KRUGMAN: "a simple, straightforward single-payer system just isn’t going to happen"
The question for progressives — a question that is now central to the Democratic primary — is whether these failings mean that they should re-litigate their own biggest political success in almost half a century, and try for something better.
My answer, as you might guess, is that they shouldn’t, that they should seek incremental change on health care (Bring back the public option!) and focus their main efforts on other issues .....................................
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What this means, as the health policy expert Harold Pollack points out, is that a simple, straightforward single-payer system just isn’t going to happen. Even if you imagine a political earthquake that eliminated the power of the insurance industry and objections to higher taxes, you’d still have to protect the interests of workers with better-than-average coverage, so that in practice single-payer, American style, would be almost as kludgy as Obamacare.
Which brings me to the Affordable Care Act, which was designed to bypass these obstacles. It was careful to preserve and even enlarge the role of private insurers. Its measures to cover the uninsured rely on a combination of regulation and subsidies, rather than simply on an expansion of government programs, so that the on-budget cost is limited — and can, in fact, be covered without raising middle-class taxes. Perhaps most crucially, it leaves employer-based insurance intact, so that the great majority of Americans have experienced no disruption, in fact no change in their health-care experience.
Even so, achieving this reform was a close-run thing: Democrats barely got it through during the brief period when they controlled Congress. Is there any realistic prospect that a drastic overhaul could be enacted any time soon — say, in the next eight years? No.
MORE:
http://www.nytimes.com/2016/01/18/opinion/health-reform-realities.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-right-region
= new reply since forum marked as read
Hyperbole does not serve political discussions well. 
We can have it if enough of us DEMAND that we have a system like other countries have. Period.
We're the richest country in the world per capita.
Top rated comments at his op-ed are all strongly against him and express massive disappointment in Paul. I guess DU members are busy over there, huh? 
Alot of us are going to die trying so enough of your " wisdom " .
When he doubts Sanders...
Can't be done in the USA because USA is exceptional or something.
Back in '09 he was talking about what a mess the ACA would be without the public option. And it is a mess - much better than what we had before, but still pretty bad in a lot of ways. For Krugman to say that it more or less achieves the progress goal on healthcare (rather than it being a step in the right direction) is to not only go against progressive ideals, but to go against what had been his own views just a few years ago. Worth noting that In 2012 he was calling the ACA "a flawed route to universal coverage."
It's also worth noting that in the article linked to above, Krugman mocked the idea that there weren't enough votes for the public option ("the essentially circular political arguments — centrist Democrats insisting that the public option must be dropped to get the votes of centrist Democrats"
, but now mocks people on the Left who complain that Obamacare relies on health insurance companies by saying that the ACA was the only politically feasible option.
So, it's silly for us on the Left to complain about the ACA, because we just couldn't get that public option when we had control of the Senate and the House. Now, Krugman tells us we shouldn't focus on distractions but on things that are achievable like...getting back the public option? (Krugman: "they should seek incremental change on health care (Bring back the public option!)" .
The problem is that Sanders' plan assumes that large savings will come from single-payer - wait, in the Rolling Stone article above Krugman said that single-payer would cover more people at a cheaper price. Eh.
But it's not going to pass, so why talk about it? It's a distraction. Except that Krugman also said that though the Progressive Caucus budget wasn't going to pass, he would be remiss if he didn't call attention to it and thought that the media should pay more attention to it as well.
I like Krugman in general, but it feels like he's a bit all over the place on this issue. It's also easy to call this a distraction when you're sitting happily with your employer provided insurance and don't have to go through the bureaucratic nightmare of the exchanges like the plebes do ("I don't have to deal with this, but I'm sure it's good enough for you folk" feels a lot like wealthsplanin').
"The question for progressives — a question that is now central to the Democratic primary — is whether these failings mean that they should re-litigate their own biggest political success in almost half a century, and try for something better.
My answer, as you might guess, is that they shouldn’t, that they should seek incremental change on health care (Bring back the public option!) and focus their main efforts on other issues — that is, that Bernie Sanders is wrong about this and Hillary Clinton is right. But the main point is that we should think clearly about why health reform looks the way it does."
