As a nurse practitioner following the single payer discussions, I continue to be struck by how little progressives care about or consult with their health care providers or understand the boots on the ground economics of practicing health care. The lawyers who make laws only care about what they can sell to their corporate and governmental stakeholders.
Health care providers can’t pay back our epic student loans on the Medicare rates all these stop gap single payer plans propose. (I had $200K—still have $60K after 17 years in practice.) MDs are in the same or worse positions. Studies show (check out the blog The Incidental Economist) any provider with office staff and/or who does procedures and so pays high malpractice rates Medicare payments do not cover the cost of overhead. Most MDs and NPs have abandoned private practice and small group practices and are working for big practices affiliated with hospitals. These providers are frequently pressed to see more and more patients and patients (you and me) don’t like it. That’s because it doesn’t feel like care at all.
As someone in private practice who buys really expensive insurance through the Washington Exchange and now has a 4K deductible with all care and referrals going through only one primary care provider in one network I think the ACA has made things much worse for me. The expansion of Medicaid is great unless you need psych care etc.


Saving maybe $50 on your health premium won’t entice people if the plans still have high deductibles that make the insurance unaffordable to use.


I'll believe it when it works, and no sooner.

The long-term care fund could be a really good idea IF and ONLY IF the fund cannot be raided to paper over the consequences of legislators' decades of overpromising in exchange for votes and endorsements. State legislatures as blue as New York and as red as Texas are equally guilty of raiding "dedicated" funds - then coming back hat-in-hand looking for "investment" in the fund they just got through cleaning out, like the murderer who kills his parents and demands mercy from the court because he's an orphan.

People have understandable trust issues with government - and the larger and more centralized the government, the larger the trust issues.

"My tribe is somewhat less incompetent, venal and sleazy than your tribe" isn't going to cut it.

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