Straight up. Single-payer or bust.

I feel admiration toward Justin Bieber. Hell's freezing has commenced.

What a good idea #1: NOTHING!

Kinda how the far left helped elect Trump.

I had a friend, a single mother who died just before Obama care was enacted.

Long story short: she died of a pre-existing condition, leaving an orphaned 13 year old daughter.

A year later she would have , via Obama Care.

The lesser of two evils, is less evil.

And no insurance, no health care is always more evil.

But the Far Left voted for more evil, so no surprise there.

You'd pick Single Payer once you understood the cost difference between uninsured emergency room visits versus single payer. Its a community benefit.

Major revelation of this article: We as a country have ceded the moral authority to Justin Fucking Bieber

single payer has some drawbacks too, but compared to what we've got going on it might be considered "minimally evil'

@3- You're not dealing with reality. The Green Party voters didn't flip this election. Most of the Far Left (like me) voted for the Democrat. The reason Trump won is because the 50% of the population didn't vote at all, and not because they're socialists.

I really don't know why I bother, but honestly you need to get real.

And hey, it's a Dan Savage post on politics that manages not to make my blood boil. Hooray!

Yup. Preach. I wonder if Trump is going to roll out a single-payer plan after all. I doubt it, but it seems like he might do it just to piss people off. In any case, I know it's a long shot, but I'll take it if he does it. As to the point about Sanders, yes it would require us paying more in taxes. In the long run, I think we'd all save money- at least most of us. I don't know if it would be that much more for people in lower middle to middle ranges anyway as their rates are already ridiculously high under Obamacare and that's before copays. But if we raised taxes on the top 1-10% could it be a wash? I don't know. Worth mentioning that the Dems also wanted drug price negotiations and the GOP prevented it, and that could save some money too, plus other protections that are in place for the medical industry that other countries don't have. Trump, oddly enough, has come out in favor of drug negotiations. I haven't the slightest idea what he'll replace Obamacare with (if anything) and obviously the GOP doesn't give a damn. It's scary.

@3 I don't know what you are calling "far left" but short of a particular gay Texan porn star from a white evangelical conservative family who self-identifies as a communist, I've heard almost nothing of people on the far left voting for Trump. Who? Stein, maybe some. Abstaining, maybe some. And both are partially to blame for Trump's win- they are top on my shit list right now and it's a lot of self-restraint to not hope they don't choke on their ideological purity. But voting for Trump? No. As for the rest of your post, you can criticize Obamacare and recognize the need for single payer without thinking it should be repealed with nothing in its place. Dan is right here. @7 is correct here, and @1 too.

@7 Wait a minute, haven't you been arguing non-stop that the 50% of the population that did not vote are essentially socialists? I thought the story was that the Dems lost because they did not push the progressive agenda of single-payer, free college and the corresponding tax hikes? Stein supporters did not flip the election by their votes but the non-stop barrage of negativity from her partisans and Sanders fanatics on social media certainly did not help in the least.

The health care system is a clusterfuck but single-payer is and will remain for the foreseeable future an absolute non-starter in this country. The only way to get there is by stealth. A public option for Obamacare would have gotten us going in that direction.

@8 - "yes it would require us paying more in taxes."

You might pay higher taxes, but you wouldn't have to pay for insurance, so the overall cost would be lower.

The universal health care systems in European countries cost between 9% and 12% of GDP. America spends about 18% of GDP on healthcare. As a nation, you spend an absolute fortune to avoid a tiny little bit of extra tax.

Having a good healthcare system that provides universal care, doesn't bankrupt people, and doesn't kill poor people would reduce your spending on healthcare by about a trillion dollars a year (that's not a hyperbolic figure I've just made up - it's 6% of your GDP).

You know what's REALLY evil? We not only know how to provide decent healthcare to everyone in a given population, WE'RE ALREADY DOING IT. We have two (compared to for-profit insurance) highly efficient single-payer systems: Medicare and Medicaid. They treat the elderly and the poor, two groups with even higher needs than the general population, at a fraction of the cost of private insurance. And, we have our own "National Health System," the V.A. Health System with dozens (hundreds?) of mostly-empty hospitals and directly-employed staff doctors and nurses who provide everything from primary care to highly-specialized surgery. Right now, it serves only veterans, but who's to say it couldn't be built out into a general system, at huge savings to Medicare/Medicaid? (And, yes, there are stories that some veterans in some places are not being properly served now, but that's a failure of funding, not structure. And, if some portion or all of the general population were to be served by a much bigger version of it, the vets would have allies in their complaints. It would get better.)

But, Republicans don't want it to get better. If they screw the insurers out of an industry, or trim pharma profits, much of their campaign cash would dry up.

A better argument than piece of mind:

Even if you get "lucky" and die suddenly in an accident and never consume insurance, the odds are almost certain that someone you love - whether it be your parents, your spouse, your children, or a best friend - will not be so lucky.

And maybe it's better that we all pay a little more in taxes so we're not just waiting around for someone we love to start begging us for money to survive.

Dan - Your story about Matthew was heartbreaking but flat-out wrong and misleading. Under the ACA, medical bankruptcies and huge bills like those were all but eliminated. If you have an ACA-compliant healthplan (in other words, all but the grandfathered plans), you have a maximum out-of-pocket cost each year of no more than $7,150 for an individual or $14,300 for a family for in-network services. It can be higher for out-of-network, or in some cases, out-of-network doesn't have an OOP max. FFS, that is one of the best aspects of the law! You can't just blame "Obamacare" for Matthew's situation.

Needless to say, I'm not defending our eff-ed up, bloated, costly, inefficient and ineffective healthcare system. If there were the political will in this country, it could be fixed over time to reduce cost and improve outcomes. The ACA was one small step in that direction, the first major healthcare reform law passed since Medicare. It got through without a single Republican vote. So now, voters blinded by bigotry against "Obama" - care have instead sent the country backwards toward an even more costly and expensive system that may wind up kicking millions off their coverage and literally killing thousands of people who are without access to care.

Signed,
JG, a California health insurance agent

I have a couple questions from the story...

-First, why did Matthew Stewart went to Urgent Care? given his serious pre existing condition, he would had known he needed to get to ER stat, he also called his doctor, if he had one, (which sounds like he didn't have a primary doctor)

-Second, he is not a good candidate for a liver transplant. There is no point in giving him a liver transplant unless they find a way to deal with his auto immune disorder. His body is probably going to attack his hypothetical new liver once the surgery is done.. The cirrhosis is by product of the auto immune disorder, and either he needs some sort of expensive medication to suppress it, or it sounds like it is still chronic.

After dealing with the myriads of our psychotic health care systems, I have sympathy, but the article leaves me with more questions about Matthew Stewart than answers. It also sounds like he stopped pay his health insurance premiums. However, even though I am taking some of the problems with a grain of salt, his plight does sound all too common in the US Healthcare nightmare we live in.. especially a third of US Bankruptcies are Healthcare related..

I agree with you, Dan -- single payer is better than the awful, complicated, protect-the-profits-of-the-insurance-companies system we have now, though Obamacare is better than what we had before it was enacted. You know who else agrees with you? Bernie Sanders. Seems strange to me that you spent a lot of energy during the primary season disparaging Bernie and his supporters, even though Hillary Clinton didn't support single payer. But that was then -- now we have to come together to protect the very modest gains of the ACA and Medicare for some (because Ryan and the Repubs want to actually destroy Medicare, not expand it to others). Those who did get insurance under the ACA (for example, those who had pre-existing conditions) are in danger of losing it now, and we need to fight to stop that. But yes, ultimately we do need a single payer system.

One other thing:

Our current system is anti-business.

Companies provide health insurance to their workers as part of their total compensation, thus actual salaries are lower. This makes U.S. companies less competitive to foreign workers who already have health coverage and don't need it from their job, and it eats into the profit margins of the business.

You'd think republicans, with all their bullshit pro-business talk, would jump all over this as a great reason to have government funded healthcare so that our companies can go be more appealing around the world.

Late last fall, just before election, I looked into applying for dual US/Canadian citizenship, and on January 3rd, I mailed in my application and paperwork. I'm one of those US citizens who can actually do this, as my mother was born in Quebec, and that technically makes me a citizen. Number one reason: Healthcare. I was born in the States, lived here all my life, and am blessed to live in one of the saner parts of the country, New England, but due to real fears of what is coming with regards to things like Medicare (I'm 51) and even the state of it at present (monthly costs, etc) I don't want to hit 65, and Paul Ryan got his way and all of us oldies are handed a "voucher" and made to go beg for somebody to please, please insure us for less than 100% of our social security checks. Nope. To have worked all of my entire life from the age of 15, and to end up in such a degrading, life threatening situation as that? No.

Best friend lives in suburban Toronto. Her son's lung collapsed a few years ago, then his other lung. He received excellent care, spent over a month in the hospital, recovered fully, and they never received a bill. No copays - they don't know what copays are, no deductibles - ditto. Nothing. No one in her extended family ages 2 to 95 has ever had to pay a medical bill. Ever. And at least in Toronto area, none of them have had to wait for care, (any more than anyone does down here). She partly jokingly asked me the other day, when I was grousing about having to meet my $1250 annual health insurance deductible, and here I am with a new shoulder injury, "what is a medical bill?" She said she doesn't even know what they look like. She was serious.

Meanwhile, her property tax bill is only a couple of hundred dollars more than mine, for my pathetic little house in Maine. Suburban Toronto vs suburban Portland, Maine, and we pay virtually the same property tax, and her house is twice the size of mine, and in a good neighborhood. Yes, they have higher taxes on goods and services than we do, higher gas and apparently electricity prices in some areas, etc., but I will quite happily pay that if it gets me free healthcare, and a pension. Did you know that, just for existing in Canada for a minimum of 10 years, not even working there, you get a pension? This is in addition to whatever pension you pay into by working. So instead of my pathetic SS check being docked whatever Medicare costs by then (if, again, it's not been fuly voucherized), I would have exactly ZERO deducted for health care, and instead be handed money every month for what Canada calls it's "Old Age Pension".

Canada is also instituting free college, even for "mature" students, full or part time, starting Sept 2017, for those making less than $50k a year.

And fuck, take a look at Justin Trudeau's cabinet, and their qualifications and experience, compared with the horrorshow going on here right now. (Hell, just take a look at Justin Trudeau). This guy stands up and says he's not only a feminist, but a proud one. I mean, holy shit. Take a look at the Canada Child Benefit - people are getting huge monthly support ie checks mailed ot them every month to cover childcare and other kid-associated costs. I could go on and on and fucking on. Compare the violence and crime and gun issues down here, mass shootings, and general bible-thumpery. The difference with our regressive Bill OReilly/Limbaugh old white asshole "leadership" types could not be more stark.

The joke could be on me - through some technicality, I suppose I could be denied citizenship, and if that happens, I'm planning to look into other countries with single payer type health care systems, if they will allow Americans to apply. I don't hate my country. It's a gigantic undertaking to up and leave - to move to another freaking country - especially at my age, but at this point, I feel like if you can get out, you should. I just need a few years to pay off my house. If it was paid off today, I would leave tomorrow.

Single payer might have had a chance in 1993 if the Clintons had taken an uncharacteristicly straightforward and tactically clever approach. Maybe.

But by 2009, the Heritage foundation's market-based Romneycare was absolutely the best anyone could have realistically hoped for. Making things a little better for the most vulnerable is never "evil", even the if at the end of the day the world isn't great. It would be like telling Harriet Tubman not to bother; helping a handful didn't lead to structural change.

And the ACA does only lead to one thing: single payer. It's exactly why the Koches and their ilk realized the Heritage Foundation and Romney got it wrong. The exchange and tax subsidies and vouchers aren't a firewall against evil socialism. They are an object lesson to America that we need a universal system, that you no more opt out of health coverage than opt out of the fire department coming to your house.

The Trump rubes are all the proof you need of this. They literally have to construct a false reality to deny the superiority of the ACA over the Ryan-Rand-Hannity Fuck You System. They imagine their ACA coverage isn't Obamacare. They cling to fake news about premiums or fake statistics about costs or numbers of polices.

You don't need an ideological realignment. You need only overcome pigheaded denial of reality. And reality is coming to bite Trump heads in the ass. Then they will love the ACA and the only way to "save" it will be single payer. Obamacare can't last forever, and we can't go back. The only thing left is moving forward to single payer.

Evil? It's the carriage what brung you to the ball. The only one that could have.

If Trump really could get an America with 5% annual growth, the only way is the productivity that comes from a population that is significantly healthier an free of financial peril. Single payer. And a shit ton of new citizens immigrating in to swell the consumer base and workforce. Not that he gets any of this.

Democrats love to talk about what's 'not possible,' and just wallow there and justify their refusal to act in the people's best interests. Republicans go out and make things possible. Terrible things, mind you, but they change the debate.

Here we are in a time of system failure with people wanting big changes, and the Democrats are still just talking about what isn't possible. No wonder why they lose, and lose and lose.

Oh, you want a guy who just promises jobs and insurance for everyone, and lower taxes and growth, and more bombers and ships, and lower debt? You want a guy who doesn't care what is and isn't possible? You got him. You should be happy.

@22

No, that wasn't my point. Not my point at all. My point is that Democrats are losers. Not that I want Republicans to win.

@18, if I could have babies, I'd send you to the front of the line. The snark about asking your employer to pay for car insurance is gold, btw.

But yeah, the entire idea of employer-based health coverage is bizarre to begin with, and completely and utterly anti-american and anti-capitalism. I haven't studied the history of it, but honestly, how the hell did this country come to embrace employers being responsible for their employees health care, for fucks sake? Makes no sense to me.

Democrats are losers everybody hates me I'm gonna go eat worms!

Obama won, ya big baby. The Democrat Obama? He won the ACA. Which has made single payer inevitable. They're trying to subvert the Constitution and install a strongman buffoon backed by an army if Brownshirt thugs. It's a stupid plan. It's not going to work, and Obama, the Democrat, will win.

#10: "You might pay higher taxes, but you wouldn't have to pay for insurance, so the overall cost would be lower."

Actually, that "might" there isn't just a way of stating a conditional, (as in "you might have to go outside if you want to go to the store"), but a serious statement of uncertainty. A while back, when I was looking at health care spending in various countries I found an unsurprising thing, a somewhat surprising thing and a rather surprising thing:

The unsurprising thing was that the US had the highest per capita spending on health care when you combined public and private spending.

Somewhat surprising what that the US had the second highest per capita spending when considering only public spending, (and the highest if you included employee health coverage where the employer was a government agency).

Rather surprising was that US per-capita public spending was higher than most other developed nations public and private spending _combined_.

IOW: If the US went to a single payer or socialized health care system, there is a good chance that it would allow taxes to go _down_.

Welp, Congress is looking to throw Medicare to the states and destroy all grants. Thanks Trump voting pices of shit.

@26: There's no such thing as a "fiscal conservative" actually saving your average voter's taxes isn't as important as the grift.