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Fine, it's impossible to run at a national level because there's some magic cutoff population point past which single-payer can't be done. Let's take your word

by patmcc 13y ago

Fine, it's impossible to run at a national level because there's some magic cutoff population point past which single-payer can't be done. Let's take your word for it. Why can't the feds force each state to figure out a single-payer system? No state is bigger than the UK or Canada (ok, California has a few more people than Canada), and they have it figured out. Look, if you like the private system for some reason, give that reason. Don't spout bullshit about "it's impossible to manage because the US is 4X larger than the UK".

gojomo 13y ago
Why can't the feds force each state to figure out a single-payer system? Our constitution, politics, and culture don't let "the feds" easily dictate such things. The federal government can nudge with some mandates and grants (as with the ACA itself), but forced nationalization of industries is hard, especially so when most states (by count) would prefer otherwise. It's also especially hard, if those in favor of single-payer takeover only barely or temporarily have the legislative majorities necessary (again, as with the ACA itself). That much larger and more diverse populations, economies, geographies, and institutions are harder to govern via a working consensus isn't "bullshit", it's a political and historical reality. (How many government shutdowns has the UK had recently?) You can stomp your feet over this, and perhaps wish that some more-powerful central government could just "force" everyone to enthusiastically implement your preferred policy... but that's not the US way. Maybe you could get a single-payer constitutional amendment passed. That'd establish clear legal authority, and prove a broad consensus that would help with implementation. Why don't you try that? I dislike national single-payer (and the baby-step of the ACA) because I don't think it can work well here. It'll have the cost-efficiency of the pentagon, the compassion of the INS, the simplicity of the tax code, and the innovative pace of the FDA. What would be a good decentralizing alternative to this current forced-march towards unprecedented-scale nationalization? Leave more details to the states. Use national action mainly to undo existing distortions, like medical cartels/protectionism and the tax-preference for non-portable employer coverage. And, provide direct payment assistance to the neediest/sickest, rather than new regulations on the shape and cost of policies for everyone.

by patmcc 13y ago

gojomo 13y ago

Why can't the feds force each state to figure out a single-payer system? Our constitution, politics, and culture don't let "the feds" easily dictate such things. The federal government can nudge with some mandates and grants (as with the ACA itself), but forced nationalization of industries is hard, especially so when most states (by count) would prefer otherwise. It's also especially hard, if those in favor of single-payer takeover only barely or temporarily have the legislative majorities necessary (again, as with the ACA itself). That much larger and more diverse populations, economies, geographies, and institutions are harder to govern via a working consensus isn't "bullshit", it's a political and historical reality. (How many government shutdowns has the UK had recently?) You can stomp your feet over this, and perhaps wish that some more-powerful central government could just "force" everyone to enthusiastically implement your preferred policy... but that's not the US way. Maybe you could get a single-payer constitutional amendment passed. That'd establish clear legal authority, and prove a broad consensus that would help with implementation. Why don't you try that? I dislike national single-payer (and the baby-step of the ACA) because I don't think it can work well here. It'll have the cost-efficiency of the pentagon, the compassion of the INS, the simplicity of the tax code, and the innovative pace of the FDA. What would be a good decentralizing alternative to this current forced-march towards unprecedented-scale nationalization? Leave more details to the states. Use national action mainly to undo existing distortions, like medical cartels/protectionism and the tax-preference for non-portable employer coverage. And, provide direct payment assistance to the neediest/sickest, rather than new regulations on the shape and cost of policies for everyone.