Some seem to think if ACA dies it would be a shortcut to single payer

[Still Sensible]

I disagree.

If the ACA dies, I believe the question would be considered political kryptonite for another generation or two... in much the same way that any discussion of any reasonable gun control has been looked at for the last 30 years... and in much the same way that the failure of the health care push in the early 90s led to nearly 20 years of nothing. If the right is able to kill ACA in the courts, it is folly to think that it will simply have the effect of re-opening the conversation... it will shut down the discussion for a very long time.

IMO, the shortest route is for ACA to survive and watch states like Vermont start morphing toward single payer.

[JNelson6563]

1. That's because some are too simple & idealistic to see it otherwise.

Reality is like a dirty word to some.

Julie

[Jackpine Radical]

2. I guess it's an empirical question, only to be resolved

in an experiment I truly hope does not happen, but it may also be a suicidal move for the Republicans to pull the plug on ACA. The great majority of people who have it like it--at least they like it better than what they had before--and even the egregiously inept Democrats ought to be able to pin it on them.

[brooklynite]

5. But "the great majority" are a minority...

Remember that the actual "great majority" already HAD insurance (through their employer), and probably most weren't faced with pre-existing conditions or spending caps. ACA expanded the pool of coverage, but the people who benefited aren't necessary a potent enough political force to make a difference.

[1StrongBlackMan]

16. I would agree ...

but the elimination of the ACA will throw the healthcare financing system into turmoil. And that turmoil will amplify the voices of those with pre-existing conditions and facing spending caps.

[Adrahil]

7. Maybe, but I doubt it.

Even with the demonstrable success of the ACA so far, few people have actually changed their mind about "Obamacare." That's because many people are idiots and will believe whatever the Koch brothers tells them to believe.

[Louisiana1976]

27. That's right. They're gullible.

[n2doc]

14. That is incredibly naive

The only Americans screaming with rage so far are the ones brainwashed by Fox and Rushbo into thinking they're going to be fed to socialist death panels. People will be fed the line that this means they can go back to their "wonderful, free enterprise health care where they can choose their own doctor"

Some will certainly be hurt, and upset, but most will end up going along. That's my prediction, anyway, if this happens. I hope I never find out.

[Still Sensible]

17. I think you're right

The righteous rage of hundreds of thousands of people that lost their homes and jobs from the financial crash, plus the ripple effect of negative consequences from that on literally millions of others, only led to the virtual stalemate we are at today...

I certainly think that rage could result in some republicans losing seats... could even get back the house for the democratic party if not in '14 then in '16...

But as the financial crisis aftermath has shown, there have been no wholesale losses to the GOP.

[GeorgeGist]

18. Well if a pundit said it ...

it must be true.

[Louisiana1976]

29. True.

[Doctor_J]

33. Millions were screaming for SP or a public option before

and against wars, and against torture...you think that has any sway at all?

[ChisolmTrailDem]

40. Oh FFS... Why does neary every reply to me on this board have to be vitriolic snark or

feel so hateful? I'm really starting to hate being here.



I'm going to go make some money. Sheesh.

[vi5]

4. If the ACA falls healthcare reform will be political kryptonite

It will be dangerous to touch for at least several generations.

The conspiracy minded/cynical part of me thinks this may have been the plan all along.

[Louisiana1976]

30. That would not be surprising.

[Swede Atlanta]

6. I agree.....

Even if the ACA is ultimately gutted in red states because of the subsidy issue, do NOT expect there to be any move anywhere to fix the problem.

The "cons" in the states that refused to set up exchanges think that is a great idea. They love the idea they have tens of thousands of their own neighbors potentially dying because they lack health insurance. Remember Ayn Rand...I got mine and the rest of you flake off....

There will be absolutely no politician that will touch this for 20-25 years. Unless we can pull the ACA through we won't likely see any serious attempt to address health care in my lifetime.

[SidDithers]

8. Nailed it...nt

Sid

[Autumn]

9. Some really ought to think that through, because you are right. IMO

[conservaphobe]

10. It's amazing how some on our side can be that dense. nt

[TreasonousBastard]

11. If ACA dies...

a lot of people will die with it. And they and theirs will have very small voices to complain with.

There might be a slim hope that a "reasonable" Republican administration might disarm the teabaggers and get it through (Remember how only Nixon could go to China?) but that's stretching hope a bit too far.

One way or another, until this current Republican scorched earth policy is over we're not going to see any improvement.

[Warpy]

12. Oh, yeah, and that pink and purple spotted hippopotamus is going to fly over any second.

It wouldn't do anything but force us back to the same, wretchedly unfair premium collection system under which actual care only went to the healthy. Once people got sick, well, that's your fault, you hosers are on your own.

We know this. Damned right we know it.

The ACA is a lousy system that left the predators in charge. However, it's got a few safeguards and that's better than no safeguards.

[leftstreet]

13. The ACA Individual Mandate will be the only thing that survives

[1StrongBlackMan]

15. I don't know ...

when 20,000,000 people, from all parts of the country and all political persuasion, have something that they like (or is better than what they had, at a comparable price), it's pretty hard to take that "Green Eggs and Ham" away from them, without them screaming for a replacement.

[Doctor_J]

19. sp is dead either way

The passage of heritage care was the death knell for actual health care in the US. If it dies, we'll be back where we were, only with "failed healthcare reform" label hanging there. If it survives, the state by state implementation will never actually happen. Maybe in fifty years or so a handful of states will have it.

I don't think it will die. Its main thrust - requiring all US citizens to purchase insurance from a private for profit corporation - is now part of the economy, and the corrupt scotus will never take it out.

[TheKentuckian]

20. And some believe there is no short cut or magic slippery slope to get there.

It will simply have to be done the Wealthcare and Profit Protection Act will not and is not designed to morph into Single Payer. CBO projections 20 years out do not even begin to consider the idea of possibly speculating on such a thing.

Projections kinder than reality I have to guess considering a substantial majority have not yet created exchanges from which there is any tender at all save it come from the Federal level.

Now is their some kernel of a reason to hope that maybe a cinder or two will cause the map to catch fire? Sure. More than a puncher's chance? I don't think that is supportable other than as an act of faith and personally I can imagine it but can't project it.
Too much good faith must be assumed while also assuming light switch perfection under extreme duress while simultaneously believing TeaPubliKlans actually believe the lame shit they espoused to justify their rob and pillage routine. They ain't fixing to see anything nor do they have the country or their people at heart and we just have a few disagreements about how to best serve them.

I think it is what it is and as such will require an actual reform effort to advance the game even as a market based strategy much less a wormhole to advance to Single Payer in this country. The overall all structure of the legislation makes it at minimum, something not actually baked into the cake.

One can point to Canada all they want but the comparison tends to fail to be really fleshed out in the situations, dynamics, government, population, distribution of income, and about anything else. I'd think there would at least be acceptance that 50 cats is a whole lot different to herd than 5, even functionally when discussing range of coverage needed for normal activities.

There are points of reasonable comparison but a model, it ain't and cannot be because there are more differences than similarities. Make no mistake, the path to the asserted destination has never been taken and cannot be considered a prime outcome. Possible? Absolutely. Plausible? I wouldn't bet the house on it, I wouldn't bet it at all save against as a hedge but I say there is not enough data to clearly guess yes on it, most optimistic appraisal.

Separately, I just can't swallow the "no politician will touch it for___" stuff. If they won't serve the public interests then elect someone who will, these folks are not supposed to be leading us around by the nose and we don't have to tolerate it. Weed them with extreme prejudice and the message will be clear - a candidate can other be viable unless they no bullshiting around advocate systemic health care reform and furthermore that a little "sanding of the roughest edges" and "curbing the worst excesses" can can hold on for the ride or get run over.

[Still Sensible]

21. I wish you were right

but if the millions effected--many absolutely devastated--by the financial crash didn't result in a mass abandonment of republican orthodoxy, and if the continuing episodes of mass killings and daily gun violence hasn't led to serious political action/discussion of rational measures to reduce gun violence... I am afraid the idea that "If they won't serve the public interests then elect someone who will," is not realistic in the political climate today. I really do wish it were.

[TheKentuckian]

23. and that is why our castles are made of sand. By definition we are operating under a false premise

one we know to be false but yet expecting to somehow use the exact same means to arrive at anything resembling a positive outcome other than through pure dumb luck which is always an option, if you want to call it one.

All ends are not achievable by all means, sometimes only certain routes will take you where you are trying to go and some paths will all but absolutely prohibit arrival at the destination. Anything truly seldom goes in any situation.

What you say maybe true but if so then the more fundamental mission is remaking the environment, everything else mostly pissing into the wind until you do, sapping energy and burning daylight and tying up fingers for the proverbial little Dutch boy.

[Still Sensible]

24. So I take it you want the ACA to die

right?

[Doctor_J]

43. The ACA isn't going to die

it's a half trillion dollar or so industry. Our corrupt government will not let such a money-maker go away.

[Doctor_J]

26. And the new HHS secretary has sworn not to let SP happen

It will simply have to be done the Wealthcare and Profit Protection Act will not and is not designed to morph into Single Payer. CBO projections 20 years out do not even begin to consider the idea of possibly speculating on such a thing.

So even if there was same little spark, our "representatives" will make sure it gets extinguished pronto. That pretty much tells you what the president and the rest of the Turd Way think about the relative status of corporations vis-a-vis citizens. It also gives a pretty good clue as to how hard the DC Dems "fought for" the public option in 2009-2010.

[GeorgeGist]

22. An cheap display of binary thinking.

Trashed.

[Savannahmann]

25. The worst case scenario, is in fact worst case.

Let's talk what if. The Supreme Court rules that the letter of the law is the deciding factor. A real possibility. That takes another year, perhaps delaying the decision until Obama has months left in the White House to save his signature issue.

The Republican House is willing to extend the subsidy to everyone, in exchange for Tort Reform. They'll allow a cap of five million dollars for any medical malpractice lawsuits, pointing out that it is plenty of money in exchange for the subsidy. Liberals hop up and down shouting. The House passes the legislation, and sends it to the Senate. Best case scenario there is that we hold a majority in the Senate, worst case we don't.

So if the President wants to help those people who get the subsidy, he has to accept Tort Reform, and some other minor changes, the Rethugs will call them fixes, to the ACA. Being on the way out, in the middle of the party struggling to get Hillary into the White House won't help, it will hurt. Then the debate on the campaign becomes the Rethug plan to fix the ACA, and our plan. Our plan from the far left is single payer. If the nomination is still going on, in other words not yet decided. The more liberal candidates will start talking about Single Payer. The Rethugs will be talking about whatever their goal is, Tort reform seems most likely, even the Rethugs aren't dumb enough to hold a national election where Roe V. Wade is the central issue.

Obama realizes that the legislation goes away if the Rethugs wins, agrees to save the ACA and accept Tort Reform. This allows the DNC to attack him from the left as too conservative in the hopes of bolstering the turnout of the Base. The Rethugs cheer the move as what should have been included six years ago.

Single Payer never gets a discussion nationally. There is no way that the Democratic Nominee (especially if it's Hillary) goes to bat for Single Payer. Only the fringe candidates like Sanders would support it. The Rethugs have a legislative victory, President Obama saves his legacy, and we get Tort Reform in the process.

That's the best case scenario. Worst Case the Rethugs sit back and let the huge financial weight of the ACA crush the poor, and win by default when the Poor abandon their Health Insurance.

Best case the Court decides for us. I figure the odds are slightly better than even that the Court decides the letter of the law is the deciding factor. But not by much. After all, the Justice Department always argues the letter of the law when they prosecute don't they?

[ErikJ]

28. Putting a public option into ACA would short-circuit subsidies

which may just be the same thing as Vernmont's single payer.

[Doctor_J]

34. Putting brad pitt's face on me would improve my sex life too

about as likely as a PO. Reid, Pelosi, Obama couldn't give that away fast enough during the negotiations.

[zipplewrath]

35. It is relatively unrelated

With or without a successful implementation of ACA, the chance for single payer has been slowed down for some time at the federal level because of the toxic environment that has been created by the process of passing ACA. No one, on either side of the aisle, will want to go anywhere near this for a couple of decades. The democrats will spend their time defending and preserving what was accomplished, and the GOP will constantly look for opportunities to undermine. Some states may make progress towards a single payer system of some sort, but until some crisis comes along, many/most of the states won't go near it for purely political reasons, and they'll have PLENTY of support from the insurance and health care industry lobbies.

I've said it before, single payer is coming and the GOP will bring it to us. When the major corporations decide it is time to dump employer based health insurance, because they are tired of competing on the international markets with companies that don't have to bear this cost, the GOP will get rid of it, with the help of conservative democrats, and single payer will become the new method. But there will be severe co-pays, it will be a two or three tiered system, and it will favor the 1% and be expensive for union workers and hourly employees.

And wait until you see what kind of mandates they dream up.

[Still Sensible]

36. Plausible scenario indeed. n/t

[Brigid]

37. One nasty little trick Repugs have been able to pull off for years . . .

Is to make sure that just enough people had health coverage they were afraid to lose, to keep the voices of those who were doing without it from being heard. I think it is going to take an outright rebellion by the uninsured to get the single payer system we need. How and when it will happen, God only knows.

[Adam051188]

42. divide and conquer works here

edited

[LWolf]

38. Nope.

I don't think the ACA's demise would be a short cut to single payer. Neither do I think it's going to get us there any quicker. I think it's a distraction from the real issue and conversation, which is not insurance, but care.

I think as long as it's there to fight about, we'll never get around to engaging the real issue, or the real conversation.

I think states can morph toward single payer, which IS, for me, the compromise, with or without the ACA.

Edited to add: I DO think the ACA is a dangerous plank to campaign on. I think it's likely to energize the rw opposition. All of the energy spent defending it may be misplaced.

[tabasco]

39. Some people are stupid idiots. n/t

[Adam051188]

41. i think having a less expensive and time consuming educational track for doctors and nurses

would do a lot more towards fixing the united states' poor healthcare practices than either creating the ACA, eliminating the ACA, or creating a single payer system.

the straw man response to this is "but then they won't know as much or be as skilled". this response reveals a lack of knowledge concerning the nature of applying to medical school or nursing school in the u.s.

[Kennah]

44. I want to disagree with you, but I can't

If the ACA were to die today, I think that public opinion would unfortunately fall into line with the "Well, I guess it was a bad idea" thinking.

If it could persist for 3 or 4 more years, then I'd say it would be pretty well assured of survival.

Single payer in Vermont, Oregon, California, Wisconsin, or somewhere else is the key to the path to universal care.

[Liberal_Stalwart71]

45. And they are stupid, too! Only states that can afford single payer would be able to implement it.

What would happen to the poor states? They don't have the tax base or the revenue to support a single payer system. It must be implemented at the federal level. That's not going to happen right now.