Was that your point?

Did you have a proposal for how we could have a universal system that is comprehensive and affordable?

It’s not universal comprehensive or affordable, and without transforming it into something quite different and no longer “Obamacare” it never will be.

Universal healthcare means that no one is excluded, everyone has coverage for their healthcare needs.

Most of the countries you listed do not offer dental, vision, etc. Through the govt. single payer coverage- it is usually provided through the employer or retiree funded extended benefit plans with private insurers (this is the case in Canada, which does offer some coverage for long term care, at least here in BC).

Here in Canada, there is never a charge for a doctor visit or hospital stay (well, one exception that I’ve noticed- podiatrists aren’t covered, so I had to pay $30 for an office visit).

I think the biggest point is, if these 18 countries can offer healthcare to all their residents, then why can’t the US?

It’s not a “pipe dream”...

I couldn't agree more!

My question is about the best and most realistic way to achieve universal healthcare. Is it by building on Obama Care or by a particular single payer plan? Most arguments in favor for Medicare for all that I have seen are REALLY arguments for universal healthcare. So the important discussion about the various paths towards universal healthcare is not taking place. I consider this a very important question. Looking at other countries that have actually achieved universal healthcare may help us design a path from our current disastrous healthcare system.

Your list omits all of the Asian countries with universal healthcare, including Japan, Singapore, South Korea and Taiwan.
Not all of them are single payer, either, but they all rank highly among the world's healthcare systems.

Thank you for bringing this up. Apparently, Japan, for example, is a country with 'almost' universal healthcare. "Health insurance is, in principle, mandatory for residents of Japan, but there is no penalty for the 10% of individuals who choose not to comply, making it optional in practice." (Wikipedia)

It's true there's no fine or tax penalty, but if you go without health insurance and then decide to sign up for it later, you may be charged up to two years' worth of back premiums (which are income-based). National health insurance is available to everyone who doesn't get it through their employer, even if some choose not to pay for it, so I consider that essentially universal.

Because in all the countries with hybrid or multi-payer systems, the level of government regulation and control is so great that there isn't much "free market magic" there at all. Which is the only way to get decent universal coverage, because the free market in healthcare doesn't work.

Basically if you had a private system, but you forced all insurers to cover the same things as M4A, and the government controlled what providers charged to what they would charge under M4A, and you subsidized and regulated premiums so that they would be the same as the taxes to fund M4A, etc., you'd get something like the German system.

And, if we want something like that here, the best, and really the only way, to get it is to start with M4A as a negotiation, and then bargain it down to a universal, highly regulated public-private hybrid system.

I really like your response. This helps. I think this is the kind of discussion I have been looking for. Should we 'bargain down' from Medicare for All or 'bargain up' from Obama Care? What is a more realistic path to universal healthcare, given the current situation? Which path is likely to get results faster?

I'd guess that starting with M4A would be more likely to get us to universal healthcare, but starting with ACA could probably get some incremental results faster, though it wouldn't be universal healthcare like other countries have.

The reason I think Bernie is the best candidate on healthcare is not because M4A is the only possible solution. It's the other part of his pitch where he says (paraphrasing) "you can nibble around the edges, but to really get universal healthcare, you have to take on the insurance and drug industries."

That's the truth. In order to get to be like Germany or Switzerland or any of those non-single-payer systems, it's going to be a big fight with the industry lobbies, basically just as big as for M4A. ACA passed using a different strategy, not taking on the lobbies, but getting them on board. But the result was a non-universal system that's also highly, and I would say, unnecessarily complex. The complexity and non-universality are the price we paid for placating insurance and pharma instead of taking them on.

Taking on powerful corporate lobbies is hard, of course, because they are powerful and have a lot of money. But that's basically the whole idea of Bernie's candidacy. It's masses of people taking on wealthy corporate interests.