and I'm not backing down.

[uponit7771]

32. Same for reparations too !!!

[onecaliberal]

33. Republicans are th true and original death panels.

They have taken tens of votes to repeal healthcare. Anyone with two brain cells to rub together should understand they do not give a rip about healthcare of people.

[Voice for Peace]

35. This might be a good time to open a small business selling pitchforks

We may need 'em.

[Wounded Bear]

37. Frankly, I'm just glad we're talking about it...

It has been such a "don't talk about it" issue since forever, that it hasn't ever been realistically debated.

I get all the opposition points, and I know the opposition and obstructionism will be on a scale never before seen. But just to get the points on the table and partially discussed is a major step forward. It's the first time the concept hasn't been summarily dismissed as "unattainable." Whatever happens, Bernie has done that much and it's a lot. I'll support him through the primaries, to be sure. And I'll vote against any R on the ticket.

[99th_Monkey]

38. Hillary: "I already tried that ... 20 years ago. IT'S JUST TOO HARD!!! No you can't" nt

[Recursion]

42. Possibly. Some of us don't want it though.

I prefer provider reform to insurance reform. Get costs down and it doesn't really matter how we finance it.

[Gothmog]

46. Here’s One Big Problem With The Bernie Sanders Plan For Health Care Utopia

This plan will not be adopted nationally http://www.huffingtonpost.com/entry/bernie-sanders-health-plan_us_569ff110e4b076aadcc50807

The Bernie Sanders health care plan, which the Vermont senator released this week, sounds pretty spectacular at first blush. It’s a proposal to create a single-payer system, which means that Sanders would wipe away existing insurance arrangements and replace them with a single government program. Everybody would get insurance, free of co-pays or deductibles.

That’d be an upgrade in benefits, even for seniors on Medicare. And while people would have to pay higher taxes, Sanders claims most people would come out ahead financially because they wouldn’t be paying private insurance premiums anymore. A typical middle-class family would save about $5,000 a year, according to a rough analysis commissioned by Sanders' presidential campaign, while society as a whole would end up saving something like $6 trillion over the next decade.

To help pay for his plan’s unprecedented benefits, Sanders proposes to extract unprecedented savings from the health care system. Here is where the details get fuzzy and hard to accept at face value, even beyond the usual optimistic assumptions that figure into campaign proposals. Sanders expects a large portion of the savings to come from reductions in administrative waste, because insurance billing would basically end. Another big chunk would come from squeezing the industries that produce health care services and supplies -- and squeezing those industries hard.

That last part should set off alarm bells for anybody who remembers the fight to pass the Affordable Care Act. Two particular episodes from 2009 -- one widely publicized, one barely noticed -- are a reminder of how much power those groups wield in Washington. For Sanders to realize his vision for single-payer health care, he’d have to overcome even greater resistance than Obamacare’s architects faced. And Sanders has offered no reason to think he could do that, which is something Democratic voters might want to keep in mind.

Two lessons from Obamacare

The first and better-known episode from 2009 was the battle over the “public option” -- a proposal, crafted by Yale political scientist Jacob Hacker, to create a government-run insurance plan that would compete with private insurers for customers. Hacker and others figured the public option could dictate lower payment rates to suppliers and providers of medical care, just like Medicare does, thereby keeping premiums low and forcing private insurers to match them.

Voters liked the idea, according to polls, and experts had certified that it would save the government money. But it ran into huge opposition -- not just from insurers, who didn’t want the competition, but from doctors, makers of drugs and medical devices, and hospitals, all of whom understood the proposal would cut into their revenues....

Bernie's vision vs. Hillary's

No, this grim political reality doesn’t mean Sanders or anybody else should stop advocating for single-payer. Progressive achievements like the minimum wage and civil rights began as ideas that the political establishment once dismissed as loopy. And the kind of reform that Sanders envisions would have a lot going for it. Single-payer works quite well abroad and a version of it could work here too -- even if, as Harold Pollack and Matthew Yglesias noted recently at Vox, it would ultimately require compromises and trade-offs that supporters rarely acknowledge.

But voters comparing Sanders and Hillary Clinton, who has proposed bolstering the Affordable Care Act rather than replacing it, should be clear about the choice they face. This isn’t a contest between a candidate who can deliver health care nirvana and one who is willing to settle for less. It’s a contest between a candidate imagining a world without political or policy constraints, and one grappling with them; between a candidate talking about what he hopes the health care system will look like someday, and one focused on what she can actually achieve now.

[Romulox]

49. But my "Middle Class" ($250,000/year--$21,000/month!) TAXES!!!!!

[H2O Man]

50. Recommended.

Thank you.

[Thenewire]

53. Can you explain to me

How does Sanders plans to completely restructure the currently corrupt medical system that overprices and under-delivers? Is he just going to continue to give them money the same way Medicare currently does without having a mechanism to drive prices down. How is he going to deal with the fallout throughout the industry as insurance companies are driven out of business and millions are left without jobs? How does he plan on changing the most deeply ingrained industry within the US economy without leading to a recession? I am all for single payer but you must be realistic. If we are not pragmatic Trump will win and all you Sanders supporters will end up not only destroying the Democratic party but also the United States and whatever little chance there was for single payer to become a reality.

[stillwaiting]

54. Yes. We're going to have to fight for it.

To do that we need to replace much of the current Democratic Leadership that stacks our Party with corporatists.

We truly need someone like Bernie to give us a Party Chairperson that will recruit and fund progressives, and we'll have to apply A LOT of sustained pressure on Democrats (and make sure there are consequences to them for failing to deliver for us).

It's the only way. I'd love it if enough of us were ready for that fight.