There isn't a snowball's chance in hell of that happening until, first, one or more states establishes a working, statewide single-payer system that can serve as a successful model. And so far, we're a long way off from that.
Two recent states have tried and failed to implement one. In Vermont, it fell apart on the costs. In Colorado, it was put to the ballot and 80% of the voters turned it down. California is now talking about it, which is promising ... but it's a very steep hill to climb, both economically and politically. From a recent Vox article:
California is undertaking an ambitious bid to establish a single-payer health care system, and now its plan has a price tag: $400 billion a year.
The state legislature has been debating a plan this year to implement a government insurance program to cover all Californians, including those without legal status.
It’s a very generous proposal, as currently conceived. The state would pay for almost all of its residents’ medical expenses — inpatient, outpatient, emergency services, dental, vision, mental health, and nursing home care — under the plan, and Californians would not have any premiums, copays, or deductibles. Those sweeping benefits drive up costs.
The major test for any effort to create a single-payer health care system is how to pay for it. California now knows the math it’s contending with. **The plan, according to the estimate by the state Senate’s Appropriations Committee, would cost twice as much as the entire state budget that Gov. Jerry Brown is proposing for the next fiscal year.**
Lawmakers have been waiting for an estimate of the costs, which they received on Monday. Here is the bottom line, from the Los Angeles Times:
The analysis found that the proposal would require:
*A total cost of $400 billion per year to cover all healthcare and administrative costs.
*Of that, $200 billion of existing federal, state and local funds could be repurposed to go toward the single-payer system.
*The additional $200 billion would need to be raised from new taxes.
Lawmakers have not settled on a plan for paying for the new system, though the analysis released Monday noted a 15 percent payroll tax on employers would cover the increased costs.
https://www.vox.com/policy-and-politics/2017/5/22/15676782/california-single-payer-health-care-estimate
I truly hope they can make it work. Especially because if California, too, fails to implement such a plan, we can kiss even the thought of a federal plan goodbye. It would be an impossible sell to Republicans, and even a really hard one for most Democrats, without evidence that this could be accomplished successfully in one or more states. So let's stop pretending that we can press Congress--especially this current Congress--on this issue, and focus on state-level initiatives first. That's how most major legislation gets its start: it moves from experiments in states to the federal level. And let's not compare our issue to other countries. The US already had a system of private, employer insurance for decades before Canada and European countries, which had no such insurance, began to work out their single-payer systems. They started from scratch, with no industry to dismantle or public attitudes to change. This isn't a simple case of snapping our fingers. It's a long, hard slog ... and longer now that we may not be able to build a slow shift of the ACA into a single-payer system. Why do you think the Republicans have wanted it repealed so avidly all these years?
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