So, how do I think we'll get universal health care, if not from Sanders's plan? O'Malley's

https://martinomalley.com/policy/health-care/

I think given 8 years we could have universal affordable healthcare in the US. I don't think that's a pipe dream; other countries have done it in less time. I don't think the particular form it would take would be single payer (which, remember, is only one particular type of financing; it's a possible means, not the goal itself).

His plan (which he could hopefully expand over 8 years) lays the start of a system that doesn't really match any other country's health care system (and very few of them match each other either), but I guess is kind of closest to Italy's (currently we're closest to Switzerland, which has the second-highest healthcare costs in the world).

Basically, his plan largely avoids the financing mess that both ACA and single payer get tangled up in, and deals directly with how much providers can charge. The plan controls prices in two ways:

1. Hospitals are put on a global-rate-setting schedule, in which everyone is charged the same as Medicare (no more $9000 snakebite kits of $25 aspirins)

2. Funding is greatly expanded for Federally Qualified Health Centers, which provide primary, dental, optometric, and behavioral care on an income-based sliding fee scale in return for a grant that covers a significant part of their operating budget (the quants in HHS go over a million details and figure out how much they need based on the population they serve; this ends up costing the government less even with the grant because Medicaid can use these cheaper providers -- in fact, Medicaid wouldn't work nowadays in many states without FQHCs)

It's pretty easy to see where this leads, if expanded: a system of more or less public community clinics for primary and urgent care, and a cost-controlled hospital system for specialist and emergency care. Specialist care would be financed by the patient, by private insurance, or by Medicaid and Medicare for those who qualify.

Availability of FQHCs would mean that overuse of emergency medicine goes away (since you can get your skin rash or whatever treated affordably at an FQHC), which also helps drive down hospital costs. Hospitals could then focus on their actual strengths: real emergency care and specialist care. HHS would set what they can charge for a given procedure, and the ACA insurance regulations would stay in place about how much the insurers financing this care can profit from that insurance.

Every hospital currently has a charge master, or big price list for every single thing they do. These prices are then negotiated down with each insurer, and with the government, but the charge master price is what the uninsured are billed. This is not just unfair, it's an active source of a ton of waste. O'Malley's plan would eliminate that: every hospital would negotiate a single charge master with HHS, based on the population they serve, and that price list would then be publicly available (and used for everyone). This is explicitly a price control regime, and it's what essentially every industrialized country except us does, which is why they can all have universal health care.

OK, Recursion, but how does he pay for it?

Now, I mentioned above that so far, a lot of FQHC money pays for itself in the sense that it lowers Medicaid spending by an equal (or greater) amount. Obviously that won't be true forever: at some point we'll run out of Medicaid "slack". However, his initial proposal doesn't ramp the funding up that much (yet). That's another great feature of the FQHC expansion: we can ramp it up (or down) at whatever speed we want; there's no "point of no return". If we double it and it turns out not to work, we let it fall again and try something else.

But, like I said, clearly making this universal will take more money. Fortunately, not all of it will come from the government. Doctors working at FQHCs, and hospitals who adopt global budgeting, make somewhat less than doctors and hospitals that don't. And, well, that's a huge part of where our clawback has to come from: the two single biggest categories of healthcare expense are hospitals ($1 Trillion or a little less) and physicians ($600 Billion). Things like pharmaceuticals ($300 Billion) and private insurance profit ($200 Billion) aren't even on that radar. So, those two pots will get smaller, probably by about a third. That still doesn't get us universal coverage yet, but that gets us past his initial plan proposal.

Obviously, to expand it farther we'll have to talk about taxes, but we can cross that bridge when we come to it. Another advantage of O'Malley's plan: it's changes we can do with the public money we're spending right now.